USMLE PRACTICE QUESTION OF THE WEEK
Question for October 24, 2025
A 16-year-old girl is brought to the emergency department by her mother after she was found crying in her room with multiple fresh, superficial horizontal cuts on both wrists made with a razor. The patient says she has felt “numb and overwhelmed” for 2 weeks after a breakup and has been skipping classes. She denies alcohol or drug use. She states, “I don’t want to die,” but cannot clearly state how she would keep herself safe at home, and adds, “Sometimes I wish I could disappear.” She has never seen a mental health clinician. Vital signs are normal. She is tearful, cooperative, and oriented; no psychosis is evident. The wounds are clean without tendon injury. The mother reports she has access to sharp objects at home and will be at work most evenings.
Which of the following is the most appropriate next step in management?
Which of the following is the most appropriate next step in management?
Correct Answer:
A. Inpatient psychiatric admission
Correct Answer Explanation:
Recent self-inflicted injury with ongoing distress, limited safety planning, and limited supervision warrants inpatient psychiatric admission for safety and comprehensive evaluation. Starting an SSRI or arranging outpatient psychotherapy may be appropriate after stabilization, but does not address the immediate risk. School counseling alone is insufficient for acute self-harm.
Further Insight:
- Hospitalize adolescents after self-harm when intent is unclear or supervision is limited.
- Remove lethal means; involve guardians in safety planning.