American Board of Family Medicine (ABFM) Practice Exam 2026 - Free ABFM Practice Questions and Study Guide

In the context of an elderly patient presenting with intense retro-orbital headache and neck pain, and with a non-contrast CT scan returning unremarkable results, the next appropriate step would be to perform a lumbar puncture. This procedure is a critical diagnostic tool when there is a high suspicion of conditions such as meningitis or subarachnoid hemorrhage, especially when initial imaging does not reveal any acute intracranial processes.

The symptoms described—intense headache and neck pain—can be indicative of serious underlying issues such as meningitis, which would not always be detectable on a non-contrast CT. A lumbar puncture allows for the analysis of cerebrospinal fluid, which can provide definitive evidence of infection, hemorrhage, or other pathological conditions.

In this scenario, it is essential to further investigate the cause of the patient's symptoms. Other choices, while they may provide some insight or relief, would not directly address the immediate concern given the serious nature of the symptoms. For instance, ordering an MRI might indeed provide additional insights but is generally not the immediate next step when there's a possibility of conditions like meningitis or hemorrhage. Blood tests, while useful for ruling out systemic infections or other issues, wouldn’t directly clarify the suspicion of