NRNP6635 Midterm Exam Psychopathology &
Diagnostic Reasoning - PMHNP Track - Walden
University 2026-2027
50 items | 100 % synthesis-level | 2 h
SECTION 1 Mood Disorders & Precision Diagnosis (Q 1 – 15)
Q1
24-y/o F, 5-week anhedonia, 10-lb loss, terminal insomnia, psychomotor agitation, mood
"void," FHx bipolar I. Most accurate initial diagnosis?
A. MDD melancholic
B. Bipolar II depressed
C. PDD with MDE
D. Adjustment disorder depressed
Correct: A – meets DSM-5-TR melancholic specifiers; absence of prior hypomania rules
out B.
Q2
CACNA1C risk allele in bipolar I correlates with which phenotype/tx implication?
A. Depressive predominance → lamotrigine preferred
,B. Early onset/rapid cycling → ↓ lithium response
C. Psychotic mania → antipsychotic need
D. Comorbid anxiety → SSRI adjunct
Correct: B – calcium-channel variant → electrical instability; valproate/quetiapine
favored.
Q3
Patient with MDD, PHQ-9 22, CRP 8 mg/L, IL-6 high, fMRI sgACC hypo-activity. Tx most
aligned with mechanism?
A. Escitalopram + aspirin
B. Bupropion XL
C. IV ketamine 0.5 mg/kg
D. Lithium augmentation
Correct: C – NMDA antagonism → rapid synaptogenesis in inflamed depression.
Q4
Which feature BEST distinguishes atypical depression from melancholic?
A. Morning worsening
B. Leaden paralysis
C. Early morning awakening
D. Weight loss
, Correct: B – reversed vegetative sign.
Q5
31-y/o M, 4-week hypomania (euphoric, ↓ need for sleep, talkative, hypersexual), no
depression history. Diagnosis?
A. Bipolar I
B. Bipolar II
C. Cyclothymia
D. Substance-induced
Correct: A – single manic episode sufficient.
Q6
Circadian gene PER3 4/4 polymorphism in bipolar predicts:
A. Lithium non-response
B. Seasonal pattern
C. Rapid cycling
D. Medication-induced switching
Correct: B – evening preference → winter depression.
Q7
MDD with comorbid OSA, AHI 35. Which symptom cluster MOST improves with CPAP?
A. Anhedonia
Diagnostic Reasoning - PMHNP Track - Walden
University 2026-2027
50 items | 100 % synthesis-level | 2 h
SECTION 1 Mood Disorders & Precision Diagnosis (Q 1 – 15)
Q1
24-y/o F, 5-week anhedonia, 10-lb loss, terminal insomnia, psychomotor agitation, mood
"void," FHx bipolar I. Most accurate initial diagnosis?
A. MDD melancholic
B. Bipolar II depressed
C. PDD with MDE
D. Adjustment disorder depressed
Correct: A – meets DSM-5-TR melancholic specifiers; absence of prior hypomania rules
out B.
Q2
CACNA1C risk allele in bipolar I correlates with which phenotype/tx implication?
A. Depressive predominance → lamotrigine preferred
,B. Early onset/rapid cycling → ↓ lithium response
C. Psychotic mania → antipsychotic need
D. Comorbid anxiety → SSRI adjunct
Correct: B – calcium-channel variant → electrical instability; valproate/quetiapine
favored.
Q3
Patient with MDD, PHQ-9 22, CRP 8 mg/L, IL-6 high, fMRI sgACC hypo-activity. Tx most
aligned with mechanism?
A. Escitalopram + aspirin
B. Bupropion XL
C. IV ketamine 0.5 mg/kg
D. Lithium augmentation
Correct: C – NMDA antagonism → rapid synaptogenesis in inflamed depression.
Q4
Which feature BEST distinguishes atypical depression from melancholic?
A. Morning worsening
B. Leaden paralysis
C. Early morning awakening
D. Weight loss
, Correct: B – reversed vegetative sign.
Q5
31-y/o M, 4-week hypomania (euphoric, ↓ need for sleep, talkative, hypersexual), no
depression history. Diagnosis?
A. Bipolar I
B. Bipolar II
C. Cyclothymia
D. Substance-induced
Correct: A – single manic episode sufficient.
Q6
Circadian gene PER3 4/4 polymorphism in bipolar predicts:
A. Lithium non-response
B. Seasonal pattern
C. Rapid cycling
D. Medication-induced switching
Correct: B – evening preference → winter depression.
Q7
MDD with comorbid OSA, AHI 35. Which symptom cluster MOST improves with CPAP?
A. Anhedonia
