NRNP 6665-01 Week 11 Final Exam Solutions 2026/2027
Complete Final Exam Guide | Actual Questions & Verified
Solutions | PMHNP Lifespan Psychiatry | Pass Guarantee
Complex Differential Diagnosis (Questions 1-30)
1. A 19-year-old college freshman presents with 6 months of declining academic
performance, social withdrawal, and unusual beliefs that classmates are "inserting
thoughts" into his mind. His roommate reports he has been talking to himself and has a
peculiar odor from not showering. PHQ-9: 12, GAD-7: 10. His aunt has schizophrenia. He
denies substance use. Urine toxicology is negative. What is the most accurate
diagnosis?
A. Major Depressive Disorder with psychotic features
B. Brief Psychotic Disorder
C. Schizophrenia, first episode
D. Schizotypal Personality Disorder
Correct Answer: C
Rationale: This patient meets DSM-5-TR criteria for schizophrenia: >6 months of
symptoms including positive symptoms (thought insertion, auditory hallucinations),
negative symptoms (social withdrawal, avolition), and functional decline with onset in
late adolescence. The chronicity (>6 months) and functional impairment rule out Brief
Psychotic Disorder (<1 month). Schizotypal Personality Disorder would not show the
frank psychotic symptoms and severe functional decline. While he has depressive
symptoms, they are secondary to the primary psychotic disorder. Family history and
prodromal phase are typical for schizophrenia spectrum.
,2. A 34-year-old woman presents with 8 weeks of persistent low mood, anhedonia,
hypersomnia, increased appetite with 12-pound weight gain, and leaden paralysis. She
reports these symptoms began postpartum 6 months ago but have worsened. EPDS:
16. She has no psychotic features. She failed to respond to sertraline 200 mg daily for 8
weeks. What is the most likely diagnosis?
A. Treatment-Resistant Major Depression
B. Atypical Depression
C. Postpartum Depression with atypical features
D. Bipolar II Disorder, depressive phase
Correct Answer: C
Rationale: The patient meets criteria for Major Depressive Disorder with atypical
features (hypersomnia, hyperphagia, weight gain, leaden paralysis) in the postpartum
period. While postpartum depression typically presents within 4 weeks, DSM-5-TR
recognizes that depressive episodes with peripartum onset can begin during pregnancy
or within 4 weeks postpartum, but clinically significant symptoms can emerge later. The
atypical features and peripartum timing make "C" more precise than "A" or "B" alone.
Bipolar II is less likely without history of hypomania.
3. A 7-year-old boy is referred by his school for "constant fidgeting, calling out in class,
and interrupting others." At home, he has meltdowns when routines change and
struggles with transitions. Parents report he's "always been this way." CBCL: Elevated
attention and aggressive behavior scales. He reads at grade level but has difficulty with
peer relationships. What is the primary diagnosis?
A. ADHD, Combined Presentation
B. Autism Spectrum Disorder, Level 1
C. Oppositional Defiant Disorder
D. Disruptive Mood Dysregulation Disorder
,Correct Answer: B
Rationale: The key differentiator is the insistence on sameness, difficulty with
transitions, and impaired peer relationships alongside behavioral dysregulation. While
ADHD symptoms are present, the social communication deficits and
restricted/repetitive behaviors (meltdowns with changes) point to ASD. CBCL doesn't
differentiate well; clinical interview reveals the ASD pattern. ODD is distinguished by
defiant/vindictive pattern toward authority. DMDD requires severe temper outbursts 3+
times weekly for 12+ months across settings, which is less specific than this
presentation.
4. A 67-year-old widower presents with 4 months of worsening memory loss, getting
lost in familiar places, and difficulty managing finances. His son reports he seems
indifferent to these problems. He scores 20/30 on MoCA (lose points on recall,
executive function). PHQ-9: 6. He has no focal neurological deficits. Labs: TSH normal,
B12: 250 pg/mL. What is the most likely diagnosis?
A. Major Neurocognitive Disorder (NCD) due to Alzheimer's disease
B. Major Depressive Disorder with pseudodementia
C. Mild NCD (MCI)
D. Major NCD with behavioral disturbance
Correct Answer: A
Rationale: The patient meets criteria for Major NCD: significant cognitive decline (MoCA
20/30) interfering with independence in IADLs (finances) and documented deficits in
memory and executive function. The indifference (anosognosia) is characteristic of
Alzheimer's dementia. While B12 is borderline, it wouldn't explain this severity.
Depression is unlikely (PHQ-9 low, lacks neurovegetative signs). The deficits exceed
MCI criteria (functional independence lost).
, 5. A 29-year-old woman presents with 2 weeks of decreased need for sleep, pressured
speech, racing thoughts, spending $15,000 on credit cards, and hypersexuality. Her
friend says this is "not like her." She has no psychotic features. She had a similar
episode 3 years ago lasting 10 days. She has been on sertraline 100 mg for "anxiety" for
6 months. What is the most accurate diagnosis?
A. Antidepressant-induced mania
B. Bipolar I Disorder, current episode manic
C. Bipolar II Disorder, hypomanic episode
D. Borderline Personality Disorder
Correct Answer: B
Rationale: This is a classic manic episode with elevated mood, decreased sleep,
pressured speech, racing thoughts, and excessive involvement in risky activities lasting
>7 days, causing marked functional impairment. The prior episode confirms bipolar
disorder. While sertraline may have precipitated, the episode's severity and duration
meet mania criteria (not hypomania). BPD would show chronic pattern of interpersonal
instability, not episodic mania.
6. A 15-year-old girl presents with 3 months of restricting food intake, 20-pound weight
loss, amenorrhea, and intense fear of weight gain. She reports feeling "fat" at BMI 16.
She also cuts her thighs daily to "cope with emotions." She is not suicidal. What is the
primary diagnosis?
A. Anorexia Nervosa, Restricting Type
B. Major Depressive Disorder, severe
C. Borderline Personality Disorder
D. Complex comorbidity requiring dual diagnosis
Correct Answer: A
Complete Final Exam Guide | Actual Questions & Verified
Solutions | PMHNP Lifespan Psychiatry | Pass Guarantee
Complex Differential Diagnosis (Questions 1-30)
1. A 19-year-old college freshman presents with 6 months of declining academic
performance, social withdrawal, and unusual beliefs that classmates are "inserting
thoughts" into his mind. His roommate reports he has been talking to himself and has a
peculiar odor from not showering. PHQ-9: 12, GAD-7: 10. His aunt has schizophrenia. He
denies substance use. Urine toxicology is negative. What is the most accurate
diagnosis?
A. Major Depressive Disorder with psychotic features
B. Brief Psychotic Disorder
C. Schizophrenia, first episode
D. Schizotypal Personality Disorder
Correct Answer: C
Rationale: This patient meets DSM-5-TR criteria for schizophrenia: >6 months of
symptoms including positive symptoms (thought insertion, auditory hallucinations),
negative symptoms (social withdrawal, avolition), and functional decline with onset in
late adolescence. The chronicity (>6 months) and functional impairment rule out Brief
Psychotic Disorder (<1 month). Schizotypal Personality Disorder would not show the
frank psychotic symptoms and severe functional decline. While he has depressive
symptoms, they are secondary to the primary psychotic disorder. Family history and
prodromal phase are typical for schizophrenia spectrum.
,2. A 34-year-old woman presents with 8 weeks of persistent low mood, anhedonia,
hypersomnia, increased appetite with 12-pound weight gain, and leaden paralysis. She
reports these symptoms began postpartum 6 months ago but have worsened. EPDS:
16. She has no psychotic features. She failed to respond to sertraline 200 mg daily for 8
weeks. What is the most likely diagnosis?
A. Treatment-Resistant Major Depression
B. Atypical Depression
C. Postpartum Depression with atypical features
D. Bipolar II Disorder, depressive phase
Correct Answer: C
Rationale: The patient meets criteria for Major Depressive Disorder with atypical
features (hypersomnia, hyperphagia, weight gain, leaden paralysis) in the postpartum
period. While postpartum depression typically presents within 4 weeks, DSM-5-TR
recognizes that depressive episodes with peripartum onset can begin during pregnancy
or within 4 weeks postpartum, but clinically significant symptoms can emerge later. The
atypical features and peripartum timing make "C" more precise than "A" or "B" alone.
Bipolar II is less likely without history of hypomania.
3. A 7-year-old boy is referred by his school for "constant fidgeting, calling out in class,
and interrupting others." At home, he has meltdowns when routines change and
struggles with transitions. Parents report he's "always been this way." CBCL: Elevated
attention and aggressive behavior scales. He reads at grade level but has difficulty with
peer relationships. What is the primary diagnosis?
A. ADHD, Combined Presentation
B. Autism Spectrum Disorder, Level 1
C. Oppositional Defiant Disorder
D. Disruptive Mood Dysregulation Disorder
,Correct Answer: B
Rationale: The key differentiator is the insistence on sameness, difficulty with
transitions, and impaired peer relationships alongside behavioral dysregulation. While
ADHD symptoms are present, the social communication deficits and
restricted/repetitive behaviors (meltdowns with changes) point to ASD. CBCL doesn't
differentiate well; clinical interview reveals the ASD pattern. ODD is distinguished by
defiant/vindictive pattern toward authority. DMDD requires severe temper outbursts 3+
times weekly for 12+ months across settings, which is less specific than this
presentation.
4. A 67-year-old widower presents with 4 months of worsening memory loss, getting
lost in familiar places, and difficulty managing finances. His son reports he seems
indifferent to these problems. He scores 20/30 on MoCA (lose points on recall,
executive function). PHQ-9: 6. He has no focal neurological deficits. Labs: TSH normal,
B12: 250 pg/mL. What is the most likely diagnosis?
A. Major Neurocognitive Disorder (NCD) due to Alzheimer's disease
B. Major Depressive Disorder with pseudodementia
C. Mild NCD (MCI)
D. Major NCD with behavioral disturbance
Correct Answer: A
Rationale: The patient meets criteria for Major NCD: significant cognitive decline (MoCA
20/30) interfering with independence in IADLs (finances) and documented deficits in
memory and executive function. The indifference (anosognosia) is characteristic of
Alzheimer's dementia. While B12 is borderline, it wouldn't explain this severity.
Depression is unlikely (PHQ-9 low, lacks neurovegetative signs). The deficits exceed
MCI criteria (functional independence lost).
, 5. A 29-year-old woman presents with 2 weeks of decreased need for sleep, pressured
speech, racing thoughts, spending $15,000 on credit cards, and hypersexuality. Her
friend says this is "not like her." She has no psychotic features. She had a similar
episode 3 years ago lasting 10 days. She has been on sertraline 100 mg for "anxiety" for
6 months. What is the most accurate diagnosis?
A. Antidepressant-induced mania
B. Bipolar I Disorder, current episode manic
C. Bipolar II Disorder, hypomanic episode
D. Borderline Personality Disorder
Correct Answer: B
Rationale: This is a classic manic episode with elevated mood, decreased sleep,
pressured speech, racing thoughts, and excessive involvement in risky activities lasting
>7 days, causing marked functional impairment. The prior episode confirms bipolar
disorder. While sertraline may have precipitated, the episode's severity and duration
meet mania criteria (not hypomania). BPD would show chronic pattern of interpersonal
instability, not episodic mania.
6. A 15-year-old girl presents with 3 months of restricting food intake, 20-pound weight
loss, amenorrhea, and intense fear of weight gain. She reports feeling "fat" at BMI 16.
She also cuts her thighs daily to "cope with emotions." She is not suicidal. What is the
primary diagnosis?
A. Anorexia Nervosa, Restricting Type
B. Major Depressive Disorder, severe
C. Borderline Personality Disorder
D. Complex comorbidity requiring dual diagnosis
Correct Answer: A
