NR 547 / NR547 Differential Diagnosis
Psychiatric-Mental Health Lifespan Final Exam Actual
2025/2026 with Detailed Rationales | 100% Verified |
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SECTION 1: Mood Disorders – Differential Diagnosis (12 questions)
Q1: A 45-year-old patient presents with depressed mood, anhedonia, fatigue, and
increased need for sleep. They report episodes of elevated mood lasting 4-5 days
every few months with increased energy and decreased need for sleep. What is the
most likely diagnosis?
A. Major depressive disorder
B. Bipolar II disorder [CORRECT]
C. Persistent depressive disorder
D. Cyclothymic disorder
Correct Answer: B
Rationale: Correct because hypomanic episodes lasting ≥4 days with depressive
episodes indicate bipolar II disorder.
Q2: A 32-year-old patient presents with elevated mood, grandiosity, decreased need
for sleep, and increased goal-directed activity lasting 6 days with significant
impairment. What is the diagnosis?
A. Hypomanic episode
B. Manic episode [CORRECT]
C. Cyclothymia
D. Bipolar disorder NOS
Correct Answer: B
Rationale: Correct because symptoms ≥7 days (or any duration if hospitalization
needed) with impairment indicate mania.
Q3: A patient presents with recurrent episodes of depressed mood alternating with
periods of elevated mood lasting 2-3 days. No significant impairment. What is the
most likely diagnosis?
A. Bipolar II disorder
,B. Cyclothymic disorder [CORRECT]
C. Bipolar I disorder
D. Borderline personality disorder
Correct Answer: B
Rationale: Correct because cyclothymia involves hypomanic and depressive
symptoms ≥2 years without major episodes.
Q4: A patient with depression reports significant fatigue, hypersomnia, and increased
appetite. Which of the following should be ruled out first?
A. Hypothyroidism [CORRECT]
B. Bipolar disorder
C. Substance use
D. Sleep apnea
Correct Answer: A
Rationale: Correct because atypical depression features warrant thyroid evaluation;
hypothyroidism commonly presents with fatigue, hypersomnia, and weight gain.
Q5: A patient with MDD reports feeling worthless, guilty, and suicidal. They have a
history of hypomanic episodes lasting 2-3 days. What is the most likely diagnosis?
A. MDD
B. Bipolar II disorder [CORRECT]
C. Persistent depressive disorder
D. Bipolar I disorder
Correct Answer: B
Rationale: Correct because bipolar II requires major depressive episodes and
hypomanic episodes; the presence of any hypomanic history changes the differential
from unipolar depression.
Q6: A patient with depression reports depressive symptoms and reports using
methamphetamine. What is the most appropriate differential?
A. Substance-induced depressive disorder [CORRECT]
B. Primary MDD
C. Bipolar disorder
D. Schizoaffective disorder
Correct Answer: A
Rationale: Correct because substance-induced disorders require ruling out
substance etiology; methamphetamine withdrawal commonly causes depressive
symptoms.
, Q7: A patient with MDD is started on an antidepressant and now reports elevated
mood, increased energy, and decreased need for sleep. What is the most likely
diagnosis?
A. Medication-induced hypomania [CORRECT]
B. Bipolar disorder
C. Normal response
D. Mania
Correct Answer: A
Rationale: Correct because antidepressant-induced elevated mood suggests bipolar
diathesis or medication effect; switching to a mood stabilizer may be indicated.
Q8: A patient with bipolar disorder is on lithium and reports confusion, ataxia, and
tremors. Lithium level is 2.1 mEq/L. What is the most likely diagnosis?
A. Lithium toxicity [CORRECT]
B. Bipolar relapse
C. Medication non-adherence
D. Cerebrovascular event
Correct Answer: A
Rationale: Correct because level >1.5 mEq/L with CNS symptoms indicates lithium
toxicity requiring immediate discontinuation and supportive care.
Q9: A patient with MDD and anxiety is started on an SSRI and now reports agitation
and restlessness. What is the most likely cause?
A. SSRI-induced agitation [CORRECT]
B. Worsening depression
C. Bipolar switch
D. Serotonin syndrome
Correct Answer: A
Rationale: Correct because SSRI activation can cause early agitation; dose
adjustment or temporary benzodiazepine coverage may be needed.
Q10: A patient with MDD reports fatigue, hypersomnia, increased appetite, and
sensitivity to rejection. What specifier applies?
A. Melancholic
B. Atypical [CORRECT]
C. Catatonic
D. Psychotic
Correct Answer: B
Rationale: Correct because hypersomnia, hyperphagia, leaden paralysis, and
rejection sensitivity are hallmark atypical features of depression.
Psychiatric-Mental Health Lifespan Final Exam Actual
2025/2026 with Detailed Rationales | 100% Verified |
Pass Guaranteed – A+ Graded
SECTION 1: Mood Disorders – Differential Diagnosis (12 questions)
Q1: A 45-year-old patient presents with depressed mood, anhedonia, fatigue, and
increased need for sleep. They report episodes of elevated mood lasting 4-5 days
every few months with increased energy and decreased need for sleep. What is the
most likely diagnosis?
A. Major depressive disorder
B. Bipolar II disorder [CORRECT]
C. Persistent depressive disorder
D. Cyclothymic disorder
Correct Answer: B
Rationale: Correct because hypomanic episodes lasting ≥4 days with depressive
episodes indicate bipolar II disorder.
Q2: A 32-year-old patient presents with elevated mood, grandiosity, decreased need
for sleep, and increased goal-directed activity lasting 6 days with significant
impairment. What is the diagnosis?
A. Hypomanic episode
B. Manic episode [CORRECT]
C. Cyclothymia
D. Bipolar disorder NOS
Correct Answer: B
Rationale: Correct because symptoms ≥7 days (or any duration if hospitalization
needed) with impairment indicate mania.
Q3: A patient presents with recurrent episodes of depressed mood alternating with
periods of elevated mood lasting 2-3 days. No significant impairment. What is the
most likely diagnosis?
A. Bipolar II disorder
,B. Cyclothymic disorder [CORRECT]
C. Bipolar I disorder
D. Borderline personality disorder
Correct Answer: B
Rationale: Correct because cyclothymia involves hypomanic and depressive
symptoms ≥2 years without major episodes.
Q4: A patient with depression reports significant fatigue, hypersomnia, and increased
appetite. Which of the following should be ruled out first?
A. Hypothyroidism [CORRECT]
B. Bipolar disorder
C. Substance use
D. Sleep apnea
Correct Answer: A
Rationale: Correct because atypical depression features warrant thyroid evaluation;
hypothyroidism commonly presents with fatigue, hypersomnia, and weight gain.
Q5: A patient with MDD reports feeling worthless, guilty, and suicidal. They have a
history of hypomanic episodes lasting 2-3 days. What is the most likely diagnosis?
A. MDD
B. Bipolar II disorder [CORRECT]
C. Persistent depressive disorder
D. Bipolar I disorder
Correct Answer: B
Rationale: Correct because bipolar II requires major depressive episodes and
hypomanic episodes; the presence of any hypomanic history changes the differential
from unipolar depression.
Q6: A patient with depression reports depressive symptoms and reports using
methamphetamine. What is the most appropriate differential?
A. Substance-induced depressive disorder [CORRECT]
B. Primary MDD
C. Bipolar disorder
D. Schizoaffective disorder
Correct Answer: A
Rationale: Correct because substance-induced disorders require ruling out
substance etiology; methamphetamine withdrawal commonly causes depressive
symptoms.
, Q7: A patient with MDD is started on an antidepressant and now reports elevated
mood, increased energy, and decreased need for sleep. What is the most likely
diagnosis?
A. Medication-induced hypomania [CORRECT]
B. Bipolar disorder
C. Normal response
D. Mania
Correct Answer: A
Rationale: Correct because antidepressant-induced elevated mood suggests bipolar
diathesis or medication effect; switching to a mood stabilizer may be indicated.
Q8: A patient with bipolar disorder is on lithium and reports confusion, ataxia, and
tremors. Lithium level is 2.1 mEq/L. What is the most likely diagnosis?
A. Lithium toxicity [CORRECT]
B. Bipolar relapse
C. Medication non-adherence
D. Cerebrovascular event
Correct Answer: A
Rationale: Correct because level >1.5 mEq/L with CNS symptoms indicates lithium
toxicity requiring immediate discontinuation and supportive care.
Q9: A patient with MDD and anxiety is started on an SSRI and now reports agitation
and restlessness. What is the most likely cause?
A. SSRI-induced agitation [CORRECT]
B. Worsening depression
C. Bipolar switch
D. Serotonin syndrome
Correct Answer: A
Rationale: Correct because SSRI activation can cause early agitation; dose
adjustment or temporary benzodiazepine coverage may be needed.
Q10: A patient with MDD reports fatigue, hypersomnia, increased appetite, and
sensitivity to rejection. What specifier applies?
A. Melancholic
B. Atypical [CORRECT]
C. Catatonic
D. Psychotic
Correct Answer: B
Rationale: Correct because hypersomnia, hyperphagia, leaden paralysis, and
rejection sensitivity are hallmark atypical features of depression.
