NR 606 DIAGNOSIS & MANAGEMENT IN
PSYCHIATRIC MENTAL HEALTH II
COMPREHENSIVE EXAM
1. A 10-year-old child presents with persistent irritability and frequent episodes of extreme
behavioral dyscontrol. The parents report these outbursts occur 3-4 times a week for the last
year. Which diagnosis is most appropriate?
A. Oppositional Defiant Disorder
B. Disruptive Mood Dysregulation Disorder
C. Bipolar I Disorder
D. Conduct Disorder
Answer: B
Conceptual Explanation: DMDD is characterized by chronic, severe persistent irritability
and frequent temper outbursts in children, intended to reduce the over-diagnosis of
Bipolar Disorder in this age group.
,2. Which of the following screening tools is specifically validated for identifying Autism
Spectrum Disorder in toddlers aged 16 to 30 months?
A. PHQ-A
B. M-CHAT-R/F
C. Vanderbilt Assessment Scale
D. SCARED
Answer: B
Conceptual Explanation: The Modified Checklist for Autism in Toddlers, Revised with
Follow-up (M-CHAT-R/F) is the gold standard for early ASD screening.
3. A PMHNP is considering starting a patient on Carbamazepine. The patient is of Asian
descent. Which genetic test must be performed before initiating treatment?
A. CYP2D6 allele
B. MTHFR gene
C. HLA-B*1502 allele
D. APOE-4 allele
Answer: C
Conceptual Explanation: The HLA-B*1502 allele is strongly associated with a high risk of
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Asian populations taking
Carbamazepine.
, 4. In a patient diagnosed with Schizophrenia, which dopaminergic pathway is associated with
the negative symptoms, such as flat affect and alogia?
A. Mesolimbic pathway
B. Nigrostriatal pathway
C. Tuberoinfundibular pathway
D. Mesocortical pathway
Answer: D
Conceptual Explanation: Negative symptoms and cognitive impairment in schizophrenia
are hypothesized to be caused by hypofunction of the mesocortical dopamine pathway.
5. A 15-year-old female patient with Anorexia Nervosa has a BMI of 14.5, bradycardia, and
orthostatic hypotension. What is the most appropriate next step in management?
A. Start Fluoxetine 20mg daily
B. Immediate hospitalization for medical stabilization
C. Refer for outpatient Cognitive Behavioral Therapy
D. Initiate family-based therapy (Maudsley approach)
Answer: B
Conceptual Explanation: Medical instability (BMI < 15, bradycardia, hypotension)
requires immediate inpatient stabilization before psychiatric treatment can be effective.
PSYCHIATRIC MENTAL HEALTH II
COMPREHENSIVE EXAM
1. A 10-year-old child presents with persistent irritability and frequent episodes of extreme
behavioral dyscontrol. The parents report these outbursts occur 3-4 times a week for the last
year. Which diagnosis is most appropriate?
A. Oppositional Defiant Disorder
B. Disruptive Mood Dysregulation Disorder
C. Bipolar I Disorder
D. Conduct Disorder
Answer: B
Conceptual Explanation: DMDD is characterized by chronic, severe persistent irritability
and frequent temper outbursts in children, intended to reduce the over-diagnosis of
Bipolar Disorder in this age group.
,2. Which of the following screening tools is specifically validated for identifying Autism
Spectrum Disorder in toddlers aged 16 to 30 months?
A. PHQ-A
B. M-CHAT-R/F
C. Vanderbilt Assessment Scale
D. SCARED
Answer: B
Conceptual Explanation: The Modified Checklist for Autism in Toddlers, Revised with
Follow-up (M-CHAT-R/F) is the gold standard for early ASD screening.
3. A PMHNP is considering starting a patient on Carbamazepine. The patient is of Asian
descent. Which genetic test must be performed before initiating treatment?
A. CYP2D6 allele
B. MTHFR gene
C. HLA-B*1502 allele
D. APOE-4 allele
Answer: C
Conceptual Explanation: The HLA-B*1502 allele is strongly associated with a high risk of
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Asian populations taking
Carbamazepine.
, 4. In a patient diagnosed with Schizophrenia, which dopaminergic pathway is associated with
the negative symptoms, such as flat affect and alogia?
A. Mesolimbic pathway
B. Nigrostriatal pathway
C. Tuberoinfundibular pathway
D. Mesocortical pathway
Answer: D
Conceptual Explanation: Negative symptoms and cognitive impairment in schizophrenia
are hypothesized to be caused by hypofunction of the mesocortical dopamine pathway.
5. A 15-year-old female patient with Anorexia Nervosa has a BMI of 14.5, bradycardia, and
orthostatic hypotension. What is the most appropriate next step in management?
A. Start Fluoxetine 20mg daily
B. Immediate hospitalization for medical stabilization
C. Refer for outpatient Cognitive Behavioral Therapy
D. Initiate family-based therapy (Maudsley approach)
Answer: B
Conceptual Explanation: Medical instability (BMI < 15, bradycardia, hypotension)
requires immediate inpatient stabilization before psychiatric treatment can be effective.
