NR547 /NR 547: Midterm Exam:
Differential Diagnosis in Psychiatric-Mental Health
across the Lifespan Practicum
2026-2028 Testing Cycle | Complete Guide
75 Questions With Answers & Expert Rationales
Guaranteed Pass | Graded A+ | Chamberlain
Q1: A 34-year-old woman presents to the clinic with persistent worry about her job performance,
finances, and her children's safety. She reports difficulty controlling this worry on more days
than not for the past 8 months. She also notes restlessness, muscle tension, difficulty
concentrating, and sleep disturbance. She denies substance use, and her TSH and CBC are within
normal limits. Which is the most likely diagnosis?
A. Panic Disorder
B. Generalized Anxiety Disorder
C. Social Anxiety Disorder
D. Specific Phobia
Correct Answer: B
Rationale: Correct because the patient meets DSM-5-TR criteria for Generalized Anxiety
Disorder, which requires excessive anxiety and worry occurring more days than not for at least 6
months, difficulty controlling the worry, and at least three associated physical symptoms from
the six-symptom cluster in adults. The normal laboratory findings and absence of substance use
support a primary psychiatric diagnosis after ruling out medical mimics and substance-induced
etiologies per the 6-step differential diagnosis process. Panic Disorder, Social Anxiety Disorder,
and Specific Phobia do not fit the clinical presentation because the patient describes pervasive
generalized worry rather than unexpected panic attacks, fear of social scrutiny, or phobic
avoidance of a specific object or situation.
,Q2: A 42-year-old man is referred by his primary care provider for evaluation of depression. He
reports fatigue, weight gain, constipation, cold intolerance, and depressed mood over the past 4
months. Which laboratory test is most essential to obtain first?
A. Comprehensive Metabolic Panel
B. Urine Drug Screen
C. Complete Blood Count
D. Thyroid Function Tests
Correct Answer: D
Rationale: Correct because hypothyroidism commonly mimics Major Depressive Disorder
through symptoms of fatigue, weight gain, cognitive slowing, and depressed mood, making
Thyroid Function Tests the most essential initial laboratory study to rule out a general medical
condition per Step 3 of the 6-step differential diagnosis process. TSH is the sensitive screening
test, with Free T4 obtained for confirmation when TSH is abnormal. A Comprehensive Metabolic
Panel, Urine Drug Screen, and Complete Blood Count are important components of a medical
workup but are not the highest-yield initial tests when the symptom cluster specifically suggests
thyroid dysfunction.
Q3: A PMHNP is evaluating a 28-year-old veteran who presents with irritability, insomnia, and
hypervigilance following a recent deployment. The patient admits to drinking 4–5 beers nightly
to help him sleep. According to the 6-step differential diagnosis process, which step must be
completed before determining the primary psychiatric disorder?
A. Rule out substance-induced etiologies
B. Rule out malingering and factitious disorder
C. Rule out general medical conditions
D. Establish the definitive diagnosis using DSM-5-TR criteria
Correct Answer: A
Rationale: Correct because Step 2 of the 6-step differential diagnosis process requires ruling out
substance-induced etiologies, including alcohol use, before proceeding to determine the primary
psychiatric disorder in Step 4. The patient's nightly alcohol consumption of 4–5 beers may
directly cause or exacerbate his irritability, insomnia, and hypervigilance, making it essential to
assess whether symptoms persist beyond the expected duration of intoxication or withdrawal.
Ruling out malingering and factitious disorder is Step 1, ruling out general medical conditions is
Step 3, and establishing the definitive diagnosis is Step 6, none of which appropriately precede
the substance-induced evaluation in this clinical scenario.
,Q4: A 29-year-old woman is brought to the emergency department after experiencing a sudden
episode of intense fear while grocery shopping. She reports palpitations, sweating, shortness of
breath, chest pain, dizziness, and fear of dying. She has no history of cardiac disease. Select all
symptoms that are consistent with DSM-5-TR criteria for a panic attack.
A. Palpitations
B. Sweating
C. Fear of dying
D. Nausea
Correct Answer(s): A, B, C, D
Rationale: Correct because DSM-5-TR criteria for a panic attack require an abrupt surge of
intense fear or discomfort reaching a peak within minutes, with at least four of thirteen specified
symptoms present, and all four options listed are recognized panic attack symptoms. Palpitations,
sweating, and fear of dying are classic symptoms frequently reported during panic attacks, while
nausea is also one of the thirteen qualifying symptoms included in the diagnostic criteria. The
patient in this vignette presents with six symptoms, clearly meeting the threshold for a panic
attack, and the absence of cardiac history further supports a primary psychiatric etiology after
medical mimics have been appropriately considered.
Q5: A 38-year-old female firefighter presents for evaluation 6 weeks after responding to a multi-
casualty incident. She reports recurrent distressing dreams about the event, avoids driving past
the scene, believes she is permanently damaged, feels detached from her family, and startles
violently at unexpected noises. Which DSM-5-TR symptom cluster is represented by her belief
that she is permanently damaged?
A. Intrusion
B. Avoidance
C. Negative Cognitions and Mood
D. Arousal and Reactivity
Correct Answer: C
Rationale: Correct because the belief that one is permanently damaged represents a persistent
negative belief about oneself, which falls within the Negative Cognitions and Mood cluster of
PTSD per DSM-5-TR criteria. This cluster includes distorted cognitions about the cause or
consequences of the traumatic event, persistent negative emotional states, and feelings of
detachment or estrangement from others. Recurrent distressing dreams represent the Intrusion
cluster, avoidance of reminders represents the Avoidance cluster, and exaggerated startle
response represents the Arousal and Reactivity cluster, none of which encompass the cognitive
distortion described in this vignette.
, Q6: A 51-year-old woman is referred for psychiatric evaluation due to anxiety, tachycardia,
tremor, weight loss, and heat intolerance that have progressed over 3 months. Her primary care
provider notes she has lost 15 pounds without dieting. Which medical condition should be
suspected?
A. Hypothyroidism
B. Pheochromocytoma
C. Hypoglycemia
D. Hyperthyroidism
Correct Answer: D
Rationale: Correct because hyperthyroidism classically mimics anxiety disorders and panic
disorder through symptoms of tachycardia, tremor, weight loss, and heat intolerance, all of which
are present in this patient's presentation. The 6-step differential diagnosis process mandates
ruling out general medical conditions before assigning a primary psychiatric diagnosis, and this
symptom cluster strongly suggests thyroid dysfunction requiring TSH and Free T4 testing.
Hypothyroidism typically presents with weight gain and cold intolerance, pheochromocytoma
causes paroxysmal hypertension and diaphoresis, and hypoglycemia produces tremors and
confusion, none of which align with the complete symptom profile described.
Q7: A PMHNP is conducting an initial evaluation of a 45-year-old man who reports persistent
anxiety. The patient completed a self-report questionnaire with scores of 6, 11, and 16 on
previous administrations. Which screening tool is being used, and what does a score of 16
indicate?
A. GAD-7; mild anxiety
B. GAD-7; severe anxiety
C. HAM-A; moderate anxiety
D. PC-PTSD-5; positive screen
Correct Answer: B
Rationale: Correct because the GAD-7 is a 7-item self-report screening tool for Generalized
Anxiety Disorder with scores ranging from 0 to 21, and the established cutoffs are 5 for mild
anxiety, 10 for moderate anxiety, and 15 for severe anxiety, making a score of 16 consistent with
severe anxiety. The HAM-A is a clinician-administered 14-item scale that does not use these
specific cutoff scores, and the PC-PTSD-5 is a 5-item screen for PTSD where a positive screen is
indicated by 3 or more positive items rather than a summed numerical score. Understanding
scoring thresholds for standardized screening tools is essential for appropriate clinical decision-
making and determining when comprehensive assessment is warranted.
Differential Diagnosis in Psychiatric-Mental Health
across the Lifespan Practicum
2026-2028 Testing Cycle | Complete Guide
75 Questions With Answers & Expert Rationales
Guaranteed Pass | Graded A+ | Chamberlain
Q1: A 34-year-old woman presents to the clinic with persistent worry about her job performance,
finances, and her children's safety. She reports difficulty controlling this worry on more days
than not for the past 8 months. She also notes restlessness, muscle tension, difficulty
concentrating, and sleep disturbance. She denies substance use, and her TSH and CBC are within
normal limits. Which is the most likely diagnosis?
A. Panic Disorder
B. Generalized Anxiety Disorder
C. Social Anxiety Disorder
D. Specific Phobia
Correct Answer: B
Rationale: Correct because the patient meets DSM-5-TR criteria for Generalized Anxiety
Disorder, which requires excessive anxiety and worry occurring more days than not for at least 6
months, difficulty controlling the worry, and at least three associated physical symptoms from
the six-symptom cluster in adults. The normal laboratory findings and absence of substance use
support a primary psychiatric diagnosis after ruling out medical mimics and substance-induced
etiologies per the 6-step differential diagnosis process. Panic Disorder, Social Anxiety Disorder,
and Specific Phobia do not fit the clinical presentation because the patient describes pervasive
generalized worry rather than unexpected panic attacks, fear of social scrutiny, or phobic
avoidance of a specific object or situation.
,Q2: A 42-year-old man is referred by his primary care provider for evaluation of depression. He
reports fatigue, weight gain, constipation, cold intolerance, and depressed mood over the past 4
months. Which laboratory test is most essential to obtain first?
A. Comprehensive Metabolic Panel
B. Urine Drug Screen
C. Complete Blood Count
D. Thyroid Function Tests
Correct Answer: D
Rationale: Correct because hypothyroidism commonly mimics Major Depressive Disorder
through symptoms of fatigue, weight gain, cognitive slowing, and depressed mood, making
Thyroid Function Tests the most essential initial laboratory study to rule out a general medical
condition per Step 3 of the 6-step differential diagnosis process. TSH is the sensitive screening
test, with Free T4 obtained for confirmation when TSH is abnormal. A Comprehensive Metabolic
Panel, Urine Drug Screen, and Complete Blood Count are important components of a medical
workup but are not the highest-yield initial tests when the symptom cluster specifically suggests
thyroid dysfunction.
Q3: A PMHNP is evaluating a 28-year-old veteran who presents with irritability, insomnia, and
hypervigilance following a recent deployment. The patient admits to drinking 4–5 beers nightly
to help him sleep. According to the 6-step differential diagnosis process, which step must be
completed before determining the primary psychiatric disorder?
A. Rule out substance-induced etiologies
B. Rule out malingering and factitious disorder
C. Rule out general medical conditions
D. Establish the definitive diagnosis using DSM-5-TR criteria
Correct Answer: A
Rationale: Correct because Step 2 of the 6-step differential diagnosis process requires ruling out
substance-induced etiologies, including alcohol use, before proceeding to determine the primary
psychiatric disorder in Step 4. The patient's nightly alcohol consumption of 4–5 beers may
directly cause or exacerbate his irritability, insomnia, and hypervigilance, making it essential to
assess whether symptoms persist beyond the expected duration of intoxication or withdrawal.
Ruling out malingering and factitious disorder is Step 1, ruling out general medical conditions is
Step 3, and establishing the definitive diagnosis is Step 6, none of which appropriately precede
the substance-induced evaluation in this clinical scenario.
,Q4: A 29-year-old woman is brought to the emergency department after experiencing a sudden
episode of intense fear while grocery shopping. She reports palpitations, sweating, shortness of
breath, chest pain, dizziness, and fear of dying. She has no history of cardiac disease. Select all
symptoms that are consistent with DSM-5-TR criteria for a panic attack.
A. Palpitations
B. Sweating
C. Fear of dying
D. Nausea
Correct Answer(s): A, B, C, D
Rationale: Correct because DSM-5-TR criteria for a panic attack require an abrupt surge of
intense fear or discomfort reaching a peak within minutes, with at least four of thirteen specified
symptoms present, and all four options listed are recognized panic attack symptoms. Palpitations,
sweating, and fear of dying are classic symptoms frequently reported during panic attacks, while
nausea is also one of the thirteen qualifying symptoms included in the diagnostic criteria. The
patient in this vignette presents with six symptoms, clearly meeting the threshold for a panic
attack, and the absence of cardiac history further supports a primary psychiatric etiology after
medical mimics have been appropriately considered.
Q5: A 38-year-old female firefighter presents for evaluation 6 weeks after responding to a multi-
casualty incident. She reports recurrent distressing dreams about the event, avoids driving past
the scene, believes she is permanently damaged, feels detached from her family, and startles
violently at unexpected noises. Which DSM-5-TR symptom cluster is represented by her belief
that she is permanently damaged?
A. Intrusion
B. Avoidance
C. Negative Cognitions and Mood
D. Arousal and Reactivity
Correct Answer: C
Rationale: Correct because the belief that one is permanently damaged represents a persistent
negative belief about oneself, which falls within the Negative Cognitions and Mood cluster of
PTSD per DSM-5-TR criteria. This cluster includes distorted cognitions about the cause or
consequences of the traumatic event, persistent negative emotional states, and feelings of
detachment or estrangement from others. Recurrent distressing dreams represent the Intrusion
cluster, avoidance of reminders represents the Avoidance cluster, and exaggerated startle
response represents the Arousal and Reactivity cluster, none of which encompass the cognitive
distortion described in this vignette.
, Q6: A 51-year-old woman is referred for psychiatric evaluation due to anxiety, tachycardia,
tremor, weight loss, and heat intolerance that have progressed over 3 months. Her primary care
provider notes she has lost 15 pounds without dieting. Which medical condition should be
suspected?
A. Hypothyroidism
B. Pheochromocytoma
C. Hypoglycemia
D. Hyperthyroidism
Correct Answer: D
Rationale: Correct because hyperthyroidism classically mimics anxiety disorders and panic
disorder through symptoms of tachycardia, tremor, weight loss, and heat intolerance, all of which
are present in this patient's presentation. The 6-step differential diagnosis process mandates
ruling out general medical conditions before assigning a primary psychiatric diagnosis, and this
symptom cluster strongly suggests thyroid dysfunction requiring TSH and Free T4 testing.
Hypothyroidism typically presents with weight gain and cold intolerance, pheochromocytoma
causes paroxysmal hypertension and diaphoresis, and hypoglycemia produces tremors and
confusion, none of which align with the complete symptom profile described.
Q7: A PMHNP is conducting an initial evaluation of a 45-year-old man who reports persistent
anxiety. The patient completed a self-report questionnaire with scores of 6, 11, and 16 on
previous administrations. Which screening tool is being used, and what does a score of 16
indicate?
A. GAD-7; mild anxiety
B. GAD-7; severe anxiety
C. HAM-A; moderate anxiety
D. PC-PTSD-5; positive screen
Correct Answer: B
Rationale: Correct because the GAD-7 is a 7-item self-report screening tool for Generalized
Anxiety Disorder with scores ranging from 0 to 21, and the established cutoffs are 5 for mild
anxiety, 10 for moderate anxiety, and 15 for severe anxiety, making a score of 16 consistent with
severe anxiety. The HAM-A is a clinician-administered 14-item scale that does not use these
specific cutoff scores, and the PC-PTSD-5 is a 5-item screen for PTSD where a positive screen is
indicated by 3 or more positive items rather than a summed numerical score. Understanding
scoring thresholds for standardized screening tools is essential for appropriate clinical decision-
making and determining when comprehensive assessment is warranted.
