NR547 DIFFERENTIAL DIAGNOSIS IN
PMH ACROSS THE LIFESPAN
COMPREHENSIVE EXAM REVIEW
1. When differentiating between Delirium and Neurocognitive Disorder (Dementia), which
clinical feature is most diagnostic of Delirium?
A. Gradual decline in memory functions
B. Acute onset with fluctuating levels of consciousness
C. Presence of aphasia and apraxia
D. Intact attention and orientation until late stages
Answer: B
Conceptual Explanation: Delirium is characterized by an acute onset, a fluctuating course,
and disturbances in consciousness and attention, whereas Dementia involves a slow,
progressive decline in cognition with clear consciousness.
2. In the differential diagnosis of Bipolar I and Bipolar II Disorder, which requirement must be
met for a Bipolar I diagnosis?
A. At least one hypomanic episode and one major depressive episode
B. A history of at least four mood cycles within a single year
,C. At least one manic episode lasting at least one week
D. Evidence of psychotic features during a depressive episode
Answer: C
Conceptual Explanation: Bipolar I requires at least one manic episode (lasting 1 week or
requiring hospitalization). Bipolar II requires at least one hypomanic episode and one
major depressive episode, but never a full manic episode.
3. A 9-year-old child presents with persistent irritability and frequent, severe temper
outbursts that are out of proportion to the situation. Which diagnosis should be considered
first over Pediatric Bipolar Disorder?
A. Oppositional Defiant Disorder (ODD)
B. Disruptive Mood Dysregulation Disorder (DMDD)
C. Attention-Deficit/Hyperactivity Disorder (ADHD)
D. Cyclothymic Disorder
Answer: B
Conceptual Explanation: DMDD was created to address the over-diagnosis of Bipolar
Disorder in children. It is characterized by chronic, persistent irritability rather than the
episodic mood swings seen in Bipolar Disorder.
, 4. To distinguish Schizoaffective Disorder from Schizophrenia with Mood Features, the
clinician must confirm:
A. Delusions or hallucinations for 2 weeks in the absence of a major mood episode
B. Mood symptoms are present for the majority of the total duration of the illness
C. Psychotic symptoms only occur during a major depressive or manic episode
D. The patient has a family history of both Bipolar and Schizophrenia
Answer: A
Conceptual Explanation: The key diagnostic criterion for Schizoaffective Disorder is the
presence of delusions or hallucinations for at least 2 weeks in the absence of a major mood
episode (depressive or manic) during the lifetime duration of the illness.
5. Which physical symptom is a primary differentiator between Serotonin Syndrome and
Neuroleptic Malignant Syndrome (NMS)?
A. Neuromuscular hyperreactivity (hyperreflexia/myoclonus)
B. Autonomic instability
C. Hyperthermia
D. Altered mental status
Answer: A
PMH ACROSS THE LIFESPAN
COMPREHENSIVE EXAM REVIEW
1. When differentiating between Delirium and Neurocognitive Disorder (Dementia), which
clinical feature is most diagnostic of Delirium?
A. Gradual decline in memory functions
B. Acute onset with fluctuating levels of consciousness
C. Presence of aphasia and apraxia
D. Intact attention and orientation until late stages
Answer: B
Conceptual Explanation: Delirium is characterized by an acute onset, a fluctuating course,
and disturbances in consciousness and attention, whereas Dementia involves a slow,
progressive decline in cognition with clear consciousness.
2. In the differential diagnosis of Bipolar I and Bipolar II Disorder, which requirement must be
met for a Bipolar I diagnosis?
A. At least one hypomanic episode and one major depressive episode
B. A history of at least four mood cycles within a single year
,C. At least one manic episode lasting at least one week
D. Evidence of psychotic features during a depressive episode
Answer: C
Conceptual Explanation: Bipolar I requires at least one manic episode (lasting 1 week or
requiring hospitalization). Bipolar II requires at least one hypomanic episode and one
major depressive episode, but never a full manic episode.
3. A 9-year-old child presents with persistent irritability and frequent, severe temper
outbursts that are out of proportion to the situation. Which diagnosis should be considered
first over Pediatric Bipolar Disorder?
A. Oppositional Defiant Disorder (ODD)
B. Disruptive Mood Dysregulation Disorder (DMDD)
C. Attention-Deficit/Hyperactivity Disorder (ADHD)
D. Cyclothymic Disorder
Answer: B
Conceptual Explanation: DMDD was created to address the over-diagnosis of Bipolar
Disorder in children. It is characterized by chronic, persistent irritability rather than the
episodic mood swings seen in Bipolar Disorder.
, 4. To distinguish Schizoaffective Disorder from Schizophrenia with Mood Features, the
clinician must confirm:
A. Delusions or hallucinations for 2 weeks in the absence of a major mood episode
B. Mood symptoms are present for the majority of the total duration of the illness
C. Psychotic symptoms only occur during a major depressive or manic episode
D. The patient has a family history of both Bipolar and Schizophrenia
Answer: A
Conceptual Explanation: The key diagnostic criterion for Schizoaffective Disorder is the
presence of delusions or hallucinations for at least 2 weeks in the absence of a major mood
episode (depressive or manic) during the lifetime duration of the illness.
5. Which physical symptom is a primary differentiator between Serotonin Syndrome and
Neuroleptic Malignant Syndrome (NMS)?
A. Neuromuscular hyperreactivity (hyperreflexia/myoclonus)
B. Autonomic instability
C. Hyperthermia
D. Altered mental status
Answer: A
