Final Exam: NR547 / NR 547 (Latest
) | Differential Diagnosis in
Psychiatric-Mental Health Practicum |
Questions & Verified Answers | Grade
A+ - Chamberlain
Q1. A 72-year-old retired teacher presents with her daughter,
who reports a 9-month progressive decline in her mother's
ability to manage finances, frequent repetition of questions,
and getting lost in her own neighborhood. The patient scores
20/30 on the MMSE, with points lost on recall, orientation, and
calculation. Neurological exam is normal. MRI shows moderate
generalized cortical atrophy and bilateral hippocampal volume
loss. Which diagnosis is most consistent with this clinical
picture?
A. Major Neurocognitive Disorder Due to Alzheimer’s Disease
B. Major Neurocognitive Disorder Due to Vascular Disease
C. Major Depressive Disorder
D. Delirium
Correct Answer: A
,Rationale: The gradual, progressive decline in memory and
visuospatial abilities, with prominent hippocampal atrophy on
imaging, is classic for Alzheimer's disease. The absence of focal
neurological signs or stepwise decline argues against vascular
etiology (B). Depression (C) does not typically cause progressive
disorientation and hippocampal atrophy. Delirium (D) is acute
and fluctuating, not progressive over 9 months.
Q2. A 24-year-old graduate student presents with a 3-week
history of elevated mood, decreased need for sleep, racing
thoughts, and spending large amounts of money on
cryptocurrency. He states he has "never felt better or more
productive." He denies any past episodes. His urine drug screen
is negative. Which would be the most appropriate initial
diagnosis?
A. Bipolar I Disorder, Current Episode Manic
B. Cyclothymic Disorder
C. Substance-Induced Bipolar Disorder
D. Bipolar II Disorder
Correct Answer: A
Rationale: The presence of a single clear manic episode
(elevated mood, decreased sleep, grandiosity, impulsivity)
lasting 3 weeks meets criteria for Bipolar I Disorder. A full manic
,episode rules out Bipolar II (D), which requires only hypomania.
The duration and lack of a pattern of hypomanic/depressive
symptoms rules out Cyclothymia (B). The negative drug screen
and absence of substance use rules out Substance-Induced (C).
Q3. A 9-year-old boy is brought in due to difficulty in school. His
teacher reports he often fails to finish work, is easily distracted,
and frequently fidgets. Symptoms are present in multiple
settings. Parents note he can play video games for hours
focused. Developmental history is unremarkable. What is the
most critical next step in assessment?
A. Diagnose ADHD, Combined Presentation
B. Order an EEG to rule out absence seizures
C. Assess for symptoms of anxiety or a specific learning disorder
D. Begin a trial of stimulant medication
Correct Answer: C
Rationale: While symptoms suggest ADHD, the ability for
sustained attention during high-interest activities (video games)
necessitates ruling out other conditions. Anxiety and learning
disorders can manifest as inattentive behaviors in school. A
comprehensive assessment for these differentials is essential
before diagnosing ADHD (A) or initiating medication (D).
, Absence seizures (B) typically involve brief lapses of
consciousness, not just inattention.
Q4. A 35-year-old woman presents with a 2-year history of
fluctuating physical complaints including joint pain, headaches,
and episodic blurred vision. She has seen multiple specialists,
with normal extensive workups. She is intensely worried about
having a serious undiagnosed illness and spends hours online
researching symptoms. Physical exam is unremarkable. What is
the likely diagnosis?
A. Illness Anxiety Disorder
B. Somatic Symptom Disorder
C. Conversion Disorder (Functional Neurological Symptom
Disorder)
D. Factitious Disorder
Correct Answer: B
Rationale: Somatic Symptom Disorder is characterized by one or
more distressing somatic symptoms AND excessive thoughts,
feelings, or behaviors related to these symptoms, as evidenced
by her disproportionate health anxiety and time spent on
symptom research. Illness Anxiety Disorder (A) involves
preoccupation with having a serious illness in the *absence* of
somatic symptoms (or with only mild symptoms). Conversion
) | Differential Diagnosis in
Psychiatric-Mental Health Practicum |
Questions & Verified Answers | Grade
A+ - Chamberlain
Q1. A 72-year-old retired teacher presents with her daughter,
who reports a 9-month progressive decline in her mother's
ability to manage finances, frequent repetition of questions,
and getting lost in her own neighborhood. The patient scores
20/30 on the MMSE, with points lost on recall, orientation, and
calculation. Neurological exam is normal. MRI shows moderate
generalized cortical atrophy and bilateral hippocampal volume
loss. Which diagnosis is most consistent with this clinical
picture?
A. Major Neurocognitive Disorder Due to Alzheimer’s Disease
B. Major Neurocognitive Disorder Due to Vascular Disease
C. Major Depressive Disorder
D. Delirium
Correct Answer: A
,Rationale: The gradual, progressive decline in memory and
visuospatial abilities, with prominent hippocampal atrophy on
imaging, is classic for Alzheimer's disease. The absence of focal
neurological signs or stepwise decline argues against vascular
etiology (B). Depression (C) does not typically cause progressive
disorientation and hippocampal atrophy. Delirium (D) is acute
and fluctuating, not progressive over 9 months.
Q2. A 24-year-old graduate student presents with a 3-week
history of elevated mood, decreased need for sleep, racing
thoughts, and spending large amounts of money on
cryptocurrency. He states he has "never felt better or more
productive." He denies any past episodes. His urine drug screen
is negative. Which would be the most appropriate initial
diagnosis?
A. Bipolar I Disorder, Current Episode Manic
B. Cyclothymic Disorder
C. Substance-Induced Bipolar Disorder
D. Bipolar II Disorder
Correct Answer: A
Rationale: The presence of a single clear manic episode
(elevated mood, decreased sleep, grandiosity, impulsivity)
lasting 3 weeks meets criteria for Bipolar I Disorder. A full manic
,episode rules out Bipolar II (D), which requires only hypomania.
The duration and lack of a pattern of hypomanic/depressive
symptoms rules out Cyclothymia (B). The negative drug screen
and absence of substance use rules out Substance-Induced (C).
Q3. A 9-year-old boy is brought in due to difficulty in school. His
teacher reports he often fails to finish work, is easily distracted,
and frequently fidgets. Symptoms are present in multiple
settings. Parents note he can play video games for hours
focused. Developmental history is unremarkable. What is the
most critical next step in assessment?
A. Diagnose ADHD, Combined Presentation
B. Order an EEG to rule out absence seizures
C. Assess for symptoms of anxiety or a specific learning disorder
D. Begin a trial of stimulant medication
Correct Answer: C
Rationale: While symptoms suggest ADHD, the ability for
sustained attention during high-interest activities (video games)
necessitates ruling out other conditions. Anxiety and learning
disorders can manifest as inattentive behaviors in school. A
comprehensive assessment for these differentials is essential
before diagnosing ADHD (A) or initiating medication (D).
, Absence seizures (B) typically involve brief lapses of
consciousness, not just inattention.
Q4. A 35-year-old woman presents with a 2-year history of
fluctuating physical complaints including joint pain, headaches,
and episodic blurred vision. She has seen multiple specialists,
with normal extensive workups. She is intensely worried about
having a serious undiagnosed illness and spends hours online
researching symptoms. Physical exam is unremarkable. What is
the likely diagnosis?
A. Illness Anxiety Disorder
B. Somatic Symptom Disorder
C. Conversion Disorder (Functional Neurological Symptom
Disorder)
D. Factitious Disorder
Correct Answer: B
Rationale: Somatic Symptom Disorder is characterized by one or
more distressing somatic symptoms AND excessive thoughts,
feelings, or behaviors related to these symptoms, as evidenced
by her disproportionate health anxiety and time spent on
symptom research. Illness Anxiety Disorder (A) involves
preoccupation with having a serious illness in the *absence* of
somatic symptoms (or with only mild symptoms). Conversion
