NR547 Week 7 Exam V2 | NR547
Differential Diagnosis in Psychiatric-
Mental Health across the Lifespan
Practicum | Q&A with Rationale (NR547
Week 7 Exam) | Chamberlain University
1. A 28-year-old female presents with persistent sadness, insomnia, and loss of interest in
activities for the past three weeks. She also reports a previous 10-day period last year where
she felt unusually energetic, required only 3 hours of sleep, and impulsively quit her job.
What is the most appropriate differential diagnosis?
A. Bipolar I Disorder
B. Major Depressive Disorder
C. Bipolar II Disorder
D. Cyclothymic Disorder
Answer: A
Rationale: The patient describes a clear manic episode characterized by increased energy,
decreased need for sleep, and functional impairment (quitting her job). According to DSM-
5-TR, a single manic episode is sufficient for a diagnosis of Bipolar I Disorder regardless of
depressive history. Major Depressive Disorder is excluded because of the history of mania.
,2. When differentiating between Schizophrenia and Schizoaffective Disorder, which clinical
feature is diagnostic of Schizoaffective Disorder?
A. The presence of hallucinations for at least 6 months.
B. Negative symptoms such as avolition and alogia.
C. A major mood episode concurrent with Criterion A of Schizophrenia.
D. Delusions occurring only during a mood episode.
Answer: C
Rationale: Schizoaffective Disorder requires a major mood episode (depressive or manic)
to be present for the majority of the total duration of the illness. Additionally, there must be
delusions or hallucinations for at least 2 weeks in the absence of a major mood episode.
This distinction is critical for choosing the correct pharmacological intervention involving
both antipsychotics and mood stabilizers.
3. A 75-year-old male is brought to the clinic by his daughter due to increased confusion and
‘low mood.’ The PMHNP notes the patient has significant psychomotor retardation and
frequently responds with ‘I don’t know’ to cognitive testing questions. What is the likely
diagnosis?
A. Alzheimer’s Disease
B. Vascular Dementia
C. Pseudodementia (Depression)
D. Delirium
,Answer: C
Rationale: Pseudodementia refers to cognitive impairment secondary to depression in
elderly patients. Unlike dementia, patients with pseudodementia often highlight their
failures and respond with ‘I don’t know’ rather than trying to compensate for memory loss.
Effective treatment of the underlying depression typically resolves the cognitive deficits
seen in these patients.
4. Which screening tool is most specific for identifying Bipolar Disorder in a primary care or
psychiatric setting?
A. MDQ
B. GAD-7
C. PHQ-9
D. CAGE
Answer: A
Rationale: The Mood Disorder Questionnaire (MDQ) is a validated screening tool
specifically designed to identify symptoms of mania and hypomania. While the PHQ-9
focuses on depression and the GAD-7 on anxiety, the MDQ helps clinicians differentiate
between unipolar and bipolar depression. A positive screen on the MDQ necessitates
further clinical interviewing to confirm a diagnosis.
, 5. A 9-year-old child presents with persistent irritability and frequent temper outbursts (3-4
times per week) that are out of proportion to the situation. These symptoms have been
present for 14 months across multiple settings. What is the most likely diagnosis?
A. Bipolar I Disorder
B. Oppositional Defiant Disorder (ODD)
C. Attention-Deficit/Hyperactivity Disorder (ADHD)
D. Disruptive Mood Dysregulation Disorder (DMDD)
Answer: D
Rationale: DMDD is characterized by chronic, severe persistent irritability and frequent
temper outbursts in children. It was introduced in the DSM-5 to address the overdiagnosis
of pediatric bipolar disorder. The symptoms must be present for at least 12 months in at
least two settings to meet the diagnostic criteria.
6. To meet the DSM-5-TR criteria for Generalized Anxiety Disorder (GAD), excessive anxiety
and worry must be present for at least how many months?
A. 1 month
B. 3 months
C. 6 months
D. 12 months
Answer: C
Differential Diagnosis in Psychiatric-
Mental Health across the Lifespan
Practicum | Q&A with Rationale (NR547
Week 7 Exam) | Chamberlain University
1. A 28-year-old female presents with persistent sadness, insomnia, and loss of interest in
activities for the past three weeks. She also reports a previous 10-day period last year where
she felt unusually energetic, required only 3 hours of sleep, and impulsively quit her job.
What is the most appropriate differential diagnosis?
A. Bipolar I Disorder
B. Major Depressive Disorder
C. Bipolar II Disorder
D. Cyclothymic Disorder
Answer: A
Rationale: The patient describes a clear manic episode characterized by increased energy,
decreased need for sleep, and functional impairment (quitting her job). According to DSM-
5-TR, a single manic episode is sufficient for a diagnosis of Bipolar I Disorder regardless of
depressive history. Major Depressive Disorder is excluded because of the history of mania.
,2. When differentiating between Schizophrenia and Schizoaffective Disorder, which clinical
feature is diagnostic of Schizoaffective Disorder?
A. The presence of hallucinations for at least 6 months.
B. Negative symptoms such as avolition and alogia.
C. A major mood episode concurrent with Criterion A of Schizophrenia.
D. Delusions occurring only during a mood episode.
Answer: C
Rationale: Schizoaffective Disorder requires a major mood episode (depressive or manic)
to be present for the majority of the total duration of the illness. Additionally, there must be
delusions or hallucinations for at least 2 weeks in the absence of a major mood episode.
This distinction is critical for choosing the correct pharmacological intervention involving
both antipsychotics and mood stabilizers.
3. A 75-year-old male is brought to the clinic by his daughter due to increased confusion and
‘low mood.’ The PMHNP notes the patient has significant psychomotor retardation and
frequently responds with ‘I don’t know’ to cognitive testing questions. What is the likely
diagnosis?
A. Alzheimer’s Disease
B. Vascular Dementia
C. Pseudodementia (Depression)
D. Delirium
,Answer: C
Rationale: Pseudodementia refers to cognitive impairment secondary to depression in
elderly patients. Unlike dementia, patients with pseudodementia often highlight their
failures and respond with ‘I don’t know’ rather than trying to compensate for memory loss.
Effective treatment of the underlying depression typically resolves the cognitive deficits
seen in these patients.
4. Which screening tool is most specific for identifying Bipolar Disorder in a primary care or
psychiatric setting?
A. MDQ
B. GAD-7
C. PHQ-9
D. CAGE
Answer: A
Rationale: The Mood Disorder Questionnaire (MDQ) is a validated screening tool
specifically designed to identify symptoms of mania and hypomania. While the PHQ-9
focuses on depression and the GAD-7 on anxiety, the MDQ helps clinicians differentiate
between unipolar and bipolar depression. A positive screen on the MDQ necessitates
further clinical interviewing to confirm a diagnosis.
, 5. A 9-year-old child presents with persistent irritability and frequent temper outbursts (3-4
times per week) that are out of proportion to the situation. These symptoms have been
present for 14 months across multiple settings. What is the most likely diagnosis?
A. Bipolar I Disorder
B. Oppositional Defiant Disorder (ODD)
C. Attention-Deficit/Hyperactivity Disorder (ADHD)
D. Disruptive Mood Dysregulation Disorder (DMDD)
Answer: D
Rationale: DMDD is characterized by chronic, severe persistent irritability and frequent
temper outbursts in children. It was introduced in the DSM-5 to address the overdiagnosis
of pediatric bipolar disorder. The symptoms must be present for at least 12 months in at
least two settings to meet the diagnostic criteria.
6. To meet the DSM-5-TR criteria for Generalized Anxiety Disorder (GAD), excessive anxiety
and worry must be present for at least how many months?
A. 1 month
B. 3 months
C. 6 months
D. 12 months
Answer: C
