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NR 547 CEA Differential Diagnosis Practicum –
Chamberlain – (2026) 150 Actual Questions &
Answers (Guarantee Pass)
Question 1 — Diagnostic Formulation and Premature Closure
A 34-year-old patient presents with low mood, fatigue, reduced concentration,
and loss of interest in previously enjoyable activities for approximately 5 weeks.
During the interview, the patient also reports palpitations, heat intolerance, and
an unintentional change in weight. A clinician immediately documents major
depressive disorder based only on the reported mood symptoms.
Which diagnostic reasoning error is most evident?
A. Availability bias
B. Premature closure
C. Spectrum bias
D. Observer expectancy bias
Correct Answer: B
Detailed Clinical Rationale: Premature closure occurs when a clinician accepts a
diagnosis before sufficiently considering alternative explanations. Although the
patient may have a depressive disorder, the associated autonomic and systemic
symptoms require consideration of medical contributors, including endocrine and
other physiologic conditions. A careful differential diagnosis should integrate
psychiatric symptoms with review of systems, medications, substances, physical
findings, and indicated diagnostic testing. The key problem is not that major
depressive disorder is impossible; it is that the diagnostic process stopped too
early.
Question 2 — Mental-Status Examination
pg. 1
,2
During an interview, a patient speaks rapidly, shifts topics frequently, and
requires repeated redirection. The patient's emotional expression appears
expansive and is inconsistent with the seriousness of several stressful events
being described.
Which combination of mental-status examination domains is most directly being
assessed?
A. Appearance and orientation
B. Speech, thought process, and affect
C. Memory and insight only
D. Judgment and abstraction only
Correct Answer: B
Detailed Clinical Rationale: Rapid speech is evaluated under the speech domain.
Frequent topic shifting and difficulty maintaining a coherent line of thought relate
to thought process, while an expansive or incongruent emotional presentation
concerns affect. A complete mental-status examination should distinguish the
patient's subjective emotional experience, often described as mood, from the
clinician's observation of emotional expression, or affect.
Question 3 — Most Likely Depressive Diagnosis
A 29-year-old patient reports persistent depressed mood, markedly reduced
interest, impaired concentration, fatigue, feelings of worthlessness, and
significant functional decline for more than 2 weeks. There is no history
suggesting a manic or hypomanic episode, no evidence that symptoms began
during intoxication or withdrawal, and no known medical explanation after
appropriate evaluation.
Which diagnosis is most consistent with the presentation?
A. Major depressive disorder
B. Cyclothymic disorder
C. Brief psychotic disorder
D. Generalized anxiety disorder
pg. 2
,3
Correct Answer: A
Detailed Clinical Rationale: The scenario describes a sustained depressive
syndrome with multiple characteristic symptoms and clinically significant
functional impairment. A history of mania or hypomania would change the
diagnostic framework toward a bipolar-spectrum disorder. Substance-induced
and medical causes must also be considered before establishing a primary
psychiatric diagnosis. The case specifically removes several competing
explanations, making major depressive disorder the most likely option.
Question 4 — Bipolar-Spectrum Differential
A 38-year-old patient seeks treatment for recurrent depression. On detailed
questioning, the patient describes a previous period lasting several days during
which there was decreased need for sleep, unusually increased energy, increased
goal-directed activity, excessive confidence, and behavior noticeably different
from baseline. The episode caused concern among family members but did not
require hospitalization and did not produce marked occupational impairment.
Which additional historical question is most important for distinguishing among
bipolar-spectrum conditions?
A. Whether the patient prefers mornings or evenings
B. Whether psychotic symptoms or marked functional impairment occurred
during the elevated period
C. Whether the patient has seasonal allergies
D. Whether the patient drinks coffee daily
Correct Answer: B
Detailed Clinical Rationale: The duration, severity, functional consequences, and
presence or absence of psychotic symptoms are central to distinguishing manic
and hypomanic episodes. A history of elevated mood or increased energy should
not be dismissed merely because the patient presents for depression. Careful
longitudinal history, including collateral information when appropriate, is
essential because patients may recognize depressive episodes more readily than
prior periods of pathological elevation.
pg. 3
, 4
Question 5 — Mood Disorder Versus Substance-Induced Presentation
A patient develops severe insomnia, agitation, elevated mood, and perceptual
disturbances shortly after beginning to use a psychoactive substance. Symptoms
repeatedly occur in close temporal association with exposure and diminish after
the expected physiologic effects have resolved.
What is the most important diagnostic consideration?
A. A primary psychiatric disorder must automatically be diagnosed
B. A substance/medication-induced condition should be considered before
assuming a primary disorder
C. The symptoms should be ignored because substances cannot affect mental
status
D. A personality disorder is the most likely explanation
Correct Answer: B
Detailed Clinical Rationale: Temporal association between substance exposure
and symptom onset is a major component of differential diagnosis. The clinician
should establish the substance involved, timing, amount, prior episodes during
abstinence, medication history, and whether symptoms persist beyond the
expected effects of intoxication or withdrawal. A substance-related explanation
does not eliminate the possibility of a coexisting primary psychiatric disorder, but
it must be considered before diagnostic attribution is finalized.
Question 6 — Generalized Anxiety Versus Medical Mimic
A patient reports persistent nervousness, tremulousness, palpitations, difficulty
sleeping, and inability to relax. The patient believes the symptoms represent
anxiety but also reports recent changes in appetite and temperature tolerance.
Which approach is best?
A. Diagnose generalized anxiety disorder immediately
B. Consider psychiatric and medical causes and complete an appropriate
differential assessment
pg. 4
NR 547 CEA Differential Diagnosis Practicum –
Chamberlain – (2026) 150 Actual Questions &
Answers (Guarantee Pass)
Question 1 — Diagnostic Formulation and Premature Closure
A 34-year-old patient presents with low mood, fatigue, reduced concentration,
and loss of interest in previously enjoyable activities for approximately 5 weeks.
During the interview, the patient also reports palpitations, heat intolerance, and
an unintentional change in weight. A clinician immediately documents major
depressive disorder based only on the reported mood symptoms.
Which diagnostic reasoning error is most evident?
A. Availability bias
B. Premature closure
C. Spectrum bias
D. Observer expectancy bias
Correct Answer: B
Detailed Clinical Rationale: Premature closure occurs when a clinician accepts a
diagnosis before sufficiently considering alternative explanations. Although the
patient may have a depressive disorder, the associated autonomic and systemic
symptoms require consideration of medical contributors, including endocrine and
other physiologic conditions. A careful differential diagnosis should integrate
psychiatric symptoms with review of systems, medications, substances, physical
findings, and indicated diagnostic testing. The key problem is not that major
depressive disorder is impossible; it is that the diagnostic process stopped too
early.
Question 2 — Mental-Status Examination
pg. 1
,2
During an interview, a patient speaks rapidly, shifts topics frequently, and
requires repeated redirection. The patient's emotional expression appears
expansive and is inconsistent with the seriousness of several stressful events
being described.
Which combination of mental-status examination domains is most directly being
assessed?
A. Appearance and orientation
B. Speech, thought process, and affect
C. Memory and insight only
D. Judgment and abstraction only
Correct Answer: B
Detailed Clinical Rationale: Rapid speech is evaluated under the speech domain.
Frequent topic shifting and difficulty maintaining a coherent line of thought relate
to thought process, while an expansive or incongruent emotional presentation
concerns affect. A complete mental-status examination should distinguish the
patient's subjective emotional experience, often described as mood, from the
clinician's observation of emotional expression, or affect.
Question 3 — Most Likely Depressive Diagnosis
A 29-year-old patient reports persistent depressed mood, markedly reduced
interest, impaired concentration, fatigue, feelings of worthlessness, and
significant functional decline for more than 2 weeks. There is no history
suggesting a manic or hypomanic episode, no evidence that symptoms began
during intoxication or withdrawal, and no known medical explanation after
appropriate evaluation.
Which diagnosis is most consistent with the presentation?
A. Major depressive disorder
B. Cyclothymic disorder
C. Brief psychotic disorder
D. Generalized anxiety disorder
pg. 2
,3
Correct Answer: A
Detailed Clinical Rationale: The scenario describes a sustained depressive
syndrome with multiple characteristic symptoms and clinically significant
functional impairment. A history of mania or hypomania would change the
diagnostic framework toward a bipolar-spectrum disorder. Substance-induced
and medical causes must also be considered before establishing a primary
psychiatric diagnosis. The case specifically removes several competing
explanations, making major depressive disorder the most likely option.
Question 4 — Bipolar-Spectrum Differential
A 38-year-old patient seeks treatment for recurrent depression. On detailed
questioning, the patient describes a previous period lasting several days during
which there was decreased need for sleep, unusually increased energy, increased
goal-directed activity, excessive confidence, and behavior noticeably different
from baseline. The episode caused concern among family members but did not
require hospitalization and did not produce marked occupational impairment.
Which additional historical question is most important for distinguishing among
bipolar-spectrum conditions?
A. Whether the patient prefers mornings or evenings
B. Whether psychotic symptoms or marked functional impairment occurred
during the elevated period
C. Whether the patient has seasonal allergies
D. Whether the patient drinks coffee daily
Correct Answer: B
Detailed Clinical Rationale: The duration, severity, functional consequences, and
presence or absence of psychotic symptoms are central to distinguishing manic
and hypomanic episodes. A history of elevated mood or increased energy should
not be dismissed merely because the patient presents for depression. Careful
longitudinal history, including collateral information when appropriate, is
essential because patients may recognize depressive episodes more readily than
prior periods of pathological elevation.
pg. 3
, 4
Question 5 — Mood Disorder Versus Substance-Induced Presentation
A patient develops severe insomnia, agitation, elevated mood, and perceptual
disturbances shortly after beginning to use a psychoactive substance. Symptoms
repeatedly occur in close temporal association with exposure and diminish after
the expected physiologic effects have resolved.
What is the most important diagnostic consideration?
A. A primary psychiatric disorder must automatically be diagnosed
B. A substance/medication-induced condition should be considered before
assuming a primary disorder
C. The symptoms should be ignored because substances cannot affect mental
status
D. A personality disorder is the most likely explanation
Correct Answer: B
Detailed Clinical Rationale: Temporal association between substance exposure
and symptom onset is a major component of differential diagnosis. The clinician
should establish the substance involved, timing, amount, prior episodes during
abstinence, medication history, and whether symptoms persist beyond the
expected effects of intoxication or withdrawal. A substance-related explanation
does not eliminate the possibility of a coexisting primary psychiatric disorder, but
it must be considered before diagnostic attribution is finalized.
Question 6 — Generalized Anxiety Versus Medical Mimic
A patient reports persistent nervousness, tremulousness, palpitations, difficulty
sleeping, and inability to relax. The patient believes the symptoms represent
anxiety but also reports recent changes in appetite and temperature tolerance.
Which approach is best?
A. Diagnose generalized anxiety disorder immediately
B. Consider psychiatric and medical causes and complete an appropriate
differential assessment
pg. 4
