NRNP 6635 PSYCHOPATHOLOGY AND
DIAGNOSTIC REASONING
COMPREHENSIVE EXAM
1. A 28-year-old patient presents with a two-week history of persistently elevated mood,
decreased need for sleep (2 hours per night), and pressured speech. However, they also
report having experienced significant auditory hallucinations and persecutory delusions for
the past two months in the absence of a prominent mood episode. Which diagnosis is most
likely?
A. Bipolar I Disorder with Psychotic Features
B. Major Depressive Disorder with Psychotic Features
C. Schizophrenia
D. Schizoaffective Disorder
Answer: D
Conceptual Explanation: Schizoaffective disorder is diagnosed when there is a period of
at least two weeks of delusions or hallucinations in the absence of a major mood episode
(manic or depressive) during the lifetime duration of the illness, while mood symptoms are
present for the majority of the total duration.
,2. When differentiating between Delirium and Dementia, which clinical feature is most
indicative of Delirium?
A. Gradual onset of memory loss
B. Fluctuating levels of consciousness and attention
C. Intact consciousness and alertness
D. Progressive decline in executive function
Answer: B
Conceptual Explanation: Delirium is characterized by an acute onset and a fluctuating
course, specifically involving deficits in attention and awareness, whereas dementia
typically involves a stable, progressive decline in cognition without acute fluctuations in
alertness.
3. In the neurobiology of Obsessive-Compulsive Disorder (OCD), which brain circuit is most
frequently implicated?
A. Nigrostriatal pathway
B. Mesolimbic pathway
C. Cortico-striato-thalamo-cortical (CSTC) loop
D. Tuberoinfundibular pathway
Answer: C
, Conceptual Explanation: The CSTC loop is the primary neuroanatomical circuit associated
with the symptoms of OCD, involving the orbitofrontal cortex and the basal ganglia.
4. A patient exhibits a pervasive pattern of detachment from social relationships and a
restricted range of expression of emotions in interpersonal settings, starting by early
adulthood. They neither desire nor enjoy close relationships. Which personality disorder does
this describe?
A. Avoidant Personality Disorder
B. Schizoid Personality Disorder
C. Schizotypal Personality Disorder
D. Antisocial Personality Disorder
Answer: B
Conceptual Explanation: Schizoid Personality Disorder is characterized by social
detachment and restricted emotional expression, unlike Avoidant PD where the individual
desires relationships but fears rejection.
5. To meet the DSM-5-TR criteria for Cyclothymic Disorder, for how long must a patient
experience numerous periods with hypomanic symptoms and depressive symptoms (without
meeting full criteria for a major episode)?
A. 6 months
B. 2 years
C. 1 year
DIAGNOSTIC REASONING
COMPREHENSIVE EXAM
1. A 28-year-old patient presents with a two-week history of persistently elevated mood,
decreased need for sleep (2 hours per night), and pressured speech. However, they also
report having experienced significant auditory hallucinations and persecutory delusions for
the past two months in the absence of a prominent mood episode. Which diagnosis is most
likely?
A. Bipolar I Disorder with Psychotic Features
B. Major Depressive Disorder with Psychotic Features
C. Schizophrenia
D. Schizoaffective Disorder
Answer: D
Conceptual Explanation: Schizoaffective disorder is diagnosed when there is a period of
at least two weeks of delusions or hallucinations in the absence of a major mood episode
(manic or depressive) during the lifetime duration of the illness, while mood symptoms are
present for the majority of the total duration.
,2. When differentiating between Delirium and Dementia, which clinical feature is most
indicative of Delirium?
A. Gradual onset of memory loss
B. Fluctuating levels of consciousness and attention
C. Intact consciousness and alertness
D. Progressive decline in executive function
Answer: B
Conceptual Explanation: Delirium is characterized by an acute onset and a fluctuating
course, specifically involving deficits in attention and awareness, whereas dementia
typically involves a stable, progressive decline in cognition without acute fluctuations in
alertness.
3. In the neurobiology of Obsessive-Compulsive Disorder (OCD), which brain circuit is most
frequently implicated?
A. Nigrostriatal pathway
B. Mesolimbic pathway
C. Cortico-striato-thalamo-cortical (CSTC) loop
D. Tuberoinfundibular pathway
Answer: C
, Conceptual Explanation: The CSTC loop is the primary neuroanatomical circuit associated
with the symptoms of OCD, involving the orbitofrontal cortex and the basal ganglia.
4. A patient exhibits a pervasive pattern of detachment from social relationships and a
restricted range of expression of emotions in interpersonal settings, starting by early
adulthood. They neither desire nor enjoy close relationships. Which personality disorder does
this describe?
A. Avoidant Personality Disorder
B. Schizoid Personality Disorder
C. Schizotypal Personality Disorder
D. Antisocial Personality Disorder
Answer: B
Conceptual Explanation: Schizoid Personality Disorder is characterized by social
detachment and restricted emotional expression, unlike Avoidant PD where the individual
desires relationships but fears rejection.
5. To meet the DSM-5-TR criteria for Cyclothymic Disorder, for how long must a patient
experience numerous periods with hypomanic symptoms and depressive symptoms (without
meeting full criteria for a major episode)?
A. 6 months
B. 2 years
C. 1 year
