NR 547 Differential Diagnosis Final Exam
2025/2026 | Chamberlain College | PMHNP
Practicum Prep | 50 Q&A & Rationale Guide
Q1. A 28-year-old female presents with a 3-week history of
persistently elevated mood, grandiose delusions about starting
a trillion-dollar company, decreased need for sleep, and
pressured speech. She was brought in after maxing out her
credit cards on extravagant purchases. Her roommate reports a
similar episode 2 years ago that lasted 4 months and resulted in
hospitalization. During that episode, she was also noted to be
severely depressed for several weeks before the mood
elevation began. What is the most accurate diagnosis?
A. Bipolar I Disorder, current episode manic
B. Bipolar II Disorder, current episode hypomanic
C. Cyclothymic Disorder
D. Schizoaffective Disorder, Bipolar Type
Correct Answer: A
Rationale: The presence of grandiose delusions (psychotic
features), significant functional impairment (financial
recklessness), and a prior episode of major depression followed
by a 4-month manic episode requiring hospitalization meet
criteria for Bipolar I Disorder. The manic episode is the current
,presentation. Bipolar II requires only hypomanic and major
depressive episodes. The prior 4-month episode with likely
severe impairment rules out hypomania and Cyclothymia.
Schizoaffective requires a period of psychotic symptoms in
the absence of prominent mood symptoms, which is not
described.
Q2. A 16-year-old male is referred for academic decline and
social withdrawal over 8 months. He reports hearing a voice
that comments on his actions in the third person, which began
insidiously. He has flat affect, vague persecutory ideas, and
significant avolition. His symptoms have worsened gradually
without any prominent mood episodes. There is no history of
substance use. His uncle has schizophrenia. Which diagnosis is
most supported?
A. Delusional Disorder
B. Major Depressive Disorder with Psychotic Features
C. Schizophreniaform Disorder
D. Schizophrenia
Correct Answer: D
Rationale: DSM-5-TR requires at least 6 months of disturbance,
including at least 1 month of active-phase symptoms (which he
has), for a diagnosis of Schizophrenia. The prodromal phase of
academic decline and withdrawal accounts for the remainder of
the 6-month period. Schizophreniaform Disorder has an
identical symptom profile but a duration of less than 6 months.
The absence of a major depressive episode rules out MDD with
,psychotic features. Delusional Disorder involves non-bizarre
delusions for 1+ months without other active-phase
schizophrenia symptoms (e.g., prominent hallucinations,
disorganized speech, negative symptoms).
Q3. A 45-year-old woman presents with 9 months of excessive
worry about her job performance, her children's health, and
household finances. She reports restlessness, muscle tension,
fatigue, and difficulty concentrating. She states she "can't
control the worry" and it occurs more days than not. She denies
discrete panic attacks, trauma history, or compulsions. Her
symptoms cause significant distress but she maintains her job
and household responsibilities. What is the most likely
diagnosis?
A. Adjustment Disorder with Anxiety
B. Generalized Anxiety Disorder
C. Persistent Depressive Disorder (Dysthymia) with Anxious
Distress
D. Somatic Symptom Disorder
Correct Answer: B
Rationale: This is a classic presentation of Generalized Anxiety
Disorder (GAD): excessive, difficult-to-control worry about
multiple domains, occurring more days than not for at least 6
months, accompanied by at least 3 physical symptoms
(restlessness, muscle tension, fatigue). The duration rules out
Adjustment Disorder (<6 months). While low mood can
accompany GAD, the primary complaint is anxiety/worry, not
, depressed mood, ruling out Persistent Depressive Disorder as
principal. Somatic complaints are not the primary focus.
Q4. (Select All That Apply) A 72-year-old man with hypertension
and hyperlipidemia is brought by his daughter for increasing
confusion over 6 months. He got lost driving to the grocery
store last week. On exam, he is alert but disoriented to date and
place. He has word-finding difficulties and impaired recall of
three objects after 5 minutes. Neurological exam is non-focal.
Which of the following are essential components of the
diagnostic workup for suspected Major Neurocognitive
Disorder? Select three.
A. Serum Vitamin B12 and TSH levels
B. Lumbar Puncture
C. Brain MRI or CT
D. Detailed neuropsychological testing
E. Electroencephalogram (EEG)
Correct Answer: A, C, D
Rationale: For the diagnosis of Major Neurocognitive Disorder
(e.g., due to Alzheimer's), DSM-5-TR and standard guidelines
require: 1) Cognitive assessment (via detailed testing - D), 2)
Exclusion of other medical causes (via labs like B12/TSH - A),
and 3) Neuroimaging (MRI/CT - C) to rule out structural causes
like tumor, hematoma, or assess for patterns of atrophy.
Lumbar puncture and EEG are not routinely essential first-line
tests; they are pursued based on specific clinical suspicions
(e.g., infection, prion disease, seizures).
2025/2026 | Chamberlain College | PMHNP
Practicum Prep | 50 Q&A & Rationale Guide
Q1. A 28-year-old female presents with a 3-week history of
persistently elevated mood, grandiose delusions about starting
a trillion-dollar company, decreased need for sleep, and
pressured speech. She was brought in after maxing out her
credit cards on extravagant purchases. Her roommate reports a
similar episode 2 years ago that lasted 4 months and resulted in
hospitalization. During that episode, she was also noted to be
severely depressed for several weeks before the mood
elevation began. What is the most accurate diagnosis?
A. Bipolar I Disorder, current episode manic
B. Bipolar II Disorder, current episode hypomanic
C. Cyclothymic Disorder
D. Schizoaffective Disorder, Bipolar Type
Correct Answer: A
Rationale: The presence of grandiose delusions (psychotic
features), significant functional impairment (financial
recklessness), and a prior episode of major depression followed
by a 4-month manic episode requiring hospitalization meet
criteria for Bipolar I Disorder. The manic episode is the current
,presentation. Bipolar II requires only hypomanic and major
depressive episodes. The prior 4-month episode with likely
severe impairment rules out hypomania and Cyclothymia.
Schizoaffective requires a period of psychotic symptoms in
the absence of prominent mood symptoms, which is not
described.
Q2. A 16-year-old male is referred for academic decline and
social withdrawal over 8 months. He reports hearing a voice
that comments on his actions in the third person, which began
insidiously. He has flat affect, vague persecutory ideas, and
significant avolition. His symptoms have worsened gradually
without any prominent mood episodes. There is no history of
substance use. His uncle has schizophrenia. Which diagnosis is
most supported?
A. Delusional Disorder
B. Major Depressive Disorder with Psychotic Features
C. Schizophreniaform Disorder
D. Schizophrenia
Correct Answer: D
Rationale: DSM-5-TR requires at least 6 months of disturbance,
including at least 1 month of active-phase symptoms (which he
has), for a diagnosis of Schizophrenia. The prodromal phase of
academic decline and withdrawal accounts for the remainder of
the 6-month period. Schizophreniaform Disorder has an
identical symptom profile but a duration of less than 6 months.
The absence of a major depressive episode rules out MDD with
,psychotic features. Delusional Disorder involves non-bizarre
delusions for 1+ months without other active-phase
schizophrenia symptoms (e.g., prominent hallucinations,
disorganized speech, negative symptoms).
Q3. A 45-year-old woman presents with 9 months of excessive
worry about her job performance, her children's health, and
household finances. She reports restlessness, muscle tension,
fatigue, and difficulty concentrating. She states she "can't
control the worry" and it occurs more days than not. She denies
discrete panic attacks, trauma history, or compulsions. Her
symptoms cause significant distress but she maintains her job
and household responsibilities. What is the most likely
diagnosis?
A. Adjustment Disorder with Anxiety
B. Generalized Anxiety Disorder
C. Persistent Depressive Disorder (Dysthymia) with Anxious
Distress
D. Somatic Symptom Disorder
Correct Answer: B
Rationale: This is a classic presentation of Generalized Anxiety
Disorder (GAD): excessive, difficult-to-control worry about
multiple domains, occurring more days than not for at least 6
months, accompanied by at least 3 physical symptoms
(restlessness, muscle tension, fatigue). The duration rules out
Adjustment Disorder (<6 months). While low mood can
accompany GAD, the primary complaint is anxiety/worry, not
, depressed mood, ruling out Persistent Depressive Disorder as
principal. Somatic complaints are not the primary focus.
Q4. (Select All That Apply) A 72-year-old man with hypertension
and hyperlipidemia is brought by his daughter for increasing
confusion over 6 months. He got lost driving to the grocery
store last week. On exam, he is alert but disoriented to date and
place. He has word-finding difficulties and impaired recall of
three objects after 5 minutes. Neurological exam is non-focal.
Which of the following are essential components of the
diagnostic workup for suspected Major Neurocognitive
Disorder? Select three.
A. Serum Vitamin B12 and TSH levels
B. Lumbar Puncture
C. Brain MRI or CT
D. Detailed neuropsychological testing
E. Electroencephalogram (EEG)
Correct Answer: A, C, D
Rationale: For the diagnosis of Major Neurocognitive Disorder
(e.g., due to Alzheimer's), DSM-5-TR and standard guidelines
require: 1) Cognitive assessment (via detailed testing - D), 2)
Exclusion of other medical causes (via labs like B12/TSH - A),
and 3) Neuroimaging (MRI/CT - C) to rule out structural causes
like tumor, hematoma, or assess for patterns of atrophy.
Lumbar puncture and EEG are not routinely essential first-line
tests; they are pursued based on specific clinical suspicions
(e.g., infection, prion disease, seizures).
