NR 547 Final Exam Guide 2025/2026:
Differential Diagnosis in Psychiatric-Mental
Health Across Lifespan | Chamberlain College
| PMHNP Practicum Mastery with 50 Q&A |
Verified Test Bank for Advanced Assessment
Q1. A 27-year-old female presents with a 3-week history of
persistent depressed mood, anhedonia, 10-lb weight loss, and
insomnia. She reports constant fatigue and feelings of
worthlessness. Her medical history is significant for Graves'
disease, diagnosed 6 months ago, for which she takes
methimazole. Her TSH from last week was 0.02 mIU/L (low) and
Free T4 was 3.2 ng/dL (high). The most appropriate initial
diagnostic consideration is:
A. Major Depressive Disorder
B. Persistent Depressive Disorder (Dysthymia)
C. Bipolar II Disorder, current episode depressed
D. Depressive Disorder Due to Another Medical Condition
(Hyperthyroidism)
Correct Answer: D
Rationale: While the symptoms meet criteria for a Major
Depressive Episode, the primary rule-out in this vignette is a
,mood disorder due to a general medical condition. The patient
has active, untreated hyperthyroidism (as evidenced by
abnormal labs), which is a known potent cause of
neuropsychiatric symptoms including depression, anxiety,
insomnia, and fatigue. DSM-5-TR requires considering the
etiological relationship; treatment of the hyperthyroidism must
precede or coincide with the definitive diagnosis of a primary
depressive disorder.
Q2. (Select All That Apply) A 16-year-old male is brought in by
his parents due to increasing social isolation and declining
grades over the past 8 months. He spends all his time in his
room on the computer, has a flat affect, and makes poor eye
contact. He reports that he sometimes hears a voice
commenting on his actions when no one is there. Which of the
following conditions must be considered in the differential
diagnosis before diagnosing Schizophrenia?
A. Autism Spectrum Disorder
B. Major Depressive Disorder with Psychotic Features
C. Substance-Induced Psychotic Disorder (e.g., from cannabis)
D. Schizotypal Personality Disorder
E. All of the above
Correct Answer: A, B, C, D
Rationale: In an adolescent, the differential for psychotic
symptoms is broad. ASD can present with social deficits and
may include psychotic-like experiences or be misidentified as
negative symptoms. Depression with psychotic features is a
,high-risk condition in teens. Substance use, particularly
cannabis, is a common cause of psychosis in this age group.
Schizotypal PD involves perceptual distortions and social
isolation. A diagnosis of Schizophrenia requires ruling out these
conditions and observing symptoms for a significant portion of
time during a 6-month period.
Q3. A 68-year-old man with a history of hypertension and Type
2 Diabetes is evaluated for a 1-year progressive decline in
memory. His wife notes he gets lost driving to familiar places,
has trouble managing finances, and repeats questions.
Neurological exam is non-focal. Montreal Cognitive Assessment
(MoCA) score is 18/30, with deficits in delayed recall,
orientation, and executive function. Brain MRI shows moderate
hippocampal atrophy and generalized cortical atrophy. The
most likely diagnosis is:
A. Major Neurocognitive Disorder Due to Alzheimer’s Disease
B. Major Neurocognitive Disorder Due to Vascular Disease
C. Mild Neurocognitive Disorder
D. Delirium
Correct Answer: A
Rationale: The progressive decline over a year rules out
Delirium. The cognitive deficits are significant enough to impair
instrumental activities of daily living (getting lost, managing
finances), supporting a Major Neurocognitive Disorder, not
Mild. While vascular risk factors exist, the clinical presentation
(prominent episodic memory loss early) and MRI findings
, (hippocampal atrophy) are classic for Alzheimer's pathology.
Vascular NCD typically shows a stepwise decline and imaging
evidence of significant cerebrovascular disease.
Q4. A 35-year-old woman presents with a 2-month history of
"attacks" involving palpitations, chest pain, shortness of breath,
dizziness, and a fear of dying. These occur unexpectedly, peak
within minutes, and cause her persistent worry about having
more attacks. She has started avoiding the gym and crowded
stores. Physical exam and cardiac workup are normal. The most
accurate diagnosis is:
A. Generalized Anxiety Disorder
B. Agoraphobia
C. Panic Disorder
D. Somatic Symptom Disorder
Correct Answer: C
Rationale: The core features are recurrent, unexpected panic
attacks followed by at least one month of persistent concern
about additional attacks and/or a significant maladaptive
change in behavior related to the attacks (avoidance). While she
has developed agoraphobic avoidance, it is secondary to the
panic attacks. The diagnosis is Panic Disorder. Agoraphobia
alone (Answer B) would involve fear in situations without a
history of panic-like symptoms.
Q5. A 9-year-old boy is referred for evaluation of inattention
and hyperactivity. Symptoms are present at school and home.
His teacher reports he daydreams, is easily distracted, and often
Differential Diagnosis in Psychiatric-Mental
Health Across Lifespan | Chamberlain College
| PMHNP Practicum Mastery with 50 Q&A |
Verified Test Bank for Advanced Assessment
Q1. A 27-year-old female presents with a 3-week history of
persistent depressed mood, anhedonia, 10-lb weight loss, and
insomnia. She reports constant fatigue and feelings of
worthlessness. Her medical history is significant for Graves'
disease, diagnosed 6 months ago, for which she takes
methimazole. Her TSH from last week was 0.02 mIU/L (low) and
Free T4 was 3.2 ng/dL (high). The most appropriate initial
diagnostic consideration is:
A. Major Depressive Disorder
B. Persistent Depressive Disorder (Dysthymia)
C. Bipolar II Disorder, current episode depressed
D. Depressive Disorder Due to Another Medical Condition
(Hyperthyroidism)
Correct Answer: D
Rationale: While the symptoms meet criteria for a Major
Depressive Episode, the primary rule-out in this vignette is a
,mood disorder due to a general medical condition. The patient
has active, untreated hyperthyroidism (as evidenced by
abnormal labs), which is a known potent cause of
neuropsychiatric symptoms including depression, anxiety,
insomnia, and fatigue. DSM-5-TR requires considering the
etiological relationship; treatment of the hyperthyroidism must
precede or coincide with the definitive diagnosis of a primary
depressive disorder.
Q2. (Select All That Apply) A 16-year-old male is brought in by
his parents due to increasing social isolation and declining
grades over the past 8 months. He spends all his time in his
room on the computer, has a flat affect, and makes poor eye
contact. He reports that he sometimes hears a voice
commenting on his actions when no one is there. Which of the
following conditions must be considered in the differential
diagnosis before diagnosing Schizophrenia?
A. Autism Spectrum Disorder
B. Major Depressive Disorder with Psychotic Features
C. Substance-Induced Psychotic Disorder (e.g., from cannabis)
D. Schizotypal Personality Disorder
E. All of the above
Correct Answer: A, B, C, D
Rationale: In an adolescent, the differential for psychotic
symptoms is broad. ASD can present with social deficits and
may include psychotic-like experiences or be misidentified as
negative symptoms. Depression with psychotic features is a
,high-risk condition in teens. Substance use, particularly
cannabis, is a common cause of psychosis in this age group.
Schizotypal PD involves perceptual distortions and social
isolation. A diagnosis of Schizophrenia requires ruling out these
conditions and observing symptoms for a significant portion of
time during a 6-month period.
Q3. A 68-year-old man with a history of hypertension and Type
2 Diabetes is evaluated for a 1-year progressive decline in
memory. His wife notes he gets lost driving to familiar places,
has trouble managing finances, and repeats questions.
Neurological exam is non-focal. Montreal Cognitive Assessment
(MoCA) score is 18/30, with deficits in delayed recall,
orientation, and executive function. Brain MRI shows moderate
hippocampal atrophy and generalized cortical atrophy. The
most likely diagnosis is:
A. Major Neurocognitive Disorder Due to Alzheimer’s Disease
B. Major Neurocognitive Disorder Due to Vascular Disease
C. Mild Neurocognitive Disorder
D. Delirium
Correct Answer: A
Rationale: The progressive decline over a year rules out
Delirium. The cognitive deficits are significant enough to impair
instrumental activities of daily living (getting lost, managing
finances), supporting a Major Neurocognitive Disorder, not
Mild. While vascular risk factors exist, the clinical presentation
(prominent episodic memory loss early) and MRI findings
, (hippocampal atrophy) are classic for Alzheimer's pathology.
Vascular NCD typically shows a stepwise decline and imaging
evidence of significant cerebrovascular disease.
Q4. A 35-year-old woman presents with a 2-month history of
"attacks" involving palpitations, chest pain, shortness of breath,
dizziness, and a fear of dying. These occur unexpectedly, peak
within minutes, and cause her persistent worry about having
more attacks. She has started avoiding the gym and crowded
stores. Physical exam and cardiac workup are normal. The most
accurate diagnosis is:
A. Generalized Anxiety Disorder
B. Agoraphobia
C. Panic Disorder
D. Somatic Symptom Disorder
Correct Answer: C
Rationale: The core features are recurrent, unexpected panic
attacks followed by at least one month of persistent concern
about additional attacks and/or a significant maladaptive
change in behavior related to the attacks (avoidance). While she
has developed agoraphobic avoidance, it is secondary to the
panic attacks. The diagnosis is Panic Disorder. Agoraphobia
alone (Answer B) would involve fear in situations without a
history of panic-like symptoms.
Q5. A 9-year-old boy is referred for evaluation of inattention
and hyperactivity. Symptoms are present at school and home.
His teacher reports he daydreams, is easily distracted, and often
