NR 547 – WEEK 8 FINAL EXAM PSYCHIATRIC-
DIFFERENTIAL DIAGNOSIS IN PSYCHIATRIC-MENTAL
HEALTH ACROSS THE LIFESPAN EXAM QUESTIONS AND 100%
VERIFIED ANSWERS WITH RATIONALES GRADED A+ LATEST
CHAMBERLAIN UNIVERSITY
Question 1
A 72-year-old male presents with progressive memory loss, difficulty performing
daily tasks, and occasional hallucinations. His MRI shows cortical atrophy, and his
Mini-Mental State Exam score is 20/30. Which is the most likely diagnosis?
A. Vascular dementia
B. Alzheimer’s disease
C. Lewy body dementia
D. Major depressive disorder with pseudodementia
Answer: B. Alzheimer’s disease
Rationale: Alzheimer’s disease presents with gradual onset of memory loss and
cognitive decline. Hallucinations are less common early but may appear later.
Cortical atrophy on MRI and a low MMSE score support this diagnosis. Vascular
dementia often has a stepwise decline, Lewy body dementia presents with early
visual hallucinations and parkinsonism, and pseudodementia typically has
reversible cognitive deficits linked to depression.
Question 2
A patient with a history of chronic alcohol use presents with confusion, ataxia, and
ophthalmoplegia. Which intervention is the priority?
A. Initiate antipsychotic therapy
B. Administer intravenous thiamine
C. Begin SSRIs
D. Refer for cognitive behavioral therapy
Answer: B. Administer intravenous thiamine
1
,Rationale: This patient shows signs of Wernicke’s encephalopathy, a medical
emergency due to thiamine deficiency. Immediate thiamine administration is
critical to prevent progression to Korsakoff’s syndrome. Antipsychotics, SSRIs, or
CBT do not address the acute, life-threatening deficiency.
Question 3
A 35-year-old female presents with a 3-week history of depressed mood,
anhedonia, insomnia, and weight loss. She reports feelings of worthlessness and
guilt. She denies mania or psychotic symptoms. Which is the most appropriate
initial pharmacologic treatment?
A. Lithium
B. SSRIs
C. Benzodiazepines
D. Antipsychotics
Answer: B. SSRIs
Rationale: The patient exhibits major depressive disorder (MDD) without
psychotic features. First-line treatment for MDD includes selective serotonin
reuptake inhibitors (SSRIs) due to efficacy and tolerability. Lithium is used
primarily for bipolar disorder, benzodiazepines target anxiety, and antipsychotics
are indicated for psychotic symptoms.
Question 4
Which feature differentiates bipolar I disorder from bipolar II disorder?
A. Presence of hypomanic episodes
B. Presence of major depressive episodes
C. Presence of manic episodes with significant functional impairment
D. Absence of mood episodes
Answer: C. Presence of manic episodes with significant functional impairment
2
,Rationale: Bipolar I is characterized by at least one manic episode, which often
causes marked functional impairment. Bipolar II involves hypomanic episodes
without significant functional impairment. Both can have major depressive
episodes.
Question 5
A 45-year-old patient with schizophrenia has been nonadherent to oral
antipsychotics and continues to experience frequent auditory hallucinations. What
is the next best step?
A. Switch to a different oral antipsychotic
B. Initiate long-acting injectable antipsychotic therapy
C. Begin benzodiazepine therapy
D. Refer to psychotherapy only
Answer: B. Initiate long-acting injectable antipsychotic therapy
Rationale: Nonadherence is a common cause of relapse in schizophrenia. Long-
acting injectable antipsychotics improve adherence and reduce relapse risk.
Switching oral agents may not address adherence issues. Benzodiazepines are
adjuncts for agitation/anxiety but not primary therapy, and psychotherapy alone is
insufficient for acute psychotic symptoms.
Question 6
A 28-year-old patient presents with persistent anxiety, hypervigilance, nightmares,
and avoidance behaviors following a motor vehicle accident 3 months ago. Which
is the most likely diagnosis?
A. Generalized anxiety disorder
B. Post-traumatic stress disorder
C. Acute stress disorder
D. Panic disorder
Answer: B. Post-traumatic stress disorder
3
, Rationale: PTSD is diagnosed when trauma-related symptoms persist for more
than one month. Acute stress disorder is diagnosed within the first month after the
traumatic event. Generalized anxiety disorder involves pervasive worry without a
specific traumatic trigger. Panic disorder involves recurrent unexpected panic
attacks.
Question 7
A patient presents with signs of alcohol withdrawal, including tremors, agitation,
and diaphoresis, 24 hours after his last drink. Which is the most appropriate initial
treatment?
A. Naltrexone
B. Disulfiram
C. Benzodiazepines
D. SSRIs
Answer: C. Benzodiazepines
Rationale: Benzodiazepines are the first-line treatment for acute alcohol
withdrawal to prevent seizures and delirium tremens. Naltrexone and disulfiram
are used for maintenance therapy, not acute withdrawal, and SSRIs are not
indicated for withdrawal symptoms.
Question 8
A patient with dementia-related psychosis is experiencing agitation and aggression.
Which is the safest antipsychotic choice in elderly patients with cardiovascular
comorbidities?
A. Haloperidol
B. Risperidone
C. Olanzapine
D. Clozapine
Answer: B. Risperidone
4
DIFFERENTIAL DIAGNOSIS IN PSYCHIATRIC-MENTAL
HEALTH ACROSS THE LIFESPAN EXAM QUESTIONS AND 100%
VERIFIED ANSWERS WITH RATIONALES GRADED A+ LATEST
CHAMBERLAIN UNIVERSITY
Question 1
A 72-year-old male presents with progressive memory loss, difficulty performing
daily tasks, and occasional hallucinations. His MRI shows cortical atrophy, and his
Mini-Mental State Exam score is 20/30. Which is the most likely diagnosis?
A. Vascular dementia
B. Alzheimer’s disease
C. Lewy body dementia
D. Major depressive disorder with pseudodementia
Answer: B. Alzheimer’s disease
Rationale: Alzheimer’s disease presents with gradual onset of memory loss and
cognitive decline. Hallucinations are less common early but may appear later.
Cortical atrophy on MRI and a low MMSE score support this diagnosis. Vascular
dementia often has a stepwise decline, Lewy body dementia presents with early
visual hallucinations and parkinsonism, and pseudodementia typically has
reversible cognitive deficits linked to depression.
Question 2
A patient with a history of chronic alcohol use presents with confusion, ataxia, and
ophthalmoplegia. Which intervention is the priority?
A. Initiate antipsychotic therapy
B. Administer intravenous thiamine
C. Begin SSRIs
D. Refer for cognitive behavioral therapy
Answer: B. Administer intravenous thiamine
1
,Rationale: This patient shows signs of Wernicke’s encephalopathy, a medical
emergency due to thiamine deficiency. Immediate thiamine administration is
critical to prevent progression to Korsakoff’s syndrome. Antipsychotics, SSRIs, or
CBT do not address the acute, life-threatening deficiency.
Question 3
A 35-year-old female presents with a 3-week history of depressed mood,
anhedonia, insomnia, and weight loss. She reports feelings of worthlessness and
guilt. She denies mania or psychotic symptoms. Which is the most appropriate
initial pharmacologic treatment?
A. Lithium
B. SSRIs
C. Benzodiazepines
D. Antipsychotics
Answer: B. SSRIs
Rationale: The patient exhibits major depressive disorder (MDD) without
psychotic features. First-line treatment for MDD includes selective serotonin
reuptake inhibitors (SSRIs) due to efficacy and tolerability. Lithium is used
primarily for bipolar disorder, benzodiazepines target anxiety, and antipsychotics
are indicated for psychotic symptoms.
Question 4
Which feature differentiates bipolar I disorder from bipolar II disorder?
A. Presence of hypomanic episodes
B. Presence of major depressive episodes
C. Presence of manic episodes with significant functional impairment
D. Absence of mood episodes
Answer: C. Presence of manic episodes with significant functional impairment
2
,Rationale: Bipolar I is characterized by at least one manic episode, which often
causes marked functional impairment. Bipolar II involves hypomanic episodes
without significant functional impairment. Both can have major depressive
episodes.
Question 5
A 45-year-old patient with schizophrenia has been nonadherent to oral
antipsychotics and continues to experience frequent auditory hallucinations. What
is the next best step?
A. Switch to a different oral antipsychotic
B. Initiate long-acting injectable antipsychotic therapy
C. Begin benzodiazepine therapy
D. Refer to psychotherapy only
Answer: B. Initiate long-acting injectable antipsychotic therapy
Rationale: Nonadherence is a common cause of relapse in schizophrenia. Long-
acting injectable antipsychotics improve adherence and reduce relapse risk.
Switching oral agents may not address adherence issues. Benzodiazepines are
adjuncts for agitation/anxiety but not primary therapy, and psychotherapy alone is
insufficient for acute psychotic symptoms.
Question 6
A 28-year-old patient presents with persistent anxiety, hypervigilance, nightmares,
and avoidance behaviors following a motor vehicle accident 3 months ago. Which
is the most likely diagnosis?
A. Generalized anxiety disorder
B. Post-traumatic stress disorder
C. Acute stress disorder
D. Panic disorder
Answer: B. Post-traumatic stress disorder
3
, Rationale: PTSD is diagnosed when trauma-related symptoms persist for more
than one month. Acute stress disorder is diagnosed within the first month after the
traumatic event. Generalized anxiety disorder involves pervasive worry without a
specific traumatic trigger. Panic disorder involves recurrent unexpected panic
attacks.
Question 7
A patient presents with signs of alcohol withdrawal, including tremors, agitation,
and diaphoresis, 24 hours after his last drink. Which is the most appropriate initial
treatment?
A. Naltrexone
B. Disulfiram
C. Benzodiazepines
D. SSRIs
Answer: C. Benzodiazepines
Rationale: Benzodiazepines are the first-line treatment for acute alcohol
withdrawal to prevent seizures and delirium tremens. Naltrexone and disulfiram
are used for maintenance therapy, not acute withdrawal, and SSRIs are not
indicated for withdrawal symptoms.
Question 8
A patient with dementia-related psychosis is experiencing agitation and aggression.
Which is the safest antipsychotic choice in elderly patients with cardiovascular
comorbidities?
A. Haloperidol
B. Risperidone
C. Olanzapine
D. Clozapine
Answer: B. Risperidone
4
