NR547 / NR 547 Midterm Exam – Real
Exam Questions with Verified Answers | Differential
Diagnosis in Psychiatric-Mental Health Across the
Lifespan | Chamberlain | 100% Correct and Updated
Questions
1. What is the first step in formulating a differential diagnosis for a psychiatric pre-
sentation?
a. Rule out malingering or factitious disorder
b. Identify the primary psychiatric disorder
c. Rule out substance-induced etiology
d. Rule out medical conditions
Correct Answer: a. Rule out malingering or factitious disorder
Explanation: The DSM-5 outlines a six-step process for differential diagnosis,
with the first step being to rule out malingering (feigning symptoms for external
gain, e.g., avoiding work) or factitious disorder (feigning symptoms for psycho-
logical gain, e.g., assuming the sick role). This ensures the clinician verifies the
authenticity of symptoms before proceeding, as deceptive presentations invalidate
further diagnostic steps.
2. A 35-year-old patient reports low mood and fatigue persisting for one month after
discontinuing cocaine use. What is the most likely diagnosis?
a. Major depressive disorder
b. Substance/medication-induced depressive disorder
c. Persistent depressive disorder
d. Adjustment disorder
Correct Answer: b. Substance/medication-induced depressive disorder
Explanation: DSM-5 criteria for substance/medication-induced depressive dis-
order require depressive symptoms attributable to substance use or withdrawal,
resolving within one month of cessation. Cocaine withdrawal commonly causes
low mood and fatigue, distinguishing this from major depressive disorder (not
substance-related) or persistent depressive disorder (chronic, �2 years). Adjustment
disorder requires a specific stressor, not substance use.
1
,3. Which symptom is required for a DSM-5 diagnosis of schizophrenia?
a. Delusions
b. Flat affect
c. Social withdrawal
d. Cognitive impairment
Correct Answer: a. Delusions
Explanation: DSM-5 requires two or more symptoms for schizophrenia (Criterion
A), including delusions, hallucinations, disorganized speech, disorganized/catatonic
behavior, or negative symptoms, with at least one being delusions, hallucinations, or
disorganized speech. Delusions are a core positive symptom. Flat affect and social
withdrawal are negative symptoms, and cognitive impairment is not a diagnostic
criterion, though common.
4. A 22-year-old presents with anxiety and palpitations after consuming energy drinks.
What is the second step in differential diagnosis?
a. Rule out medical conditions
b. Rule out substance etiology
c. Identify primary anxiety disorder
d. Rule out adjustment disorder
Correct Answer: b. Rule out substance etiology
Explanation: After ruling out malingering/factitious disorder, the second DSM-
5 differential diagnosis step is to rule out substance etiology. Caffeine in energy
drinks can induce anxiety and palpitations, suggesting a substance-induced anxiety
disorder. Medical conditions (third step) and primary disorders (fourth step) are
considered later, and adjustment disorder is differentiated last.
5. A 50-year-old with depression and severe memory loss is evaluated. What should
be considered in the differential diagnosis?
a. Major depressive disorder alone
b. Substance-induced neurocognitive disorder
c. General medical condition
d. Adjustment disorder
Correct Answer: c. General medical condition
Explanation: DSM-5 advises considering medical conditions when psychiatric
symptoms are atypical, such as severe memory loss with depression, which is not
typical for major depressive disorder alone. Conditions like hypothyroidism or de-
mentia may cause both symptoms. Substance-induced disorders require substance
use history, and adjustment disorder involves a stressor, neither indicated here.
6. Which criterion distinguishes adjustment disorder from other specified depressive
disorder?
a. Chronic duration
2
, b. Identifiable stressor
c. Psychotic symptoms
d. Recurrent episodes
Correct Answer: b. Identifiable stressor
Explanation: DSM-5 defines adjustment disorder as emotional or behavioral
symptoms within three months of an identifiable stressor, disproportionate to the
stressor’s severity, and resolving within six months after the stressor ends. Other
specified depressive disorder lacks a specific stressor and may involve subthreshold
depressive symptoms without this temporal link.
7. A 40-year-old reports hallucinations and seizures. What is the most likely etiology
to consider first?
a. Schizophrenia
b. Substance-induced psychotic disorder
c. General medical condition
d. Bipolar disorder
Correct Answer: c. General medical condition
Explanation: Hallucinations with seizures suggest a medical condition (e.g., epilepsy,
brain tumor) as the primary etiology, per DSM-5’s third differential diagnosis step.
Symptoms beginning with a medical condition or varying with its severity indicate
a medical etiology. Substance-induced disorders require substance use history, and
schizophrenia or bipolar disorder are considered after ruling out medical causes.
8. Which of the following is a negative symptom of schizophrenia?
a. Delusions
b. Hallucinations
c. Anhedonia
d. Disorganized speech
Correct Answer: c. Anhedonia
Explanation: DSM-5 classifies negative symptoms of schizophrenia as diminished
emotional expression or avolition, including anhedonia (loss of pleasure). Delusions,
hallucinations, and disorganized speech are positive symptoms. Negative symptoms
are critical for differential diagnosis, as they help distinguish schizophrenia from
other psychotic disorders like brief psychotic disorder.
9. A 28-year-old with panic attacks reports no substance use or medical conditions.
What is the next diagnostic step?
a. Rule out malingering
b. Identify the primary disorder
c. Rule out adjustment disorder
d. Confirm stressor presence
3
Exam Questions with Verified Answers | Differential
Diagnosis in Psychiatric-Mental Health Across the
Lifespan | Chamberlain | 100% Correct and Updated
Questions
1. What is the first step in formulating a differential diagnosis for a psychiatric pre-
sentation?
a. Rule out malingering or factitious disorder
b. Identify the primary psychiatric disorder
c. Rule out substance-induced etiology
d. Rule out medical conditions
Correct Answer: a. Rule out malingering or factitious disorder
Explanation: The DSM-5 outlines a six-step process for differential diagnosis,
with the first step being to rule out malingering (feigning symptoms for external
gain, e.g., avoiding work) or factitious disorder (feigning symptoms for psycho-
logical gain, e.g., assuming the sick role). This ensures the clinician verifies the
authenticity of symptoms before proceeding, as deceptive presentations invalidate
further diagnostic steps.
2. A 35-year-old patient reports low mood and fatigue persisting for one month after
discontinuing cocaine use. What is the most likely diagnosis?
a. Major depressive disorder
b. Substance/medication-induced depressive disorder
c. Persistent depressive disorder
d. Adjustment disorder
Correct Answer: b. Substance/medication-induced depressive disorder
Explanation: DSM-5 criteria for substance/medication-induced depressive dis-
order require depressive symptoms attributable to substance use or withdrawal,
resolving within one month of cessation. Cocaine withdrawal commonly causes
low mood and fatigue, distinguishing this from major depressive disorder (not
substance-related) or persistent depressive disorder (chronic, �2 years). Adjustment
disorder requires a specific stressor, not substance use.
1
,3. Which symptom is required for a DSM-5 diagnosis of schizophrenia?
a. Delusions
b. Flat affect
c. Social withdrawal
d. Cognitive impairment
Correct Answer: a. Delusions
Explanation: DSM-5 requires two or more symptoms for schizophrenia (Criterion
A), including delusions, hallucinations, disorganized speech, disorganized/catatonic
behavior, or negative symptoms, with at least one being delusions, hallucinations, or
disorganized speech. Delusions are a core positive symptom. Flat affect and social
withdrawal are negative symptoms, and cognitive impairment is not a diagnostic
criterion, though common.
4. A 22-year-old presents with anxiety and palpitations after consuming energy drinks.
What is the second step in differential diagnosis?
a. Rule out medical conditions
b. Rule out substance etiology
c. Identify primary anxiety disorder
d. Rule out adjustment disorder
Correct Answer: b. Rule out substance etiology
Explanation: After ruling out malingering/factitious disorder, the second DSM-
5 differential diagnosis step is to rule out substance etiology. Caffeine in energy
drinks can induce anxiety and palpitations, suggesting a substance-induced anxiety
disorder. Medical conditions (third step) and primary disorders (fourth step) are
considered later, and adjustment disorder is differentiated last.
5. A 50-year-old with depression and severe memory loss is evaluated. What should
be considered in the differential diagnosis?
a. Major depressive disorder alone
b. Substance-induced neurocognitive disorder
c. General medical condition
d. Adjustment disorder
Correct Answer: c. General medical condition
Explanation: DSM-5 advises considering medical conditions when psychiatric
symptoms are atypical, such as severe memory loss with depression, which is not
typical for major depressive disorder alone. Conditions like hypothyroidism or de-
mentia may cause both symptoms. Substance-induced disorders require substance
use history, and adjustment disorder involves a stressor, neither indicated here.
6. Which criterion distinguishes adjustment disorder from other specified depressive
disorder?
a. Chronic duration
2
, b. Identifiable stressor
c. Psychotic symptoms
d. Recurrent episodes
Correct Answer: b. Identifiable stressor
Explanation: DSM-5 defines adjustment disorder as emotional or behavioral
symptoms within three months of an identifiable stressor, disproportionate to the
stressor’s severity, and resolving within six months after the stressor ends. Other
specified depressive disorder lacks a specific stressor and may involve subthreshold
depressive symptoms without this temporal link.
7. A 40-year-old reports hallucinations and seizures. What is the most likely etiology
to consider first?
a. Schizophrenia
b. Substance-induced psychotic disorder
c. General medical condition
d. Bipolar disorder
Correct Answer: c. General medical condition
Explanation: Hallucinations with seizures suggest a medical condition (e.g., epilepsy,
brain tumor) as the primary etiology, per DSM-5’s third differential diagnosis step.
Symptoms beginning with a medical condition or varying with its severity indicate
a medical etiology. Substance-induced disorders require substance use history, and
schizophrenia or bipolar disorder are considered after ruling out medical causes.
8. Which of the following is a negative symptom of schizophrenia?
a. Delusions
b. Hallucinations
c. Anhedonia
d. Disorganized speech
Correct Answer: c. Anhedonia
Explanation: DSM-5 classifies negative symptoms of schizophrenia as diminished
emotional expression or avolition, including anhedonia (loss of pleasure). Delusions,
hallucinations, and disorganized speech are positive symptoms. Negative symptoms
are critical for differential diagnosis, as they help distinguish schizophrenia from
other psychotic disorders like brief psychotic disorder.
9. A 28-year-old with panic attacks reports no substance use or medical conditions.
What is the next diagnostic step?
a. Rule out malingering
b. Identify the primary disorder
c. Rule out adjustment disorder
d. Confirm stressor presence
3
