NR 547 Differential Diagnosis Final
Exam Guide 2025/2026 | 50 Graduate-
Level Practice Questions | DSM-5-TR
Focus for Chamberlain College PMHNP
Practicum
**Q1.** A 72-year-old retired teacher is brought by her
daughter for evaluation of "strange thoughts." Over the past 8
months, she has become progressively convinced that her
neighbors are stealing her mail and poisoning her tap water
with "mind-control drugs." She hears faint, unintelligible
whispering at night which she attributes to the neighbors'
surveillance devices. Her cognitive screening (MoCA) is 28/30,
with points lost only in delayed recall. She has no prior
psychiatric history. Her vital signs and neurological exam are
normal. What is the MOST likely diagnosis?
A. Delusional Disorder
B. Schizophrenia
C. Major Neurocognitive Disorder with Behavioral Disturbance
(Alzheimer's type)
D. Unspecified Schizophrenia Spectrum and Other Psychotic
Disorder
,**Correct Answer: A**
**Rationale:** This is a classic presentation of Delusional
Disorder. Key features are persistent, non-bizarre delusions
(e.g., poisoning, persecution) for >1 month without prominent
hallucinations. Auditory hallucinations, if present, are not
prominent and are related to the delusional theme. The intact
cognitive screening and normal neurological exam argue against
a major neurocognitive disorder. The late age of onset, absence
of disorganized speech/behavior, and preserved functioning
outside the delusional area are not typical of schizophrenia.
**Q2.** A 28-year-old software developer presents with a 6-
month history of fatigue, anhedonia, and a 15-pound weight
gain. He reports "feeling heavy and slow," sleeping 10-12 hours
nightly, and craving carbohydrates. His concentration is poor at
work. He denies suicidal ideation but states he feels "like a
failure." He has had two prior similar episodes in winter that
remitted by spring. Which specifier is MOST appropriate for his
Major Depressive Disorder diagnosis?
A. With Peripartum Onset
B. With Melancholic Features
C. With Atypical Features
D. With Seasonal Pattern
,**Correct Answer: D**
**Rationale:** While the hypersomnia, hyperphagia/weight
gain, and leaden paralysis are criteria for Atypical Features (C),
the cardinal feature of Seasonal Pattern is a regular temporal
relationship between the onset/remission of major depressive
episodes and a particular time of year (e.g., fall/winter onset,
spring remission). The history of recurrent winter episodes is
the defining characteristic here, making Seasonal Pattern the
primary, most appropriate specifier.
**Q3.** A 9-year-old boy is referred for assessment. His
teacher reports he frequently interrupts lessons, leaves his seat,
and talks excessively. His parents note he is always "on the go,"
has difficulty waiting his turn in games, and often loses things.
Symptoms have been present since age 5 and occur both at
school and at home, causing significant academic and social
impairment. His developmental history is otherwise normal.
What is the NEXT most appropriate step in the diagnostic
process?
A. Diagnose ADHD, Combined Presentation and initiate
stimulant therapy.
B. Order a comprehensive educational psychoeducational
evaluation.
, C. Rule out Generalized Anxiety Disorder and Oppositional
Defiant Disorder.
D. Obtain parent and teacher standardized rating scales (e.g.,
Vanderbilt, SNAP-IV).
**Correct Answer: D**
**Rationale:** Although the history is suggestive of ADHD,
DSM-5-TR requires that symptoms be documented in multiple
settings, typically via standardized rating scales from parents
and teachers. This is a crucial step before formal diagnosis to
confirm pervasiveness and quantify severity. While educational
testing (B) may be helpful, it is not a primary diagnostic tool for
ADHD. Ruling out other conditions (C) is part of the differential
but begins with structured assessment. Immediate diagnosis
and medication (A) is premature before gathering corroborative
rating scale data.
**Q4.** A 45-year-old woman presents with a 3-year history of
widespread pain, profound fatigue, and cognitive complaints
("fibro fog"). She reports her symptoms began after a viral
illness. Physical exam reveals tenderness at 16 of 18 designated
tender points. Extensive prior workup for rheumatological and
endocrine disorders has been negative. Which of the following
comorbidities is she at HIGHEST risk for?
A. Obsessive-Compulsive Disorder
Exam Guide 2025/2026 | 50 Graduate-
Level Practice Questions | DSM-5-TR
Focus for Chamberlain College PMHNP
Practicum
**Q1.** A 72-year-old retired teacher is brought by her
daughter for evaluation of "strange thoughts." Over the past 8
months, she has become progressively convinced that her
neighbors are stealing her mail and poisoning her tap water
with "mind-control drugs." She hears faint, unintelligible
whispering at night which she attributes to the neighbors'
surveillance devices. Her cognitive screening (MoCA) is 28/30,
with points lost only in delayed recall. She has no prior
psychiatric history. Her vital signs and neurological exam are
normal. What is the MOST likely diagnosis?
A. Delusional Disorder
B. Schizophrenia
C. Major Neurocognitive Disorder with Behavioral Disturbance
(Alzheimer's type)
D. Unspecified Schizophrenia Spectrum and Other Psychotic
Disorder
,**Correct Answer: A**
**Rationale:** This is a classic presentation of Delusional
Disorder. Key features are persistent, non-bizarre delusions
(e.g., poisoning, persecution) for >1 month without prominent
hallucinations. Auditory hallucinations, if present, are not
prominent and are related to the delusional theme. The intact
cognitive screening and normal neurological exam argue against
a major neurocognitive disorder. The late age of onset, absence
of disorganized speech/behavior, and preserved functioning
outside the delusional area are not typical of schizophrenia.
**Q2.** A 28-year-old software developer presents with a 6-
month history of fatigue, anhedonia, and a 15-pound weight
gain. He reports "feeling heavy and slow," sleeping 10-12 hours
nightly, and craving carbohydrates. His concentration is poor at
work. He denies suicidal ideation but states he feels "like a
failure." He has had two prior similar episodes in winter that
remitted by spring. Which specifier is MOST appropriate for his
Major Depressive Disorder diagnosis?
A. With Peripartum Onset
B. With Melancholic Features
C. With Atypical Features
D. With Seasonal Pattern
,**Correct Answer: D**
**Rationale:** While the hypersomnia, hyperphagia/weight
gain, and leaden paralysis are criteria for Atypical Features (C),
the cardinal feature of Seasonal Pattern is a regular temporal
relationship between the onset/remission of major depressive
episodes and a particular time of year (e.g., fall/winter onset,
spring remission). The history of recurrent winter episodes is
the defining characteristic here, making Seasonal Pattern the
primary, most appropriate specifier.
**Q3.** A 9-year-old boy is referred for assessment. His
teacher reports he frequently interrupts lessons, leaves his seat,
and talks excessively. His parents note he is always "on the go,"
has difficulty waiting his turn in games, and often loses things.
Symptoms have been present since age 5 and occur both at
school and at home, causing significant academic and social
impairment. His developmental history is otherwise normal.
What is the NEXT most appropriate step in the diagnostic
process?
A. Diagnose ADHD, Combined Presentation and initiate
stimulant therapy.
B. Order a comprehensive educational psychoeducational
evaluation.
, C. Rule out Generalized Anxiety Disorder and Oppositional
Defiant Disorder.
D. Obtain parent and teacher standardized rating scales (e.g.,
Vanderbilt, SNAP-IV).
**Correct Answer: D**
**Rationale:** Although the history is suggestive of ADHD,
DSM-5-TR requires that symptoms be documented in multiple
settings, typically via standardized rating scales from parents
and teachers. This is a crucial step before formal diagnosis to
confirm pervasiveness and quantify severity. While educational
testing (B) may be helpful, it is not a primary diagnostic tool for
ADHD. Ruling out other conditions (C) is part of the differential
but begins with structured assessment. Immediate diagnosis
and medication (A) is premature before gathering corroborative
rating scale data.
**Q4.** A 45-year-old woman presents with a 3-year history of
widespread pain, profound fatigue, and cognitive complaints
("fibro fog"). She reports her symptoms began after a viral
illness. Physical exam reveals tenderness at 16 of 18 designated
tender points. Extensive prior workup for rheumatological and
endocrine disorders has been negative. Which of the following
comorbidities is she at HIGHEST risk for?
A. Obsessive-Compulsive Disorder
