APEA PMHNP 3P HIGH STAKES EXAM
(2026 EDITION) 200 Questions | Answers &
Rationales
Format: 200 multiple-choice questions
Domains: Psychiatric Assessment (25%), Psychopharmacology (30%),
Psychotherapy & Therapeutic Interventions (20%), Differential Diagnosis
(15%, Professional & Legal Issues (10%)
Time limit (simulated): 4 hours
Passing threshold (simulated): 70% (140/200)
Questions 1–50: Psychiatric Assessment & Differential Diagnosis
1. A 24-year-old woman reports depressed mood, anhedonia, increased
appetite, and sleeping 12 hours per day for the past 3 weeks. She denies
mania or psychosis. Which specifier applies?
A) Melancholic features
B) Atypical features
C) Catatonic features
D) Peripartum onset
Answer:: Atypical features include increased appetite, hypersomnia, leaden
paralysis, and rejection sensitivity.
2. A 32-year-old man presents with a 4-day history of elevated mood,
decreased need for sleep, grandiosity, and excessive spending. He has no
prior episodes. Most likely diagnosis?
A) Bipolar II disorder
B) Cyclothymic disorder
,C) Bipolar I disorder, manic episode
D) Substance-induced mood disorder
Answer: C
Rationale: Manic episode lasting ≥7 days with functional impairment =
Bipolar I disorder.
3. A 45-year-old woman reports recurrent panic attacks, worry about having
more attacks, and avoids public places. Symptoms present for 8 months.
Most likely?
A) Panic disorder with agoraphobia
B) Generalized anxiety disorder
C) Social anxiety disorder
D) Specific phobia
Answer: A
Rationale: Recurrent unexpected panic attacks + ≥1 month of worry/behavior
change + agoraphobia = panic disorder with agoraphobia.
4. A 19-year-old college student presents with preoccupation with a
perceived defect in her nose. She spends hours checking it in the mirror and
seeks rhinoplasty. Most likely?
A) Body dysmorphic disorder
B) Illness anxiety disorder
C) Obsessive-compulsive disorder
D) Narcissistic personality disorder
Answer: A
Rationale: Preoccupation with imagined/exaggerated defect in appearance
with repetitive behaviors = BDD.
5. A 30-year-old woman reports recurrent pulling out her eyebrow hair,
resulting in visible bald patches. She feels tension before and relief after.
Most likely?
,A) Trichotillomania
B) Excoriation disorder
C) OCD
D) Body dysmorphic disorder
Answer: A
Rationale: Recurrent hair pulling with tension and relief = trichotillomania.
6. A 55-year-old man reports persistent difficulty falling asleep, staying
asleep, and daytime fatigue for 6 months. No medical or substance cause.
Most likely?
A) Insomnia disorder
B) Circadian rhythm disorder
C) Obstructive sleep apnea
D) Restless legs syndrome
Answer: A
Rationale: Chronic insomnia without other cause = insomnia disorder.
7. A 28-year-old woman reports recurrent episodes of binge eating large
amounts of food in 2 hours with loss of control, followed by self-induced
vomiting. Episodes occur 3×/week for 4 months. Most likely?
A) Bulimia nervosa
B) Anorexia nervosa, binge-purge type
C) Binge eating disorder
D) Purging disorder
Answer: A
Rationale: Binge eating + compensatory vomiting = bulimia nervosa (normal
weight range).
, 8. A 22-year-old man with schizophrenia reports hearing a voice
commenting on his actions. Which type of auditory hallucination is most
characteristic?
A) Third-person hallucination
B) Second-person hallucination
C) Command hallucination
D) Lilliputian hallucination
Answer: A
Rationale: Third-person auditory hallucinations (voices commenting or
discussing the patient) are highly characteristic of schizophrenia.
9. A 40-year-old woman reports believing that the FBI is following her and
hiding cameras in her home. She is otherwise well-groomed and coherent.
Most likely?
A) Delusional disorder, persecutory type
B) Schizophrenia
C) Paranoid personality disorder
D) Schizoaffective disorder
Answer: A
Rationale: Non-bizarre delusions for ≥1 month without other psychotic
symptoms = delusional disorder.
10. A 70-year-old man with Parkinson’s disease develops visual hallucinations
of small animals and children. He is alert and oriented. Most likely?
A) Lewy body dementia
B) Schizophrenia
C) Delirium
D) Parkinson’s psychosis
Answer: D
(2026 EDITION) 200 Questions | Answers &
Rationales
Format: 200 multiple-choice questions
Domains: Psychiatric Assessment (25%), Psychopharmacology (30%),
Psychotherapy & Therapeutic Interventions (20%), Differential Diagnosis
(15%, Professional & Legal Issues (10%)
Time limit (simulated): 4 hours
Passing threshold (simulated): 70% (140/200)
Questions 1–50: Psychiatric Assessment & Differential Diagnosis
1. A 24-year-old woman reports depressed mood, anhedonia, increased
appetite, and sleeping 12 hours per day for the past 3 weeks. She denies
mania or psychosis. Which specifier applies?
A) Melancholic features
B) Atypical features
C) Catatonic features
D) Peripartum onset
Answer:: Atypical features include increased appetite, hypersomnia, leaden
paralysis, and rejection sensitivity.
2. A 32-year-old man presents with a 4-day history of elevated mood,
decreased need for sleep, grandiosity, and excessive spending. He has no
prior episodes. Most likely diagnosis?
A) Bipolar II disorder
B) Cyclothymic disorder
,C) Bipolar I disorder, manic episode
D) Substance-induced mood disorder
Answer: C
Rationale: Manic episode lasting ≥7 days with functional impairment =
Bipolar I disorder.
3. A 45-year-old woman reports recurrent panic attacks, worry about having
more attacks, and avoids public places. Symptoms present for 8 months.
Most likely?
A) Panic disorder with agoraphobia
B) Generalized anxiety disorder
C) Social anxiety disorder
D) Specific phobia
Answer: A
Rationale: Recurrent unexpected panic attacks + ≥1 month of worry/behavior
change + agoraphobia = panic disorder with agoraphobia.
4. A 19-year-old college student presents with preoccupation with a
perceived defect in her nose. She spends hours checking it in the mirror and
seeks rhinoplasty. Most likely?
A) Body dysmorphic disorder
B) Illness anxiety disorder
C) Obsessive-compulsive disorder
D) Narcissistic personality disorder
Answer: A
Rationale: Preoccupation with imagined/exaggerated defect in appearance
with repetitive behaviors = BDD.
5. A 30-year-old woman reports recurrent pulling out her eyebrow hair,
resulting in visible bald patches. She feels tension before and relief after.
Most likely?
,A) Trichotillomania
B) Excoriation disorder
C) OCD
D) Body dysmorphic disorder
Answer: A
Rationale: Recurrent hair pulling with tension and relief = trichotillomania.
6. A 55-year-old man reports persistent difficulty falling asleep, staying
asleep, and daytime fatigue for 6 months. No medical or substance cause.
Most likely?
A) Insomnia disorder
B) Circadian rhythm disorder
C) Obstructive sleep apnea
D) Restless legs syndrome
Answer: A
Rationale: Chronic insomnia without other cause = insomnia disorder.
7. A 28-year-old woman reports recurrent episodes of binge eating large
amounts of food in 2 hours with loss of control, followed by self-induced
vomiting. Episodes occur 3×/week for 4 months. Most likely?
A) Bulimia nervosa
B) Anorexia nervosa, binge-purge type
C) Binge eating disorder
D) Purging disorder
Answer: A
Rationale: Binge eating + compensatory vomiting = bulimia nervosa (normal
weight range).
, 8. A 22-year-old man with schizophrenia reports hearing a voice
commenting on his actions. Which type of auditory hallucination is most
characteristic?
A) Third-person hallucination
B) Second-person hallucination
C) Command hallucination
D) Lilliputian hallucination
Answer: A
Rationale: Third-person auditory hallucinations (voices commenting or
discussing the patient) are highly characteristic of schizophrenia.
9. A 40-year-old woman reports believing that the FBI is following her and
hiding cameras in her home. She is otherwise well-groomed and coherent.
Most likely?
A) Delusional disorder, persecutory type
B) Schizophrenia
C) Paranoid personality disorder
D) Schizoaffective disorder
Answer: A
Rationale: Non-bizarre delusions for ≥1 month without other psychotic
symptoms = delusional disorder.
10. A 70-year-old man with Parkinson’s disease develops visual hallucinations
of small animals and children. He is alert and oriented. Most likely?
A) Lewy body dementia
B) Schizophrenia
C) Delirium
D) Parkinson’s psychosis
Answer: D
