NR547 MIDTERM EXAM LATEST 2026/2027 | Differential
Diagnosis Psychiatric-Mental Health Across Lifespan |
Weeks 1-4 Practicum Exam Review | Complete Guide |
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Section 1: Differential Diagnosis Foundations & Clinical Reasoning (Questions 1-
10)
Q1. Which of the following represents the first step in the DSM-5-TR differential
diagnosis process when evaluating a patient presenting with psychiatric symptoms?
A. Determine the primary mental disorder(s) based on symptom clusters
B. Rule out substance/medication-induced disorders
C. Rule out malingering and factitious disorder
D. Rule out medical conditions that may mimic psychiatric symptoms
C. Rule out malingering and factitious disorder [CORRECT]
Rationale: The DSM-5-TR prescribes a hierarchical differential diagnosis approach
beginning with ruling out malingering and factitious disorder (external incentive vs.
desire to assume sick role), followed by substance-induced conditions, medical
conditions, and finally determining primary mental disorders. This sequencing
prevents misattribution of intentional or secondary symptoms to primary psychiatric
illness.
Correct Answer: C
Q2. The Cultural Formulation Interview (CFI) in DSM-5-TR is designed to accomplish
which of the following objectives?
A. Establish standardized diagnostic criteria across all cultures
B. Assess cultural identity, conceptualization of illness, psychosocial stressors, and
cultural features of vulnerability and resilience
,C. Determine whether symptoms are culturally appropriate and therefore non-
pathological
D. Replace the standard diagnostic interview in ethnically diverse populations
B. Assess cultural identity, conceptualization of illness, psychosocial stressors, and
cultural features of vulnerability and resilience [CORRECT]
Rationale: The CFI is a semi-structured interview that explores how cultural contexts
shape symptom expression, meaning, and help-seeking; it does not invalidate
pathology based on cultural norms nor replace standard diagnostic procedures. It
enhances diagnostic accuracy by identifying cultural idioms of distress and
explanatory models.
Correct Answer: B
Q3. In diagnostic reasoning, which cognitive process involves generating potential
explanations after data collection and before hypothesis testing?
A. Pattern recognition
B. Hypothesis generation
C. Diagnostic verification
D. Anchoring heuristic
B. Hypothesis generation [CORRECT]
Rationale: Diagnostic reasoning follows a sequential process: data collection (history,
exam, labs), hypothesis generation (creating a differential list), and hypothesis testing
(ruling in/out through further evaluation). Pattern recognition is a rapid automatic
process, while anchoring heuristic is a cognitive bias to be avoided.
Correct Answer: B
Q4. A 34-year-old man presents with dramatic paralysis following a car accident. He
is applying for disability and becomes angry when told objective testing shows intact
,motor function. He has no desire for medical care beyond documentation. Which
diagnosis best fits this presentation?
A. Factitious disorder
B. Conversion disorder (functional neurological symptom disorder)
C. Malingering
D. Somatic symptom disorder
C. Malingering [CORRECT]
Rationale: Malingering is distinguished by the presence of external incentives
(disability benefits, legal gain) and the intentional production of symptoms, whereas
factitious disorder involves the desire to assume the sick role without obvious
external reward. Conversion disorder is not intentionally produced, and somatic
symptom disorder features excessive thoughts and anxiety about symptoms.
Correct Answer: C
Q5. A 28-year-old woman presents with depressed mood, fatigue, and poor
concentration that began two weeks after starting prednisone 60 mg daily for lupus
exacerbation. Which is the most appropriate diagnostic consideration?
A. Major depressive disorder, single episode
B. Substance/medication-induced depressive disorder
C. Adjustment disorder with depressed mood
D. Persistent depressive disorder
B. Substance/medication-induced depressive disorder [CORRECT]
Rationale: Corticosteroids such as prednisone are well-documented causes of
substance/medication-induced depressive disorders. The temporal relationship
(onset within weeks of starting the medication) and known physiological mechanism
support this diagnosis over a primary depressive disorder. Adjustment disorder
requires an identifiable psychosocial stressor, not a biological agent.
Correct Answer: B
, Q6. A 42-year-old man presents with new-onset anxiety, irritability, tremor, and
weight loss. Which medical differential should be evaluated first given the highest
prevalence and reversibility?
A. Vitamin B12 deficiency
B. Hyperthyroidism
C. Pheochromocytoma
D. Multiple sclerosis
B. Hyperthyroidism [CORRECT]
Rationale: Hyperthyroidism is among the most common medical mimics of anxiety
disorders, presenting with autonomic hyperarousal, irritability, and weight loss. It is
readily detectable via TSH and free T4 testing and is reversible with treatment. While
pheochromocytoma can cause similar symptoms, it is far less common.
Correct Answer: B
Q7. The DSM-5-TR decision trees for differential diagnosis organize conditions
primarily by which framework?
A. Chronological age of symptom onset
B. Predominant symptom presentation (e.g., psychosis, mood, anxiety, cognitive
impairment)
C. Severity of functional impairment
D. Etiological causation (biological vs. psychological)
B. Predominant symptom presentation (e.g., psychosis, mood, anxiety, cognitive
impairment) [CORRECT]
Rationale: DSM-5-TR decision trees guide clinicians through differential diagnosis by
starting with the predominant symptom category and branching through medical,
substance-induced, and primary psychiatric explanations. This symptom-based
approach facilitates systematic evaluation regardless of presumed etiology.
Correct Answer: B
Diagnosis Psychiatric-Mental Health Across Lifespan |
Weeks 1-4 Practicum Exam Review | Complete Guide |
Chamberlain | Pass Guaranteed - A+ Graded
Section 1: Differential Diagnosis Foundations & Clinical Reasoning (Questions 1-
10)
Q1. Which of the following represents the first step in the DSM-5-TR differential
diagnosis process when evaluating a patient presenting with psychiatric symptoms?
A. Determine the primary mental disorder(s) based on symptom clusters
B. Rule out substance/medication-induced disorders
C. Rule out malingering and factitious disorder
D. Rule out medical conditions that may mimic psychiatric symptoms
C. Rule out malingering and factitious disorder [CORRECT]
Rationale: The DSM-5-TR prescribes a hierarchical differential diagnosis approach
beginning with ruling out malingering and factitious disorder (external incentive vs.
desire to assume sick role), followed by substance-induced conditions, medical
conditions, and finally determining primary mental disorders. This sequencing
prevents misattribution of intentional or secondary symptoms to primary psychiatric
illness.
Correct Answer: C
Q2. The Cultural Formulation Interview (CFI) in DSM-5-TR is designed to accomplish
which of the following objectives?
A. Establish standardized diagnostic criteria across all cultures
B. Assess cultural identity, conceptualization of illness, psychosocial stressors, and
cultural features of vulnerability and resilience
,C. Determine whether symptoms are culturally appropriate and therefore non-
pathological
D. Replace the standard diagnostic interview in ethnically diverse populations
B. Assess cultural identity, conceptualization of illness, psychosocial stressors, and
cultural features of vulnerability and resilience [CORRECT]
Rationale: The CFI is a semi-structured interview that explores how cultural contexts
shape symptom expression, meaning, and help-seeking; it does not invalidate
pathology based on cultural norms nor replace standard diagnostic procedures. It
enhances diagnostic accuracy by identifying cultural idioms of distress and
explanatory models.
Correct Answer: B
Q3. In diagnostic reasoning, which cognitive process involves generating potential
explanations after data collection and before hypothesis testing?
A. Pattern recognition
B. Hypothesis generation
C. Diagnostic verification
D. Anchoring heuristic
B. Hypothesis generation [CORRECT]
Rationale: Diagnostic reasoning follows a sequential process: data collection (history,
exam, labs), hypothesis generation (creating a differential list), and hypothesis testing
(ruling in/out through further evaluation). Pattern recognition is a rapid automatic
process, while anchoring heuristic is a cognitive bias to be avoided.
Correct Answer: B
Q4. A 34-year-old man presents with dramatic paralysis following a car accident. He
is applying for disability and becomes angry when told objective testing shows intact
,motor function. He has no desire for medical care beyond documentation. Which
diagnosis best fits this presentation?
A. Factitious disorder
B. Conversion disorder (functional neurological symptom disorder)
C. Malingering
D. Somatic symptom disorder
C. Malingering [CORRECT]
Rationale: Malingering is distinguished by the presence of external incentives
(disability benefits, legal gain) and the intentional production of symptoms, whereas
factitious disorder involves the desire to assume the sick role without obvious
external reward. Conversion disorder is not intentionally produced, and somatic
symptom disorder features excessive thoughts and anxiety about symptoms.
Correct Answer: C
Q5. A 28-year-old woman presents with depressed mood, fatigue, and poor
concentration that began two weeks after starting prednisone 60 mg daily for lupus
exacerbation. Which is the most appropriate diagnostic consideration?
A. Major depressive disorder, single episode
B. Substance/medication-induced depressive disorder
C. Adjustment disorder with depressed mood
D. Persistent depressive disorder
B. Substance/medication-induced depressive disorder [CORRECT]
Rationale: Corticosteroids such as prednisone are well-documented causes of
substance/medication-induced depressive disorders. The temporal relationship
(onset within weeks of starting the medication) and known physiological mechanism
support this diagnosis over a primary depressive disorder. Adjustment disorder
requires an identifiable psychosocial stressor, not a biological agent.
Correct Answer: B
, Q6. A 42-year-old man presents with new-onset anxiety, irritability, tremor, and
weight loss. Which medical differential should be evaluated first given the highest
prevalence and reversibility?
A. Vitamin B12 deficiency
B. Hyperthyroidism
C. Pheochromocytoma
D. Multiple sclerosis
B. Hyperthyroidism [CORRECT]
Rationale: Hyperthyroidism is among the most common medical mimics of anxiety
disorders, presenting with autonomic hyperarousal, irritability, and weight loss. It is
readily detectable via TSH and free T4 testing and is reversible with treatment. While
pheochromocytoma can cause similar symptoms, it is far less common.
Correct Answer: B
Q7. The DSM-5-TR decision trees for differential diagnosis organize conditions
primarily by which framework?
A. Chronological age of symptom onset
B. Predominant symptom presentation (e.g., psychosis, mood, anxiety, cognitive
impairment)
C. Severity of functional impairment
D. Etiological causation (biological vs. psychological)
B. Predominant symptom presentation (e.g., psychosis, mood, anxiety, cognitive
impairment) [CORRECT]
Rationale: DSM-5-TR decision trees guide clinicians through differential diagnosis by
starting with the predominant symptom category and branching through medical,
substance-induced, and primary psychiatric explanations. This symptom-based
approach facilitates systematic evaluation regardless of presumed etiology.
Correct Answer: B
