NR547 MIDTERM EXAM LATEST 2026/2027 | Differential
Diagnosis Psychiatric-Mental Health Across Lifespan |
Practicum Exam Review Questions | Chamberlain | Pass
Guaranteed - A+ Graded
Section 1: Differential Diagnosis Foundations (Q1-10)
Q1. A 42-year-old patient presents with new-onset psychosis. According to DSM-5-
TR differential diagnosis hierarchy, which condition should be ruled out FIRST?
A. Schizophrenia
B. Bipolar I disorder with psychotic features
C. Substance/medication-induced psychotic disorder
D. Delusional disorder
Correct Answer: C [CORRECT]
Rationale: Per DSM-5-TR diagnostic hierarchy, general medical conditions and
substance/medication-induced causes must be ruled out before diagnosing a
primary mental disorder. Substance-induced psychosis (C) is evaluated first through
history, urine toxicology, and timeline analysis. Schizophrenia (A), bipolar disorder (B),
and delusional disorder (D) are primary mental disorder diagnoses made only after
medical and substance causes are excluded.
Q2. A patient intentionally produces physical symptoms to assume the sick role and
undergoes multiple unnecessary surgeries. There is no external incentive. This
presentation is MOST consistent with:
A. Malingering
B. Factitious disorder
,C. Somatic symptom disorder
D. Illness anxiety disorder
Correct Answer: B [CORRECT]
Rationale: Factitious disorder involves intentional production of physical or
psychological symptoms to assume the sick role, with no external incentives (unlike
malingering). The patient seeks medical care and procedures for psychological
gratification. Malingering (A) requires external gain (disability, legal, drugs). Somatic
symptom disorder (C) involves distressing symptoms not intentionally produced.
Illness anxiety disorder (D) involves preoccupation with having a serious illness
without somatic symptoms.
Q3. A patient reports depressive symptoms that began after starting prednisone for
lupus. The symptoms resolved after discontinuation. The MOST appropriate
diagnosis is:
A. Major depressive disorder
B. Depressive disorder due to another medical condition
C. Medication-induced depressive disorder
D. Adjustment disorder with depressed mood
Correct Answer: C [CORRECT]
Rationale: DSM-5-TR requires identifying substance/medication-induced disorders
when symptoms are attributable to a substance. Prednisone is a known cause of
mood disturbances. The temporal relationship (onset after starting, resolution after
discontinuation) confirms medication-induced etiology. MDD (A) is a primary mental
disorder diagnosis. Depressive disorder due to another medical condition (B) applies
to direct physiological effects of a medical condition, not medication. Adjustment
disorder (D) requires a psychosocial stressor, not a medication.
Q4. During the cultural formulation interview, which component assesses how the
patient's cultural identity affects their understanding of illness and help-seeking?
,A. Cultural identity of the individual
B. Cultural conceptualizations of distress
C. Psychosocial stressors and cultural features of vulnerability and resilience
D. Cultural features of the clinician-patient relationship
Correct Answer: B [CORRECT]
Rationale: Cultural conceptualizations of distress (B) evaluate how the patient
understands, names, and experiences symptoms within their cultural framework,
including idioms of distress, causal explanations, and help-seeking patterns. Cultural
identity (A) focuses on racial, ethnic, linguistic, and religious affiliations. Psychosocial
stressors (C) examine social context. Clinician-patient relationship (D) addresses
cultural differences in the therapeutic alliance.
Q5. A patient with documented epilepsy presents with episodes of staring,
unresponsiveness, and automatic behaviors lasting 1-2 minutes, followed by
confusion. These episodes are MOST likely:
A. Dissociative episodes
B. Complex partial seizures
C. Panic attacks
D. Psychogenic non-epileptic seizures
Correct Answer: B [CORRECT]
Rationale: Complex partial (focal impaired awareness) seizures present with altered
consciousness, staring, automatisms (lip smacking, fumbling), and post-ictal
confusion lasting 1-2 minutes. The documented epilepsy history supports this
diagnosis. Dissociative episodes (A) lack the stereotyped quality and post-ictal
confusion. Panic attacks (C) involve autonomic arousal without unresponsiveness.
PNES (D) typically have longer duration, asynchronous movements, and lack post-
ictal EEG changes.
, Q6. A patient presents with anxiety, tremor, tachycardia, and elevated blood
pressure. Which laboratory finding would MOST support a medical cause requiring
immediate attention?
A. Elevated TSH
B. Elevated free T4
C. Normal complete blood count
D. Elevated BUN
Correct Answer: B [CORRECT]
Rationale: Elevated free T4 with suppressed TSH indicates hyperthyroidism, which can
cause anxiety, tremor, tachycardia, and hypertension mimicking panic disorder or
GAD. This requires medical intervention before psychiatric diagnosis. Elevated TSH
(A) indicates hypothyroidism (depression, fatigue). Normal CBC (C) rules out anemia
but does not identify a medical cause. Elevated BUN (D) suggests renal dysfunction
but is less directly linked to these symptoms.
Q7. A patient with a history of alcohol use disorder presents with hallucinations 48
hours after last drink. Visual hallucinations of insects and tactile hallucinations are
prominent. The MOST likely diagnosis is:
A. Schizophrenia
B. Alcohol withdrawal delirium
C. Alcohol hallucinosis
D. Wernicke-Korsakoff syndrome
Correct Answer: C [CORRECT]
Rationale: Alcohol hallucinosis occurs within 12-48 hours of cessation, characterized
by clear sensorium with auditory, visual, or tactile hallucinations without the
autonomic hyperactivity or confusion of delirium tremens. The clear sensorium
distinguishes it from withdrawal delirium (B). Schizophrenia (A) lacks the temporal
relationship to alcohol cessation. Wernicke-Korsakoff (D) presents with confusion,
ataxia, and ophthalmoplegia (Wernicke) or anterograde amnesia (Korsakoff).
Diagnosis Psychiatric-Mental Health Across Lifespan |
Practicum Exam Review Questions | Chamberlain | Pass
Guaranteed - A+ Graded
Section 1: Differential Diagnosis Foundations (Q1-10)
Q1. A 42-year-old patient presents with new-onset psychosis. According to DSM-5-
TR differential diagnosis hierarchy, which condition should be ruled out FIRST?
A. Schizophrenia
B. Bipolar I disorder with psychotic features
C. Substance/medication-induced psychotic disorder
D. Delusional disorder
Correct Answer: C [CORRECT]
Rationale: Per DSM-5-TR diagnostic hierarchy, general medical conditions and
substance/medication-induced causes must be ruled out before diagnosing a
primary mental disorder. Substance-induced psychosis (C) is evaluated first through
history, urine toxicology, and timeline analysis. Schizophrenia (A), bipolar disorder (B),
and delusional disorder (D) are primary mental disorder diagnoses made only after
medical and substance causes are excluded.
Q2. A patient intentionally produces physical symptoms to assume the sick role and
undergoes multiple unnecessary surgeries. There is no external incentive. This
presentation is MOST consistent with:
A. Malingering
B. Factitious disorder
,C. Somatic symptom disorder
D. Illness anxiety disorder
Correct Answer: B [CORRECT]
Rationale: Factitious disorder involves intentional production of physical or
psychological symptoms to assume the sick role, with no external incentives (unlike
malingering). The patient seeks medical care and procedures for psychological
gratification. Malingering (A) requires external gain (disability, legal, drugs). Somatic
symptom disorder (C) involves distressing symptoms not intentionally produced.
Illness anxiety disorder (D) involves preoccupation with having a serious illness
without somatic symptoms.
Q3. A patient reports depressive symptoms that began after starting prednisone for
lupus. The symptoms resolved after discontinuation. The MOST appropriate
diagnosis is:
A. Major depressive disorder
B. Depressive disorder due to another medical condition
C. Medication-induced depressive disorder
D. Adjustment disorder with depressed mood
Correct Answer: C [CORRECT]
Rationale: DSM-5-TR requires identifying substance/medication-induced disorders
when symptoms are attributable to a substance. Prednisone is a known cause of
mood disturbances. The temporal relationship (onset after starting, resolution after
discontinuation) confirms medication-induced etiology. MDD (A) is a primary mental
disorder diagnosis. Depressive disorder due to another medical condition (B) applies
to direct physiological effects of a medical condition, not medication. Adjustment
disorder (D) requires a psychosocial stressor, not a medication.
Q4. During the cultural formulation interview, which component assesses how the
patient's cultural identity affects their understanding of illness and help-seeking?
,A. Cultural identity of the individual
B. Cultural conceptualizations of distress
C. Psychosocial stressors and cultural features of vulnerability and resilience
D. Cultural features of the clinician-patient relationship
Correct Answer: B [CORRECT]
Rationale: Cultural conceptualizations of distress (B) evaluate how the patient
understands, names, and experiences symptoms within their cultural framework,
including idioms of distress, causal explanations, and help-seeking patterns. Cultural
identity (A) focuses on racial, ethnic, linguistic, and religious affiliations. Psychosocial
stressors (C) examine social context. Clinician-patient relationship (D) addresses
cultural differences in the therapeutic alliance.
Q5. A patient with documented epilepsy presents with episodes of staring,
unresponsiveness, and automatic behaviors lasting 1-2 minutes, followed by
confusion. These episodes are MOST likely:
A. Dissociative episodes
B. Complex partial seizures
C. Panic attacks
D. Psychogenic non-epileptic seizures
Correct Answer: B [CORRECT]
Rationale: Complex partial (focal impaired awareness) seizures present with altered
consciousness, staring, automatisms (lip smacking, fumbling), and post-ictal
confusion lasting 1-2 minutes. The documented epilepsy history supports this
diagnosis. Dissociative episodes (A) lack the stereotyped quality and post-ictal
confusion. Panic attacks (C) involve autonomic arousal without unresponsiveness.
PNES (D) typically have longer duration, asynchronous movements, and lack post-
ictal EEG changes.
, Q6. A patient presents with anxiety, tremor, tachycardia, and elevated blood
pressure. Which laboratory finding would MOST support a medical cause requiring
immediate attention?
A. Elevated TSH
B. Elevated free T4
C. Normal complete blood count
D. Elevated BUN
Correct Answer: B [CORRECT]
Rationale: Elevated free T4 with suppressed TSH indicates hyperthyroidism, which can
cause anxiety, tremor, tachycardia, and hypertension mimicking panic disorder or
GAD. This requires medical intervention before psychiatric diagnosis. Elevated TSH
(A) indicates hypothyroidism (depression, fatigue). Normal CBC (C) rules out anemia
but does not identify a medical cause. Elevated BUN (D) suggests renal dysfunction
but is less directly linked to these symptoms.
Q7. A patient with a history of alcohol use disorder presents with hallucinations 48
hours after last drink. Visual hallucinations of insects and tactile hallucinations are
prominent. The MOST likely diagnosis is:
A. Schizophrenia
B. Alcohol withdrawal delirium
C. Alcohol hallucinosis
D. Wernicke-Korsakoff syndrome
Correct Answer: C [CORRECT]
Rationale: Alcohol hallucinosis occurs within 12-48 hours of cessation, characterized
by clear sensorium with auditory, visual, or tactile hallucinations without the
autonomic hyperactivity or confusion of delirium tremens. The clear sensorium
distinguishes it from withdrawal delirium (B). Schizophrenia (A) lacks the temporal
relationship to alcohol cessation. Wernicke-Korsakoff (D) presents with confusion,
ataxia, and ophthalmoplegia (Wernicke) or anterograde amnesia (Korsakoff).
