NR547 MENTAL HEALTH DISORDERS EXAM 2026 WITH 100% ACCURATE
ANSWERS.
1–10: Depressive Disorders
1. A patient reports depressed mood, anhedonia, insomnia, fatigue, and poor
concentration for 3 weeks. Which additional symptom would confirm a diagnosis
of major depressive disorder (MDD)?
A) Grandiose delusions
B) Manic episodes
C) Significant weight loss or gain
D) Fear of abandonment
Answer: C – MDD requires ≥5 symptoms (including depressed mood/anhedonia)
for ≥2 weeks; weight change is one criterion. Mania rules out MDD.
2. A 72-year-old with no previous depression presents with memory complaints,
low mood, and psychomotor retardation. The MMSE is 24/30. What is the most
appropriate next step?
A) Diagnose Alzheimer’s disease
B) Start donepezil
C) Treat for depression and re-evaluate cognition
D) Order brain MRI immediately
,Answer: C – Pseudodementia (depression mimicking dementia) is common in
elderly; treat depression first.
3. Which medication is most associated with sexual dysfunction as a side effect in
MDD treatment?
A) Bupropion
B) Mirtazapine
C) Sertraline
D) Vortioxetine
Answer: C – SSRIs (sertraline) cause high rates of sexual dysfunction; bupropion
has lowest risk.
4. A patient with MDD fails two adequate SSRI trials. Next best step?
A) Add buspirone
B) Switch to MAOI
C) Consider venlafaxine or mirtazapine
D) ECT immediately
Answer: C – Venlafaxine (SNRI) or mirtazapine (NaSSA) are guideline-supported
next steps after two SSRI failures.
,5. Which symptom differentiates persistent depressive disorder (dysthymia) from
MDD?
A) Psychosis
B) Chronicity (≥2 years) with less severe symptoms
C) Only occurs postpartum
D) Seasonal pattern
Answer: B – Dysthymia requires ≥2 years of depressed mood most days plus 2
other symptoms, without symptom-free periods >2 months.
6. For MDD with melancholic features, which is most characteristic?
A) Hypersomnia
B) Mood reactivity
C) Early morning awakening and worse depression in AM
D) Rejection sensitivity
Answer: C – Melancholic features include terminal insomnia, worse depression in
morning, and profound anhedonia.
7. A patient with MDD and chronic pain is started on duloxetine. What is the
primary rationale?
A) Fewer GI side effects
, B) Dual reuptake inhibition (SRI and NRI) for pain + mood
C) Rapid onset for anxiety
D) No CYP interactions
Answer: B – Duloxetine is FDA-approved for MDD and chronic musculoskeletal
pain (e.g., diabetic neuropathy, fibromyalgia).
8. Premenstrual dysphoric disorder (PMDD) diagnosis requires symptoms in the
luteal phase that remit within days of menses and include:
A) Only physical symptoms like bloating
B) At least one affective symptom (e.g., mood swings, anger)
C) Mania
D) Psychosis
Answer: B – PMDD requires ≥1 of: marked affective lability, irritability, depressed
mood, or anxiety.
9. Which lab finding is most associated with depression in the elderly that is
reversible?
A) Low B12
B) High cortisol
C) Elevated TSH
ANSWERS.
1–10: Depressive Disorders
1. A patient reports depressed mood, anhedonia, insomnia, fatigue, and poor
concentration for 3 weeks. Which additional symptom would confirm a diagnosis
of major depressive disorder (MDD)?
A) Grandiose delusions
B) Manic episodes
C) Significant weight loss or gain
D) Fear of abandonment
Answer: C – MDD requires ≥5 symptoms (including depressed mood/anhedonia)
for ≥2 weeks; weight change is one criterion. Mania rules out MDD.
2. A 72-year-old with no previous depression presents with memory complaints,
low mood, and psychomotor retardation. The MMSE is 24/30. What is the most
appropriate next step?
A) Diagnose Alzheimer’s disease
B) Start donepezil
C) Treat for depression and re-evaluate cognition
D) Order brain MRI immediately
,Answer: C – Pseudodementia (depression mimicking dementia) is common in
elderly; treat depression first.
3. Which medication is most associated with sexual dysfunction as a side effect in
MDD treatment?
A) Bupropion
B) Mirtazapine
C) Sertraline
D) Vortioxetine
Answer: C – SSRIs (sertraline) cause high rates of sexual dysfunction; bupropion
has lowest risk.
4. A patient with MDD fails two adequate SSRI trials. Next best step?
A) Add buspirone
B) Switch to MAOI
C) Consider venlafaxine or mirtazapine
D) ECT immediately
Answer: C – Venlafaxine (SNRI) or mirtazapine (NaSSA) are guideline-supported
next steps after two SSRI failures.
,5. Which symptom differentiates persistent depressive disorder (dysthymia) from
MDD?
A) Psychosis
B) Chronicity (≥2 years) with less severe symptoms
C) Only occurs postpartum
D) Seasonal pattern
Answer: B – Dysthymia requires ≥2 years of depressed mood most days plus 2
other symptoms, without symptom-free periods >2 months.
6. For MDD with melancholic features, which is most characteristic?
A) Hypersomnia
B) Mood reactivity
C) Early morning awakening and worse depression in AM
D) Rejection sensitivity
Answer: C – Melancholic features include terminal insomnia, worse depression in
morning, and profound anhedonia.
7. A patient with MDD and chronic pain is started on duloxetine. What is the
primary rationale?
A) Fewer GI side effects
, B) Dual reuptake inhibition (SRI and NRI) for pain + mood
C) Rapid onset for anxiety
D) No CYP interactions
Answer: B – Duloxetine is FDA-approved for MDD and chronic musculoskeletal
pain (e.g., diabetic neuropathy, fibromyalgia).
8. Premenstrual dysphoric disorder (PMDD) diagnosis requires symptoms in the
luteal phase that remit within days of menses and include:
A) Only physical symptoms like bloating
B) At least one affective symptom (e.g., mood swings, anger)
C) Mania
D) Psychosis
Answer: B – PMDD requires ≥1 of: marked affective lability, irritability, depressed
mood, or anxiety.
9. Which lab finding is most associated with depression in the elderly that is
reversible?
A) Low B12
B) High cortisol
C) Elevated TSH
