NR547 Differential Diagnosis in Psychiatric-Mental Health
Across the Lifespan Practicum Final Exam Question Bank
(Latest 2026/2027 Edition) – Questions, Answers & Detailed
Rationales
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SECTION 1: Differential Diagnosis in Child and Adolescent Mental Health
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Question 1
A 9-year-old boy is referred by his teacher for inability to sit still, interrupting others, and
failing to complete assignments. His mother reports similar behavior since age 5, but
notes he can focus for hours on building Lego sets. His pediatrician recently started him
on albuterol for asthma. Which differential diagnosis should be prioritized before
confirming ADHD?
A. Generalized anxiety disorder with excessive motor tension
B. Asthma medication-induced hyperactivity and tremor
C. Autism spectrum disorder with restricted interests
D. Oppositional defiant disorder with defiance toward authority
Correct Answer:
B — Asthma medication-induced hyperactivity and tremor
Rationale:
Albuterol is a beta-agonist that can cause hyperactivity, tremor, and restlessness
mimicking ADHD symptoms. Rule out iatrogenic causes before diagnosing a
neurodevelopmental disorder. While anxiety and ODD may coexist, medication effects
are reversible and must be assessed first.
Question 2
,A 14-year-old girl presents with sudden onset of severe anxiety, intrusive thoughts about
contamination, and compulsive hand-washing that consumes 4 hours daily. She had a
streptococcal throat infection 3 weeks ago. Which diagnosis should be considered in
the differential?
A. Pediatric autoimmune neuropsychiatric disorder associated with streptococcal
infections (PANDAS)
B. Early-onset schizophrenia with obsessive-compulsive features
C. Separation anxiety disorder with school avoidance
D. Body dysmorphic disorder with excessive grooming
Correct Answer:
A — Pediatric autoimmune neuropsychiatric disorder associated with streptococcal
infections (PANDAS)
Rationale:
PANDAS/PANS should be considered when OCD or tic symptoms have a sudden onset
following streptococcal infection. The temporal relationship and abrupt symptom
emergence distinguish this from primary OCD. Schizophrenia is unlikely given the lack
of psychosis; separation anxiety and BDD do not fit the contamination focus
post-infection.
Question 3
A 7-year-old boy is brought in for evaluation after his parents report he has no friends,
speaks in a monotone voice, and becomes distressed when his daily routine is altered.
He has an intense interest in train schedules and memorizes every station. Which
differential diagnosis is most appropriate?
A. Social anxiety disorder with avoidance of peer interaction
B. Autism spectrum disorder level 1 with restricted interests
C. Obsessive-compulsive disorder with ordering rituals
D. Intellectual developmental disorder with social skill deficits
,Correct Answer:
B — Autism spectrum disorder level 1 with restricted interests
Rationale:
The combination of persistent deficits in social communication, restricted repetitive
interests (train schedules), and insistence on sameness is characteristic of autism
spectrum disorder. Social anxiety does not explain the restricted interests; OCD involves
ego-dystonic obsessions rather than circumscribed interests; intellectual disability
alone does not account for the specific social-communication profile.
Question 4
A 16-year-old male presents with irritability, decreased need for sleep, racing thoughts,
and risky sexual behavior over the past 2 weeks. His mother reports he was depressed
and withdrawn for 3 months prior. Urine drug screen is negative. Which diagnosis best
fits this presentation?
A. Major depressive disorder with psychotic features
B. Attention-deficit/hyperactivity disorder with emotional dysregulation
C. Bipolar I disorder with current manic episode
D. Conduct disorder with emerging antisocial traits
Correct Answer:
C — Bipolar I disorder with current manic episode
Rationale:
The distinct period of elevated/expansive mood, decreased sleep, racing thoughts, and
hypersexuality lasting one week following a depressive episode is consistent with
bipolar I disorder. The prior depression may have been a major depressive episode or
part of the bipolar course. ADHD and conduct disorder do not explain the episodic
nature and mood symptoms.
Question 5
, A 12-year-old female presents with refusal to eat, significant weight loss, lanugo hair,
and bradycardia. She states she is "fat" despite being underweight. Her parents recently
divorced. Which differential diagnosis must be distinguished from anorexia nervosa?
A. Avoidant/restrictive food intake disorder with sensory aversion
B. Major depressive disorder with appetite loss and weight change
C. Body dysmorphic disorder with preoccupation beyond weight
D. Social anxiety disorder with fear of eating in public
Correct Answer:
B — Major depressive disorder with appetite loss and weight change
Rationale:
While anorexia nervosa is the primary diagnosis given the fear of weight gain, body
image disturbance, and physiologic signs, MDD with appetite loss must be
differentiated as it can cause weight loss without body image distortion. ARFID lacks
the fear of fatness; BDD involves perceived defects not primarily weight-related; social
anxiety does not explain the physiologic changes.
Question 6
A 10-year-old boy exposed to domestic violence and parental substance use presents
with nightmares, hypervigilance, emotional numbing, and aggressive outbursts at
school. Symptoms began 2 months ago after witnessing his father assault his mother.
Which diagnosis is most appropriate?
A. Adjustment disorder with disturbance of conduct
B. Posttraumatic stress disorder in a child
C. Disruptive mood dysregulation disorder with chronic irritability
D. Reactive attachment disorder with social disinhibition
Correct Answer:
B — Posttraumatic stress disorder in a child
Across the Lifespan Practicum Final Exam Question Bank
(Latest 2026/2027 Edition) – Questions, Answers & Detailed
Rationales
──────────────────────────────
SECTION 1: Differential Diagnosis in Child and Adolescent Mental Health
──────────────────────────────
Question 1
A 9-year-old boy is referred by his teacher for inability to sit still, interrupting others, and
failing to complete assignments. His mother reports similar behavior since age 5, but
notes he can focus for hours on building Lego sets. His pediatrician recently started him
on albuterol for asthma. Which differential diagnosis should be prioritized before
confirming ADHD?
A. Generalized anxiety disorder with excessive motor tension
B. Asthma medication-induced hyperactivity and tremor
C. Autism spectrum disorder with restricted interests
D. Oppositional defiant disorder with defiance toward authority
Correct Answer:
B — Asthma medication-induced hyperactivity and tremor
Rationale:
Albuterol is a beta-agonist that can cause hyperactivity, tremor, and restlessness
mimicking ADHD symptoms. Rule out iatrogenic causes before diagnosing a
neurodevelopmental disorder. While anxiety and ODD may coexist, medication effects
are reversible and must be assessed first.
Question 2
,A 14-year-old girl presents with sudden onset of severe anxiety, intrusive thoughts about
contamination, and compulsive hand-washing that consumes 4 hours daily. She had a
streptococcal throat infection 3 weeks ago. Which diagnosis should be considered in
the differential?
A. Pediatric autoimmune neuropsychiatric disorder associated with streptococcal
infections (PANDAS)
B. Early-onset schizophrenia with obsessive-compulsive features
C. Separation anxiety disorder with school avoidance
D. Body dysmorphic disorder with excessive grooming
Correct Answer:
A — Pediatric autoimmune neuropsychiatric disorder associated with streptococcal
infections (PANDAS)
Rationale:
PANDAS/PANS should be considered when OCD or tic symptoms have a sudden onset
following streptococcal infection. The temporal relationship and abrupt symptom
emergence distinguish this from primary OCD. Schizophrenia is unlikely given the lack
of psychosis; separation anxiety and BDD do not fit the contamination focus
post-infection.
Question 3
A 7-year-old boy is brought in for evaluation after his parents report he has no friends,
speaks in a monotone voice, and becomes distressed when his daily routine is altered.
He has an intense interest in train schedules and memorizes every station. Which
differential diagnosis is most appropriate?
A. Social anxiety disorder with avoidance of peer interaction
B. Autism spectrum disorder level 1 with restricted interests
C. Obsessive-compulsive disorder with ordering rituals
D. Intellectual developmental disorder with social skill deficits
,Correct Answer:
B — Autism spectrum disorder level 1 with restricted interests
Rationale:
The combination of persistent deficits in social communication, restricted repetitive
interests (train schedules), and insistence on sameness is characteristic of autism
spectrum disorder. Social anxiety does not explain the restricted interests; OCD involves
ego-dystonic obsessions rather than circumscribed interests; intellectual disability
alone does not account for the specific social-communication profile.
Question 4
A 16-year-old male presents with irritability, decreased need for sleep, racing thoughts,
and risky sexual behavior over the past 2 weeks. His mother reports he was depressed
and withdrawn for 3 months prior. Urine drug screen is negative. Which diagnosis best
fits this presentation?
A. Major depressive disorder with psychotic features
B. Attention-deficit/hyperactivity disorder with emotional dysregulation
C. Bipolar I disorder with current manic episode
D. Conduct disorder with emerging antisocial traits
Correct Answer:
C — Bipolar I disorder with current manic episode
Rationale:
The distinct period of elevated/expansive mood, decreased sleep, racing thoughts, and
hypersexuality lasting one week following a depressive episode is consistent with
bipolar I disorder. The prior depression may have been a major depressive episode or
part of the bipolar course. ADHD and conduct disorder do not explain the episodic
nature and mood symptoms.
Question 5
, A 12-year-old female presents with refusal to eat, significant weight loss, lanugo hair,
and bradycardia. She states she is "fat" despite being underweight. Her parents recently
divorced. Which differential diagnosis must be distinguished from anorexia nervosa?
A. Avoidant/restrictive food intake disorder with sensory aversion
B. Major depressive disorder with appetite loss and weight change
C. Body dysmorphic disorder with preoccupation beyond weight
D. Social anxiety disorder with fear of eating in public
Correct Answer:
B — Major depressive disorder with appetite loss and weight change
Rationale:
While anorexia nervosa is the primary diagnosis given the fear of weight gain, body
image disturbance, and physiologic signs, MDD with appetite loss must be
differentiated as it can cause weight loss without body image distortion. ARFID lacks
the fear of fatness; BDD involves perceived defects not primarily weight-related; social
anxiety does not explain the physiologic changes.
Question 6
A 10-year-old boy exposed to domestic violence and parental substance use presents
with nightmares, hypervigilance, emotional numbing, and aggressive outbursts at
school. Symptoms began 2 months ago after witnessing his father assault his mother.
Which diagnosis is most appropriate?
A. Adjustment disorder with disturbance of conduct
B. Posttraumatic stress disorder in a child
C. Disruptive mood dysregulation disorder with chronic irritability
D. Reactive attachment disorder with social disinhibition
Correct Answer:
B — Posttraumatic stress disorder in a child
