A 23-year-old unmarried pool cleaner has a 4-year history of active and residual symptoms of schizophrenia. During these 4 years, he has developed symptoms of depression, including depressed mood and anhedonia, that lasted 3 months and resolved with treatment. These symptoms do not meet criteria for major depression. Which diagnosis best fits this clinical presentation?
Bipolar disorder with psychotic features
Schizoaffective disorder
Schizophreniform disorder
Schizophrenia and unspecified depressive disorder
The Correct Answer is D
Choice A reason: Bipolar disorder with psychotic features requires the presence of manic or depressive episodes that meet full diagnostic criteria, with psychotic symptoms occurring exclusively during mood episodes. This patient’s psychosis is chronic and independent of mood symptoms, which rules out bipolar disorder.
Choice B reason: Schizoaffective disorder requires mood episodes (either depressive or manic) that meet full diagnostic criteria and occur concurrently with psychotic symptoms. Additionally, psychotic symptoms must persist for at least two weeks in the absence of mood symptoms. Since the depressive symptoms in this case do not meet criteria for major depression, schizoaffective disorder is not appropriate.
Choice C reason: Schizophreniform disorder is diagnosed when schizophrenia-like symptoms persist for more than one month but less than six months. This patient has had symptoms for four years, which exceeds the time frame for this diagnosis.
Choice D reason: Schizophrenia with unspecified depressive disorder is the most accurate diagnosis. The patient has a chronic course of schizophrenia and has experienced depressive symptoms that do not meet full criteria for major depressive disorder. This combination fits the clinical picture.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Cellulitis is a bacterial infection of the dermis and subcutaneous tissues, most commonly caused by group A beta-hemolytic Streptococcus and Staphylococcus aureus. It presents with warmth, erythema, swelling, and tenderness, often with systemic symptoms. The infection typically enters through breaks in the skin.
Choice B reason: This describes acne or folliculitis, which involves inflammation of pilosebaceous units. Cellulitis affects deeper layers of the skin and is not limited to hair follicles.
Choice C reason: This describes the pathogenesis of psoriasis, a chronic inflammatory skin condition. Psoriasis involves keratinocyte hyperproliferation, not infection.
Choice D reason: Psychological stress and environmental allergens may exacerbate certain dermatologic conditions like eczema or urticaria, but they are not causative factors in cellulitis, which is infectious in origin.
Correct Answer is B
Explanation
Choice A reason: While untreated streptococcal infections can lead to rheumatic fever or glomerulonephritis, they are not implicated in the pathogenesis of SLE. SLE is an autoimmune disease, not a post-infectious sequela of strep or scarlet fever.
Choice B reason: SLE arises from a complex interplay of genetic susceptibility and environmental triggers (e.g., UV light, infections, medications). These factors activate the innate immune system, leading to autoantibody production, immune complex deposition, and systemic inflammation. ANA positivity reflects this autoimmune activity.
Choice C reason: Epstein-Barr virus has been studied as a potential environmental trigger in autoimmune diseases, including SLE, but it is not the primary cause. Its role is contributory rather than causative.
Choice D reason: HPV is associated with cervical dysplasia and cancer, not autoimmune diseases like SLE. There is no established link between HPV infection and the pathogenesis of lupus.
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