Bipolar Disorder Questions - PDF

**[Bipolar]** **Epidemiology & Risk Factors** 1. **At what age range do most cases of bipolar disorder first present?** - A\) 5-10 years - B\) 15-19 years - C\) 25-30 years - D\) 35-40 years **Answer: B) 15-19 years** *(Second most common onset: 20-24 years.)* 2....

**[Bipolar]** **Epidemiology & Risk Factors** 1. **At what age range do most cases of bipolar disorder first present?** - A\) 5-10 years - B\) 15-19 years - C\) 25-30 years - D\) 35-40 years **Answer: B) 15-19 years** *(Second most common onset: 20-24 years.)* 2. **What is the relative risk of developing bipolar disorder if a first-degree relative has the condition?** - A\) 3x - B\) 5x - C\) 7x - D\) 10x **Answer: C) 7x** 3. **Which form of bipolar disorder has the highest risk of suicide?** - A\) Bipolar I - B\) Bipolar II - C\) Cyclothymia - D\) Rapid cycling bipolar **Answer: D) Rapid cycling bipolar** *(More refractory, higher risk of completed suicide.)* 4. **Which feature is associated with a higher suicide risk in bipolar disorder?** - A\) History of hospitalization - B\) Mixed episode - C\) Family history of anxiety disorder - D\) History of stimulant use **Answer: B) Mixed episode** 5. **What percentage of bipolar disorder patients have a lifetime history of substance use disorder?** - A\) 40% - B\) 50% - C\) 61% - D\) 75% **Answer: C) 61%** **Bipolar Disorder Types & Diagnosis** 6. **How long must a manic episode last to meet DSM-5 criteria for Bipolar I disorder?** - A\) 2 days - B\) 4 days - C\) 1 week - D\) 2 weeks **Answer: C) 1 week** *(Or any duration if hospitalization is required.)* 7. **What is the minimum duration for a hypomanic episode in Bipolar II disorder?** - A\) 1 day - B\) 2 days - C\) 4 days - D\) 7 days **Answer: C) 4 days** 8. **Which symptom must never be present for a Bipolar II diagnosis?** - A\) Psychotic features - B\) Increased energy - C\) Impulsivity - D\) Rapid speech **Answer: A) Psychotic features** *(Presence of psychosis classifies as Bipolar I.)* 9. **Which disorder is characterized by at least 2 years of cycling hypomanic and depressive symptoms that never meet full criteria for hypomania or major depression?** - A\) Persistent depressive disorder - B\) Cyclothymic disorder - C\) Bipolar I disorder - D\) Bipolar II disorder **Answer: B) Cyclothymic disorder** 10. **How many discrete affective episodes per year define rapid cycling bipolar disorder?** - A\) 2 - B\) 3 - C\) 4 - D\) 5 **Answer: C) 4** **Neurobiology & Pathophysiology** 11. **Which neurotransmitter is primarily responsible for elevated mood during mania?** - A\) Dopamine - B\) GABA - C\) Serotonin - D\) Acetylcholine **Answer: A) Dopamine** 12. **Which phenomenon explains why earlier and more frequent bipolar episodes lead to more severe and persistent illness?** - A\) Kindling effect - B\) Dopaminergic surge - C\) HPA axis dysfunction - D\) Genetic anticipation **Answer: A) Kindling effect** 13. **Which brain region is hyperactive in mania and hypoactive in depression?** - A\) Hippocampus - B\) Amygdala - C\) Prefrontal cortex - D\) Basal ganglia **Answer: B) Amygdala** 14. **Which factor is most strongly associated with inducing a first manic episode?** - A\) High caffeine intake - B\) Social isolation - C\) Stressful life event - D\) Antidepressant use **Answer: C) Stressful life event** *(Major triggers include university, new job, marriage, or excessive stimulation.)* 15. **Which pathway is dysregulated in bipolar neuroinflammation theory?** - A\) HPA axis - B\) Mesolimbic dopamine system - C\) Glutamatergic system - D\) TNF-alpha pathway **Answer: D) TNF-alpha pathway** *(Elevated pro-inflammatory cytokines in BPD.)* **Treatment & Pharmacology** 16. **Which mood stabilizer is considered the gold standard for Bipolar I disorder?** - A\) Valproate - B\) Carbamazepine - C\) Lamotrigine - D\) Lithium **Answer: D) Lithium** 17. **What is the target lithium serum trough level for maintenance therapy?** - A\) 0.3--0.8 mmol/L - B\) 0.6--1.2 mmol/L - C\) 1.2--1.5 mmol/L - D\) 1.5--2.0 mmol/L **Answer: B) 0.6--1.2 mmol/L** 18. **Which life-threatening cardiac defect is associated with lithium exposure in pregnancy?** - A\) Tetralogy of Fallot - B\) Coarctation of the aorta - C\) Ebstein's anomaly - D\) Hypoplastic left heart syndrome **Answer: C) Ebstein's anomaly** *(Tricuspid valve defect.)* 19. **Which mood stabilizer is preferred in rapid cycling bipolar disorder?** - A\) Lithium - B\) Valproate - C\) Lamotrigine - D\) Carbamazepine **Answer: B) Valproate** *(More effective than lithium in rapid cycling.)* 20. **Which mood stabilizer requires HLA-B\*1502 screening in Asian populations due to Stevens-Johnson Syndrome risk?** - A\) Lithium - B\) Valproate - C\) Carbamazepine - D\) Lamotrigine **Answer: C) Carbamazepine** **Adverse Effects & Drug Monitoring** 21. **Which mnemonic is used for lithium's major toxicities?** - A\) DIG FAST - B\) LMNOP - C\) SIG E CAPS - D\) ABCD **Answer: B) LMNOP** *(Lithium toxicity: Movement, Nephrotoxicity, hypOthyroidism, Pregnancy risk.)* 22. **Which anticonvulsant mood stabilizer is most associated with weight gain?** - A\) Lamotrigine - B\) Valproate - C\) Carbamazepine - D\) Lithium **Answer: B) Valproate** *(Significant weight gain and metabolic syndrome risk.)* 23. **Which drug class increases lithium levels and raises risk of toxicity?** - A\) Loop diuretics - B\) NSAIDs - C\) Beta-blockers - D\) Calcium channel blockers **Answer: B) NSAIDs** *(Except aspirin.)* 24. **Which lab test should be obtained before starting lithium therapy?** - A\) ALT - B\) TSH - C\) CK - D\) D-dimer **Answer: B) TSH** *(Lithium can induce hypothyroidism.)* **Epidemiology & Risk Factors** 1. **What percentage of the general population has Bipolar I disorder?** - A\) 0.5% - B\) 1% - C\) 2% - D\) 5% **Answer: B) 1%** 2. **Which major life event is most commonly associated with the onset of the first manic episode?** - A\) Divorce - B\) Starting college - C\) Death of a loved one - D\) Chronic illness diagnosis **Answer: B) Starting college** *(Stressful transitions trigger first manic episodes.)* 3. **Which personality disorder is most commonly comorbid with Bipolar I disorder?** - A\) Narcissistic - B\) Borderline - C\) Schizotypal - D\) Avoidant **Answer: B) Borderline** 4. **What is the strongest genetic risk factor for developing bipolar disorder?** - A\) First-degree relative with bipolar disorder - B\) Family history of schizophrenia - C\) Family history of major depressive disorder - D\) Childhood ADHD **Answer: A) First-degree relative with bipolar disorder** *(7x increased risk.)* 5. **What percentage of patients with bipolar disorder attempt suicide at least once?** - A\) 10% - B\) 25% - C\) 50% - D\) 70% **Answer: C) 50%** **Bipolar Subtypes & Diagnostic Criteria** 6. **What is the required duration of mood symptoms in cyclothymic disorder?** - A\) 6 months - B\) 1 year - C\) 2 years - D\) 5 years **Answer: C) 2 years** *(1 year in children/adolescents.)* 7. **Which bipolar subtype has the worst long-term prognosis?** - A\) Bipolar I - B\) Bipolar II - C\) Rapid cycling bipolar - D\) Cyclothymic disorder **Answer: C) Rapid cycling bipolar** *(More refractory, harder to treat.)* 8. **Which bipolar disorder specifier is characterized by 4+ affective episodes per year?** - A\) Mixed features - B\) Rapid cycling - C\) Bipolar with psychotic features - D\) Bipolar with anxious distress **Answer: B) Rapid cycling** 9. **Which symptom must be present for Bipolar I but not Bipolar II?** - A\) Impulsivity - B\) Hypersexuality - C\) Psychosis - D\) Increased energy **Answer: C) Psychosis** *(Manic episodes in Bipolar I may include psychotic symptoms.)* 10. **Which bipolar disorder is most commonly misdiagnosed as major depressive disorder?** - A\) Bipolar I - B\) Bipolar II - C\) Cyclothymic disorder - D\) Rapid cycling bipolar **Answer: B) Bipolar II** *(Often presents with recurrent depression.)* **Pathophysiology & Neurotransmitters** 11. **Which neurotransmitter is elevated in mania and depleted in depression?** - A\) Serotonin - B\) Dopamine - C\) GABA - D\) Acetylcholine **Answer: B) Dopamine** 12. **Which neurotransmitter is low in both manic and depressive episodes of bipolar disorder?** - A\) Dopamine - B\) GABA - C\) Serotonin - D\) Glutamate **Answer: C) Serotonin** 13. **Which brain region is hypoactive in depression and hyperactive in mania?** - A\) Amygdala - B\) Prefrontal cortex - C\) Hippocampus - D\) Thalamus **Answer: A) Amygdala** 14. **Which inflammatory marker is elevated in bipolar disorder?** - A\) IL-6 - B\) CRP - C\) TNF-alpha - D\) All of the above **Answer: D) All of the above** *(Neuroinflammation is a key theory in bipolar disorder.)* 15. **What is the kindling hypothesis in bipolar disorder?** - A\) Recurrent episodes become progressively severe - B\) Stress hormones trigger mood instability - C\) Dopamine surges worsen with age - D\) Sleep disruption leads to mood episodes **Answer: A) Recurrent episodes become progressively severe** **Bipolar Treatment & Medications** 16. **Which mood stabilizer has the best evidence for reducing suicide risk?** - A\) Lithium - B\) Valproate - C\) Carbamazepine - D\) Lamotrigine **Answer: A) Lithium** *(Only mood stabilizer with proven anti-suicidal effects.)* 17. **What is the therapeutic range for lithium maintenance therapy?** - A\) 0.3--0.6 mmol/L - B\) 0.6--1.2 mmol/L - C\) 1.2--1.8 mmol/L - D\) 1.8--2.2 mmol/L **Answer: B) 0.6--1.2 mmol/L** 18. **Which side effect of lithium is irreversible with long-term use?** - A\) Hypothyroidism - B\) Diabetes insipidus - C\) Tremor - D\) Nausea **Answer: B) Diabetes insipidus** *(Nephrogenic DI due to renal impairment.)* 19. **Which mood stabilizer is best for bipolar depression?** - A\) Lithium - B\) Valproate - C\) Lamotrigine - D\) Carbamazepine **Answer: C) Lamotrigine** *(Best for **bipolar depression**, NOT mania.)* 20. **Which drug class should be avoided as monotherapy in bipolar disorder due to risk of mania?** - A\) SSRIs - B\) Benzodiazepines - C\) Antipsychotics - D\) Beta-blockers **Answer: A) SSRIs** *(Antidepressant monotherapy can induce mania.)* **Drug Monitoring & Lithium Toxicity** 21. **Which drug class increases lithium levels, raising toxicity risk?** - A\) NSAIDs - B\) Beta-blockers - C\) SSRIs - D\) Calcium channel blockers **Answer: A) NSAIDs** *(Except aspirin.)* 22. **Which cardiac defect is associated with lithium exposure in pregnancy?** - A\) Tetralogy of Fallot - B\) Ebstein's anomaly - C\) Coarctation of the aorta - D\) Patent ductus arteriosus **Answer: B) Ebstein's anomaly** 23. **Which test must be routinely monitored in lithium patients?** - A\) Liver function tests - B\) Creatinine - C\) White blood cell count - D\) Hemoglobin A1c **Answer: B) Creatinine** *(Lithium can cause renal impairment.)* 24. **Which anticonvulsant mood stabilizer requires monitoring for pancreatitis?** - A\) Valproate - B\) Carbamazepine - C\) Lamotrigine - D\) Topiramate **Answer: A) Valproate** *(Monitor **lipase** and **LFTs**.)*