Bipolar Disorder Practice Questions PDF

**Diagnosis & Symptom Recognition** 1. **A patient presents to the ER after being brought in by police for disruptive behavior. He has not slept for 5 days, claims to have special powers, and has maxed out multiple credit cards. He has no known psychiatric history. Which factor would c...

**Diagnosis & Symptom Recognition** 1. **A patient presents to the ER after being brought in by police for disruptive behavior. He has not slept for 5 days, claims to have special powers, and has maxed out multiple credit cards. He has no known psychiatric history. Which factor would confirm a diagnosis of Bipolar I rather than another psychiatric condition?** - A\) The presence of grandiosity and impulsivity - B\) A past history of at least one depressive episode - C\) Symptoms lasting for at least 4 continuous days - D\) A prior history of a psychotic episode in the absence of mood symptoms **Answer: A) The presence of grandiosity and impulsivity** *(These are core features of mania, which alone is sufficient for a Bipolar I diagnosis.)* 2. **A 26-year-old woman reports periods of "feeling amazing" for a few days, followed by depressive slumps. During her highs, she is productive and social but never requires hospitalization. What key symptom would immediately rule out a diagnosis of Bipolar II disorder?** - A\) Experiencing an episode of severe depression - B\) Having occasional mood swings with irritability - C\) Reporting a history of hallucinations during mood elevation - D\) Describing periods of increased goal-directed activity **Answer: C) Reporting a history of hallucinations during mood elevation** *(Psychotic symptoms indicate mania, which classifies as Bipolar I, not Bipolar II.)* 3. **A patient is experiencing alternating mood episodes, none of which meet full criteria for either hypomania or major depression. Symptoms have been present for 20 months. Which diagnosis is most likely?** - A\) Bipolar II Disorder - B\) Persistent Depressive Disorder - C\) Cyclothymia - D\) Rapid-Cycling Bipolar Disorder **Answer: C) Cyclothymia** *(Cyclothymia involves subclinical mood fluctuations lasting at least 2 years.)* **Neurobiology & Risk Factors** 4. **Which of the following findings best supports the neuroinflammation theory of Bipolar Disorder?** - A\) Increased levels of brain-derived neurotrophic factor (BDNF) - B\) Reduced dopamine transmission during depressive episodes - C\) Elevated pro-inflammatory cytokines in manic states - D\) Decreased gray matter volume in the prefrontal cortex **Answer: C) Elevated pro-inflammatory cytokines in manic states** *(Neuroinflammation is implicated in mood dysregulation.)* 5. **A patient's twin sibling was recently diagnosed with Bipolar I disorder. Based on genetic studies, how much more likely is this patient to develop the disorder compared to the general population?** - A\) 3x more likely - B\) 5x more likely - C\) 7x more likely - D\) 10x more likely **Answer: C) 7x more likely** *(First-degree relatives of bipolar patients have a 7x increased risk.)* 6. **Which factor has been identified as a common trigger for the first manic episode in Bipolar I disorder?** - A\) Childhood neglect - B\) Starting a new job or university - C\) Chronic exposure to cortisol - D\) High caffeine intake **Answer: B) Starting a new job or university** *(Stressful life changes often precipitate initial manic episodes.)* **Treatment & Pharmacology** 7. **A patient with Bipolar I disorder is started on lithium. Which lab finding would require immediate discontinuation of the medication?** - A\) TSH level of 6.0 mU/L - B\) Creatinine level of 2.2 mg/dL - C\) Sodium level of 140 mEq/L - D\) Leukocyte count of 10,000/µL **Answer: B) Creatinine level of 2.2 mg/dL** *(Significant renal impairment is a contraindication for lithium use.)* 8. **Which mood stabilizer is most effective for treating rapid-cycling bipolar disorder?** - A\) Lithium - B\) Valproate - C\) Carbamazepine - D\) Lamotrigine **Answer: B) Valproate** *(Valproate is superior to lithium for rapid cycling.)* 9. **A bipolar patient with severe depression is prescribed an antidepressant without a mood stabilizer. What is the greatest risk of this treatment approach?** - A\) Development of psychotic symptoms - B\) Induction of a manic episode - C\) Increased risk of suicide - D\) Worsening cognitive impairment **Answer: B) Induction of a manic episode** *(Antidepressants can trigger mania if not combined with a mood stabilizer.)* 10. **Which mood stabilizer is associated with weight loss rather than weight gain?** - A\) Valproate - B\) Lithium - C\) Lamotrigine - D\) Quetiapine **Answer: C) Lamotrigine** *(Lamotrigine is weight-neutral or associated with mild weight loss.)* **Suicide Risk & Prevention** 11. **Which of the following is the most significant risk factor for suicide in Bipolar Disorder?** - A\) History of psychotic features - B\) Past suicide attempt - C\) Presence of comorbid anxiety - D\) Early age of onset **Answer: B) Past suicide attempt** *(Strongest predictor of future attempts.)* 12. **What is the most common cause of death in patients with Bipolar Disorder?** - A\) Suicide - B\) Substance overdose - C\) Cardiovascular disease - D\) Lithium toxicity **Answer: A) Suicide** *(Mortality rates are 2--3x higher than the general population.)* **Advanced Treatment Considerations** 13. **A patient taking lithium for Bipolar I disorder is found to have a lithium level of 1.8 mmol/L. Which symptom would most likely indicate impending toxicity?** - A\) Polyuria - B\) Hand tremor - C\) Ataxia - D\) Weight gain **Answer: C) Ataxia** *(Neurological symptoms like ataxia, confusion, and seizures suggest toxicity.)* 14. **Which medication is most appropriate for treating Bipolar Depression in a patient who does not tolerate lithium?** - A\) Bupropion - B\) Lamotrigine - C\) Quetiapine - D\) Carbamazepine **Answer: B) Lamotrigine** *(Most effective for bipolar depression.)* 15. **Which of the following statements about lithium is most accurate?** - A\) Lithium is primarily excreted through the liver - B\) Lithium is associated with decreased gray matter volume - C\) Lithium reduces suicide risk in bipolar patients - D\) Lithium is contraindicated in all trimesters of pregnancy **Answer: C) Lithium reduces suicide risk in bipolar patients** *(Lithium is the only mood stabilizer with proven anti-suicidal effects.)* **Diagnosis & Symptom Recognition** 1. **A 23-year-old man presents with irritability, increased energy, and decreased need for sleep lasting five days. He denies grandiosity or psychotic symptoms. He has never had a major depressive episode. What is the most appropriate diagnosis?** - A\) Bipolar I Disorder - B\) Bipolar II Disorder - C\) Cyclothymic Disorder - D\) No diagnosis at this time **Answer: D) No diagnosis at this time** *(Bipolar I requires 7 days of mania, Bipolar II requires a past depressive episode, and cyclothymia requires chronic symptom cycling for \>2 years.)* 2. **Which clinical feature is most suggestive of mania rather than hypomania?** - A\) Increased goal-directed activity - B\) Distractibility - C\) Impulsivity leading to hospitalization - D\) Elevated mood for more than 4 days **Answer: C) Impulsivity leading to hospitalization** *(Mania is defined by **hospitalization, psychosis, or 7+ days of symptoms**.)* 3. **A patient presents with a history of depressive episodes and recurrent periods of increased energy, impulsivity, and excessive spending that last for 3 days before returning to baseline. What is the most likely diagnosis?** - A\) Bipolar I Disorder - B\) Bipolar II Disorder - C\) Borderline Personality Disorder - D\) Cyclothymic Disorder **Answer: D) Cyclothymic Disorder** *(Symptoms never meet full hypomanic or depressive episode criteria, and have persisted for \>2 years.)* 4. **Which finding differentiates a mixed episode from a rapid-cycling bipolar presentation?** - A\) Presence of psychotic features - B\) Frequency of mood shifts - C\) Co-occurrence of manic and depressive symptoms - D\) Presence of suicidal ideation **Answer: C) Co-occurrence of manic and depressive symptoms** *(Mixed states involve simultaneous mania + depression, while rapid cycling involves **≥4 separate mood episodes per year**.)* **Neurobiology & Risk Factors** 5. **Which neurotransmitter imbalance is most strongly linked to manic symptoms in Bipolar Disorder?** - A\) Increased norepinephrine and dopamine - B\) Increased serotonin and GABA - C\) Decreased glutamate and norepinephrine - D\) Decreased dopamine and increased GABA **Answer: A) Increased norepinephrine and dopamine** *(Mania is associated with excessive dopamine and norepinephrine activity.)* 6. **Which structural brain abnormality has been most consistently associated with Bipolar Disorder?** - A\) Increased hippocampal volume - B\) Prefrontal cortex hypoactivity - C\) Increased caudate nucleus activation - D\) Thalamic atrophy **Answer: B) Prefrontal cortex hypoactivity** *(Reduced prefrontal control over the limbic system contributes to mood dysregulation.)* 7. **Which environmental factor is most commonly linked to an earlier age of onset in Bipolar Disorder?** - A\) Childhood trauma - B\) Chronic sleep deprivation - C\) Urban living - D\) Lack of social support **Answer: A) Childhood trauma** *(Associated with **earlier onset, more severe course, and increased rapid cycling**.)* **Treatment & Pharmacology** 8. **A patient with Bipolar I disorder is started on lithium. Which symptom would most strongly suggest early lithium toxicity?** - A\) Fine hand tremor - B\) Polyuria - C\) New-onset confusion and dysarthria - D\) Increased thirst **Answer: C) New-onset confusion and dysarthria** *(Neurological symptoms are **early markers** of lithium toxicity.)* 9. **Which medication is FDA-approved for the treatment of bipolar depression?** - A\) Lithium - B\) Lamotrigine - C\) Carbamazepine - D\) Haloperidol **Answer: B) Lamotrigine** *(Most effective for **bipolar depression**, but not for mania.)* 10. **Which medication is most effective for treating acute mania?** - A\) Fluoxetine - B\) Haloperidol - C\) Lamotrigine - D\) Quetiapine **Answer: B) Haloperidol** *(First-generation antipsychotics are highly effective for **acute mania stabilization**.)* 11. **Which medication requires genetic testing for HLA-B\*1502 before starting in certain populations due to the risk of Stevens-Johnson Syndrome?** - A\) Valproate - B\) Lithium - C\) Carbamazepine - D\) Lamotrigine **Answer: C) Carbamazepine** *(Risk of **life-threatening rash** in **Asian populations**.)* **Suicide Risk & Prognosis** 12. **Which of the following statements about suicide in Bipolar Disorder is most accurate?** - A\) Patients with Bipolar II have a higher **attempt** rate than those with Bipolar I - B\) Bipolar patients have **higher** suicide rates than those with MDD - C\) Suicide attempts are most common **during manic episodes** - D\) Suicide risk is highest **within the first 6 months** of diagnosis **Answer: A) Patients with Bipolar II have a higher attempt rate than those with Bipolar I** *(But **Bipolar I** has higher **completion rates**.)* 13. **Which of the following factors is most predictive of suicide completion in Bipolar Disorder?** - A\) Male gender - B\) Family history of suicide - C\) Presence of mixed episodes - D\) Number of prior hospitalizations **Answer: C) Presence of mixed episodes** *(Strongly linked to **higher impulsivity and suicidality**.)* **Advanced Clinical Considerations** 14. **A patient with Bipolar I disorder is maintained on lithium but continues to experience frequent depressive episodes. What is the most appropriate next step?** - A\) Increase the lithium dose - B\) Switch to valproate - C\) Add lamotrigine - D\) Prescribe fluoxetine **Answer: C) Add lamotrigine** *(Best augmentation for bipolar depression.)* 15. **Which factor suggests a worse prognosis in Bipolar Disorder?** - A\) Longer euthymic periods - B\) Fewer total mood episodes - C\) Early onset before age 20 - D\) Good medication adherence **Answer: C) Early onset before age 20** *(Earlier onset = more **severe** and **chronic course**.)* 16. **A patient with Bipolar I disorder taking lithium is planning pregnancy. What is the best management strategy?** - A\) Continue lithium, as it is safe in pregnancy - B\) Switch to lamotrigine - C\) Discontinue lithium immediately - D\) Replace lithium with fluoxetine **Answer: B) Switch to lamotrigine** *(Safer in pregnancy than lithium, which can cause **Ebstein's anomaly.**)*