Bipolar disorder UK Medical PG Practice Questions and MCQs
Practice UK Medical PG questions for Bipolar disorder. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Bipolar disorder UK Medical PG Question 1: A 58-year-old man presents with progressive memory loss and behavioral changes over 10 months. MRI shows asymmetric frontotemporal atrophy. What is the most appropriate symptomatic treatment?
- A. Cholinesterase inhibitors
- B. Memantine
- C. Antipsychotics for behavior
- D. Supportive care only (Correct Answer)
- E. Antidepressants
Bipolar disorder Explanation: ***Supportive care only*** - Frontotemporal dementia (FTD), characterized by **progressive memory loss**, **behavioral changes**, and **asymmetric frontotemporal atrophy** on MRI, currently lacks disease-modifying treatments. - Management focuses on **supportive care**, including symptom management for agitation, sleep disturbances, and nutritional needs, alongside comprehensive caregiver support. *Cholinesterase inhibitors* - These medications, like donepezil or rivastigmine, are primarily used in **Alzheimer's disease** to enhance cholinergic neurotransmission. - They are generally **ineffective** in FTD and can potentially worsen behavioral symptoms in some patients. *Memantine* - Memantine is an **NMDA receptor antagonist** approved for moderate to severe **Alzheimer's disease**. - Its efficacy in FTD has **not been established**, and it is typically not recommended as a primary symptomatic treatment. *Antipsychotics for behavior* - While **antipsychotics** can be used cautiously to manage severe behavioral disturbances like aggression or psychosis in FTD, they are not a primary symptomatic treatment for the core disease process. - Their use carries **significant risks**, including increased mortality in elderly dementia patients, and should be reserved for severe, refractory symptoms. *Antidepressants* - **Antidepressants** may be used to address co-occurring **mood symptoms** such as depression or anxiety, which can be present in FTD. - They do not directly treat the core cognitive or behavioral aspects of FTD and are not considered a primary symptomatic treatment for the dementia itself.
Bipolar disorder UK Medical PG Question 2: A 68-year-old man presents with progressive memory loss and parkinsonism. He has visual hallucinations and fluctuating cognition. What is the most likely diagnosis?
- A. Alzheimer's disease
- B. Parkinson's disease dementia
- C. Lewy body dementia (Correct Answer)
- D. Vascular dementia
- E. Frontotemporal dementia
Bipolar disorder Explanation: ***Lewy body dementia*** - The classic triad of **progressive memory loss** (dementia), **parkinsonism**, and **recurrent visual hallucinations**, along with **fluctuating cognition**, are hallmark diagnostic features of Lewy body dementia. - This condition is characterized by the presence of **Lewy bodies** in the brainstem and cortex, leading to a combination of cognitive and motor symptoms. *Alzheimer's disease* - While memory loss is prominent, **Alzheimer's disease** typically does not present with early or significant **parkinsonism** or prominent **visual hallucinations**. - Cognitive fluctuations are also not a primary distinguishing feature of Alzheimer's, which is more characterized by a gradual, progressive decline in memory and other cognitive domains. *Parkinson's disease dementia* - In **Parkinson's disease dementia (PDD)**, the **dementia** typically develops at least **one year after** the onset of well-established **parkinsonism**. - Although PDD can also feature visual hallucinations and cognitive fluctuations, the **temporal relationship** (parkinsonism preceding dementia by a significant period) is crucial for its diagnosis, unlike in LBD where symptoms often emerge concurrently or dementia precedes parkinsonism by less than a year. *Vascular dementia* - This condition is characterized by a **step-wise cognitive decline**, often associated with a history of stroke or cerebrovascular disease, and typically presents with **focal neurological deficits**. - **Parkinsonism** and **visual hallucinations** are not typical primary features of vascular dementia; cognitive decline is usually related to specific brain lesions. *Frontotemporal dementia* - **Frontotemporal dementia (FTD)** typically presents with prominent early changes in **behavior** (e.g., disinhibition, apathy) or **language difficulties**, rather than primary memory loss. - **Parkinsonism** and **visual hallucinations** are not characteristic features of FTD and would make this diagnosis less likely.
Bipolar disorder UK Medical PG Question 3: A 70-year-old man presents with confusion, agitation, and visual hallucinations that fluctuate throughout the day. He has a shuffling gait and mild tremor. His daughter reports he often falls asleep during conversations. What is the most likely diagnosis?
- A. Alzheimer's disease
- B. Vascular dementia
- C. Lewy body dementia (Correct Answer)
- D. Frontotemporal dementia
- E. Delirium
Bipolar disorder Explanation: ***Lewy body dementia***- The combination of **fluctuating cognition** (confusion, agitation, falling asleep during conversations), recurrent, well-formed **visual hallucinations**, and spontaneous **parkinsonism** (shuffling gait, mild tremor) is the classic diagnostic triad for Lewy body dementia.- It is characterized by the accumulation of **alpha-synuclein** protein deposits (Lewy bodies) in neurons, affecting both cognitive and motor functions.*Alzheimer's disease*- Typically presents with **insidious onset** of **progressive memory impairment** as the predominant symptom, rather than prominent fluctuations or early hallucinations.- Motor symptoms like parkinsonism appear very late, if at all, and are not core diagnostic features of early Alzheimer's.*Vascular dementia*- Cognitive decline often occurs in a **stepwise** fashion, frequently associated with a history of **cerebral vascular events** (strokes) or risk factors.- While gait disturbance is common, florid visual hallucinations and dramatic cognitive fluctuations are not typical or primary features of pure vascular dementia.*Frontotemporal dementia*- Primarily involves early changes in **personality**, **behavior** (e.g., disinhibition, apathy), or **language deficits**, often with executive dysfunction.- Lacks the characteristic combination of prominent visual hallucinations, rapid cognitive fluctuations, and parkinsonism seen in this patient.*Delirium*- Delirium is an **acute** and usually reversible disturbance in attention and consciousness, often triggered by underlying medical illness, infection, or medication.- While fluctuations and agitation are present, the patient's history describes chronic, progressive features consistent with a **dementia syndrome**, not an acute confusional state.
Bipolar disorder UK Medical PG Question 4: A 78-year-old man presents with confusion and falls. His wife reports he has been increasingly forgetful over the past year. MMSE score is 18/30. What is the most appropriate initial investigation?
- A. CT head (Correct Answer)
- B. MRI brain
- C. Lumbar puncture
- D. EEG
- E. PET scan
Bipolar disorder Explanation: ***CT head***
- Given the patient's age (78 years), confusion, falls, and cognitive decline (MMSE 18/30), an initial **CT head** is crucial to rapidly rule out **reversible causes** of dementia and acute structural pathologies.
- It efficiently identifies conditions like **subdural hematoma**, **normal pressure hydrocephalus (NPH)**, or **mass lesions** (e.g., tumors, large strokes) that require urgent management and can present with cognitive symptoms and falls.
*MRI brain*
- While **MRI brain** provides superior resolution for detecting subtle structural changes, such as **vascular disease**, **small infarcts**, or **white matter lesions**, it is often reserved for a more detailed evaluation after initial screening.
- It is less available, more time-consuming, and not the primary initial choice when urgent exclusion of acute, potentially life-threatening causes is paramount.
*Lumbar puncture*
- This invasive procedure is typically indicated for the investigation of **rapidly progressive dementia**, suspected **infectious causes** (e.g., neurosyphilis, chronic meningitis), or **inflammatory conditions**.
- It is not a routine initial investigation for gradual cognitive decline unless there are specific clinical features suggestive of these conditions.
*EEG*
- **Electroencephalography (EEG)** assesses brain electrical activity and is primarily used to investigate **seizure disorders** (e.g., non-convulsive status epilepticus mimicking confusion) or specific types of dementia like **Creutzfeldt-Jakob disease (CJD)**.
- It does not provide the structural information needed to identify lesions or hydrocephalus that can cause acute confusion and falls.
*PET scan*
- **Positron Emission Tomography (PET)** scans (e.g., FDG-PET or amyloid-PET) are specialized functional imaging modalities used later in the diagnostic process to help differentiate specific types of dementia (e.g., **Alzheimer’s disease** from **frontotemporal dementia**).
- It is a costly, advanced investigation and is not appropriate as the initial screening tool for structural brain pathology or reversible causes of cognitive impairment.
Bipolar disorder UK Medical PG Question 5: A 27-year-old woman presents with amenorrhea, weight loss, and excessive exercise. She has fine lanugo hair and her BMI is 16 kg/m². She denies having an eating disorder. What is the most likely diagnosis?
- A. Hyperthyroidism
- B. Anorexia nervosa (Correct Answer)
- C. Depression
- D. Celiac disease
- E. Addison's disease
Bipolar disorder Explanation: ***Anorexia nervosa***- The triad of significantly **low BMI** (<17.5 kg/m² indicating severe restriction), **amenorrhea** due to HPO axis suppression, and **lanugo hair** (a compensatory mechanism for body temperature regulation in starvation) is highly specific for anorexia nervosa.- The presence of excessive exercise alongside severe weight loss strongly indicates the behavioral pathology of this disorder, even with the patient's denial, which is common.*Hyperthyroidism*- Although hyperthyroidism causes weight loss, it is typically accompanied by symptoms like **tachycardia**, **tremors**, goiter, and heat intolerance, which are absent here.- Hyperthyroidism does not cause the development of **lanugo hair**, which is a sign of chronic severe malnutrition.*Depression*- Depression can cause weight change and sometimes secondary amenorrhea, but it lacks the specific combination of the **low BMI**, excessive exercise, and physiological signs of starvation like **lanugo hair**.- The focus on weight-related behaviors (excessive exercise) points primarily toward an **eating disorder** rather than an isolated mood disorder.*Celiac disease*- Celiac disease leads to weight loss primarily through **malabsorption**, often associated with GI symptoms like chronic diarrhea or abdominal pain.- It does not explain the behavioral feature of **excessive exercise** or the dermatological finding of **lanugo hair** due strictly to gluten intolerance.*Addison's disease*- Addison's disease causes weight loss and fatigue but is classically characterized by **hyperpigmentation** (primary adrenal insufficiency) and volume depletion.- It does not typically present with the specific severe **malnutrition** signs (BMI 16, lanugo hair) or the core psychopathology of restricted intake and **excessive exercise** seen in this patient.
Bipolar disorder UK Medical PG Question 6: A 52-year-old woman presents with progressive memory loss and personality changes over 8 months. MRI shows frontotemporal atrophy. CSF shows elevated tau but normal amyloid-β. What is the most likely diagnosis?
- A. Alzheimer's disease
- B. Frontotemporal dementia (Correct Answer)
- C. Lewy body dementia
- D. Vascular dementia
- E. Normal pressure hydrocephalus
Bipolar disorder Explanation: ***Frontotemporal dementia***- The combination of progressive **personality changes** and memory loss, particularly with **frontotemporal atrophy** on MRI, is highly characteristic of Frontotemporal Dementia (FTD).- CSF showing **elevated tau** but **normal amyloid-β** further supports FTD (specifically tauopathies), as low amyloid-β is typically seen in Alzheimer's disease.*Alzheimer's disease*- While memory loss is prominent, **personality changes** are usually not the initial or most prominent symptom in early Alzheimer's compared to FTD.- **CSF amyloid-β** is typically **low** in Alzheimer's disease due to its deposition in plaques, which contradicts the normal amyloid-β finding in this patient.*Lewy body dementia*- This condition presents with a classic triad of **fluctuating cognition**, **recurrent visual hallucinations**, and **parkinsonism**, none of which are described.- MRI in LBD typically shows less specific atrophy, and CSF markers alone are not usually sufficient for differentiation without the characteristic clinical features.*Vascular dementia*- Vascular dementia is characterized by a **step-wise decline** in cognitive function, often associated with stroke or cerebrovascular disease, not typically a progressive decline over 8 months with frontotemporal atrophy.- Imaging would show evidence of **infarcts** or **white matter lesions**, which are not mentioned.*Normal pressure hydrocephalus*- The classic triad for NPH includes **gait disturbance**, **urinary incontinence**, and **dementia**, with MRI showing **ventriculomegaly**.- The patient's presentation of prominent personality changes and frontotemporal atrophy does not align with NPH.
Bipolar disorder UK Medical PG Question 7: A 67-year-old man presents with progressive memory loss and personality changes over 12 months. His wife reports he has become disinhibited and uses inappropriate language. MR shows asymmetric frontotemporal atrophy. What is the most likely diagnosis?
- A. Alzheimer's disease
- B. Vascular dementia
- C. Frontotemporal dementia (Correct Answer)
- D. Lewy body dementia
- E. Normal pressure hydrocephalus
Bipolar disorder Explanation: ***Frontotemporal dementia***
- The combination of **progressive personality changes**, **disinhibition**, and **inappropriate language** with **asymmetric frontotemporal atrophy** on MRI is highly characteristic.
- This presentation points to the **behavioral variant of FTD**, where changes in social conduct and executive function precede significant memory loss.
*Alzheimer's disease*
- Typically presents with **prominent early episodic memory loss** and difficulties with learning new information, which are not the primary features here.
- MRI usually shows **medial temporal lobe atrophy** (e.g., hippocampus), not predominantly frontotemporal atrophy.
*Vascular dementia*
- Often presents with a **step-wise decline** in cognitive function, focal neurological deficits, and evidence of cerebrovascular disease on imaging.
- The described gradual, progressive personality changes and specific atrophy pattern are less consistent with this diagnosis.
*Lewy body dementia*
- Key features include **fluctuating cognition**, **recurrent visual hallucinations**, and **spontaneous parkinsonism**.
- While cognitive decline is present, the prominent disinhibition and specific atrophy pattern are not typical for Lewy body dementia.
*Normal pressure hydrocephalus*
- Characterized by a **classic triad of gait disturbance**, **urinary incontinence**, and **dementia** (often executive dysfunction).
- MRI would show **enlarged ventricles** out of proportion to sulcal atrophy, rather than asymmetric frontotemporal atrophy.
Bipolar disorder UK Medical PG Question 8: A 52-year-old woman presents with progressive memory loss and language difficulties over 10 months. MRI shows asymmetric frontotemporal atrophy. CSF shows elevated tau but normal amyloid-β42. What is the most likely diagnosis?
- A. Alzheimer's disease
- B. Frontotemporal dementia (Correct Answer)
- C. Lewy body dementia
- D. Vascular dementia
- E. Creutzfeldt-Jakob disease
Bipolar disorder Explanation: ***Frontotemporal dementia***
Bipolar disorder UK Medical PG Question 9: A 67-year-old man presents with progressive memory loss and behavioral changes. He has difficulty with language and shows disinhibited behavior. MRI shows frontotemporal atrophy. What is the most likely diagnosis?
- A. Alzheimer's disease
- B. Frontotemporal dementia (Correct Answer)
- C. Vascular dementia
- D. Lewy body dementia
- E. Normal pressure hydrocephalus
Bipolar disorder Explanation: ***Frontotemporal dementia***- This diagnosis is strongly supported by the patient's prominent **progressive behavioral changes**, including disinhibition, alongside difficulty with language (aphasia) and memory loss. The MRI finding of **frontotemporal atrophy** is the characteristic neuroradiological feature defining this group of dementias, particularly the behavioral variant (bvFTD).- It involves the primary atrophy of the frontal and temporal lobes, associated with accumulation of abnormal proteins like **tau** or **TDP-43**.*Alzheimer's disease*- AD typically begins with profound impairment of **episodic memory** (hippocampal system involvement), preceding severe personality or behavioral changes.- Radiologically, AD is characterized by early **hippocampal or medial temporal lobe atrophy**, followed by parietotemporal involvement, rather than selective **frontotemporal atrophy**. *Vascular dementia*- This dementia usually presents with a **stepwise decline** in cognitive function, and patients often have a history of strokes or significant cardiovascular risk factors.- Imaging findings typically include evidence of multiple **cortical or subcortical infarcts** or significant **ischemic white matter lesions**. *Lewy body dementia*- Characteristic features include **fluctuating cognition**, **recurrent visual hallucinations**, and spontaneous **Parkinsonism** (rigidity, tremor), none of which are detailed here.- While memory is affected, the initial presentation is often distinct, and the primary cognitive deficit is typically in **visual and spatial function** rather than **disinhibition** and language. *Normal pressure hydrocephalus*- NPH presents with a distinct triad: **gait ataxia**, urinary incontinence, and subcortical dementia (poor executive function, slowness).- The MRI hallmark is **ventricular enlargement** (hydrocephalus) out of proportion to the degree of cerebral atrophy, which contrasts with the significant cortical shrinkage described as frontotemporal atrophy.
Bipolar disorder UK Medical PG Question 10: A 63-year-old man presents with progressive memory loss and parkinsonian features. He has visual hallucinations and fluctuating consciousness. His wife reports he acts out his dreams. What is the most likely diagnosis?
- A. Alzheimer's disease with agitation
- B. Lewy body dementia (Correct Answer)
- C. Parkinson's disease with dementia
- D. Vascular dementia
- E. Frontotemporal dementia
Bipolar disorder Explanation: ***Lewy body dementia***
- **Progressive memory loss**, **parkinsonian features**, **visual hallucinations**, and **fluctuating consciousness** are the cardinal clinical features of Lewy body dementia.
- **Acting out dreams** (REM sleep behavior disorder) is a highly characteristic and often early symptom that strongly supports this diagnosis.
*Alzheimer's disease with agitation*
- While **memory loss** is prominent, **parkinsonian features**, **visual hallucinations**, and **fluctuating consciousness** are not typical core diagnostic criteria for Alzheimer's disease.
- **REM sleep behavior disorder** is much less common in Alzheimer's disease compared to Lewy body dementia, even if agitation can be present.
*Parkinson's disease with dementia*
- In **Parkinson's disease with dementia**, motor symptoms (**parkinsonian features**) must precede the onset of dementia by at least **one year**.
- The concurrent presentation of memory loss and parkinsonian features, along with other symptoms like visual hallucinations, points away from PDD and towards LBD.
*Vascular dementia*
- Characterized by a **stepwise cognitive decline**, often associated with **focal neurological deficits** and evidence of cerebrovascular disease.
- **Visual hallucinations**, **fluctuating consciousness**, and **REM sleep behavior disorder** are not typical features of vascular dementia.
*Frontotemporal dementia*
- Primarily affects **personality**, **behavior**, and **language**, with memory often relatively preserved in the early stages.
- The presence of prominent **parkinsonian features**, **visual hallucinations**, **fluctuating consciousness**, and **REM sleep behavior disorder** is inconsistent with frontotemporal dementia.
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