Bipolar disorder Practice Questions

Question 1

A 35-year-old man is brought to the emergency department by his wife. She was called by his coworkers to come and pick him up from work after he barged into the company’s board meeting and was being very disruptive as he ranted on about all the great ideas he had for the company. When they tried to reason with him, he became hostile and insisted that he should be the CEO as he knew what was best for the future of the company. The patient’s wife also noted that her husband has been up all night for the past few days but assumed that he was handling a big project at work. The patient has no significant past medical or psychiatric history. Which of the following treatments is most likely to benefit this patient’s condition?

Accepted Answer

Valproic acid

Answer

Antidepressants

Answer

Haloperidol

Answer

Psychotherapy

Answer

Clozapine

Question 2

A 58-year-old man with a past medical history of diabetes, hypertension, and hyperlipidemia was brought into the emergency department by his wife after she observed him go without sleep for several days and recently open and max out several credit cards. She also reports that he has quit his bartending job and has been excessively talkative and easily annoyed for the last several weeks. The patient has no previous psychiatric history. Routine medical examination, investigations, and toxicology rule out a medical cause or substance abuse. Lab results are consistent with chronically impaired renal function. What is the single best treatment for this patient?

Accepted Answer

Valproic acid

Answer

Lithium

Answer

Gabapentin

Answer

Pregabalin

Answer

Lamotrigine

Question 3

A 33-year-old woman is brought to the physician by her husband because of persistent sadness for the past 2 months. During this period, she also has had difficulty sleeping and an increased appetite. She had similar episodes that occurred 2 years ago and 9 months ago that each lasted for 4 months. Between these episodes, she reported feeling very energetic and rested after 3 hours of sleep. She often went for long periods of time without eating. She works as a stock market trader and received a promotion 5 months ago. She regularly attends yoga classes on the weekends with her friends. On mental status examination, she has a blunted affect. She denies suicidal thoughts and illicit drug use. Which of the following is the most likely diagnosis?

Accepted Answer

Bipolar II disorder

Answer

Major depressive disorder with seasonal pattern

Answer

Persistent depressive disorder

Answer

Major depressive disorder with atypical features

Answer

Cyclothymic disorder

Question 4

A 24-year-old woman is brought to the emergency department by her roommate because of bizarre behavior and incoherent talkativeness for the past week. Her roommate reports that the patient has been rearranging the furniture in her room at night and has ordered a variety of expensive clothes online. The patient says she feels “better than ever” and has a lot of energy. She had absence seizures as a child and remembers that valproate had to be discontinued because it damaged her liver. She has been otherwise healthy and is not taking any medication. She is sexually active with her boyfriend. She does not smoke, drink alcohol, or use illicit drugs. Physical and neurologic examinations show no abnormalities. Her pulse is 78/min, respirations are 13/min, and blood pressure is 122/60 mm Hg. Mental status examination shows pressured and disorganized speech, flight of ideas, lack of insight, and affective lability. Which of the following is the best initial step before deciding on a therapy for this patient's condition?

Accepted Answer

Obtain TSH, β-hCG, and serum creatinine concentration

Answer

Obtain CBC, liver function studies, and beta-HCG

Answer

Obtain BMI, HbA1c, lipid levels, and prolactin levels

Answer

Perform urine drug testing and begin cognitive behavior therapy

Answer

Assess for suicidal ideation and obtain echocardiography

Question 5

A 21-year-old female is brought to the emergency department by her roommate. Her roommate says that the patient has been acting “strangely” for the past 10 days. She has noticed that the patient has been moving and talking on the phone at all hours of the night. She doesn’t think that the patient sleeps more than one to two hours a night. She also spends hours pacing up and down the apartment, talking about “trying to save the world.” She also notices that the patient has been speaking very fast. When asking the patient if anything seems different, the patient denies anything wrong, only adding that, “she’s made great progress on her plans." The patient said she has felt like this on one occasion 2 years ago, and she recalled being hospitalized for about 2 weeks. She denies any history of depression, although she said about a year ago she had no energy and had a hard time motivating herself to go to class and see her friends for months. She denies hearing any voices or any visual hallucinations. What is the most likely diagnosis in this patient?

Accepted Answer

Bipolar I disorder

Answer

Bipolar II disorder

Answer

Major depressive disorder

Answer

Persistent Depressive Disorder

Answer

Schizoaffective disorder

Question 6

A 55-year-old man presents to his primary care physician with complaints of fluctuating mood for the past 2 years. He feels great and full of energy for some months when he is very creative with tons of ideas just racing through his mind. He is noted to be very talkative and distracted by his different ideas. During these times, he is very productive and able to accomplish much at work and home. However, these periods are frequently followed by a prolonged depressed mood. During this time, he has low energy, poor concentration, and low self-esteem. The accompanying feeling of hopelessness from these cycling “ups” and “downs” have him eating and sleeping more during the “downs.” He does not remember a period within the last 2 years where he felt “normal.” What is the most likely diagnosis?

Accepted Answer

Cyclothymic disorder

Answer

Dysthymic disorder

Answer

Bipolar II disorder

Answer

Persistent depressive disorder

Answer

Bipolar I disorder

Question 7

A 23-year-old woman is brought to the physician by her father because of irritability, mood swings, and difficulty sleeping over the past 10 days. A few days ago, she quit her job and spent all of her savings on supplies for a “genius business plan.” She has been energetic despite sleeping only 1–2 hours each night. She was diagnosed with major depressive disorder 2 years ago. Mental status examination shows pressured speech, a labile affect, and flight of ideas. Throughout the examination, she repeatedly states “I feel great, I don't need to be here.” Urine toxicology screening is negative. Which of the following is the most likely diagnosis?

Accepted Answer

Bipolar disorder type I

Answer

Schizoaffective disorder

Answer

Bipolar disorder type II

Answer

Delusional disorder

Answer

Attention-deficit hyperactivity disorder

Question 8

A 25-year-old woman is brought to the emergency department by EMS after being found naked in a busy downtown square. The patient stated that she is liberating people from material desires and was found destroying objects. Her temperature is 99.5°F (37.5°C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 22/min, and oxygen saturation is 98% on room air. Physical exam is deferred due to patient combativeness. The patient is given diphenhydramine and haloperidol and transferred to the psychiatric ward. On day 1 on the ward, the patient is no longer aggressive or agitated and has calmed down. She states that she feels severely depressed and wants to kill herself. The patient is started on a medication and monitored closely. On day 3 of the patient's stay in the hospital she is found in her room drawing up plans and states that she has major plans to revamp the current energy problems in the country. Which of the following is the most likely medication that was started in this patient?

Accepted Answer

Sertraline

Answer

Quetiapine

Answer

Olanzapine

Answer

Lamotrigine

Answer

Lithium

Question 9

A 26-year-old female college student is brought back into the university clinic for acting uncharacteristically. The patient presented to the same clinic 6 weeks ago with complaints of depressed mood, insomnia, and weightloss. She had been feeling guilty for wasting her parent’s money by doing so poorly at the university. She felt drained for at least 2 weeks before presenting to the clinic for the first time. She was placed on an antidepressant and was improving but now presents with elevated mood. She is more talkative with a flight of ideas and is easily distractible. Which of the following statements is most likely true regarding this patient’s condition?

Accepted Answer

Her diagnosis of unipolar depression is incorrect.

Answer

The patient may have psychotic features.

Answer

The patient may have a history of mania.

Answer

Antidepressants are inappropriate.

Answer

Her new symptoms need to last at least 7 days.

Question 10

A 29-year-old man comes to the physician with his wife because she has noticed a change in his behavior over the past 2 weeks. His wife reports that he is very distracted and irritable. His colleagues have voiced concerns that he has not been turning up for work regularly and behaves erratically when he does. Previously, her husband had been a reliable and reasonable person. The patient says that he feels “fantastic”; he only needs 4 hours of sleep each night and wakes up cheerful and full of energy each morning. He thinks that his wife is overreacting. The patient has been healthy except for a major depressive episode 5 years ago that was treated with paroxetine. He currently takes no medications. His pulse is 98/min, respirations are 12/min, and blood pressure is 128/62 mm Hg. Mental status examination shows frenzied speech and a flight of ideas. Which of the following is the strongest predisposing factor for this patient's condition?

Accepted Answer

Genetic predisposition

Answer

Advanced paternal age

Answer

Higher socioeconomic class

Answer

Maternal obstetric complications

Answer

Being married

Bipolar disorder

Study Resources

Lessons

Questions

Flashcards

Lessons

Bipolar I disorder diagnostic criteria

Bipolar II disorder diagnostic criteria

Cyclothymic disorder

Manic episode criteria and features

Hypomanic episode criteria and features

Mixed features specification

Rapid cycling bipolar disorder

First episode management

Maintenance therapy principles

Mood stabilizers mechanisms and selection

Antipsychotics in bipolar disorder

Psychosocial interventions

Bipolar disorder in pregnancy

Practice Questions

Flashcards

About Bipolar disorder for USMLE

Lessons in Bipolar disorder

Master Bipolar disorder