Barkley PMHNP CHaPter Quiz 13: BiPolar
aNd related disorders – CoMPreHeNsive
exaMiNatioN 150 advaNCed MultiPle-
CHoiCe QuestioNs witH CorreCt aNswers
aNd detailed ratioNales a well
detailed oNe writteN aNd
graded a+ uPgraded
SECTION A: DIAGNOSTIC CRITERIA AND CLINICAL PRESENTATION (Questions 1-30)
1. A 34-year-old patient presents with a distinct period of abnormally elevated mood,
increased goal-directed activity, and decreased need for sleep lasting 8 days. The patient
reports feeling "on top of the world" and has engaged in excessive spending sprees. Which of
the following DSM-5-TR criteria must be met to confirm a manic episode?
A. Duration of at least 2 weeks with three or more associated symptoms
B. Duration of at least 1 week (or any duration if hospitalization is required) with three or more
associated symptoms
C. Duration of at least 4 days with four or more associated symptoms
D. Duration of at least 1 month with two or more associated symptoms
Correct Answer: B
Rationale: According to DSM-5-TR criteria for a manic episode, there must be a distinct period
of abnormally and persistently elevated, expansive, or irritable mood and abnormally and
persistently increased goal-directed activity or energy, lasting at least 1 week and present most
,of the day, nearly every day (or any duration if hospitalization is necessary). During this period,
three or more of the associated symptoms (inflated self-esteem, decreased need for sleep,
pressured speech, flight of ideas, distractibility, increased goal-directed activity, excessive
involvement in activities with high potential for painful consequences) must be present.
2. A 28-year-old female presents with a 5-day history of elevated mood, increased energy,
decreased need for sleep, and excessive involvement in multiple new business ventures with
poor judgment. She has never been hospitalized for psychiatric symptoms. According to DSM-
5-TR criteria, which diagnosis is most appropriate?
A. Bipolar I disorder, current episode manic
B. Bipolar II disorder, current episode hypomanic
C. Cyclothymic disorder
D. Substance/medication-induced bipolar and related disorder
Correct Answer: B
Rationale: The duration of 4 or more days distinguishes a hypomanic episode from a manic
episode. Since the patient's symptoms have lasted only 5 days and she has not required
hospitalization, this meets criteria for a hypomanic episode (minimum 4 consecutive days),
which is characteristic of Bipolar II disorder. A manic episode requires at least 1 week of
symptoms or any duration if hospitalization is required.
3. Which of the following symptom presentations would most strongly suggest a mixed
features specifier in a patient with bipolar I disorder?
A. Elevated mood, grandiosity, and decreased need for sleep
B. Depressed mood, anhedonia, and hypersomnia
C. Elevated mood with three or more depressive symptoms (e.g., depressed mood, anhedonia,
guilt)
D. Irritable mood with increased goal-directed activity and pressured speech
Correct Answer: C
Rationale: The mixed features specifier is applied when an individual meets full criteria for a
manic or hypomanic episode and has at least three depressive symptoms (depressed mood,
diminished interest, psychomotor retardation, fatigue, guilt, sleep disturbance, appetite change,
or suicidal ideation) during the episode. This specifier is clinically significant because mixed
episodes are associated with increased suicide risk and poorer treatment outcomes.
,4. A 45-year-old male with bipolar I disorder presents with a manic episode. Which of the
following is the minimum number of associated symptoms required to meet DSM-5-TR
diagnostic criteria, assuming the mood disturbance is elevated?
A. Two symptoms
B. Three symptoms
C. Four symptoms
D. Five symptoms
Correct Answer: B
Rationale: For a manic episode, three or more of the following symptoms must be present (four
if the mood is only irritable): inflated self-esteem or grandiosity, decreased need for sleep, more
talkative than usual or pressure to keep talking, flight of ideas or subjective experience that
thoughts are racing, distractibility, increase in goal-directed activity or psychomotor agitation,
excessive involvement in activities that have a high potential for painful consequences.
5. A 22-year-old college student presents with a 6-month history of numerous periods of
hypomanic symptoms that do not meet full criteria for a hypomanic episode, alternating with
periods of depressive symptoms that also do not meet full criteria for a major depressive
episode. The patient has never had a manic or major depressive episode. What is the most
likely diagnosis?
A. Bipolar I disorder
B. Bipolar II disorder
C. Cyclothymic disorder
D. Unspecified bipolar and related disorder
Correct Answer: C
Rationale: Cyclothymic disorder is characterized by at least 2 years (1 year in children and
adolescents) of numerous periods with hypomanic symptoms that do not meet criteria for a
hypomanic episode and numerous periods with depressive symptoms that do not meet criteria
for a major depressive episode. The symptoms must be present for at least half of the time and
the individual must not have been without symptoms for more than 2 months at a time.
6. Which of the following best describes the difference between a manic episode and a
hypomanic episode?
, A. Manic episodes require hospitalization; hypomanic episodes do not
B. Manic episodes last at least 1 week and cause marked impairment; hypomanic episodes last
at least 4 days and do not cause marked impairment
C. Manic episodes include psychotic features; hypomanic episodes do not
D. Manic episodes require three associated symptoms; hypomanic episodes require two
Correct Answer: B
Rationale: The key distinguishing features are duration and functional impairment. A manic
episode lasts at least 1 week (or any duration if hospitalization is required) and causes marked
impairment in social or occupational functioning, or requires hospitalization to prevent harm to
self or others, or includes psychotic features. A hypomanic episode lasts at least 4 consecutive
days and is associated with an unequivocal change in functioning that is uncharacteristic of the
individual, but the episode is not severe enough to cause marked impairment or require
hospitalization.
7. A 30-year-old patient with bipolar I disorder is in a manic episode. Which of the following is
the most appropriate initial laboratory assessment to rule out organic causes?
A. Complete blood count and basic metabolic panel
B. Thyroid function tests, urine toxicology, and basic metabolic panel
C. Liver function tests and serum cortisol levels
D. Genetic testing and electroencephalogram
Correct Answer: B
Rationale: Initial laboratory assessment for suspected bipolar disorder should include thyroid
function tests (to rule out hyperthyroidism), urine toxicology (to rule out substance-induced
causes), and basic metabolic panel (to assess baseline renal function and electrolytes, especially
if considering lithium therapy). Other causes such as neurologic conditions, medications, and
other medical conditions should also be considered.
8. A 52-year-old female with a history of bipolar I disorder presents with a manic episode. She
has been non-adherent with her lithium for the past 3 months. Which of the following is the
most significant risk factor for recurrence of a manic episode?
A. Female gender
B. Older age at onset
aNd related disorders – CoMPreHeNsive
exaMiNatioN 150 advaNCed MultiPle-
CHoiCe QuestioNs witH CorreCt aNswers
aNd detailed ratioNales a well
detailed oNe writteN aNd
graded a+ uPgraded
SECTION A: DIAGNOSTIC CRITERIA AND CLINICAL PRESENTATION (Questions 1-30)
1. A 34-year-old patient presents with a distinct period of abnormally elevated mood,
increased goal-directed activity, and decreased need for sleep lasting 8 days. The patient
reports feeling "on top of the world" and has engaged in excessive spending sprees. Which of
the following DSM-5-TR criteria must be met to confirm a manic episode?
A. Duration of at least 2 weeks with three or more associated symptoms
B. Duration of at least 1 week (or any duration if hospitalization is required) with three or more
associated symptoms
C. Duration of at least 4 days with four or more associated symptoms
D. Duration of at least 1 month with two or more associated symptoms
Correct Answer: B
Rationale: According to DSM-5-TR criteria for a manic episode, there must be a distinct period
of abnormally and persistently elevated, expansive, or irritable mood and abnormally and
persistently increased goal-directed activity or energy, lasting at least 1 week and present most
,of the day, nearly every day (or any duration if hospitalization is necessary). During this period,
three or more of the associated symptoms (inflated self-esteem, decreased need for sleep,
pressured speech, flight of ideas, distractibility, increased goal-directed activity, excessive
involvement in activities with high potential for painful consequences) must be present.
2. A 28-year-old female presents with a 5-day history of elevated mood, increased energy,
decreased need for sleep, and excessive involvement in multiple new business ventures with
poor judgment. She has never been hospitalized for psychiatric symptoms. According to DSM-
5-TR criteria, which diagnosis is most appropriate?
A. Bipolar I disorder, current episode manic
B. Bipolar II disorder, current episode hypomanic
C. Cyclothymic disorder
D. Substance/medication-induced bipolar and related disorder
Correct Answer: B
Rationale: The duration of 4 or more days distinguishes a hypomanic episode from a manic
episode. Since the patient's symptoms have lasted only 5 days and she has not required
hospitalization, this meets criteria for a hypomanic episode (minimum 4 consecutive days),
which is characteristic of Bipolar II disorder. A manic episode requires at least 1 week of
symptoms or any duration if hospitalization is required.
3. Which of the following symptom presentations would most strongly suggest a mixed
features specifier in a patient with bipolar I disorder?
A. Elevated mood, grandiosity, and decreased need for sleep
B. Depressed mood, anhedonia, and hypersomnia
C. Elevated mood with three or more depressive symptoms (e.g., depressed mood, anhedonia,
guilt)
D. Irritable mood with increased goal-directed activity and pressured speech
Correct Answer: C
Rationale: The mixed features specifier is applied when an individual meets full criteria for a
manic or hypomanic episode and has at least three depressive symptoms (depressed mood,
diminished interest, psychomotor retardation, fatigue, guilt, sleep disturbance, appetite change,
or suicidal ideation) during the episode. This specifier is clinically significant because mixed
episodes are associated with increased suicide risk and poorer treatment outcomes.
,4. A 45-year-old male with bipolar I disorder presents with a manic episode. Which of the
following is the minimum number of associated symptoms required to meet DSM-5-TR
diagnostic criteria, assuming the mood disturbance is elevated?
A. Two symptoms
B. Three symptoms
C. Four symptoms
D. Five symptoms
Correct Answer: B
Rationale: For a manic episode, three or more of the following symptoms must be present (four
if the mood is only irritable): inflated self-esteem or grandiosity, decreased need for sleep, more
talkative than usual or pressure to keep talking, flight of ideas or subjective experience that
thoughts are racing, distractibility, increase in goal-directed activity or psychomotor agitation,
excessive involvement in activities that have a high potential for painful consequences.
5. A 22-year-old college student presents with a 6-month history of numerous periods of
hypomanic symptoms that do not meet full criteria for a hypomanic episode, alternating with
periods of depressive symptoms that also do not meet full criteria for a major depressive
episode. The patient has never had a manic or major depressive episode. What is the most
likely diagnosis?
A. Bipolar I disorder
B. Bipolar II disorder
C. Cyclothymic disorder
D. Unspecified bipolar and related disorder
Correct Answer: C
Rationale: Cyclothymic disorder is characterized by at least 2 years (1 year in children and
adolescents) of numerous periods with hypomanic symptoms that do not meet criteria for a
hypomanic episode and numerous periods with depressive symptoms that do not meet criteria
for a major depressive episode. The symptoms must be present for at least half of the time and
the individual must not have been without symptoms for more than 2 months at a time.
6. Which of the following best describes the difference between a manic episode and a
hypomanic episode?
, A. Manic episodes require hospitalization; hypomanic episodes do not
B. Manic episodes last at least 1 week and cause marked impairment; hypomanic episodes last
at least 4 days and do not cause marked impairment
C. Manic episodes include psychotic features; hypomanic episodes do not
D. Manic episodes require three associated symptoms; hypomanic episodes require two
Correct Answer: B
Rationale: The key distinguishing features are duration and functional impairment. A manic
episode lasts at least 1 week (or any duration if hospitalization is required) and causes marked
impairment in social or occupational functioning, or requires hospitalization to prevent harm to
self or others, or includes psychotic features. A hypomanic episode lasts at least 4 consecutive
days and is associated with an unequivocal change in functioning that is uncharacteristic of the
individual, but the episode is not severe enough to cause marked impairment or require
hospitalization.
7. A 30-year-old patient with bipolar I disorder is in a manic episode. Which of the following is
the most appropriate initial laboratory assessment to rule out organic causes?
A. Complete blood count and basic metabolic panel
B. Thyroid function tests, urine toxicology, and basic metabolic panel
C. Liver function tests and serum cortisol levels
D. Genetic testing and electroencephalogram
Correct Answer: B
Rationale: Initial laboratory assessment for suspected bipolar disorder should include thyroid
function tests (to rule out hyperthyroidism), urine toxicology (to rule out substance-induced
causes), and basic metabolic panel (to assess baseline renal function and electrolytes, especially
if considering lithium therapy). Other causes such as neurologic conditions, medications, and
other medical conditions should also be considered.
8. A 52-year-old female with a history of bipolar I disorder presents with a manic episode. She
has been non-adherent with her lithium for the past 3 months. Which of the following is the
most significant risk factor for recurrence of a manic episode?
A. Female gender
B. Older age at onset
