# MCCQE Part I Bipolar Disorder Questions: 10 Free Practice MCQs > 10 free MCCQE Part I bipolar disorder questions with answers and explanations, from a bank of 13 bipolar disorder questions. Try them now, no sign up. Canonical: https://medhub.one/practice/mccqe-part-1/bipolar-disorder Last updated: 2026-10-31 Bipolar disorder questions test recognition and the medication decision. The MCC objectives expect you to identify a manic or hypomanic episode, distinguish it from psychosis and substance use, and avoid the mistake of treating it with an antidepressant alone. They also expect a risk assessment, a plan for the acute episode and a maintenance strategy that accounts for pregnancy, renal function and adherence. ## Where candidates lose marks * Prescribing an antidepressant alone and triggering a manic switch. * Missing the mixed episode where depression and agitation coexist with high risk. * Starting lithium without checking renal and thyroid function and without a level plan. * Ignoring the risks of stopping treatment abruptly. **Guideline to follow:** The MCCQE Part I follows the CANMAT guidelines for bipolar disorder and the Canadian Psychiatric Association guidance on mood stabilisers and monitoring. Ten MCCQE Part I-style bipolar disorder questions with the answer and the reasoning behind it. They come from the CA.med bank, which has 13 bipolar disorder questions and many more across every topic. [Free timed mock exam](https://medhub.one/practice/mccqe-part-1/mock) 1. 1 / 10 A 38-year-old man with bipolar I disorder has had complete resolution of manic symptoms after 6 weeks of lithium, and he now feels well. He asks whether he still needs the medication, and mentions that he would prefer to stop it because he dislikes the blood tests. What is the most appropriate advice about maintenance treatment? Show answer **Answer: B.** Continue lithium at a therapeutic level, because withdrawal can precipitate recurrence **Why:** Maintenance treatment aims to consolidate remission, restore functioning and prevent recurrence. The medication that was effective in the acute phase is generally continued into the maintenance phase, and the guidelines note that treatment withdrawal may precipitate recurrence, with 50% to 90% of patients who discontinue lithium experiencing a recurrence within 3 to 5 months. Lithium, quetiapine, divalproex, lamotrigine, asenapine and aripiprazole, as monotherapy or in combination, should be considered first-line for those initiating or switching treatment during maintenance. Antidepressant monotherapy is not recommended in bipolar I disorder, and benzodiazepines do not prevent mood episodes. * **A.** Stopping the mood stabiliser once symptoms remit leaves him at high risk of recurrence, since most patients who discontinue lithium relapse within 3 to 5 months. * **C.** An antidepressant alone does not protect against manic relapse and is not recommended as monotherapy in bipolar I disorder, so it cannot replace mood stabilisation. * **D.** Benzodiazepines do not prevent mood episodes, carry risks of dependence and sedation, and have no role as maintenance treatment for bipolar disorder. Sources: CANMAT/ISBD 2018 guidelines for the management of patients with bipolar disorder 2. 2 / 10 A 26-year-old woman with bipolar I disorder has been stable on divalproex for 3 years. She tells her family physician that she and her partner plan to conceive in the next few months and asks whether she should keep taking the same medication. What is the most appropriate advice? Show answer **Answer: B.** Switch to an appropriate alternative before conception, because valproate has a high teratogenic potential **Why:** Divalproex and carbamazepine should be used with caution in women of childbearing age. Health Canada recommends that valproate products should not be used in female children, female adolescents, women of childbearing potential and pregnant women unless alternative treatments are ineffective or not tolerated, because of the high teratogenic potential and the risk of developmental disorders in infants exposed in utero. Women of childbearing potential must use effective contraception during treatment and be informed of these risks, and in women planning to become pregnant every effort should be made to switch to an appropriate alternative before conception. Stopping all treatment is not the answer, because untreated bipolar disorder carries a substantial risk of recurrence; the switch should simply be planned. * **A.** Continuing valproate through conception is discouraged because of its high teratogenic potential and the risk of developmental disorders in infants exposed in utero. * **C.** Abrupt withdrawal of mood stabilisation is not required and would leave her at high risk of relapse, so the aim is a planned switch rather than no treatment. * **D.** The guidelines state that there is not enough evidence that folic acid, even in high doses, protects against spina bifida following the use of anticonvulsants. Sources: CANMAT/ISBD 2018 guidelines for the management of patients with bipolar disorder 3. 3 / 10 A 40-year-old man with a history of bipolar disorder presents to his family physician with a 2-week history of increased thirst and urination. His blood glucose level is 15 mmol/L, and his hemoglobin A1c is 10%. He is currently taking lithium and olanzapine for his bipolar disorder. What is the most appropriate next step in managing this patient's condition? Show answer **Answer: B.** Refer to a psychiatrist for medication adjustment **Why:** The patient's bipolar disorder and diabetes require careful management, and a psychiatrist can help adjust his medications to minimize the risk of worsening his psychiatric condition. According to Diabetes Canada, patients with diabetes and mental health conditions require comprehensive care that addresses both their physical and mental health needs. * **A.** While metformin is a common treatment for type 2 diabetes, it is not the most appropriate next step in managing this patient's condition, given his complex medical and psychiatric history. * **C.** While insulin therapy may be necessary for this patient, it is not the most appropriate next step, given the need to adjust his psychiatric medications and manage his bipolar disorder. * **D.** While monitoring his blood glucose levels is important, it is not the most appropriate next step in managing this patient's condition, given the need to adjust his medications and manage his bipolar disorder. Sources: Diabetes Canada 4. Like these? CA.med has a bank of 1500 questions, plus timed mock exams. 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The guidelines recommend routine screening of thyroid function because lithium causes hypothyroidism, which is itself associated with an increased risk of affective episodes, rapid cycling and more severe depression, and monitoring of serum calcium because lithium can cause hyperparathyroidism. Renal function and plasma calcium should be assessed at 6 months and at least annually thereafter, or more often if clinically indicated. Serum lithium levels should be measured at the trough, about 12 h after the last dose, with two consecutive levels in the therapeutic range during the acute phase and repeat measurement every 3 to 6 months or more frequently if clinically indicated. * **A.** Glucose and lipid monitoring is relevant to antipsychotic therapy, whereas lithium requires monitoring of endocrine and renal parameters. * **B.** Sodium and urine osmolality are not the parameters recommended for routine lithium surveillance, although lithium can affect renal concentrating ability. * **D.** Liver enzymes and amylase are not the recommended routine tests for lithium, which is not hepatotoxic in the way that divalproex can be. Sources: CANMAT/ISBD 2018 guidelines for the management of patients with bipolar disorder 6. 5 / 10 A 24-year-old man is brought to the emergency department after 8 days of sleeping only 2 hours a night without feeling tired, talking rapidly, describing grand plans to start a company, and spending several thousand dollars on equipment he cannot afford. He has had two past episodes of low mood that lasted weeks. His physical examination is unremarkable and his urine drug screen is negative. What is the most likely diagnosis? Show answer **Answer: B.** Bipolar I disorder **Why:** Bipolar I disorder requires at least one manic episode. A manic episode is a distinct period of abnormally and persistently elevated, expansive or irritable mood with abnormally and persistently increased activity or energy, present most of the day nearly every day for at least one week, or for less time if hospital assessment is necessary, together with at least three additional symptoms such as grandiosity, decreased need for sleep and pressured speech. Hypomanic episodes are not severe enough to cause marked impairment or require hospital assessment, and the absence of manic episodes is what separates bipolar II disorder from bipolar I disorder. Unipolar major depressive disorder is the most frequent misdiagnosis in people who later prove to have bipolar disorder, because patients usually present during depression and may not report past periods of elevated mood. Past depressive episodes are common in bipolar I disorder and do not exclude it. * **A.** Hypomania by definition does not cause marked impairment or require hospital assessment, so an episode of this severity is not bipolar II disorder. * **C.** Although he has had past episodes of low mood, the present illness is dominated by elevated mood and increased activity rather than depressed mood, so unipolar depression does not explain it. * **D.** Mood-incongruent psychotic symptoms outside a mood episode are required for schizoaffective disorder, and none are described here. Sources: CANMAT/ISBD 2018 guidelines for the management of patients with bipolar disorder 7. 6 / 10 A 30-year-old patient presents to the clinic with a history of recurrent depressive episodes and periods of elevated mood, increased energy, and decreased need for sleep. The patient reports that these episodes have been occurring for several years and have caused significant impairment in their daily life. What is the most likely diagnosis for this patient? Show answer **Answer: A.** Bipolar II Disorder **Why:** The patient's history of recurrent depressive episodes and periods of elevated mood, increased energy, and decreased need for sleep is consistent with a diagnosis of Bipolar II Disorder. The Canadian Network for Mood and Anxiety Treatments recommends a comprehensive diagnostic evaluation, including a thorough clinical interview and assessment of mood symptoms, to establish a diagnosis of Bipolar II Disorder. * **B.** While the patient has a history of depressive episodes, the presence of periods of elevated mood and increased energy suggests a more complex diagnosis. * **C.** While the patient has a history of mood instability, the episodes of elevated mood and increased energy are not consistent with the diagnostic criteria for Cyclothymic Disorder. * **D.** While the patient has a history of mood instability, the presence of periods of elevated mood and increased energy is not consistent with the diagnostic criteria for Borderline Personality Disorder. Sources: Canadian Network for Mood and Anxiety Treatments 8. 7 / 10 A 27-year-old woman describes a 10-year history of recurrent episodes of low mood lasting weeks, interspersed with shorter periods in which she feels unusually energetic, needs less sleep, talks more than usual and is more productive at work. These shorter periods last about 5 days, her friends notice the change, and she continues to work without needing admission to hospital. She has no history of psychosis. What is the most likely diagnosis? Show answer **Answer: C.** Bipolar II disorder **Why:** Bipolar II disorder is a distinct condition from bipolar I disorder. The diagnosis requires one or more episodes of hypomania, one or more episodes of depression, and an absence of manic episodes. Hypomanic symptoms must be uncharacteristic of the individual, observable by others, and last at least 4 consecutive days; unlike mania they cannot be severe enough to cause marked impairment or require hospital assessment, and psychosis is absent. Bipolar I disorder requires a manic episode. Major depressive disorder is diagnosed when there has been no hypomanic or manic episode at all. Cyclothymic disorder describes chronic mood fluctuations that do not meet the full criteria for a hypomanic or depressive episode. * **A.** A manic episode with marked impairment or the need for hospital assessment has not occurred, so her course does not meet the threshold for bipolar I disorder. * **B.** The recurring periods of elevated energy and reduced need for sleep are hypomanic episodes, so labelling her illness as unipolar depression alone is incomplete. * **D.** Chronic subthreshold mood swings that do not meet full episode criteria would suggest cyclothymic disorder, which does not match her history of full depressive and hypomanic episodes. Sources: CANMAT/ISBD 2018 guidelines for the management of patients with bipolar disorder 9. 8 / 10 A 32-year-old woman with bipolar I disorder has a current depressive episode. Two years ago she became elated and slept only 3 hours a night for a week after she was started on an antidepressant, and she has also had recent rapid cycling. She asks whether an antidepressant could be added to her lithium. What is the most appropriate advice? Show answer **Answer: D.** Avoid the antidepressant where possible, or use it cautiously with mood stabilisation, because of her history of antidepressant-induced mania and rapid cycling **Why:** Treatment-emergent switch is a central safety consideration in bipolar disorder. CANMAT and the International Society for Bipolar Disorders advise that antidepressants should ideally be avoided, or used cautiously if necessary, in patients with a history of antidepressant-induced mania or hypomania, current or predominant mixed features, or recent rapid cycling. Antidepressant monotherapy is not recommended for the treatment of bipolar I depression. Patients and caregivers should be educated about the early warning symptoms of mood switching or cycle acceleration, and the antidepressant should be discontinued if these emerge. * **A.** Combining an antidepressant with a mood stabiliser reduces but does not eliminate the risk of a treatment-emergent switch, and her previous antidepressant-induced mania and rapid cycling make this a high-risk situation. * **B.** Antidepressant monotherapy is not recommended for bipolar I depression, and stopping lithium would remove the mood stabilisation she needs. * **C.** Lowering the lithium dose would reduce protective mood stabilisation while leaving the switch risk unchanged, which is the opposite of what is wanted. Sources: CANMAT/ISBD 2018 guidelines for the management of patients with bipolar disorder 10. 9 / 10 A 31-year-old man is referred with a third episode of major depression. He has responded partially to two different antidepressants. He describes prominent fatigue, anhedonia and early morning waking, and he mentions that his father had a mood disorder. The referral letter does not record any assessment of past periods of elevated mood. What is the most appropriate next step in assessment? Show answer **Answer: C.** Ask him and a collateral informant specifically about past periods of abnormally elevated or irritable mood, increased energy and decreased need for sleep **Why:** Bipolar disorder is most often misdiagnosed as major depressive disorder because patients usually present while depressed and may not recall, or may not interpret as pathological, past periods of hypomania or mania. The Canadian bipolar guidelines note that many individuals are not accurately diagnosed until up to 10 years after the onset of symptoms, with one to four alternate diagnoses typically given beforehand, and that this delay leads to inadequate initial treatment and worse outcomes. Asking the patient and a collateral informant directly about past episodes of elevated or irritable mood with increased energy and decreased need for sleep is therefore the highest-yield next step, and it may change the treatment plan away from antidepressant monotherapy. * **A.** Combining antidepressants addresses symptom relief but does not resolve the question of whether his recurrent depression is in fact part of a bipolar course. * **B.** Substance use is worth reviewing, but it does not replace the key historical question about past hypomanic or manic episodes in a patient with recurrent depression. * **D.** Electroconvulsive therapy is considered for severe or refractory illness, and pursuing it before clarifying the diagnosis would leave the missed question of a bipolar course unresolved. Sources: CANMAT/ISBD 2018 guidelines for the management of patients with bipolar disorder 11. 10 / 10 A 30-year-old woman with bipolar I disorder is brought to hospital with a manic episode that began 10 days ago. She is taking no medication, she has no mixed features and no history of substance misuse, and she has previously responded well to lithium. Which medication is recommended as the first-line treatment for her acute mania? Show answer **Answer: A.** Lithium **Why:** The Canadian bipolar guidelines recommend lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone and cariprazine, alone or in combination, as first-line treatments for acute mania, and they advise that agents placed higher in the hierarchy be tried first, in the order listed, with lithium considered first unless patient-specific reasons such as mixed features or previous non-response to lithium argue otherwise. Lamotrigine is not a first-line antimanic agent. Antidepressant monotherapy is not recommended in bipolar I disorder because of the risk of treatment-emergent switch. Benzodiazepines serve only short-term control of agitation. * **B.** This anticonvulsant has a role in bipolar depression and in maintenance treatment, but it is not among the agents recommended first-line for an acute manic episode. * **C.** An antidepressant given alone is not recommended in bipolar I disorder and could aggravate the manic episode rather than treat it. * **D.** A benzodiazepine may be used for short-term control of agitation, but it is not a definitive first-line treatment for the manic episode itself. Sources: CANMAT/ISBD 2018 guidelines for the management of patients with bipolar disorder ## Explore the 1500-question bank in CA.med Timed practice, spaced repetition and AI clinical simulations that grade you like an examiner. Free to start. 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