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Bipolar I disorder — USMLE Step 2 CK MCQ

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EasyPsychiatryBipolar I disorderUSMLE Step 2 CK

A 64-year-old Middle Eastern man comes to the clinic because of changes in mood, behavior, or thinking. History and focused examination are notable for decreased need for sleep, grandiosity, pressured speech, and risky spending for one week. Temperature is 98.6°F (37.0°C), blood pressure is 126/78 mmHg, pulse is 84/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. There is no evidence of intoxication, delirium, or a primary neurologic disorder unless described in the vignette. Which of the following is the most appropriate next step in management?

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Correct answer: A — Lithium or valproate plus antipsychotic when acutely manic

The vignette describes Bipolar I disorder, supported by decreased need for sleep, grandiosity, pressured speech, and risky spending for one week. Lithium or valproate plus antipsychotic when acutely manic is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: APA Bipolar Disorder Guideline