Acronyms & MSE Flashcards
DEMENTIA mnemonic
D- drugs/alcohol/depression
E- ears/eyes
M- metabolic (hypoNa2+, DM, hypoThyroid)
E- emotional problems (loneliness)
N- nutrition (diet: vit B deficiency, teeth probs)
T- tumours/trauma (of CNS)
I- infection
A- arteriovascular Disease (cerebral insufficiency)
Geriatric ABCs
A- ADLs
B- balance, frailty test
C- cognition
D- depression/drugs/dentition (nutrition, weight, stability)
E- environment: home situation, social support, finances, ACPs etc.
F- falls risk (Hx & test it!)
G- gait speed
H- hearing/vision
I- incontinence
Consultation Sequence: x 6
History
Examination
Explanation (findings, DDx, management plan)
Ordering/conducting/explaining investigations
Treatment commencement
Disposition decisions (Tx/P5/Non-Tx)
Physical exam approach: x 5
- hand hygiene
- introduction/consent/chaperone
- confidentiality
- positioned comfortably
- expose only as necessary
Physical observation general: x 10
- first impressions
- mobility
- SOB
- general appearance: jaundice, cyanosis, pallor, hair cond
- vital signs
- weight, body habitus, posture/gait
- hydration/skin turgor
- hands: fingernails/arthritis
- smell: acetone, uraemia (renal failure), UTI, cigarettes, halitosis, alcohol, melaena
- systematic approach/focused assessments: inspect, palpate, percuss, auscultate, +/- assessment of function
History sequence steps: x 7
1- Presenting symptom/reason
2- Hx presenting illness
3- medication & Rx Hx
4- PMHx
5- Social Hx
6- Family Hx
7- Systems review
Hx Presenting Illness: x 4
- current illness/symptoms
- prev similar episodes
- extent of functional disability (if any)
- effect of the illness
Medication & Rx Hx: x 4
- current Rx (physically look at them)
- drugs (OTC, Prescribed, Alternatives): dose, duration, indication (reason Vs Pt’s perception), & side effects.
- past Rxs
- allergies or reactions
PMHx: x 5
- past illnesses
- surgical operations
- females: menstrual/reproductive Hx/issues
- immunisations
- blood transfusions
Social Hx: x 8
- upbringing & education level/language barriers
- martial status/social support/living cond/financial situation/pets
- diet & exercise/mobility
- occupation/hobbies
- travel
- smoking/ETOH
- analgesic/illicit drug use
- mood/sexual Hx
Family Hx: x 2
- parents/siblings/dependents
- any medical Hx that runs in the family
Systems Review: x 9 + 2
- CVS
- Resp
- GIT
- GU
- Haematological
- MSK
- Endocrine
- Reproductive
- Neuro
Extras:
- ENT
- IntegSys
Mental Health Assessment : x 5
- reason for call/Pt’s response to yr presence
- PP/PPHx
- Mental Health Hx
- Fam MH Hx
- substance use Hx
MSE Components: x 8 (Act PC IJM)
1- Appearance, physical activity & behaviour
2- Conversation, mood & affect
3- Thought form, content & process
4- Perceptions
5- Conscious Awareness
6- Insight
7- Judgement
8- Memory
Appearance: x 7
- General appearance, ability to conduct ADLs & appropriateness of attire
- Gender & ethnicity
- Gen app: chronological age & apparent age
- Physical characteristics - body build, posture, distinguishing marks
- Clothing - condition of clothes, cleanliness, appropriateness to weather
- Grooming - peculiarities of dress, use of cosmetics, jewellery, hair style
- Gait
MSE Physical activity & Behaviour: x 7
- observable behaviour, manner & attitude
- posture, gait, gestures, tics, grimaces, tremors, mannerisms
- Activity - overactive/underactive, purposeful/disorganised, pacing, restless, sedentary
- Any signs of physically slowing down
- Facial expression: alert, tense, worked, happy , sad, frightened, angry, laughing, smiling, suspicious
- Rapport w interviewer: friendly or aloof
- Attitude during interview: indifferent, friendly, dramatic, evasive, sullen, irritable, afraid, impulsive, embarrassed, sexually provocative
MSE Conversation: x 4
- how the person talks: quantity, rate volume
- soft, loud, stuttering or hesitant
- Flow of speech: even/uneven, slow/rapid
- any references to: disordered, negative, unrealistic or unusual thoughts
MSE Affect: x 2
- the feeling or emotional state observed by the assessor on the Pt’s statements, appearance, behaviours
- egs; full range (normal), blunted, flat, inappropriate/incongruent, labile (fluctuating) or restricted
MSE Mood: x 1 w egs
- the person’s subjective statements about their emotional state
- egs; depressed, happy/sad, neutral/apathetic, irritable, anxious/angry, fearful/euphoric
MSE Thought Form: x 5
- amount of thought & its rate of production
- Lack of ideas - cannot identity any thoughts
- Flight of ideas - cannot remain on one topic
- Loose associations- thinking jumps around without apparent connection
- slow/hesitant
MSE Thought Content: x 6
- topics or areas that one thinks about
- makes a judgement about what the person is saying: does it make sense; are the ideas related - do they flow logically
- Ask about suicidal or self-harm ideation
- Delusions
- Obsessions
- Compulsions
Delusions: x 5 + 3
Fixed false beliefs or uncompromising beliefs;
- persecutory
- grandiose
- delusions of reference
- delusions of influence
- religious
May also involve:
- thought insertion (someone else’s thoughts inserted)
- thought broadcasting (sending out thoughts to others)
- thought withdrawal (thoughts taken out of one’s mind)
Obsessions
Involuntary & unwelcome ideas that intrude on the person’s other thoughts
- they then demand attention even though the person may recognise them as irrational
Compulsions
Insistent, repetitive & unwanted urges to perform a certain act
Thoughts Process: x 6
- the movement & dynamics of how one thoughts connects to the next
- Logical thought
- Loose associations (lack of connection between ideas)
- Word salad (jumble of extremely incoherent speech)
- Echolalia (unsolicited repetition of vocalisations made by another person)
- Clang associations (putting words together because of how they sound, not their meaning)
- Perseveration (‘getting stuck’ on a topic/thoughts/emotions)
Perceptions: x 4
The person’s experience of their world through their senses, may include false or misperceptions;
- Hallucinations (auditory, visual, olfactory, gustatory or tactile)
- Illusions (misinterpretation of an actual external stimulus)
- Depersonalisation (feeling of unreality where the perception of self seems different or unfamiliar - out of body experience or - often associated w stress, fatigue & extreme anxiety)
- Derealisation (sense that the external world feels unreal, different or altered - feeling cut-off from the world - often associated w stress, fatigue & extreme anxiety).
Conscious Awareness: x 4
LOC - A/V/P/U
Orientation - time, place, person
Concentration - count backwards from 100 in serial 7s OR spell WORLD backwards OR repeat a 3-part task.
Abstract Thinking - ability to deal with concepts & to extract meaning or to juggle more than one idea at a time (don’t put all yr eggs in the one basket).
Insight
Degree to which the person realised the significance of their symptoms or illness & their current situation or the degree of self-understanding
Judgement
Ability to make sensible decision based on expected consequences in everyday activities & social situations
Memory: x 3
Remote past recall - coherent life story w dates & places
Recent past recall - Hx & events leading up to yr attendance
Immediate past recall - ability to recall a person’s name & 3 unrelated facts 5 mins post being given them.
Additional Info req for MSE: x 10 egs
- reason for presentation, nature of PP & PPHx
- precipitating factors & recent stressors
- compliance w current Rx
- any urgent social issues that need addressing
- support structures available to the person
- strengths & any predisposing, precipitating & perpetuating factors
- Medical Hx
- Psychiatric Hx
- Risk assessment - to self, others, falls, poor nutrition
- Social Hx - per prev presentations
SPACESPIT
S- size
P- position
A- attachments
C- consistency
E- edge
S- surface & shape
P- pulsation, thrills & bruits
I- inflammation
T- trans illumination
