Chapter 1 Pt 1 Flashcards
what are the parts of the mental status exam
appearance/behavior speech mood affect thought process thought content perceptual disturbances cognition memory fund of knowledge abstract thought insight judgement
what are the characteristics of DELIRIUM
acute onset waxing/waning sensorium (worse at night) disorientation inattention impaired cognition disorganized thinking altered sleep-wake cycle perceptual disorders (hallucinations, illusion)
what are come causes of DELIRIUM
drugs (narcotics, benzos, anticholinergics, TCAs, steroids, diphenhydramine…)
EtOH withdrawal
metabolic (cardiac, respiratory, renal, hepatic, endocrine)
infection
neurological causes (increased ICP, encephalitis, postictal, stroke)
what routine investigations should be performed on a patient with delirium
CBC electrolytes glucose renal panel LFTs TFTs UA UDS CXR O2 saturation HIV
what are some medium yield studies in a delirium patient
EKG (silent MI)
blood gas
ionized calcium
if the routine and medium yield studies are inconclusive in a delirium patient what studies should be done
head CT/MRI
EEG
LP
what is tested on a mini-mental status exam
orientation (10) registration (3) attention (5) delayed recall (3) language (9)
how does one test orientation on mini-mental status exam
What is the [year] [season] [date] [day] [month]?
Where are we [state] [county] [town] [hospital] [floor]?
1pt each for total of 10
how does one test registration on mini-mental status exam
ask patient to repeat 3 unrelated objects
if incomplete first try, repeat up to 6 times (record # of trials)
how does one test attention on mini-mental status exam
serial 7’s
spell “world” back words
how does one test delayed recall on mini-mental status exam
ask patient to recall 3 previously asked objects for registration
how does one test language on mini-mental status exam
name 2 common objects
repeat following sentence: “no if ands or buts”
give patient paper “take it in your right hand, use both hands to fold it in half, and then put it on the floor”
have patient read and follow: “close your eyes”
ask patient to write sentence
ask patient to copy design
what is the pneumonic for Mania
DIG FAST
Distractibility
Irritable mood/Insomnia
Grandiosity
Flight of ideas
Agitation/increase in goal directed Activity
Speedy thoughts/Speech
Thoughtlessness (seek pleasure without regard to consequences)
what is the pneumonic for Suicide Risk
SAD PERSONS Sex-male Age >60 Depression Previous Attempt Ethanol/drug abuse Rational thinking loss Suicide in family Organized plan/access No support Sickness
what is the pneumonic for depression
SIG E. CAPS Sleep Interest Guilt Energy Concentration Appetite Psychomotor changes Suicidal ideation (hopelessness, helplessness, worthlessness)
