CNS & Mental Status Exam Flashcards
What are the five components of the MSE?
- Appearance and behavior
- Mood and affect
- Speech and language
- Thoughts and Perception
- Cognition and Executive function
Note: each step should be performed in order
Which component is level of consciousness a part of and how is it classified?
This is a part of appearance and behavior. A patient can be determined to be alert, lethargic, stuporous, or comatose.
Aside from level of consciousness what other things (3) should be considered in appearance and behavior?
Posture, motor activity, and hygeine
What should the assessment of language include (6)?
Spontaneous speech, naming, comprehension, repetition, reading, and writing.
How do you assess articulation and what is paraphasia?
Is there appropriate word finding. This is part of assessing spontaneous speech.
Paraphasia - substitution of similar sounding words and syllables
What are parts of verbal fluency?
Does a patient maintain a consistent verbal rate, volume, meaning, and melody. This is part of spontaneous speech.
What is aphasia?
Disorder in understanding or producing language.
How can you assess naming, comprehension, repetition, reading, and writing?
Ask the patient to name specific objects. Lack of this ability is called anomia and it is the most common symptom in true aphasia.
Verbally give the patient a task to perform.
Ask the patient to repeat words or phrases.
Have them read and write short sentences.
What is dysphasia?
Impairment in use of speech that is clear. They fail to organize words properly.
What is dysarthria?
Impairment of speech due to lack of motor coordination.
What is Broca’s aphasia?
This is “expressive” aphasia where understanding of spoken language is mostly preserved.
What is Wernicke’s aphasia?
“Receptive” aphasia. Patient speaks fluently but does not make sense.
What is apraxia?
Inability to turn verbal requests into motor performance
What are the four components of thoughts and perception?
Process, content, insight, and judgement
What are the three components of cognitive function?
Orientation - person, place, and time
Attention - ability to concentrate
Memory - recent and remote
How is recent memory typically tested?
Give the patient three object to recall 3 to 5 minutes later
When would remote memory be tested?
To confirm diagnosis of dementia
What are the three components of executive funciton?
Abstract thinking, calculation, and constructional thinking
How can abstract thinking be assessed?
Asking a patient to describe the meaning of proverbs. Ask the patient to answer situational questions. Ask the patient to describe similarities and differences between objects.
What is delerium and dementia? How can you easily differentiate the two?
Delerium - an acute episode of poor judgment and poor attention
Dementia - insidious. Flat affect. Typically maintain orientation and attention until late in process
The two are differentiated by the patient’s ability to maintain attention
What are some ways for assessing a patient’s ability to perform calculations?
Spell a word backwards. Count a span of 5 or 6 numbers in order. Name the months of the year backwards and forwards. Be able to double a number multiple times.
How can construcitonal ability be tested?
Ask the patient to copy or draw a simple figure.
What are the three components of cerebellar testing?
Gait. Heel-to-shin. Rhomberg.
How is gait tested?
Regular walking, tandem walking, walking on heels, and walking on toes.
What does a Rhomberg test determine?
If ataxia is cerebellar or proprioceptive. Proprioceptive ataxia will only be present when the eyes are closed.
What does pronator drift indicate?
This is specific for a corticospinal tract lesion
How can dysmetria be assessed?
Finger-to-nose with eyes open
What is dysdiadochokinesis?
Inability to perform rapidly alternating and opposite movements
How is CN I tested and when are abnormalities typically seen?
Assess with coffee beans or cinnamon. Abnormalities seen in concussions.
How can CN II be tested?
Visual acuity, pupillary reflex, and visual field
How can CN III, IV, VI be tested?
Test extra-ocular movements
How can CN V be tested?
Test sensory in all three division and movement of the mandible. Corneal reflex.
How can CN VII be tested?
Assess the muscles of facial expression
How can CN VIII be tested?
Directly test hearing. Vestibular portion is assessed by determining a history of vertigo.
How can CN IX and X be tested?
Assess the gag reflex
How can CN XI be tested?
Have patient shrug shoulders or tilt head
How can CN XII be tested?
Have patient move tongue
