CNS/MSE

Question 1

Mental status exam?

Answer 1

1. appearance & behavior & LOC
2. mood/affect
3. speech/language
4. thoughts/perceptions
5. cognitive/executive function

Question 2

LOL

Answer 2

LOC
orientation = A&O x3
language

Question 3

AMEN

Answer 3

attention
memory
executive function
non dominant hemisphere

Question 4

appearance & behavior

Answer 4

alert - awake, sleepy, tired
lethargic - awake but tends to fall asleep
stuporous - falls asleep unless vigorously stimulated
comatose - sleep like state from which pt cannot be awakened

Question 5

mood/affect

Answer 5

appropriate for situation?
depressed, fatigue, insomnia, concentration
anxiety, fear, paranoia

Question 6

language

Answer 6

spontaneous speech, naming, comprehension, repetition, reading, writing, articulation, paraphasic errors, prosody
*evaluating for aphasia

Question 7

language disorders?

Answer 7

1. aphasia: can’t understand or produce language
   -localized lesion of dominant hemisphere of brain
2. dysphasia: impairment in use of speech
3. dysarthria: imperfect articulation d/t lack of motor coordination

Question 8

Wernicke’s

Answer 8

sensory input into neural word representations to give a word meaning
-expressive aphasia

Question 9

Broca’s

Answer 9

transforms neural word representations into actual articulations that can be spoken
-receptive aphasia

Question 10

apraxia

Answer 10

inability to turn verbal request into motor performance

Question 11

thoughts & perception

Answer 11

process, content, insight, judgment

Question 12

cognitive function

Answer 12

orientation (person, place, time)
memory (recent, remote)
attention (ability to concentrate)

Question 13

delirium

Answer 13

acute confusion episode
-infection, uremia, alcohol withdrawal
-disoriented, poor judgment, delusions, poor attention

Question 14

dementia

Answer 14

insidious, slow progressive, flat affect
-Alzheimer’s, B12 deficiency, hypothyroid, trauma

Question 15

executive function

Answer 15

abstract thinking/insight (mostly for dementia)
calculation (repeat 5-6 #s in order)
constructional ability (ask them to copy a drawing)

Question 16

gait cerebellar testing

Answer 16

regular walk
tandem (one in front of other)
heel/toe walk

Question 17

heel to shin

Answer 17

slide heel along shin for b/l smoothness & coordination

Question 18

romberg/pronator drift

Answer 18

poor stance eyes closed: posterior column
poor stance eyes open: cerebellar ataxia
pronator drift: contralateral corticospinal
*direction of fall may indicate where lesion is

Question 19

Finger to Nose

Answer 19

1. eyes open: ensure pt extends arm completely & moves finger up, down & midline
   - clumsy, vary in speed, past pointing = dysmetria
2. eyes closed: drunk test (bring pointer finger to nose)

Question 20

dysdiadochokinesis

Answer 20

flip hand over in palm, must lift hand off palm
-irregular & clumsy

Question 21

CN I

Answer 21

• olfactory
  -usually tested with coffee beans or cinnamon or mint

Question 22

CN II

Answer 22

-optic
-acuity, pupillary reflex, visual field exam
-ophthalmoscopic exam

Question 23

CN III, IV, VI

Answer 23

III: oculomotor / IV: trochlear / VI: abducens
-esotropia: medial deviation
-exotropia: lateral deviation
-horizontal diplopia: mild or total loss of LR function

Question 24

CN V

Answer 24

sensory: ophthalmic, maxillary, mandibular
motor: masseter & pterygoid
-corneal reflex (touch eye with cotton, afferent V, efferent VII)

Question 25

CN VII

Answer 25

facial n
close eyes, raise eyebrows, smile
central: lower face, contralat side affected
peipheral: unilat involvement, ipsilat upper & lower face

Question 26

CN VIII

Answer 26

vestibulocochlear n
hearing & balance

Question 27

TBI (concussion)

Answer 27

injured nerves:
I, VII, VIII

Question 28

CN IX

Answer 28

glossopharyngeal n = sensory to soft palate

Question 29

CN X

Answer 29

vagus nerve = raise palate

Question 30

gag reflex

Answer 30

in IX, out X

Question 31

CN XI

Answer 31

spinal accessory n
motor to SCM & trap

Question 32

CN XII

Answer 32

hypoglossal nerve
motor to tongue / look for atrophy or fasciculations
*peripheral lesion = tongue deviates to same side