CNS/MSE Flashcards
Mental status exam?
- appearance & behavior & LOC
- mood/affect
- speech/language
- thoughts/perceptions
- cognitive/executive function
LOL
LOC
orientation = A&O x3
language
AMEN
attention
memory
executive function
non dominant hemisphere
appearance & behavior
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
mood/affect
appropriate for situation?
depressed, fatigue, insomnia, concentration
anxiety, fear, paranoia
language
spontaneous speech, naming, comprehension, repetition, reading, writing, articulation, paraphasic errors, prosody
*evaluating for aphasia
language disorders?
- aphasia: can’t understand or produce language
-localized lesion of dominant hemisphere of brain - dysphasia: impairment in use of speech
- dysarthria: imperfect articulation d/t lack of motor coordination
Wernicke’s
sensory input into neural word representations to give a word meaning
-expressive aphasia
Broca’s
transforms neural word representations into actual articulations that can be spoken
-receptive aphasia
apraxia
inability to turn verbal request into motor performance
thoughts & perception
process, content, insight, judgment
cognitive function
orientation (person, place, time)
memory (recent, remote)
attention (ability to concentrate)
delirium
acute confusion episode
-infection, uremia, alcohol withdrawal
-disoriented, poor judgment, delusions, poor attention
dementia
insidious, slow progressive, flat affect
-Alzheimer’s, B12 deficiency, hypothyroid, trauma
executive function
abstract thinking/insight (mostly for dementia)
calculation (repeat 5-6 #s in order)
constructional ability (ask them to copy a drawing)
gait cerebellar testing
regular walk
tandem (one in front of other)
heel/toe walk
heel to shin
slide heel along shin for b/l smoothness & coordination
romberg/pronator drift
poor stance eyes closed: posterior column
poor stance eyes open: cerebellar ataxia
pronator drift: contralateral corticospinal
*direction of fall may indicate where lesion is
Finger to Nose
- eyes open: ensure pt extends arm completely & moves finger up, down & midline
- clumsy, vary in speed, past pointing = dysmetria - eyes closed: drunk test (bring pointer finger to nose)
dysdiadochokinesis
flip hand over in palm, must lift hand off palm
-irregular & clumsy
CN I
- olfactory
-usually tested with coffee beans or cinnamon or mint
CN II
-optic
-acuity, pupillary reflex, visual field exam
-ophthalmoscopic exam
CN III, IV, VI
III: oculomotor / IV: trochlear / VI: abducens
-esotropia: medial deviation
-exotropia: lateral deviation
-horizontal diplopia: mild or total loss of LR function
CN V
sensory: ophthalmic, maxillary, mandibular
motor: masseter & pterygoid
-corneal reflex (touch eye with cotton, afferent V, efferent VII)
CN VII
facial n
close eyes, raise eyebrows, smile
central: lower face, contralat side affected
peipheral: unilat involvement, ipsilat upper & lower face
CN VIII
vestibulocochlear n
hearing & balance
TBI (concussion)
injured nerves:
I, VII, VIII
CN IX
glossopharyngeal n = sensory to soft palate
CN X
vagus nerve = raise palate
gag reflex
in IX, out X
CN XI
spinal accessory n
motor to SCM & trap
CN XII
hypoglossal nerve
motor to tongue / look for atrophy or fasciculations
*peripheral lesion = tongue deviates to same side
