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HMS PDR > Mental Status Exam > Flashcards

Mental Status Exam Flashcards

1
Q

Ideal context for the mental status exam

A

If possible, the mental status examination should occur when the physician is alone with the patient and again in the presence of the patient’s friends or family members who can provide more longitudinal insight into problems the patient may be having

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2
Q

11 Different functions that the cognitive assessment tests for

A
  1. Attention
  2. Executive function
  3. Gnosia
  4. Language
  5. Memory
  6. Orientation
  7. Praxis
  8. Prosody
  9. Thought content
  10. Thought processes
  11. Visuospatial proficiency
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3
Q

Mood vs Affect

A
  • Mood: Patient’s subjective assessment of their emotional status
  • Affect: Physician’s subjective assessment of the patient’s emotional state based on evidence from the encounter
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4
Q

Akathisia

A

Excessive motor activity (e.g., pacing, wringing of hands, inability to sit still)

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5
Q

Bradykinesia

A

Psychomotor retardation (e.g., slowing of physical and emotional reactions)

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6
Q

Catatonia

A

Immobility with muscular rigidity or inflexibility

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7
Q

Executive functioning

A

Ordering and implementation of cognitive functions necessary to engage in appropriate behaviors

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8
Q

Gnosia

A

Ability to name objects and their function

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9
Q

Declarative vs procedural memory

A
  • Declarative: recall of recent and past events
  • Procedural: ability to complete learned tasks without conscious thought
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10
Q

Praxis

A

Ability to carry out intentional motor acts

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11
Q

Apraxia

A

Inability to carry out motor acts; deficits may exist in motor or sensory systems, comprehension, or cooperation

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12
Q

Tests for executive function

A
  • Clock-drawing test (ask patient to draw a clock with hands set to 11:10)
  • Trail-making test: ask patient to alternate numbers with letters in ascending order (e.g., A1B2C3)
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13
Q

Prosody

A

Ability to recognize the emotional aspects of language

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14
Q

Thought content vs Though process

A

Thought content: What is the patient thinking?

Thought process: Organization of thoughts in a goal-oriented pattern (may be circumferential, tangential, disorganized)

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15
Q

Circumferential thought process

A

Patient goes through multiple related thoughts before arriving at the answer to a question

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16
Q

Tangential thought process

A

Patient listens to question and begins discussing related thoughts, but never arrives at the answer

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17
Q

Disorganized thought process

A

Patient moves from one topic to another without organization or coherence

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18
Q

Visuospatial proficiency

A

Ability to perceive and manipulate objects and shapes in space

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19
Q

Diagnosis of cognitive impairment and dementia

A

Requires a deficit in at least two cognitive or behavioral functions, including learning and information recall, reasoning or task completion, visuospatial proficiency, speech, reading and writing, behavior, and personality.

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20
Q

Test for prosody

A
  • Repeat “Why are you here?” with multiple inflections (e.g., happy, surprised, excited, angry, sad) and ask patient to identify the emotion
  • Ask the patient to do the same for the given emotions
21
Q

Cognitive screening tool summary

A
22
Q

Blurb on each cognitive screening tool

A
  • MMSE: Very effective, but proprietary
  • Mini-cog: Quite effective for significant impairment
  • Montreal cognitive assessment: Effective for mild impairment
  • ACE-R: Very effective for dementia specifically, but fairly long
23
Q

Initial laboratory studies to consider in patients with an abnormal mental status examination

A
  • Glucose
  • BUN
  • Creatinine clearance
  • Urinalysis
  • Calcium
  • Sometimes thyroid hormone, when >50 y.o. and other clinical symptoms present
  • Imaging in more serious cases where nonpsychiatric symptoms or systemic symptoms are implicated.
24
Q

“The dual diagnosis”

A
  1. Depression or anxiety
  2. Substance use
25
Q

Somatic symptom disorder

A

Somatic symptoms are either very distressing or result in significant disruption of functioning, as well as excessive and disproportionate thoughts, feelings, and behaviors related to those symptoms. Symptoms should be specific if with predominant pain.

26
Q

Illness anxiety disorder

A

Preoccupation with having or acquiring a serious illness where somatic symptoms, if present, are only mild in intensity.

27
Q

Conversion disorder

A

Syndrome of symptoms of deficits mimicking neurologic or medical illness in which psychological factors are judged to be of etiologic importance.

28
Q

Factitious disorder

A

Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception. The individual presents himself or herself as ill, impaired, or injured even in the absence of external rewards.

29
Q

Body dysmorphic disorder

A

Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear only slight to others.

30
Q

Dissociative disorder

A

Disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior.

31
Q

Prevalence of mental disorders in primary care

A
32
Q

Lethargic vs Obtunded

A
  • Lethargic patients are drowsy, but open their eyes and look at you, respond to questions, and then fall asleep.
  • Obtunded patients open their eyes and look at you, but respond slowly and are somewhat confused.
33
Q

Dysarthria, aphasia, and dysphonia

A
  • Dysarthria refers to defective articulation
  • Aphasia is a disorder of language.
  • Dysphonia results from impaired volume, quality, or pitch of the voice
34
Q

Circumlocutions

A

Phrases or sentences are substituted for a word the person cannot think of, such as “what you write with” for “pen”

35
Q

Paraphasias

A

Words are malformed (“I write with a den”), wrong (“I write with a bar”), or invented (“I write with a dar”).

36
Q

A person who can write a correct sentence does not have ___.

A

A person who can write a correct sentence does not have aphasia.

37
Q

Confusion Assessment Method (CAM)

A

Test for delirium specifically, whereas basically every other test was designed for dementia but may pick up delirious patients as well.

For the CAM to be positive, the patient must have acute onset or fluctuating course and inattention, as well as one of: disorganized thinking and altered level of consciousness

38
Q

Preventing delirium in hospitalized patients

A
39
Q

PHQ-2

A

Screening test for depression. Very simple, only consists of two questions with answers given on a 0-3 scale.

40
Q

Medications that may contribute to depression

A

Metoprolol and opioids

41
Q

SIGECAPS mnemonic for depression

A
  • Sleep changes;
  • Interest (loss of)
  • Guilt (worthless)
  • E nergy (lack)
  • Cognition/Concentration
  • Appetite;
  • Psychomotor changes;
  • Suicidal ideation/death preoccupation
42
Q

PHQ-9

A

Longer than PHQ-2, but unlike the PHQ-2, the PHQ-9 is a diagnostic test that may be used as part of a clinical evaluation to diagnose depression.

43
Q

The Golden Rule of the Mental Status Exam

A

When / If you are unsure about terminology:

DIRECTLY DESCRIBE WHAT YOU OBSERVED

44
Q

The ___ domain is often neglected in mental status testing, yet it is one of the highest correlates with ability to live independently.

A

The visuospatial-executive domain is often neglected in mental status testing, yet it is one of the highest correlates with ability to live independently.

45
Q

“Domains” of cognitive fuctioning

A
46
Q

When a patient presents with a CC of “memory difficulty”, you should be aware that. . .

A

. . . this is a common presenting complaint for impairement in domains unrelated to memory, such as attention, gnosia, etc.

47
Q

ABSEPTIC

A

Mnemnonic for MSE structure

  • Appearance (Dress, grooming, self-care)
  • Behavior (Gait, posture, movement, eye contact, activity level)
  • Speech (HOW it is said, not what is said: rate, volume, quantity, articulation)
  • Emotion (Mood, affect)
  • Perception (hallucinations, response to internal stimuli)
  • Thought
    • Thought process (How sequential are ideas? linear, tangential, loose associations)
    • Thought content (What is the person thinking? paranoid ideation, delusions, suicidal ideation, homicidal ideation)
  • Insight (insight into illness specifically: what do you think is causing your symptoms?)
  • Cognitive (alertness/arousal, orientation, attention, memory)
48
Q

Affect terminology compass

A

HMS PDR (30 decks)

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