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Psychiatry Clerkship > MSE > Flashcards

MSE Flashcards

1
Q

What are the 10 categories of the MSE?

A
  1. Appearance
  2. Behavior
  3. Mood
  4. Affect
  5. Speech
  6. Thought Process
  7. Thought Content
  8. Cognition
  9. Judgment
  10. Insight
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2
Q

List 12 general categories of appearance.

A
  1. Demographics
  2. Hair
  3. Facial Hair
  4. Makeup
  5. Hygiene
  6. Odor
  7. Facial expression
  8. Eye contact
  9. Clothing
  10. Physical aids
  11. ID markings
  12. Relevant physical exam findings
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3
Q

Descriptors of demographics?

A 
Gender (M/F)
Age (younger/older/stated age)
Ethnicity
Height (tall/short/petite)
Weight (underweight/thin, overweight/husky/stocky, obese/moderately obese/morbidly obese, muscular/lean, emaciated, frail)
Healthy/sickly
Attractive/unattractive
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4
Q

Descriptors of hair?

A 
Color
Length (long/short/bald)
Grooming (neat/styled/disarray, pulled back from face/hiding face)
Clean/dirty
Straight/curly
Lanugo
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5
Q

Descriptors of facial hair?

A

Mustache/beard/goatee

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6
Q

Descriptors of make-up?

A

Worn/not worn
Carefully done/carelessly done/overdone
Manicured nails/nail polish

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7
Q

Descriptors of hygiene?

A

Clean/dirty

Meticulous

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8
Q

Descriptors of odor?

A

Alcohol/smoke/MJ
Unbathed
Urine/stool
Cologne/perfume

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9
Q

Descriptors of facial expression?

A

Smiling, animated, interested, excited, elated

Sad, worried, fearful, scowling, tense, preoccupied, suspicious, smirking

Perplexed, bored, blank, dazed, blushing

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10
Q

Descriptors of eye contact?

A 
Indirect
Avoidant/downcast/none
Staring at/through interviewer
Fixed/staring
Glaring
Fleeting/darting/shifty/scanning
Sporadic/intermittent
Wearing sunglasses
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11
Q

Descriptors of clothing?

A 
Appropriate to age/season/occasion
Clean/neat/tidy/meticulous
New/worn
Bright/dull colors
Coordinated/mismatched
Casual/formal
Suit/blazer, shirt/tie, dress/skirt, blouse/short-sleeved/t-shirt (logo?), pants/jeans/sweats/shorts, boots/dress shoes/sneakers/sandals, hat (logo?)
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12
Q

Descriptors of physical aids?

A 
Glasses/sunglasses
Hearing aid(s)
Teeth braces
Cast/brace
Walker/wheelchair/scooter
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13
Q

Descriptors of ID markings?

A 
Jewelry (rings, necklaces, earrings, bracelets)
Missing teeth
Scars/bruises
Tattoos
Piercings
Needle marks
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14
Q

List 5 categories of behavior.

A
  1. Attitude/rapport
  2. Gait
  3. Movements
  4. Posture
  5. Handshake
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15
Q

Descriptors of attitude/rapport?

A

Appropriate
Friendly, cooperative/compliant, pleasant, warm, playful
Evasive, negative, suspicious/frightened, demanding, threatening, defensive/aggressive/manipulative, angry/hostile, indifferent/aloof, withdrawn, distant, seductive/provocative, ingratiating, arrogant, shy, disinterested, passive, submissive, condescending, patronizing, puzzled

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16
Q

Descriptors of gait?

A 
Brisk
Slow, hesitant
Shuffling
Ataxic
Uncoordinated
Dancing/chorea
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17
Q

Descriptors of movements?

A

Purposeful/aimless/purposeless
Voluntary/involuntary
Grimaces, twitches, picking, lip smacking, tongue thrusting or rolling, chewing, facial dyskinesia, tics
Agitated/restless (handwringing, tapping foot, fidgeting, rocking, twisting, pacing, shifting in chair, drumming fingers, unable to sit still, disorganized, etc.)
Calm (sitting quietly, legs crossed, hands together, slowed movements, deficits that restrict movement)
Asterixis
Stereotyping (isolated, purposeless movement performed repetitively)
Echopraxia (repetitive imitation of movements of another person)

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18
Q

Qualifiers of movements?

A

Rate - hyperactive/psychomotor agitation, psychomotor retardation, rapid, slow

Coordination - awkward, clumsy, agile

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19
Q

Descriptors of posture?

A 
Slouched, slumped, hunched over, stooped
Relaxed
Rigid, tense, stiff
Erect
Posturing/bizarre
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20
Q

Descriptors of handshake?

A 
Firm/weak
Warm/cool
Hearty, heavy
Prolonged
Resistant
Refused
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21
Q

Descriptors of mood?

A 
Elated/euphoric
Euthymic/happy
Dysthymic/depressed/sad
Angry/irritable/hostile
Anxious/nervous/apprehensive
Alexithymic
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22
Q

Components of affect?

A

Range
Appropriateness
Congruence

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23
Q

Descriptors of range, appropriateness, and congruence (affect)?

A

Range - full, guarded, constricted, blunted/flat, superficial, labile
Appropriateness - appropriate vs. inappropriate
Congruence - congruent/incongruent with mood

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24
Q

List 8 categories of speech.

A
  1. Clarity
  2. Fluency
  3. Impairments
  4. Flow
  5. Quantity
  6. Rate
  7. Tone
  8. Volume
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25
Q

Descriptors of clarity?

A 
Clear/coherent
Dysarthria/dysphagia
Repetitive
Accent
Profanity
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26
Q

Descriptors of fluency?

A

Fluent or non-fluent (ability to produce sentences of normal length, rhythm, and prosody)

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27
Q

Descriptors of impairments?

A

Stuttering, slurring, mumbling, lisping, stammering, garbled, aphasic, accented

(Typical or new?)

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28
Q

Descriptors of flow?

A 
Spontaneous
Hesitant/halting
Difficulty finding words
Long pauses
Rambling
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29
Q

Descriptors of quantity?

A 
Talkative
Verbose
Minimal/brief responses
Impoverished
Spontaneous/non-spontaneous
Laconic (brief, empty replies)
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30
Q

Descriptors or rate?

A

Slow, hesitant, rapid, pressured, relaxed/conversational

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31
Q

Descriptors of tone?

A 
Animated/excited
Sarcastic/angry
Monotone
Dysprosody
Inflection
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32
Q

Descriptors of volume?

A 
Shouting
Loud
Conversational
Soft-spoken
Whispers
Inaudible
Mute

(Remember to check if someone is hearing impaired)

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33
Q

List 3 categories of thought process.

A
  1. General
  2. Loosening of association
  3. Flow
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34
Q

General descriptors of thought process?

A 
Logical/illogical
Goal-directed/sequential
Coherent
Circumstantial
Tangential
Flight-of-ideas (topic to topic, not completely disjointed)
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35
Q

Types of loosening of association?

A 
Fragmentation
Verbigeration/palilalia
Coprolalia
Echolalia
Word salad
Incoherence
Neologisms
Clang associations
36
Q

Define fragmentation.

A

Words and individual phases are intact but the phrases are disconnected, making sentences and ideas meaningless

37
Q

Define verbigeration/palilalia.

A

Repeating words or sounds

38
Q

Define echolalia.

A

Repeating whole phrases or sentences

39
Q

Define word salad.

A

Words intact, but all sentence structure is lost

40
Q

Define incoherence.

A

Words unintelligible, no phrases or sentence structure

41
Q

Define neologisms.

A

New words created by a patient

42
Q

Define clang associations.

A

Association of words similar in sound but not in meaning

43
Q

Descriptors of flow?

A

Racing thoughts
Thought blocking
Derailment
Perseveration

44
Q

Define racing thoughts.

A

Thoughts are so fast that the patient cannot articulate them or keep up with them

45
Q

Define thought blocking.

A

Stop talking midsentence

46
Q

Define derailment.

A

Speech stops suddenly and then restarts having shifted to another topic

47
Q

Define perseveration.

A

Repetition of verbal responses despite changing questions

48
Q

List 6 categories of thought content.

A
  1. Thoughts of death, passive/active SI/VI/HI
  2. Illusions/hallucinations
  3. Obsessions/compulsions
  4. Derealization/depersonalization
  5. Phobias
  6. Overvalued ideas/delusions
49
Q

Types of delusions?

A

Paranoid/persecutory
Referential (random events are of some special significance)
Grandiose (unrecognized talent/insight/great discovery/special relationship to someone famous)
Jealous
Erotomanic (someone is in love with the patient)
Somatic
Bizarre (thought broadcasting/withdrawal/insertion, delusion of control)

50
Q

List 5 categories of cognition.

A
  1. Sensorium/level of consciousness
  2. Attention/concentration
  3. Memory
  4. Fund of knowledge
  5. Abstract thinking
51
Q

Descriptors of sensorium/level of cognition?

A

Alert and oriented x4 (person, place, time, situation)

Sedated/groggy/drowsy
Clouding (impaired awareness of environment)
Stupor
Somnolent/lethargic
Coma
52
Q

Descriptors of attention?

A

Sufficient/deficient

Easily distractible/short attention span

53
Q

Descriptors of memory?

A

Immediate (recall)
Remote (childhood data, important events, etc.)
Recent (recent news events from the past few months)

54
Q

Components/score of the MMSE?

A
  1. Orientation (10)
  2. Registration (3)
  3. Attention and Calculation (5)
  4. Recall (3)
  5. Language (9)
55
Q

Test orientation (MMSE)?

A
  1. What is the (day/date/month/year/season)? - 5 points

2. Where are we? (hospital/floor/city/country/state)? - 5 points

56
Q

Test registration (MMSE)?

A

Name 3 unrelated objects and ask the patient to repeat them - 3 points

57
Q

Test attention and calculation (MMSE)?

A

Serial 7’s (stop after 5 subtractions, score = # of correct answers)

Spell WORLD backwards (score = # of letters correct)

5 points

58
Q

Test recall (MMSE)?

A

As patient to recall the 3 items from the registration test

3 points

59
Q

Components of language testing in the MMSE?

A
  1. Naming
  2. Repetition
  3. 3-Stage Command
  4. Reading
  5. Writing
  6. Copying
60
Q

Test language (MMSE)?

A
  1. Naming - show patient wristwatch and ask what it is; repeat for pencil - 2 points
  2. Repetition - ask patient to repeat, “No ifs, ands, or buts” - 1 point
  3. 3-stage command - 1 point for each step done correctly
  4. Reading - print “Close Your Eyes” on paper and ask the patient to read it and do what it says - 1 point
  5. Writing - ask the patient to write a sentence with a subject and a verb - 1 point
  6. Copying - ask the patient to copy an image - 1 point
61
Q

Scoring the MMSE?

A

21+ - mild cognitive impairment
10-20 - moderate
<10 - severe

62
Q

Descriptors of judgment?

A

Ability to make and carry out plans consistent with reality, to control one’s actions, and to predict what one would do in an imaginary situation

Good/fair/poor

63
Q

Descriptors of insight?

A

Degree of awareness and understanding of illness

Good/fair/poor

Denial/blaming others, slightly aware, recognizes there is a problem, awareness/understanding of the illness (knows treatment is needed)

64
Q

What psychiatric illness?

Appearance: decreased body weight, poor grooming, poor hygiene
Behavior: psychomotor retardation or agitation, withdrawn
Speech: decreased quantity, soft
Thought content: SI/HI
Cognition: poor concentration, indecisive

A

Major depression

65
Q

What psychiatric illness?

Appearance: decreased body weight, baggy clothes, lanugo

A

Anorexia

66
Q

What psychiatric illness?

Appearance: arcus senilis, bruising, palmar erythema, spider angiomata, poor grooming, poor hygiene

A

Alcohol abuse/dependence

67
Q

What psychiatric illness?

Thought content: hallucinosis

A

Alcohol withdrawal

68
Q

What psychiatric illness?

Thought content: formication

A

Cocaine intoxication

69
Q

What psychiatric illness?

Appearance: pupil dilation/constriction, poor grooming/hygiene, sedated, groggy
Cognition: decreased alertness, disoriented, poor concentration

A

Substance intoxication/withdrawal

70
Q

What psychiatric illness?

Appearance: needle marks/tracks, clothing to hide needle marks

A

IV drug use/dependence

71
Q

What psychiatric illness?

Appearance: sunglasses, injected conjunctiva

A

Marijuana abuse

72
Q

What psychiatric illness?

Appearance: fastidiously groomed
Behavior: repetitive behavior
Thought Content: obsessions and compulsions

A

OCD

73
Q

What psychiatric illness?

Thought Content: preoccupation with rules, order, organization such that the point of the activity is lost

A

OCPD

74
Q

What psychiatric illness?

Behavior: muscle tension, nervous, sweaty palms
Affect: guarded
Speech: increased quantity, rapid speech

A

GAD/anxiety disorders

75
Q

What psychiatric illness?
Appearance: fastidiously groomed
Behavior: arrogant, entitled attitude
Thought Content: grandiose sense of importance, believes others are envious of him

A

Narcissistic personality

76
Q

What psychiatric illness?

Appearance: excessive makeup, jewelry, brightly colored clothing
Behavior: demanding, provocative, seductive, restless, distractible
Affect: labile
Speech: increased quantity, rapid, pressured
Thought Process: racing thoughts, flight-of-ideas
Cognition: distractible, poor concentration

A

Mania

77
Q

What psychiatric illness?

Appearance: excessive makeup, jewelry, brightly colored clothing

A

Histrionic personality disorder

78
Q

What psychiatric illness?

Appearance: tattoos, scars
Behavior: calm, glib, manipulative, demanding

A

Anti-social personality disorder

79
Q

What psychiatric illness?

Behavior: odd, eccentric, peculiar behavior
Thought Content: odd beliefs, suspiciousness or paranoid ideas

A

Schizotypal personality

80
Q

What psychiatric illness?

Affect: flat
Speech: decreased quantity
Thought Process: looseness of association, derailment, incoherence (if severe)
Thought Content: delusions, SI/HI, any hallucination

A

Schizophrenia

81
Q

What psychiatric illness?

Appearance: poor grooming, food stains on bib of clothes, body odor
Behavior: awkward social interaction, evasive, puzzled, calm or restless
Affect: labile, blunted, constricted
Speech: non-spontaneous, hesitant
Thought Process: errors in word choice and grammar
Thought Content: delusions, any hallucination
Cognition: memory impairment, poor abstract thinking, apraxia, agnosia

A

Dementia

82
Q

Medications that can cause tremor as a side effect?

A

Lithium, depakote, conventional anti-psychotics

83
Q

Medications that can cause tardive dyskinesia, dystonia, and akathisia?

A

Conventional anti-psychotics

84
Q

Medications that can cause tremor with rigidity and akinesia?

A

Drugs causing parkinsonism, NMS, serotonin syndrome

85
Q

What psychiatric illness?
Affect: labile or blunted
Thought Process: any disorder in thought process
Thought Content: delusions, any hallucination
Cognition: disorientation to situation, time, and place, rarely to person; very poor concentration (serial MMSE testing encouraged)

A

Delirium

86
Q

What psychiatric illness?
Affect: guarded
Thought Content: suspicion that others want to harm him; preoccupied about the loyalty of others

A

Paranoid personality disorder

87
Q

What psychiatric illness?

Thought Process: neologisms, echolalia

A

Autism

Psychiatry Clerkship (8 decks)

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