PD - Mental Status Exam

Question 1

appearance and behavior

Answer 1

body type 
physical stigmata 
posture
bearing
clothes
grooming
alertness
level of comfort
ambulation status. 

Also note unusual, inappropriate, or repetitive behaviors.

Question 2

Components of the Mental Status Exam

Answer 2

1. Appearance And Behavior
2. Motor Activity
3. Mood And Affect
4. Speech And Language
5. Thought Process
6. Thought Content
7. Perception
8. Insight
9. Judgment
10. Cognition

Question 3

motor activity

Answer 3

amount
speed
posture
gait

(Hyperactivity, Agitation, Tremor, Dystonia, Chorea, Tic, Bradykinesia, Akinesia, Stereotypy, Psychomotor retardation, Mannerism)

Question 4

mood

Answer 4

patient’s self-described emotional state

Question 5

affect

Answer 5

emotional response observed by examiner

range, intensity, stability, appropriateness, relatedness

Question 6

terms to describe affect

Answer 6

• congruent (or incongruent)
• dysphoric
• euophric
• labile (highly variable/quick change)
• flat

Question 7

5 parameters of speech

Answer 7

Amount
Speed
Volume
Clarity (articulation)
Fluency (Broca’s)

Question 8

3 parameters of language

Answer 8

complexity, comprehension, and coherence

Question 9

terms to describe speech

Answer 9

• Latency [to respond]
• Pressured speech [uninterruptable]
• dysarthria
• incoherence
• aphasia

Question 10

Thought process

Answer 10

Logical connectivity between thoughts.

Quantity, Tempo, Form/Coherence.

Question 11

Thought content

Answer 11

Divided by preoccupations and disturbances/delusions [fixed, false beliefs].

Phobias, health preoccupation, SI/HI, delusions, obsessions.

Question 12

Perceptual abnormalities

Answer 12

Hallucinations (sensory perception w/o stimulus)

illusions (misperception of a stimulus)

neglect (inattention)

depersonalization (self-disconnection)

derealization (world-disconnection)

Question 13

insight

Answer 13

pt’s awareness that his or her sx are normal or abnormal

• denial
• minimization
• indifference

Question 14

Judgment

Answer 14

Cognitive ability to evaluate and compare alternatives.

Insight + Judgment necessary for consent.

Ask “what would you do if you found a stamped, addressed envelope”?, how do you handle affairs like cooking meals etc.

Question 15

Cognition

Answer 15

general ability of the patient to think and reason, assessed w/ mini-mental state exam (orientation, registration, attention, recall, language.)

Also …

• General intellectual function: Ask about current events.
• Level of consciousness
• Abstraction: Ask similarity/difference questions. (“How are a car and train alike?”)

Question 16

delirium

Answer 16

Short duration mental disturbance, usually toxic etiology.

Illusions, hallucinations, delusions, excitement, restlessness, incoherence.

Question 17

dementia

Answer 17

Generalized insidious loss of intellect/cognition/memory.

Changes in personality (not including changes due to clouding of consciousness, depression, or other functional mental disorder)

Question 18

Clinical features of delirium

Answer 18

acute

fluctuating w/ lucid intervals

worse at night

lasts hours-weeks

always disrupted sleep/wake cycle

general med illness or drug toxicity may be PRESENT

Question 19

dementia

Answer 19

insidious

slowly progressive

lasts months-years

sleep is fragmented

general med illness or drug toxicity often ABSENT

Question 20

possible causes of delirium

Answer 20

delirium tremens (w/d from alcohol)

uremia

acute hepatic failure

acute cerebral vasculitis

atropine poisoning

Question 21

possible causes of dementia

Answer 21

reversible: vitamin B12 deficiency, thyroid disorders
irreversible: Alzheimer’s disease, vascular dementia, dementia via head trauma