SS stuff

Question 1

What do we assess during mental status screening?

Answer 1

1. Take a thorough history
2. Observe physical appearance and behavior
3. Investigate cognitive functioning
4. Observe speech and language
5. Evaluate emotional stability

Question 2

What tools are used to screen for cognitive function?

Answer 2

1. Mini-Cog (give 3 words, draw clock, then ask to recall words; abnormal clock or inability to recall = impaired)
2. 6CIT – 6 item Cognitive Impairment Test
3. MMSE - Mini Mental State Examination
4. SLUMS – St. Louis University Mental Status Examination
5. Montreal Cognitive Assessment

Question 3

When testing a myotome, how many seconds does the patient have to hold the position?

Answer 3

5 seconds

Question 4

How should you test for spasticity?

Answer 4

Passive motion and speed up as you go

• If testing a muscle that primarily flexes a joint, place the joint in a maximally flexed position and move to a position of maximal extension over one second (count “one thousand one”)
• Compare right/left and upper/lower

Question 5

What would a 0 on the modified ash worth scale indicate?

Answer 5

No increase in muscle tone

Question 6

What would a 1 on the modified ash worth scale indicate?

Answer 6

Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion when the affected part(s) is moved in flexion or extension

Question 7

What would a 1+ on the modified ash worth scale indicate?

Answer 7

Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM

Question 8

What would a 2 on the modified ash worth scale indicate?

Answer 8

More marked increase in muscle tone through most of the ROM, but affected part(s) easily moved

Question 9

What would a 3 on the modified ash worth scale indicate?

Answer 9

Considerable increase in muscle tone, passive movement difficult

Question 10

What would a 4 on the modified ash worth scale indicate?

Answer 10

Affected part(s) rigid in flexion or extension

Question 11

How do you test for coordination?

Answer 11

1. Rapid rhythmic alternating movements
   - Alternate turning palms up/down on lap or alternate PF/DF
   - Alternative test: touch thumb to each finger and back on the same hand
   - Increase speed gradually
2. Accuracy of movement
   - Finger-to-nose test or alternate finger-to-nose test
   - Alternative test: heel-to-shin test
3. Impairments may indicate cerebellar disease

Question 12

How do you test for balance?

Answer 12

1. Equilibrium
   - Romberg test
   - 4 Stage Balance test
2. Gait
   - Observe the expected gait sequence, noting simultaneous arm movements and upright posture
   - Heel-toe walking

Question 13

What is the 4 stage balance test?

Answer 13

1. stand with feet side by side
2. place instep of one foot so it is touching the big toe of the other foot
3. place one foot in front of the other, heel touching toe
4. stand on one foot
   (5. hopping of one foot)\
   - first three should be able to be done for 10s to be normal
   - last should be done for at least 5s

Question 14

What is the Romberg test

Answer 14

Standing with feet side by side with eyes closed

• slight sway is normal
• points to loss of vestibular function or proprioception
• cerebellar will be unsteady with eyes open

Question 15

What are the superficial sensations to be tested?

Answer 15

1. Light Touch
2. Pain (sharp/dull)
3. Temp
4. Pressure

Question 16

What are the deep sensations to be tested?

Answer 16

1. Position sense
2. Kinestesia
3. Vibration

Question 17

How do you test position sense?

Answer 17

1. Move a distal joint up/down/in/out

2. Ask patient to describe the position at end range

Question 18

How do you test kinesthesia?

Answer 18

1. Move a distal joint up/down/in/out very slowly
   - Pt recognizes while your moving
2. Ask patient to describe the position while you are moving

Question 19

What are the combined (cortical) sensations to be tested?

Answer 19

1. Stereognosis
2. Two point discrimination
3. Extinction phenomenon
4. Graphesthesia
5. Tactile localization (often tested with light touch)

Question 20

How do you test extinction phenomenon?

Answer 20

1. Simultaneously touch 2 areas on each side of the body

2. Ask patient to tell how many stimuli are felt

Question 21

How should interpretation of monofilament testing be interpreted?

Answer 21

4. 17 monofilament = 1 gram pressure = decreased sensation
5. 07 monofilament = 10 grams pressure = loss of protective sensation
6. 10 monofilament = 75 grams of pressure = absent sensation

Question 22

How do you test CN III, IV, and VI?

Answer 22

Oculomotor, Trochlear, Abducens

• opening of eyelids
• pupillary reflex - pupil constricts in response to light
• consensual reflex - pupil constricts in response to light in other eye
• accommodation-convergence reflex - pt follows finger as it is brought toward nose (pupils should constrict)
• extraocular movement testing - letter ‘H’

Question 23

How do you test CN V?

Answer 23

Trigeminal

• Light touch sensation to the entire face with pts eyes closed
• pt bites down hard and palpate master muscle
• Corneal reflex

Question 24

How do you test CN VII?

Answer 24

Facial

• Crease up the forehead
• Keep eyes closed against resistance
• Reveal the teeth
• Puff out cheeks

Question 25

How do you test CN XI?

Answer 25

Accessory

- Strength of traps and SCM

Question 26

How do you test CN XII?

Answer 26

Hypoglossal

• tongue movement and strength
• protrude tongue (deviates toward side of weakness) and move from side to side

Question 27

Four strategies for effective communication

Answer 27

1. Courtesy
2. Comfort
3. Connection
4. Confirmation