CNS & Mental Status Exam

Question 1

What are the five components of the MSE?

Answer 1

1. Appearance and behavior
2. Mood and affect
3. Speech and language
4. Thoughts and Perception
5. Cognition and Executive function

Note: each step should be performed in order

Question 2

Which component is level of consciousness a part of and how is it classified?

Answer 2

This is a part of appearance and behavior. A patient can be determined to be alert, lethargic, stuporous, or comatose.

Question 3

Aside from level of consciousness what other things (3) should be considered in appearance and behavior?

Answer 3

Posture, motor activity, and hygeine

Question 4

What should the assessment of language include (6)?

Answer 4

Spontaneous speech, naming, comprehension, repetition, reading, and writing.

Question 5

How do you assess articulation and what is paraphasia?

Answer 5

Is there appropriate word finding. This is part of assessing spontaneous speech.

Paraphasia - substitution of similar sounding words and syllables

Question 6

What are parts of verbal fluency?

Answer 6

Does a patient maintain a consistent verbal rate, volume, meaning, and melody. This is part of spontaneous speech.

Question 7

What is aphasia?

Answer 7

Disorder in understanding or producing language.

Question 8

How can you assess naming, comprehension, repetition, reading, and writing?

Answer 8

Ask the patient to name specific objects. Lack of this ability is called anomia and it is the most common symptom in true aphasia.
Verbally give the patient a task to perform.
Ask the patient to repeat words or phrases.
Have them read and write short sentences.

Question 9

What is dysphasia?

Answer 9

Impairment in use of speech that is clear. They fail to organize words properly.

Question 10

What is dysarthria?

Answer 10

Impairment of speech due to lack of motor coordination.

Question 11

What is Broca’s aphasia?

Answer 11

This is “expressive” aphasia where understanding of spoken language is mostly preserved.

Question 12

What is Wernicke’s aphasia?

Answer 12

“Receptive” aphasia. Patient speaks fluently but does not make sense.

Question 13

What is apraxia?

Answer 13

Inability to turn verbal requests into motor performance

Question 14

What are the four components of thoughts and perception?

Answer 14

Process, content, insight, and judgement

Question 15

What are the three components of cognitive function?

Answer 15

Orientation - person, place, and time
Attention - ability to concentrate
Memory - recent and remote

Question 16

How is recent memory typically tested?

Answer 16

Give the patient three object to recall 3 to 5 minutes later

Question 17

When would remote memory be tested?

Answer 17

To confirm diagnosis of dementia

Question 18

What are the three components of executive funciton?

Answer 18

Abstract thinking, calculation, and constructional thinking

Question 19

How can abstract thinking be assessed?

Answer 19

Asking a patient to describe the meaning of proverbs. Ask the patient to answer situational questions. Ask the patient to describe similarities and differences between objects.

Question 20

What is delerium and dementia? How can you easily differentiate the two?

Answer 20

Delerium - an acute episode of poor judgment and poor attention

Dementia - insidious. Flat affect. Typically maintain orientation and attention until late in process

The two are differentiated by the patient’s ability to maintain attention

Question 21

What are some ways for assessing a patient’s ability to perform calculations?

Answer 21

Spell a word backwards. Count a span of 5 or 6 numbers in order. Name the months of the year backwards and forwards. Be able to double a number multiple times.

Question 22

How can construcitonal ability be tested?

Answer 22

Ask the patient to copy or draw a simple figure.

Question 23

What are the three components of cerebellar testing?

Answer 23

Gait. Heel-to-shin. Rhomberg.

Question 24

How is gait tested?

Answer 24

Regular walking, tandem walking, walking on heels, and walking on toes.

Question 25

What does a Rhomberg test determine?

Answer 25

If ataxia is cerebellar or proprioceptive. Proprioceptive ataxia will only be present when the eyes are closed.

Question 26

What does pronator drift indicate?

Answer 26

This is specific for a corticospinal tract lesion

Question 27

How can dysmetria be assessed?

Answer 27

Finger-to-nose with eyes open

Question 28

What is dysdiadochokinesis?

Answer 28

Inability to perform rapidly alternating and opposite movements

Question 29

How is CN I tested and when are abnormalities typically seen?

Answer 29

Assess with coffee beans or cinnamon. Abnormalities seen in concussions.

Question 30

How can CN II be tested?

Answer 30

Visual acuity, pupillary reflex, and visual field

Question 31

How can CN III, IV, VI be tested?

Answer 31

Test extra-ocular movements

Question 32

How can CN V be tested?

Answer 32

Test sensory in all three division and movement of the mandible. Corneal reflex.

Question 33

How can CN VII be tested?

Answer 33

Assess the muscles of facial expression

Question 34

How can CN VIII be tested?

Answer 34

Directly test hearing. Vestibular portion is assessed by determining a history of vertigo.

Question 35

How can CN IX and X be tested?

Answer 35

Assess the gag reflex

Question 36

How can CN XI be tested?

Answer 36

Have patient shrug shoulders or tilt head

Question 37

How can CN XII be tested?

Answer 37

Have patient move tongue