Mental Status Exam

Question 1

Different LOC

Answer 1

Level of Conciousness 
Alert
Lethargic
Obtunded 
Stupor or semi-coma 
Coma 
Delirium

Question 2

General Survey - Physical Appearance

Answer 2

Age
Gender
Skin Color
Facial Features

Question 3

General Survey - Body Structure

Answer 3

Posture
Position
BMI

Question 4

General Survey - Mobility

Answer 4

Gait

ROM

Question 5

General Survey - Behavior

Answer 5

Facial Expression

Speech

Question 6

General Survey - Pain

Answer 6

Verbal and nonverbal

Cultural, developmental and gender considerations

Question 7

Cerebrum

Answer 7

Primarily responsible for mental status
Divided into two hemispheres or lobes
Grey outer layer, the cerebral cortex, houses higher mental fxns and responsible for perception and behavior

Question 8

Cerebrum - Frontal Lobe

Answer 8

Contains motor cortex associated with
Speech formation (Brocca area)
Goal-oriented behavior
Ability to concentrate and short-term behavior

Question 9

Parietal Lobe

Answer 9

Responsible for processing sensory data

Question 10

Temporal Lobe

Answer 10

Perception and long-term memory
Wernicke area - comprehension of written and spoken language
involved in the integration of behaior, emotion and personality

Question 11

Limbic System

Answer 11

Certain patterns of behavior that determines survival
reactions to emotions
expressions between emotions and behavior is mediated by connections between limbic system and frontal lobe

Question 12

Reticular Activating System (RAS)

Answer 12

in the brainstem regulates level of wakefulness or arousal

Disruption of ascending RAS can lead to altered mental status

Question 13

Neuro. Infants and Children

Answer 13

All brain cells present at birth but first years to develop and myelinize
Brain insults such as infection, trauma, or metabolic imbalance, can damage brain cells, leading to potentially serious dysfunction in mental status

Question 14

Adolescents - Neuro

Answer 14

Abstract thinking develops theories, logical reasoning, making future plans, generalizations, consider risks and possibilities
Judgment begins to develop with education, intelligence and experience

Question 15

Older Adults - Neuro

Answer 15

Cognitive fxn most sensitive to aging include the speed at which new information is perceived, encoded, processed and retrieved
Minimal decline in cognitive and daily functioning should occur unless systemic or neurologic disorder develops

Question 16

What other cognitive functions can diminish in older adults?

Answer 16

Remote memory may be more efficient than short-term
Studies suggest higher education achievement leads to better and longer-lasting cognitive function
Loss of recent memory, delayed response time and diminished ability to learn complex information may occur

Question 17

HPI: Disorientation and Confusion

Answer 17

Onset
Associated health problems
Associated symptoms
Medications

Question 18

HPI: Depression

Answer 18

Troubling thoughts or feelings
low energy level 
recent changes in living situation 
SIGECAPS
Two questions for depression screening
Feel like hurting self, thoughts about dying or suicide
Medications: antidepressants

Question 19

HPI: Anxiety

Answer 19

Sudden unexplained attacks of fear, anxiety or panic
Avoids or feels uncomfortable with people
Experienced extremely traumatic event
Associated Symptoms
DIGFAST
Medications: antidepressants, steroids, BDZ, alternative or complementary therapies

Question 20

PMH

Answer 20

Neurologic disorder, brain surgery, brain injury, residual effects, chronic disease, or debilitating condition
Requires psychiatric therapy or hospitalization

Question 21

Family History

Answer 21

Psychiatric disorders, mental illness, alcoholism
ALZ
Learning disorder, mental retardation, autism

Question 22

Personal and Social Hx

Answer 22

Emotional status
Life goals, attitudes, relationship with family
Intellectual level, education
Communication pattern
Changes in sleep pattern
Use of alcohol, street drugs, especially mood-altering

Question 23

Children

Answer 23

Speech and language
Behavior 
Performance or self-care activities
Personality and behavior patterns
Learning or school difficulties

Question 24

Adolescents

Answer 24

Risk-taking behaviors
School performance and peer interactions
Family interactions, reluctance to communicate and to speak of attitudes and experience

Question 25

Older Adults

Answer 25

Changes in cognitive functioning, thought processes, and memory Depression, somatic complaints, hopelessness, helplessness, lack of interest in personal care

Question 26

How is mental status assessed?

Answer 26

``` Evaluate: Physical appearance and behavior State of consciousness Cognitive abilities Speech and language skills Emotional stability ```

Question 27

Physical Appearance and Behavior

Answer 27

Grooming: poor hygiene, lack of concern, inappropriate appearance Emotional status: carelessness, apathy, insensitivity, docility, rage, irritability Body language: slumped posture, lack of expression or eye contact, excessively energetic, constantly watchful

Question 28

State of Consciousness

Answer 28

Person disorientation: cerebral trauma, seizures, or amnesia Place disorientation: psychiatric disorders, delirium, and cognitive impairment Time disorientation: anxiety, delirium, depression, and cognitive impairment Time is usually the first to go, followed by place then person

Question 29

Screening tests to test cognition

Answer 29

Mini-Mental State Examination (MMSE) Mini-Cog Three unrelated words Clock face (clock drawing test CDT)

Question 30

Testing cognitive abilities

Answer 30

Analogies – what is similar peach and lemon, ocean and lake Abstract reasoning – stitch in time saves nine Arithmetic calculation – start at 100 and substract 7 Writing ability – write name and address Execution of motor skills – comb hair Memory – four words, repeat series of numbers Attention span – Spell World forward and backwards Judgment – plans for future

Question 31

When is emotional stability evaluated?

Answer 31

when the patient does not seem to be coping well or does not have resources to meet his or her needs. Mood and feelings Thought process and content Perceptual distortions and hallucinations

Question 32

Depression/Sadness in Infants

Answer 32

``` Levels of activity Lethargic Drowsy Stuporous Alert Active Irritable ```

Question 33

Depression in Children

Answer 33

``` Types of words and speech patterns Mood Activity level Preferences Responsiveness to parent and ability to separate Self-comforting measures Does the child play and have fun? Attempt memory testing at about age 4. ```

Question 34

Pregnant Women and Postpartum Depression

Answer 34

Risk factors for postpartum depression History of depression Prior postpartum depression Depression may interfere with the mother’s attachment to the newborn and the infant’s subsequent development.

Question 35

Cognitive Decline in Older Adults

Answer 35

problem-solving skills deteriorate with age and disease. Skills involving vocabulary and inventories of available information remain at younger adult level performance Isaac Set Test: name 10 items in each of four groups―fruits, animals, colors, towns Recent memory is believed to deteriorate before remote memory.

Question 36

What are some other causes of dementia/delirium/confusion?

Answer 36

Cardiovascular Hepatic Renal Metabolic

Question 37

Medication effect on older adults

Answer 37

``` Slow reaction times Disorientation Confusion Loss of memory Tremors Anxiety ```

Question 38

Other things to assess with older adults

Answer 38

ADLs Facial expressions and stance masklike and dramatic stooped and fearful

Question 39

What is a concussion?

Answer 39

An alteration in mental status resulting from a blow to the head or neck transient disruption in the reticular neurons that maintain alertness.

Question 40

What causes a concussion?

Answer 40

Sports injuries Motor vehicle accidents Falls

Question 41

S/S of concussions

Answer 41

``` Dizziness or dazed look Slurred speech Slow motor and verbal responses Irritability Nausea and vomiting Loss of consciousness may indicate severe injury. Amnesia Deficits in coordination, memory, attention ```

Question 42

What causes delirium?

Answer 42

``` Impaired cognition, consciousness, mood and behavioral dysfunction of acute onset Risk factors Serious illness Injury Preexisting cognitive decline ```

Question 43

Somatic complaints of depression

Answer 43

altered appetite, sleep problems, constipation, headache, and fatigue

Question 44

S/S of depression

Answer 44

Memory loss, poor concentration, lack of motivation, indecisiveness Slow, sluggish speech Delusions of worthlessness or paranoid ideation Disorder may result from grief, reaction to medical or neurologic diseases, or change in lifestyle.

Question 45

Specific disorders of anxiety

Answer 45

``` Imbalances of serotonin and NE Panic attacks Generalized anxiety disorder Specific phobias Obsessive-compulsive disorder (OCD) Post-traumatic stress disorder (PTSD) ```

Question 46

S/S of anxiety

Answer 46

Palpitations, tachycardia Sweating, shaking, trembling, choking Chest pain or discomfort, nausea, abdominal distress Dizziness, faintness Feeling unreal or detached from self, “going crazy” Paresthesias

Question 47

S/S of mental retardation in children

Answer 47

delayed motor development | delayed speech and language skills

Question 48

S/S of ADHD

Answer 48

dopamine disturbances Short attention span Easily distracted Trouble completing assignments Fidgets and squirms, moving, running, jumping Disruptive behavior, poor impulse control

Question 49

Autistic Disorder

Answer 49

Pervasive neurodevelopmental disorder of unknown etiology Refers to a wide spectrum of disorders typically prior to 3 years of age Believed to have multifactorial causes and a strong genetic influence

Question 50

Dementia

Answer 50

A chronic, slowly progressive disorder of: Failing memory Cognitive impairment Behavioral abnormalities Personality changes Often begins after 60 years of age Usually related to structural diseases of the brain

Question 51

S/S of dementia

Answer 51

Impaired memory, forgets appointments Getting lost in familiar areas, wandering Unable to manage shopping, food preparation, medication, finances, and driving Behavioral changes, inappropriate dress or conduct, impaired grooming, impulsiveness, disinhibition, Aphasia, agnosia, apraxia Apathy, withdrawal Anxiety, irritability Changes in mood