Mental Status Exam

The total expression of person's emotional response, mood, cognitive function, and personality is called their ___.

mental status

Ability to think, reason, and make judgment is called ___.

cognition

The ___ lobe of the brain is implicated in decision making, problem solving, ability to concentrate, short-term memory, executing a purposeful motor act, emotions, affect, drive, and self-awareness.

frontal

The ___ lobe of the brain is implicated in emotional response/behavior, personality, long term memory, perceiving and interpreting sounds, and understanding spoken and written words.

temporal

The ___ area is the receptive language (sensory) area in the temporal lobe of the dominant hemisphere that allows you to understand spoken and written words.

Wernicke's

The ___ area is the expressive language area in the frontal lobe of the dominant hemisphere that allows you to express yourself in spoken and written words.

Broca's

The ___ hemisphere is dominant in most people.

left

If the ___ area is damaged, a pt can't understand words and therefore what you say back has nothing to do with the encounter.

Wernicke's

If the ___ area is damaged, the pt knows what you are saying, but can't find the words to express themselves. They are unable to fix the wrong words that are coming out of their mouth.

Broca's

The ___ lobe of the brain is implicated in perception and interpretation of sensory information and praxis (formation of the idea of a purposeful motor act).

parietal

When a person can act out a motion but cannot plan it accordingly (awkward movements), this is called ___.

dyspraxia

Difficulty doing a motor act is ___.

apraxia

The ___ lobe of the brain is implicated in vision, recognition of color, faces, objects, and perceiving motion.

occipital

The time of day, s___, f___, a___, p___, m___, and a pt's social and educational background can alter a mental status exam.

stress

fatigue

anxiety

pain

medication

True or False:

cognitive function should be intact in healthy older adults

true

(after 60-70 yrs, some have a decline in cognitive function considered "normal")

True or False:

speed of processing information and psychomotor speeds starts to decline after 30 yrs

true

True or False:

cognitive decline leading to dementia can occur over 20-30 yrs

true

True or False:

older people should take the same amount of time as a younger person to respond

false

(may take slightly longer but the response should be appropriate)

During inspection your ____ and ___ should be used.

eyes

nose

When assessing hygiene, dress, and concern for appearance, it should be ___ for the encounter (but take in mind pt's career and time of day).

appropriate

If a pt is poorly or inappropriately groomed, but was appropriate in previous encounters, this could be a sign of ___, ___, or ___.

depression

schizophrenia

dementia

If the pt's grooming/appearance is excessive and they are excessively worried about their appearance, this could be a sign of ___, ___, or ___.

OCD

hyperthyroidism

mania

If there is one sided neglect in a patient's appearance, there could be a lesion on the same/opposite side of the ___ lobe.

opposite

parietal

Emotional response to an event (appropriate, abnormal, flat) is called ___.

affect

Lack of interest, enthusiasm or concern about a human being, a thing or activity is called ___.

apathy

Poor posture, lack of facial expression & eye contact are signs of ___.

depression

Tension, anxiety, and being fidgety is seen in those with anxiety, m___ disorders, and ___ effects.

metabolic

drug

Singing, dancing, exaggerated movements are seen in ___.

mania

The tests of cognitive function that must be done first are ___ and ___.

LOC (level of consciousness)

orientation

LOC, orientation, analogies, abstract reasoning, math, writing, motor skills, memory, attention span, judgement/reasoning, and current events are included in a ___ exam.

cognitive function

A pt who is drowsy, responds on command appropriately and then falls back to sleep is ___.

lethargic

(not awake when you enter the room, does not wake on their own, responds verbally)

A pt who responds on command, responds slowly with some confusion and decreased interest and then falls back to sleep is ___.

obtunded

(answer is not immediate, pt uninterested, not completely correct answer sometimes)

A pt who has a brief arousal to pain, slow or absent response, and minimal awareness are ___.

stuporous

(does not arouse on verbal command, painful stimulus arouses them)

A pt who is unarousable/unaware but may posture to stimuli are ___.

comatose

True or False:

level of consciousness will change based on time of day, drug use, etc. and will not give an accurate presentation of the patient's cognition

true

The ___ coma scale is used to evaluate the LOC in a pt with head trauma or a hypoxic event that evaluates the best eye-opening response, verbal response, and motor response. Scores range from 3-15, 15 is the maximum level of consciousness.

Glasgow

Scores on the Glasgow range from ___ (minimum) to ___ (maximum) LOC.

3

15

The three areas that are evaluated in the Glasgow coma scale are ___, ___, and ___ response.

eye opening

verbal

motor

The maximum score for the eye-opening response is a ___.

4

(spontaneous opening w/blinking)

The maximum score for the verbal response is a ___.

5

(oriented)

The maximum score for the motor response is a ___.

6

(obeys commands for movements)

In ___ posturing, the arms come up in flexion after administration of a painful stimulus. Tells you that the lesion causing the coma is located in the corticospinal tracts above the brainstem (better prognosis).

decorticate

If a pt has a decorticate posturing response, the lesion causing the coma is located in/above the brainstem.

above

(better prognosis)

In ___ posturing, the arms respond in rigid extension after administration of a painful stimulus.

decerebrate

If a pt has a decerebrate posturing response, the lesion causing the coma is located in/above the brainstem.

in

(worse prognosis)

Disorientation to ___ occurs with head trauma, seizures, and amnesia.

person

Disorientation to ___ occurs with psych disorders, delirium, and OBS (organic brain syndrome).

place

Disorientation to ___ occurs with anxiety, depression, delirium, and OBS (organic brain syndrome).

time

When a pt has some type of mental dysfunction not caused by a psychiatric disorder, it is called ___.

OBS

(organic brain syndrome)

During the ___ part of the exam, ask the pt if they can tell you their full name, the full date, and where they are.

orientation

During the ___ part of the exam, ask the pt what is similar or different between to objects.

analogies

A correct analogy response requires c___, j___, and average i___.

comprehension

judgment

intelligence

If a pt cannot answer correctly, they may have a ___ hemisphere lesion.

dominant

During the ___ portion of the exam, ask the pt to interpret a proverb or metaphor.

abstract reasoning

A concrete response to an abstract reasoning question is indicative of ___.

mental retardation

If a patient cannot explain an abstract reasoning metaphor, they may have poor cognition, ___, brain damage, or ___.

dementia

schizophrenia

During the ___ part of the exam, ask the pt to subtract serial 7s or verbalize a word forward than backward.

math/spelling

A functional dominant hemisphere and average intelligence is needed for ___ and ___.

math

spelling

If there are many errors in mathematical calculations/backward spelling, it may indicate lower intelligence, d___, d___, lesion in the ___ hemisphere, or ___ lobe disease.

depression

dementia

dominant

frontal

True or False:

in certain cases it is okay for a pt to draw something rather than write their name in the writing portion of the exam

true

If there is uncoordinated writing ability, it may indicate d___, ___ lobe damage, a lesion in the ___, or peripheral ___.

dementia

parietal

cerebellum

neuropathy

If there are omissions, additions, or mirror writing, it indicates ___.

aphasia

Impaired expression and/or understanding or speech, reading, writing is called ___.

aphasia

In the execution of motor skills portion of the exam, a pt should perform a motor task after being given ___.

a set of commands

Ability to perform a motor activity on command is called ___.

praxis

Apraxia or dyspraxia is indicated when there is a ___ or ___ lesion, causing movement difficulties that are unrelated to lack of ___ or ___.

Simply: can't put intention into action.

frontal

parietal

comprehension

paralysis

In the memory portion of the exam, there is ___ recall, ___ memory, and ___ memory.

immediate (repeat a sentence)

recent

(show 4-5 objects, list them 5-10 min later)

remote

(ask about verifiable past events)

Loss of immediate and recent memory is seen in ___ or ___.

dementia

delirium

Infection, frontal or temporal lobe lesion/trauma, depression, anxiety, and intoxication can be underlying causes of ___.

memory loss

In the ___ portion of the exam, ask the pt to repeat a short phrase, story, or set of directions.

attention span

Fatigue, anxiety, medication, frontal lobe lesion, depression, or delirium are indicated if there is a lack of a pt's ___.

attention span

True or False:

a pt needs to repeat the sentence word for word in the attention span test

false

(needs to repeat it back within reason)

In the ___ portion of the exam, a pt should give a solution to a hypothetical situation.

judgement

Judgement requires higher ___ function.

cerebral

Mental retardation, emotional disturbance, dementia, psychosis, or frontal lobe injury is indicated if there is ___ impairment.

judgement

Ask a pt about minor/major current events.

major

Knowledge of current events requires ___, ___ memory, and ___ thinking.

orientation

recent

abstract

In speech and language skills, the quality of ___, a___, c___, c___, and potential a___ should be noted.

voice

articulation

comprehension

coherence

aphasia

Disorder of volume, quality, or pitch is called ___ which could be due to disorders of larynx or vocal cords.

disphonia

Stuttering, hesitancy, and pronunciation abnormalities should be noted in a pt's ___.

articulation

Defect in articulation is called ___ which could be due to motor deficit of lips, tongue, palate, pharynx, or stroke, inebriation, CP, or Parkinson's.

dysarthria

True or False:

dysphonia and dysarthria are disorders that have to do with mental status

false

To ensure that the patient can comprehend speech, ask the pt to follow ___ and ___ step directions.

one

two

Use of meaningless statements, rhyming words, or repetition are part of ___ speech.

incoherent

Drug and ETOH intoxication or psych disorders can indicate ___.

incoherent speech

"Roundabout speech" or using many words when being evasive is called ___.

circumlocution

Repeating a word, phrase, or gesture is called ___.

perseveration

Disordered words or sentences is called ___.

flight of ideas

Meaningless disconnected words is called ___.

word salad

Made up words are called ___.

neologisms

Words rhyme in a nonsensical manner is called ___.

clang association

Repeating another person's words is called ___.

echolalia

Inability to properly express oneself by speech or writing or the inability to properly comprehend spoken or written language is called ___.

aphasia

When a patient can speak and understand words but will not due to a psychological condition is called ___ aphasia.

psychogenic

Aphasia could be caused by ___ or ___ lobe disease, motor impairment of the ___ or ___, or psychogenic.

frontal

temporal

face

tongue

Impaired speech or writing that is labored is ___ aphasia in which the pt is searching for words and may speak in gibberish tone.

Broca's

Broca's aphasia occurs in the ___ lobe.

frontal

Inability to understand written or spoken words is called ___ aphasia in which a pt cannot comprehend language but can speak words with ease.

Wernicke's

(pt talks in word salad)

Wernicke's aphasia affects the ___ lobe.

temporal

True or False:

Wenicke's aphasia only occurs in the dominant hemisphere

true