COMPONENTS OF MENTAL STATUS EXAM INCLUDE: - correct answer A-B-C-T
APPEARANCE; posture, body movements, dress, grooming and hygiene
BEHAVIOR; LOC,
... [Show More] Facial expression, speech, mood and affect
COGNITION; address, phone#, etc. date?, attention span, recent and remote memory, new learning
THOUGHT PROCESS; perceptions, should be logical and consistent this person make sense?
how do people treat you?, do you feel you are being watched, followed or controlled? have you heard your name when alone?
___________________ screens for Anxiety - correct answer GAD- 7
questions to ask for depression or suicidal ideations: - correct answer Depression:
Over the past two weeks, have you fell down, depressed or hopeless?
Over the past 2 weeks, have you felt little interest or pleasure in doing things?
Suicidal:
Have you ever felt so blue you thought of hurting yourself?
Do you have a plan to hurt yourself?
How would you do it?
***Must not ignore any talk of suicide***
When is a full mental status exam necessary? - correct answer * Patients whose initial screening suggests an anxiety disorder or depression
* Behavioral changes: such as memory loss, inappropriate social interaction
* Brain lesions: trauma, tumor, cerebrovascular accident or stroke
* Aphasia: impairment of language ability secondary to brain damage
* Symptoms- of psychiatric mental illness especially with acute onset
________________ Screens for Alcoholism. - correct answer CAGE: Score 2 or greater highly significant
* Have you ever felt you should CUT down on your drinking?
* Have people ANNOYED you by criticizing your drinking?
* Have you ever felt bad or GUILTY about your drinking?
* Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover? (EYE OPENER)
Things to Consider When Assessing Older Adults mental status include: - correct answer Ask about chronic illness and how they are managing?
Sensory impairments?
Polypharmacy (med list again!)
Social isolation
Physiological issue
- Delirium vs. Dementia
- UTI
- Sundowners
Delirium VS Dementia VS Depression:
Onset
course
duration
consciousness
attention
psychomotor changes
reversibility - correct answer Delirium ** Dementia ** Depression:
==========================================
O: Acute insidious Acute or insidious
C: Fluctuating Progressive May be chronic
D: Hrs to wks Mos to yrs Mos to yrs
C: Altered Usually clear clear
A: Impaired Normal unless May be decreased
severe dementia
P: increased often normal may be slowed in decreased severe cases
R: usually irreversible usually
Delirium Causes: - correct answer D- Dementia
E- Electrolyte disorders
L - Lung, liver, heart, kidney, brain dysfunction
I- Infection
R- Rx Drugs
I- Injury, pain, stress
U- Unfamiliar environment
M- Metabolic
Adolescent: heeadsss psychosocial interview: - correct answer - Home
- Education & Employment
- Eating
- Activities
- Drugs
- Sexuality
- Suicide & Depression
- Safety (injury/violence)
When assessing children for mental heath disorders, things to consider: - correct answer Does the child seem sad, tired, restless?
Does the child spend a lot of time alone?
Frequent outbursts of shouting, complaining, or crying?
Lost interest in hobbies like music/sports?
Talks about death or suicide?
Sleep too much or not enough?
Other questions...
____________________ is the test for Proprioception. - correct answer Romberg's Test:
- Stand with feet together
- Arms out with palms up
- Shut eyes
- If pt sways or looses balance = Positive Romberg's
Risks Related to Undiagnosed Ear Disorders: - correct answer - Poor language development
- Delayed learning
- Social isolation
- Hearing loss
- Risk for falls
- Missed diagnoses of respiratory and oral infections
Major symptoms of ear disease include: - correct answer Hearing loss
Vertigo
Tinnitus
Otorrhea
Otalgia
Itching
Questions to ask if acute hearing loss occurs: - correct answer - Is the hearing loss in one ear?
- For how long have you been aware of the hearing loss?
- Was the loss sudden?
- Is there a family history of hearing loss?
- What type of work do you do (or have you done)?
- What types of hobbies do you have?
- Have you noticed you can hear better when it's noisy?
- What kind of medications are you currently taking?
- Do you know if you have been given an antibiotic called streptomycin or gentamicin?
Types and Causes of Hearing Loss: - correct answer Conductive:
- Poor transmission of sound waves through the external and/or middle ear
- Tend to speak softer
Sensorineural
- Diseases of the cochlea and/or poor conduction of sound-generated impulses along the eighth cranial nerve to the brain stem
- Tend to speak louder
Mixed
- Combination of both conductive and sensorineural hearing loss in the same ear
Questions to ask if acute vertigo occurs: - correct answer - How long have you had this sensation?
- Have you had repeated attacks?
- How long does an attack last? Seconds? Minutes? Hours? Days?
- Is the onset of an attack abrupt?
- Was the sensation brought on by, or worsened by, changes in position?
- Does the spinning sensation get worse during an attack?
- Are there positions that make you feel better?
During an attack have you had double vision? Loss of strength? Decreased hearing? A disturbance of gait? Nausea? Vomiting? Ringing in your ears?
- What medications are you currently taking?
- Do you know if you have been given an antibiotic called streptomycin or gentamicin?
Tinnitus is defined as ___________________. - correct answer Buzzing or ringing in the ears without environmental input
Causes of Tinnitus can include: - correct answer - Meniere's disease
- Noise trauma
- Ototoxic drugs
- Otosclerosis
Pulsatile tinnitus is ____________________ and can be caused by _______________________. - correct answer - Beats at the same rate as the heart
- vascular tumor of head or neck
Characteristics of Tinnitus include: - correct answer - Originates in the central auditory system
- Affects approximately 10% of the population
- Can be transient or continuous
- Can be mild, moderate, or severe
- Can be subjective (audible only to patient) or objective (sound also audible to examiner as a bruit)
- Incidence increases with age
Otorrhea is _________________. - correct answer discharge from the ear. Usually indicates acute or chronic infection.
Questions to ask a patient with Otorrhea include: - correct answer - Can you describe the discharge?
- Have you had similar episodes?
- Do you experience dizziness?
- Do you have ear pain?
- Have you had a recent ear or throat infection?
- Have you had any change in your hearing?
- Have you used ear drops?
- Have you been swimming recently?
- Have you had any recent head or ear injuries?
Otalgia is _______________ , and may be related to ________________. - correct answer - an earache or ear pain.
- inflammatory conditions in or around the ear, or it may be referred from distant anatomic sites in the head and neck.
Whats the difference between Primary and Secondary Otalgia? - correct answer - Primary (originating within ear structures)
* Infections and inflammations of middle and external ear structures and mastoid tissues.
- Secondary (referred to the ear from other regions)
* TMJ problems, dental and periodontal problems
* Infections in the sinuses and nasopharyngeal areas
* Lesions of the tongue
* Cervical musculoskeletal problems
* Neuralgias
Itching in the Ear can be caused by _____________ . - correct answer - Yeast infection of ear
- Systemic
* Diabetes
* Hepatitis
* Lymphoma
The presence of a tophi is __________________ and is defined as_________________________. - correct answer - a highly specific but nonsensitive sign of gout.
- Tophi are deposits of uric acid crystals. They appear as hard nodules in the helix or antihelix.
Cauliflower ear is a ______________________. - correct answer pinna that is gnarled as a result of repeated trauma.
If discharge is present in the ear you should __________________. - correct answer note its characteristics, such as color, consistency, and clarity.
Test for Auditory Acuity include: - correct answer - Whisper test
- Finger rub test
- Tuning Fork Tests 512-Hz fork ideal
* Test the ability of the patients to hear pure tones
- Weber Test
* Tests for adequacy of bone conduction
> Conductive loss - Lateralized to affected hear
> Sensorineural - lateralized to unaffected ear
> Normal - no lateralization
- Rinne Test
* Tests for comparison of air conduction to bone conduction in each ear separately
> AC in compared to BC
> AC > BC = Positive Rinne
Questions to ask if obstruction in the nose is suspected: - correct answer - Is the obstruction on one side?
- Have you ever had an injury to your nose?
- How long has the obstruction been present?
- Do you have any allergies?
- Does the obstruction worsen with stress?
- Is there a history of nasal polyps?
- Is the obstruction associated with other symptoms?
- Is there a seasonal change in your symptoms?
* Which season is worse?
Types of dIscharge from nose include: - correct answer - Thin and watery
- Thick and purulent
- Bloody
- Foul smelling
Sinus Disease Symptoms include: - correct answer - Fever
- Malaise
- Cough
- Nasal congestion
- Maxillary toothache
- Purulent nasal drainage
- Headache
- Decongestants ineffective
- Pain worse when bending over
Three Major Salivary Glands in mouth include __________________ . - correct answer - Parotid glands
*Located in the cheek area below and in front of the ears; secrete saliva via Stensen's ducts (AKA parotid duct)
- Sublingual glands
*Found under the tongue; provide saliva via several ducts
- Submandibular glands
* Located in the floor of the oral cavity; secrete saliva into the mouth
Review of specific symptoms questions for oral cavity should include: - correct answer - When did you last see a dentist?
- What did the dentist do?
- Do your gums bleed?
- Have you any pain, sores, or masses on your lips or in your mouth that do not heal?
- Have you had any problems after extraction of a tooth?
- Do you wear dentures?
- Have you noticed any change in the way your dentures fit?
Common Symptoms Related to the Oral Cavity include: - correct answer - Pain
- Ulceration
- Bleeding
- Mass
- Halitosis
- Xerostomia
Questions related to pain in oral cavity should include:
OLDCARTS - correct answer - Where is the pain?
- Describe the pain?
- Do you feel the pain anywhere else?
- How long has the pain been present?
- What brings the pain on?
- What makes it better? Worse?
- When you have the pain, do you have any other symptoms?
If there is an ulcer in the oral cavity, questions to ask should include: - correct answer - Have you had a lesion like this before?
- Are there multiple lesions?
- How long have the lesions been present?
- Are there lesions anywhere else on the body, such as in the vagina? Urethra? Anus?
- Are the lesions painful?
- Do you smoke?
- How much?
- Do you drink alcohol?
- Do you have a history of venereal disease?
If a patient snores or if suspected sleep apnea, questions you should include: - correct answer - Have you been told you snore?
- How often do you snore?
- Does your snoring bother other people?
- Have breathing pauses been noticed?
- Are you tired after sleeping?
- Are you tired during the daytime?
- Have you ever fallen asleep while driving?
- Do you have high blood pressure?
- Is your BMI greater than 28?
- Are you 50 years or older?
- Are you a man with a neck circumference greater than 17 inches or a woman with a neck circumference greater than 16 inches?
- During usual sleep, have you noticed or been told that you toss and turn frequently?
- Have you noticed or been told that you kick or jerk your legs repeatedly?
- During the time you are usually awake, how often do you become irresistibly sleepy or fall asleep in the following situations:
* After a meal
* Reading or watching TV
* Sitting and talking to someone
* At work
* While a passenger in a vehicle
* While driving a vehicle
- About how many times per night do you wake up?
- Do you have difficulty falling asleep at night?
- How many hours do you sleep?
Dysphonia is ______________________. - correct answer hoarseness; the major symptom of laryngeal disease is a change in voice.
Four Chambers of the Heart include: - correct answer Upper two chambers: (right and left atria)
- Thin-walled, low-pressure chambers
- Receive blood from the venae cava and pulmonary arteries
- Pump blood into the respective ventricle
Lower two chambers (right and left ventricles)
- Thick muscular-walled chambers
- Pump blood from the atria to the lungs and throughout the body via the aorta
- Animation of cardiac cycle: https://www.youtube.com/watch?v=SwxA3L55yqs
Epicardium is ____________________. - correct answer the thin, outmost protective layer of the heart.
Myocardium is ____________________. - correct answer - Thick muscular middle layer
- Pumps blood through the heart
Endocardium is ____________________. - correct answer - Lines the inner cavities; covers the heart valves
- Limits heart motion; provides a barrier to infection
What are the different Valves of the Heart and where are these Heart Sounds heard? - correct answer Aortic region - the 2nd intercostal space, right sternal border.
Pulmonic region - the 2nd intercostal space, left sternal border.
Erb's points - 3rd intercostal space, left sternal border.
Tricuspid region - the 5th intercostal space, left sternal border.
Mitral region - the 5th intercostal space, left mid-clavicular line.
Phases of the Cardiac Cycle include: - correct answer Systole ; The contraction of the ventricles as blood is ejected from the right ventricle into the pulmonary arteries and from the left ventricle into the aorta
* Heard best at the apex of the heart
* S1 - closure of AV valves (M1 T1)
Diastole ; The passive filling of the ventricles followed by contraction of the atria, thereby moving blood from the atria to the ventricles
< Heard best at the base of the heart
* Pt: deep breath, exhale, hold breath & lean forward
< S2 - closure of semilunar valves (A2 P2)
Extra Heart Sounds - correct answer - S3 and S4
* Sometimes classified as extra cardiac sounds
* Presence is not necessarily indicative of a pathologic condition
* Best heard at/near apex of heart
* If over 30 years old or symptomatic, evaluate further
S3 - "ventricular gallop"
- Volume overload to the ventricles
- Regurgitant valvular lesion
- CHF
S4 - "atrial gallop"
- Ventricular hypertrophy
- Myocardial ischemia
- "Summation gallop" - all 4 heart sounds present simultaneously
Most common murmurs - systolic vs diastolic:
MS.ARD & MR.ASS = - correct answer M
S
A
R
D
Mitral Stenosis (5ICS-MCL but can radiate laterally)
Aortic Regurg (Erb's point)
Diastolic murmurs
M
R
A
S
S
Mitral Regurg (5ICS-MCL)
Aortic Stenosis (2ICS-RSB & clavicle)
Systolic murmurs
Audible mid-systolic click is indicative of _________________. - correct answer MVP (mitral valve prolapse)
Erb's point auscultate especially for __________________ . - correct answer - opening snap of MVP
- Aortic valve regurgitation
- Patent VSD
How do you describe any murmurs heard in heart? - correct answer - Timing in the cardiac cycle
- Location
- Radiation
- Duration
- Intensity
- Pitch
- Quality
- Relationship to respiration
- Relationship to body position
WHAT ARE THE 6 LEVELS OF THE LEVINE SCALE FOR GRADING MURMURS? - correct answer I/VI. The murmur can only be heard if one listens carefully for some time.
II/VI. The murmur is faint but can be heard straightaway with a stethoscope.
III/VI. The murmur is moderately loud and can be heard immediately but
there is no palpable thrill (vibration that can be felt).
IV/VI. The murmur is loud and accompanies a palpable thrill.
V/VI. The murmur accompanies a palpable thrill and is loud enough to be
heard with just a slight touch of a stethoscope's rim.
VI/VI. The murmur accompanies a palpable thrill and is so loud that it can
be heard before a stethoscope even makes contact with skin.
Resource: http://mvpresource.com/what-is-the-levine-grading-scale/
What are the Symptoms Associated with Chest Pain? - correct answer - Anxiety
- Dyspnea
- Nausea
- Vomiting
- Diaphoresis
- Faintness
- Clamminess
- Pallor
What are the Types of Chest Pain? - correct answer - Angina
* Stable and unstable
* Atypical presentations
- Vascular
- Pulmonary
- Musculoskeletal
- Neural
- Gastrointestinal
Common Cardiac CC's include: - correct answer - Palpitations
- Dyspnea
* PND vs DOE
- Syncope
- Fatigue
- Edema (dependent?)
- Hemoptysis
- Cyanosis
* Differential cyanosis
What should you inspect for in a Cardiovascular assessment? - correct answer - General
- Skin
* Color
* Xanthomata
-Nails
* Splinter hemorrhages
- Lichstein's sign (beware false + or -)
- Eyes
*Arcus senilis
*Xanthelasma
*Hypertelorism
- Mouth
* Palatal petechiae
- Neck
* Webbing
- Chest configuration
- Extremities
When inspecting the Skin, with suspected cardiovascular issues, you should assess for ___________. - correct answer - Color- is cyanosis present? Does it appear central or peripheral? Is Pallor present?
- Temp
Xanthomata are __________. - correct answer stony- hard, slightly yellowish masses that are commonly found on the extensor tendons of the fingers- indicative of extremely high serum cholesterol >450mg/dL
Eruptive Xanthomata result from ______________. - correct answer elevations in plasma triglyceride concentrations, >1500mg/dL
When assessing the Nails, with suspected cardiovascular issues, you should assess for ___________. - correct answer Splinter hemorrhages: visible, small reddish-brown lines in the nail bed. classically associated with infective endocarditis.
- Lichstein's sign is ____________. - correct answer (not reliable -beware false + or -):
Earlobe crease; is an oblique crease, often bilateral, seen frequently in patients older than 50 yrs with significant CHD
Arcus senilis, if found in patients younger than 40 years old may be due to - correct answer -hypercholesterolemia
What does Arcus senilis look like? - correct answer a whitish ring at the perimeter of the cornea.
Xanthelasma is __________ and is due to possible _______________. - correct answer - the presence of yellowish plaques on the eyelids.
- hyperlipoproteinemia
Hypertelorism is ___________ and is often associated with ____________. - correct answer - widely set eyes
- congenital heart problems such as mitral valve prolapse.
When cardiovascular issues are suspected, a high-arched palate may be associated with ________________. - correct answer congenital heart problems such as mitral valve prolapse.
Palatal petechiae is often associated with ___________________. - correct answer infective endocarditis.
Webbing of neck, as seen in individuals with Turners syndrome and in patients with Noonan's syndrome, may be due to _______________. - correct answer coarctation of the aorta.
Pectus excavatum is ______________ . - correct answer caved in chest
Pectus carinatum is _______________. - correct answer pigeon breast
Questions to assess during General Appearance assessment for cardiac patient should include: - correct answer is the patient in acute distress? What is the patients breathing like? Is it labored? Are accessory muscles being used?
Common symptoms associated with DVT are ______________. - correct answer - Swelling in one or both legs
- Pain or tenderness in one or both legs, may occur only --when standing or walking
- Warmth of skin of the affected leg
- Red or discolored skin of the affected leg
- Visible surface veins
- Leg fatigue
How do you elicit a Homan's sign? - correct answer First support patients die with one hand in his foot with the other. Bend his leg slightly at the knee; then firmly and abruptly dorsiflex the ankle. Resulting deep calf pain indicates a positive Homan's sign. The patient may also resist ankle dorsiflexion or flex the knee involuntarily if Homan's sign is positive.
Name the Extra Cardiac Sounds one may hear. - correct answer - Systolic Ejection Clicks
< Early systolic:
* Aortic ejection click
* Pulmonic ejection click
< Midsystolic:
* Single or multiple; associated with prolapse of mitral or tricuspid valves
- Diastolic Sounds
* Opening snap of the mitral valve or tricuspid valves if pathologically deformed
- Other sounds
* Pericardial friction rub
* Mediastinal crunch
What diagnostic tests are for Chest Pain? - correct answer - Electrocardiogram (ECG)
- Chest X-ray
- Hematologic studies
- Cardiac catheterization
What diagnostic test is for murmurs? - correct answer Echocardiogram
What are the main symptoms of pulmonary disease? - correct answer - Cough
- Sputum production
- Hemoptysis
- Dyspnea
- Wheezing
- Cyanosis
- Chest Pain
- Snoring
What components of the physical assessment for pulmonary disease should you include? - correct answer - Inspection (anterior and posterior)
* Should include general assessment of patient's overall "attitude"
- Distress
- Posture
- Chest configuration
- Inspect hands for clubbing
- Respiratory rate/pattern
Barrel Chest is seen in patients with ________________. - correct answer COPD
The use of accessory muscles during breathing is indicative of __________________. - correct answer respiratory distress
Palpation of chest is used to assess _______________. - correct answer - Areas of tenderness
- Symmetry
- Tactile fremitus
Increased tactile fremitus can be a result of ___________. - correct answer - Pulmonary consolidation
- Pneumonia
- Pulmonary edema
- Alveolar fibrosis
- Alveolar tumor
Decreased tactile fremitus can be a result of ___________. - correct answer - Decreased tactile fremitus
- Separation between lung and chest wall
- Pleural effusion
- Pneumothorax
- Obesity
- Atelectasis
- Airway obstruction
- Tumor or foreign body
- Bronchopneumonia
- Pulmonary hyperinflation
- Emphysema (COPD)
Tracheal Shifts toward side of what diseases? - correct answer Atelectasis
Lung cancer pulling on a bronchus
Tracheal Shifts away from side of what diseases? - correct answer Pneumothorax
Large pleural effusion
What does asymmetrical chest excursion indicate? - correct answer Localized pulmonary disease may cause one side of the chest to move less than the opposite side.
Name the Percussion notes in the lung and what they are indicative of. - correct answer - Tympany
> Large pneumothorax
- Hyperresonance
> Emphysema
- Resonance
> Normal lung [Show Less]