1. Ms. Pammy is a 36-year-old woman who presents to your office with a complaint of depression. She is experiencing anger, fear, and sorrow. Which of the
... [Show More] following regulates feelings of anger, fear, and sorrow?
A. Limbic system
B. Corpus callosum
C. Temporal lobes
D. Caudate nucleus
A. Limbic system
The limbic system mediates certain patterns of behavior that determine survival (e.g., mating, aggression, fear, and affection). Reactions to emotions such as anger, love, hostility, and envy originate here, but the expression of emotion and behavior is mediated by connections between the limbic system and the frontal lobe. Answers b, c, and d are incorrect because they are responsible for other functions.
Mrs. Hilliard brings her 9-year-old daughter to your office. She has been diagnosed with autistic disorder. Which of the following statements best describes this disorder?
A. Pervasive neurodevelopmental disorder
B. Global intellectual deficit
C. Social impairment syndrome
D. Right brain dysfunction
A. Pervasive neurodevelopmental disorder
Autism is a pervasive neurodevelopmental disorder of unknown etiology that includes a wide spectrum of disorders typically identified before 3 years of age and is more common in boys than girls.
Mr. Edwards presents to the emergency department after an auto accident. Which of the following scales would be used to evaluate the mental status of a patient after head trauma?
A. Mini-Mental State Examination
B. Perceptual distortion assessment
C. Glasgow Coma Scale
D. Functional assessment
C. Glasgow Coma Scale
The Glasgow Coma Scale is used to quantify level of consciousness after an acute brain injury or medical condition. The Mini-Mental State Examination (MMSE) is a standardized tool to assess cognitive function changes over time. Perceptual distortion assessment evaluates the variation between a reported perception of a stimulus and the normal response. Functional assessment is an objective measure of a person's ability to perform the activities of daily living.
Disordered perceptions, decreased attention span, suspiciousness, and fear with motor and sensory excitement are characteristics of which disorder?
A. Delirium
B. Dementia
C. Schizophrenia
D. Depression
A. Delirium
Delirium is impaired cognition and consciousness and mood and behavioral dysfunction of acute onset. Disordered perceptions, decreased attention span, suspiciousness, and fear with motor and sensory excitement are objective characteristics found in delirium.
Mr. Yates is a 67-year-old patient who presents to your office with his son. Which of the following would best test Mr. Yates's comprehension?
A. Ask him to count backward by 7s from 100.
B. Ask him to follow one- and two-step commands.
C. Ask him the meaning of "a stitch in time saves nine."
D. Ask him his name, the date, and the season.
B. Ask him to follow one- and two-step commands.
Asking simple one- and two-step directions measures a patient's comprehension. Patients should be able to follow instructions of this type. Answers a, c, and d measure other cognitive abilities, like abstract reasoning.
Mrs. Tucker presents to your office today for a follow-up appointment. She appears to fidget in her seat and with her hands. Which of the following would assess her attention span?
A. Are you usually this anxious?
B. I am going to ask you to name four items; do the best you can.
C. What does this phrase mean: "A stitch in time saves nine?"
D. Could you take this paper, fold it in half, and put it on the counter?
D. Could you take this paper, fold it in half, and put it on the counter?
Answer d is an example of asking the patient a set of short commands that measures attention span. Answer a is a form of validation. Asking answer c measures cognitive abilities, whereas answer b does not provide enough information to determine what the examiner is trying to measure.
A mother brings her child, an 18-month-old boy, to the clinic. She states that the child rarely talks or smiles. She has also noticed that he does not like to be held. She states that his motor development seems to be normal. With what condition are these symptoms consistent?
A. Dementia
B. Autistic disorder
C. Attention deficit
D. Delirium
B. Autistic disorder
Symptoms such as delayed or underdeveloped language skills and resisting being held or touched are signs of autism, a pervasive neurodevelopmental disorder of unknown etiology that includes a wide spectrum of disorders typically identified before 3 years of age and is more common in boys than girls.
Mr. Johnson presents to your office with a complaint of anxiety. Which area of the mental assessment corresponds to his complaint?
A. Cognitive abilities
B. Speech/language
C. Emotional stability
D. Appearance and behavior
C. Emotional stability
Emotional stability is evaluated when the patient does not seem to be coping well or does not have resources to meet his or her personal needs. Anxiety may be present in other components of the mental assessment, but it is a measure of the patient's emotional stability.
Mrs. Karon is a 46-year-old female patient who presents to your office for a physical. When you enter the room, her arms are folded tight and she will not look up to address you. Into which category of examination findings do these observations belong?
A. Cognitive abilities
B. Speech/language
C. Emotional stability
D. Appearance and behavior
D. Appearance and behavior
Body language, grooming, and emotional status comprise the patient's appearance and behavior. A lack of concern with appearance, or inappropriate dress for season or occasion in a previously well-groomed individual may indicate depression, a psychiatric disorder, or dementia, which are indicative of the patient's emotional status. Answer b is inappropriate becauase the patient did not verbalize anything.
Mrs. Horter brings her 14-year-old son in with a complaint that he has a poor attention span. Which of the following examination categories is most reflective of attention span?
A. Cognitive abilities
B. Speech/language
C. Emotional stability
D. Appearance and behavior
A. Cognitive abilities
Attention span, state of consciousness, responses to analogies, abstract reasoning, arithmetic calculation, and memory are assessed to evaluate cognitive abiliites. Signs of possible cognitive impairment are poor attention span, significant memory loss, confusion (impaired cognitive function with disorientation, attention and memory deficits, and difficulty answering questions or following commands), impaired communication, inappropriate affect, personal care difficulties, hazardous behavior, agitation, and suspiciousness.
Which is a major difference between Alzheimer disease and vascular dementia?
A. Etiology
B. Degree of memory loss
C. Functional ability
D. Extent of personality disintegration
A. Etiology
Dementia is a chronic, slowly progressive disorder of failing memory, cognitive impairment, behavioral abnormalities, and personality changes that often begins after age 60 years and is usually related to structural diseases. Vascular dementia is a type of dementia related to acute or embolic strokes or cerebral hemorrhages caused by hypertension. Up to 70% of Alzheimer dementia is caused by the presence of senile plaques and neurofibrillary tangles with abnormal amyloid processing or deposits.
Which of the following actions would best evaluate the patient's judgment?
A. Ask the patient the meaning of the statement "A stitch in time saves nine."
B. Provide the patient with four unrelated words and ask the patient to remember them.
C. Ask the patient, "What do you plan to do after you are discharged from the hospital?"
D. Give the patient pencil and paper and ask him to write a paragraph about judgment.
C. Ask the patient, "What do you plan to do after you are discharged from the hospital?"
Questions that focus on the patient's plan for the future are used to assess the patient's judgment, as well as questions to illicit how the patient meets his or her social and familial obligations and those based on hypothetical situations. Answers a, b, and d measure other categories of mental functioning
Mr. Gates is a 68-year-old man who is brought to your office by his daughter. Which of the following would demonstrate an evaluation of thought process and content?
A. Observing the person's patterns of thinking, especially the appropriateness of sequence, logic, coherence, and relevance to the topics discussed
B. Observing congruence of affect and speech
C. Inquiring about visual, auditory, or tactile hallucinations
D. Asking the patient a question such as "What would you do if you were in a theater and saw a fire starting?"
A. Observing the person's patterns of thinking, especially the appropriateness of sequence, logic, coherence, and relevance to the topics discussed
Thought process and content are evaluated by observing the patient's thought patterns, especially the appropriateness of sequence, logic, coherence, and relevance to the topics discussed. The patient's thought process should be easy to follow, with logical and goal-directed ideas expressed. Illogical, disorganized, or unrealistic thought processes, flight of ideas (rapid disconnected thoughts), blocking (i.e., an inappropriate pause in the middle of a thought, phrase, or sentence), or impaired stream of thinking (e.g., repetition of a word, phrase, or behavior) indicates an emotional disturbance or a psychiatric disorder. Answers b, c, and d evaluate other components of mental function.
Mr. Brooks is a 65-year-old patient who presents to your office with his daughter. The daughter states that her father has intact reading comprehension, impaired writing skills, and uses only nouns and verbs in speech. Which of the following best identifies this condition?
A. Wernicke aphasia
B. Broca aphasia
C. Dementia aphasia
D. Global aphasia
B. Broca aphasia
Broca aphasia is an expressive type of aphasia characterized by intact reading comprehension, impaired writing skills, and using only nouns and verbs in speech. Wernicke and Broca aphasias display different symptoms, and the patient's speech with dementia aphasia may be rambled, incoherent and disordered or the patient may struggle to find the right words.
Mr. Santos is a 78-year-old patient who presents to your office with his daughter. The daughter describes difficulties that include a sudden onset of cognitive impairment, illogical flow of ideas, and hallucinations. Which of the following best describes this condition?
A. Delirium
B. Alzheimer-type dementia
C. Vascular-type dementia
D. Anxiety disorder
A. Delirium
Characteristics of delirium include a sudden onset of cognitive impairment, illogical flow of ideas, and hallucinations that fluctuates during the day and last hours or days. Patients with answers b, c, and d display different characteristics.
Mr. Green returns to your office with his son 3 months after his CVA. The son questions when his father's speech will improve. Which of the following areas of the brain are integral to motor speech?
A. Broca area (frontal lobe)
B. Reticular activating system
C. Limbic system
D. Insula
A. Broca area (frontal lobe)
Broca area (frontal lobe) contains the motor cortex, which is associated with speech formation, as well as decision making, problem solving, the ability to concentrate, and short-term memory. Answers b, c, and d are associated with different areas of the brain and other characteristics.
Mr. Reasoner brings his son in for a routine physical examination. On examination, you note impaired attention for his age, impulsivity, and hyperactivity. Your impression is attention-deficit/hyperactivity disorder. You know that this occurs in children before they are:
A. 5 years old.
B. 7 years old.
C. 9 years old.
D. 11 years old.
B. 7 years old.
Attention-deficit/hyperactivity disorder is a neurobehavioral problem of impaired attention and hyperactive behavior affecting 5% to 10% of school-age children, with an onset before 7 years of age.
A review of related history includes detailed inquiry about:
A. disorientation and confusion.
B. depression.
C. medication use.
D. all of the above.
D. all of the above.
Responses to questions about these topics provide clues for focusing the physical examination and the development of an appropriate diagnostic evaluation. Questions regarding medication use (prescription and over-the-counter preparations) as well as complementary/alternative therapies are relevant for each area.
Schizophrenia affects which of the following?
A. A person's perceptions
B. A person's mood
C. Attention span
D. Only older adults
A. A person's perceptions
Schizophrenia is a severe, persistent, psychotic syndrome with impaired reality that relapses throughout life. Other disorders may affect a person's mood, attention span, and the older adult.
Mr. Jared is a 68-year-old patient who presents to your office with his daughter. During the interview, you note that he has a slumped posture in the chair and lack of facial expression. These observations are most suggestive of which of the following conditions?
A. Endocrine disorder
B. Concussion
C. Parkinson disease
D. Vascular dementia
C. Parkinson disease
Slumped posture and a lack of facial expression may indicate depression or a neurologic condition such as Parkinson disease.
The limbic system mediates:
A. vomiting.
B. emotions.
C. speech.
D. balance.
B. emotions.
The limbic system mediates certain patterns of behavior that determine survival (e.g., mating, aggression, fear, and affection). Reactions to emotions such as anger, love, hostility, and envy originate here, but the expression of emotion and behavior is mediated by connections between the limbic system and the frontal lobe. Answers a, c, and d are not a part of the anatomy and physiology of the brain.
Mrs. Gerrard is a 72-year-old patient who presents to your office. After your examination, you suspect she is depressed. Which of the following findings could indicate depression in an adult patient?
A. Unable to demonstrate abstract reasoning
B. Unable to correctly write his or her name
C. Unable to comb his or her hair
D. Demonstrates impaired math skills
D. Demonstrates impaired math skills
Impairment of arithmetic skills may be associated with depression and diffuse brain disease. The patient's inability to demonstrate abstract reasoning, correctly write his or her name, or comb his or her hair are associated with other impaired cognitive abilities.
Anger or rage reactions, impulsive behavior, and hyperarousal persisting for more than a month are characteristic signs of which problem?
A. Schizophrenia
B. Attention-deficit/hyperactivity disorder
C. Posttraumatic stress disorder
D. Vascular dementia
C. Posttraumatic stress disorder
Anger or rage reactions, impulsive behavior, hyperarousal, condition persists for more than 4 weeks are objective data of posttraumatic stress disorder.
Mrs. Bates is a 56-year-old patient who presents to your office with her son. He states she has had a change in mental status. On examination, you note that her judgment is poor. With which problem is poor judgment most closely associated?
A. Drug toxicity
B. Dementia
C. Temporal lobe injury
D. Limbic system dysfunction
B. Dementia
Impaired judgment may indicate intellectual disability, emotional disturbance, frontal lobe injury, dementia, or psychosis.
The examiner asks the patient to complete this statement: "A bird is to air as a fish is to _________." This is an example of what type of testing?
A. Calculation
B. Analogies
C. Judgment
D. Mood and feelings
B. Analogies
An analogy is a comparison of two things based on their being alike in some way. Analogies are used to investigate cognitive abilities.
An inability to describe similarities or differences between common objects such as carrots and green beans is suggestive of which problem?
A. A left cerebral hemisphere lesion
B. Depression
C. An eating disorder
D. Aphasia
A. A left cerebral hemisphere lesion
Patients with average intelligence should be able to describe the similarities and differences between common objects. An inability to describe similarities or differences may indicate a lesion of the left or dominant cerebral hemisphere.
A 65-year-old woman is brought to the clinic by her family, who report that they have noticed a change in her mental abilities over the past 2 weeks. Normally she is independent, intelligent, and socially oriented. Her medical history is unremarkable except for congestive heart failure, which is controlled with digoxin. She has had no major changes in her health. What question would be the most important for the examiner to ask the family?
A. "Is there a family history of Alzheimer disease?"
B. "How much alcohol does she drink in an average week?"
C. "When was her digoxin blood level last checked?"
D. "Did you know that mental function begins to decline after the age of 60?"
C. "When was her digoxin blood level last checked?"
Digoxin may cause disorientation and confusion. Responses to questions regarding medication use are important for evaluating present illness.
A patient who has difficulty writing or drawing is most likely to have which condition?
A. Temporal lobe damage
B. Peripheral neuropathy
C. Wernicke paralysis
D. Psychiatric hallucinations
B. Peripheral neuropathy
Uncoordinated writing or drawing may indicate dementia, parietal lobe damage, a cerebellar lesion, or peripheral neuropathy.
Which is a classical indication of Alzheimer disease?
A. Use of clang associations
B. Occurrence of visual hallucinations
C. Disintegration of personality
D. Flat affect and mood
C. Disintegration of personality
Eventual profound disintegration of personality and complete disorientation occur in a majority of Alzheimer cases (dementia).
In babies, babbling and cooing usually occur around:
A. 2 to 3 months.
B. 3 to 4 months.
C. 4 to 6 months.
D. 6 to 8 months.
B. 3 to 4 months.
Cooing and babbling are expected after 3 and 4 months of age, respectively.
At what age do babies usually say one or two words, such as "Mama" and "Dada"?
A. 4 to 6 months
B. 6 to 8 months
C. 8 to 10 months
D. 10 to 12 months
D. 10 to 12 months
Expressive language milestones for this age include words such as "Mama," "Dada," and "Bye-Bye."
Social smiling usually occurs around:
A. 2 to 3 months.
B. 3 to 4 months.
C. 4 to 6 months.
D. 6 to 8 months.
A. 2 to 3 months.
Social smiling occurs in the 2- to 3-month-old infant. The examiner should be concerned when it is difficult or impossible to elicit a social smile in an infant who appears ill. This may be indicative of a neurologic condition or infection, such as meningitis.
Typical changes in mental functioning that occur with aging include distinctive personality changes.
A. True
B. False
B. False
Verbal skills and general knowledge continue to increase into the 60s and often remain stable into the 80s. Recent memory for important events and conversations is usually not impaired. The older adult may complain about memory loss but this is not predictive of cognitive decline. Older adults are expected to maintain the same level of interpersonal skills and have no personality changes.
Which part of the brain mediates certain patterns of behavior that determine survival, such as mating, aggression, fear, and affection?
A. Frontal lobe
B. Parietal lobe
C. Temporal lobe
D. Limbic system
D. Limbic system
The limbic system mediates certain patterns of behavior that determine survival (e.g., mating, aggression, fear, and affection), whereas the frontal, parietal, and temporal lobes do not.
The Mini-Mental Status examination is designed to track cognitive changes over time.
A. True
B. False
A. True
The MMSE is a standardized tool to assess cognitive function changes over time. There are 11 items measuring orientation, registration, attention and calculation, recall, and language, and it takes approximately 5 to 10 minutes to administer.
Screening for depression should be a routine part of care for all new mothers.
A. True
B. False
A. True
An estimated 39% of women who have depression during pregnancy have postpartum depression. An estimated 13% of women have postpartum depression (Underwood, Waldie, D'Souza, et al., 2016). Postpartum psychosis occurs in 0.1% to 0.2% of women (Berrisford, Lambert, and Heron, 2015). Because depression may interfere with the mother's health, ability to work, and attachment to the newborn and the infant's subsequent development, all new mothers should be screened for depressive symptoms.
Problem solving and short-term recall memory are associated with which section of the brain?
A. Frontal lobe
B. Parietal lobe
C. Temporal lobe
D. Limbic system
A. Frontal lobe
The frontal lobe, containing the motor cortex, is associated with speech formation, decision making, problem solving, the ability to concentrate, and short-term memory. The parietal lobe is primary responsible for receiving and processing sensory data. The temporal lobe is responsible for perception and interpretation of sounds as well as localizing their source. The limbic system is responsible for emotions.
Which area in the brain regulates the level of arousal?
A. Limbic system
B. Reticular activating system
C. Temporal lobe
D. Occipital lobe
B. Reticular activating system
The reticular activating system (RAS) in the brainstem regulates awareness and arousal. Answers a, c, and d regulate other areas of the brain.
Which part of the brain contains the Wernicke speech area, which permits speech and comprehension of written language?
A. Frontal lobe
B. Parietal lobe
C. Temporal lobe
D. Limbic system
C. Temporal lobe
The temporal lobe is responsible for perception and interpretation of sounds as well as localizing their source. It contains the Wernicke speech area, which allows a person to understand spoken and written language. It is also involved in the integration of behavior, emotion, and personality, as well as long-term memory. Answers a, b, and d regulate other characterisitics.
Long-term memory is associated with which area of the brain?
A. Frontal lobe
B. Parietal lobe
C. Temporal lobe
D. Limbic system
C. Temporal lobe
The temporal lobe not only contains the Wernicke speech area, it is also involved in the integration of behavior, emotion, and personality, as well as long-term memory. Answers a, b, and d regulate other characterisitics.
Distorted Thinking
Unrealistic sense of persecution, jealousy, grandiose ideas, or ideas of reference - neutral things in the environment have a special meaning to the person.
MoCA verses MMSE
The MoCA has more cognitively demanding task related to memory recall and executive functioning than the MMSE. The MoCA was found to better discriminate patients with mild cogative impairment at risk for dementia than the MMSE, as well as those patients with multiple domain verses single domain mild cognitive impairment.
Assessing orientation to person, place, and time helps determine:
Ability to understand analogies
Abstract reasoning
Attention span
State of consciousness
ANS: D
Rationale: Orientation to person, place, and time are measures of states of consciousness and awareness, not degrees of attention span. Analogies and abstract reasoning are higher functions than orientation. Emotional status can be better evaluated by observing behaviors.
One method to evaluate mental status, cognitive function, and assess for dementia is:
Mini-Cog
Glasgow Coma Scale
Geriatric depression inventory
Coherence testing scale
ANS: A
Rationale: The Mini-Cog is a brief screening tool for measuring cognitive function; it takes 5 minutes to administer
Testing the patient's arithmetic calculation will assist in determining:
Dementia and Parkinson disease
Depression and diffuse brain disease
Schizophrenia and brain damage
Intellectual disability
ANS: B
Rationale: Arithmetic calculations should be completed with few errors and within 1 minute. When the patient has average intelligence, impairment of arithmetic skills may be associated with depression and diffuse brain disease.
Glasgow Coma Scale
Used to quantify consciousness in person with head trauma or hypoxic event
Versions are available for adult, infant, and young child
Assesses the function of the cerebral cortex and brainstem through the patient's verbal, motor, and eye opening responses to specific stimuli
Scores range from 3 to 15, with 15 being the optimal level of consciousness.
THIS IS PERTINENT IN EMERGENT/INPATIENT SITUATIONS. Refresh your memory so that you are ready for the HESI final.
Delirium
Impaired cognition, arousal, consciousness, mood and behavioral dysfunction of acute onset
Dementia
A chronic, slowly progressive disorder of failing memory, cognitive impairment, behavioral abnormalities, and personality changes that often begins after age 60 years
Brocha Aphasia (Expressive)
Word Comprehension - fair to good
Spontaneous speech - impaired speech flow; laborious effort to peak; know what they want to say but cannot articulate properly; telegraphic speech (mostly nouns and verbs)
Reading Comp - Intact
Writing - Impaired
Wernicke Aphasia (Receptive)
Word Comprehension - Can hear words but cannot relate them to previous experience
Spontaneous speech - Fluent speech but uses words inappropriatly, such as neologisms or word substitutions; may be totally incomprehensible.
Reading Comp - Impaired
Writing - Impaired
Global Aphasia (Expressive and Receptive)
Word Comprehension - Absent or reduced to person's own name, few select words
Spontaneous speech - Absent or reduced to only a few words or sounds
Reading Comp - Severely impaired
Writing - Severely impaired
Cerebrum
Area of the brain responsible for all voluntary activities of the body
frontal lobe
Motor cortex, speech formation, decision making, problem solving, ability to concentrate, short term memory.
Associated areas that relate to strong emotions and reactions to them originate here.
parietal lobe
receiving and processing sensory data
Temporal lobe
Perception and integration of sounds/source; Wernicke speech area ~ ability to understand spoken and written language; integration of behavior, emotion, and personality; long term memory
Limbic System
mediates behaviors that determine survival ~ mating, aggression, fear, and affection
Reactions to emotions like anger, love, hostility, and envy originate here, BUT the expression of emotion and behavior is mediated by connections between the limbic system and the frontal lobe
Reticular System
the part of the brain that is involved in attention, sleep, and arousal.
Regulates vital reflexes such as heart and respiratory functioning.
Disruption of ascending reticular activating system can lead to AMS ~ confusion or delirium [Show Less]