Mental Status Assessment

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Contextual project

Texila American University
Neurological System & Mental Status Assessment

The neurological exam should be incorporated into the rest of your physical exam. Although it can be intimidating to those just learning it and although it will inevitably take you a long time to do at first, practice will certainly allow you to become proficient. Your job at this stage is to work on accuracy and thoroughness, not speed. In practice, the neurological exam is tailored to the patient’s symptoms and to your hypothesis about lesion localization. The screening neurological exam for the asymptomatic patient undergoing a routine physical is very different
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You can assess much of patients’ mental status via simple observation and through their answers to your questions during history taking. For a screening exam, you are done if the patient makes appropriate eye contact and does not drift off or need things repeated, is able to converse normally with you, and answers questions about medical history and recent events in a consistent manner. Obviously, if the patient’s spouse or child is sitting there shaking his or her head, repeatedly correcting the patient, or giving you a completely different account of historical or recent events, you will need to do a more formal assessment. Seven areas of mental status need to be considered:

1. Level of awareness.
2. Attentiveness: Is the patient paying attention to you and your questions or is he distractible and requiring re-focusing?
3. Orientation: to self, place, time. Disorientation to time typically occurs before disorientation to place or person. Disorientation to self is typically a sign of psychiatric disease.
4. Speech & language: includes fluency, repetition, comprehension, reading, writing, naming.
5. Memory: includes registration and retention.
6. Higher intellectual function: includes general knowledge, abstraction, judgment, insight, reasoning.
7. Mood and affect: The primary purpose of assessing mood and affect in the neurological exam is
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The following table lists the various testable functions of each of the cranial nerves. The functions in bold are those that should be tested in a screening exam. I cannot stress enough the importance of the fundoscopic exam in all patients from the standpoint of both the general physical exam and the neurological exam. Visual acuity is certainly a vital part of the general exam, but I did not include it as vital in the screening neurological exam because the vast majority of impairment in visual acuity is due to refractive errors rather than optic nerve dysfunction.
Cranial Nerve Assessments
I – Olfactory nerve –smell
• Test if: report loss of smell, had head trauma, with abnormal mental status or when suspect intracranial lesion
• Each nostril should identify odour –may with aging
• Occlude each & test with non-noxious smells: coffee, toothpaste, orange, vanilla, soap, peppermint

II – Optic nerve –vision
• visual acuity/visual fields, opthalmoscopic exam

III, IV, VI –Occulomotor, Trochlear, & Abducens –Extra ocular eye movements
• Check pupil size, regularity, equality, direct & consensual light reaction &

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