Physical Assessment Gable

Frontal Lobe

  • Speech
  • Emotional regulation
  • Drive to do things
  • Memory
  • Affect (how we display our emotions)

Parietal Lobe

  • Sensory data (processing of senses)

Temporal Lobe

  • Sound
  • Comprehension of language, both spoke and written

Occipital Lobe
Visual
Anterograde Amnesia
Forgetting what you did this morning
Retrograde Amnesia
Forgetting what high school you went to, mother’s maiden name
Delirium vs Amnesia

Delirium

  • Happens abruptly (ie, caused by medications)

Amnesia

  • Happens over time

What should you remember when asking a patient about their associated symptoms?

SIGECAPS

;

Sleep patterns

Interest level (ask them what they enjoy in life)

Guilt, hopelessness (do you feel things getting better)

Energy changes

Concentration

Appetite changes

Psychomotor slowed/aggitation

Suicidal thoughts

;

What should you remember about the Mental Status Exam?

AMSIT

;

1.; Appearance

Behavior

attitude, psychomotor activity, eye contact, gait, posture, impulse control, abnormal movemements

Speech

rhythm, rate, tone

Language

voice quality, articulation, comprehension, coherence, aphasia

2.; Mood

depressed, dysphoric, euthymic, elevated, euphoric

Affect

appropriate vs inappropriate

3.; Sensorium

Orientation

time, place, person

4.; Intelligence

analogies, abstract reasoning, calculations, writing ability, memory (immediate recall), attention span, execution of motor skills, insight, judgement,

5.; Thought Process and Content

;

Abnormalities with Thought Process and what they indicate

1.; Circumstantial

  • Excess information, eventually answers question
  • Manic patients

2.; Tangential

  • Go off on tangent, never answers question
  • Manic patients

3.; Flight of Ideas

  • One idea to the next, connected, very fast
  • Bipolar, manic patients

4.; Loose Associations

  • All over the place, no connected thoughts
  • Schizophrenic patients

5.; Concrete Thinking

  • Very literal thinking
  • Severely disorganized in thought process, mental retardation, child not fully developed

6.; Thought Blocking

  • Conversation starts linear but stops abruptly
  • Severely disorganized in thought process, schizophrenic patients

Abnormalities with Thought Content and what they indicate

1.; Delusions

  • False, fixed belief
  • Schizophrenic patients

2.; Suicidality/Homicidality

  • Always asked as part of thought content

3.; Thought insertion/Broadcasting

  • Paranoia

4.; Ideas of Reference

  • An airplane flew by and sent special messages
  • Severe mental illness, bipolar disorder

5.; Hypersexuality

;

6.; Hallucinations

  • Auditory (most common), visual, tactile (substance abuse or withdrawal), olfactory (post-seizure), gustatory

Expressive Language Milestones in Children

12-15 months

;

says 3-4 words, including names; uses flow of connected sounds that have inflection and seem like a sentence

;

15-18 months

;

uses 10 words including names; makes requests by naming objects; begins repeating words heard in conversations

;

18-24 months

;

uses short sentences; uses pronouns, tells full names; echoes rhythms

;

24-36 months

;

caregiver understands 90% of speech; uses noun-verb communications with correct verb-tense; repeats 3 numbers

Disorders in Infants and Children

  • Mental Retardation — IQ < 70
  • ADHD — onset less than 7 years
  • Autism — before the age of 3 (social interactions, language deficits, behavioral traits, odd or repetitive behavior)

Abnormal Findings in Infants and Children

  • Drooling after 2 yo
  • Shrill, whiny, high-pitched cry
  • Delayed developmental milestones
  • Developmentally inappropriate inattention, impulsivity, hyperactivity
  • Communication deficits and behavioral traits

Disorders of Altered Mental Status

  • Delirium
  • Delirium Tremens (long term alcohol use and withdrawal)
  • Dementia (Alzheimers, Vascular)
  • Concussion

Dementia vs Delirium

Dementia

  • chronic onset
  • memory impairment
  • slowly progressive
  • persistent
  • impaired abstract thinking, judgement, memory, thought, pattern, calculations, permanent and progressive
  • Delusions, no hallucinations

Delirium

  • abrupt onset
  • consciousness impairment
  • fluctuating, worse at night
  • hours to days
  • impairment of memory, attentiveness, consciousness, calculations
  • visual, auditory, tactile hallucinations, delusions

Triggers for Dementia vs Delirium

Dementia

  • chronic alcoholism
  • vitamin B12 deficiency
  • vascular infarcts
  • HIV encephalopathy
  • Alzheimer’s disease

Delirium

  • physical condition
  • drug toxicity
  • brain injury
  • alcohol withdrawal response

Glasgow Coma Scale

Used to quantify consciousness when it is altered due to head trauma or hypoxic event

15 = optimal level of consciousness

3 = deepest coma

Mini-Mental Status Exam (MMSE)

  • 10 minute screening test
  • Assesses several cognitive domains that may be impaired in AD:

Memory

Orientation

Language

Praxis

Attention/Concentration

 

24-30 normal

18-23 mild dementia

10-17 moderate dementia

< 10 severe dementia

Symptoms of Mania

GIDDINESS

 

Grandiosity

Increased Activity

Decrease Judgement

Distractibility

Irritability

Need for sleep decreased

Elevated mood

Speedy thoughts

Speedy speach

Symptoms of Depression

D+ SIGECAPS

 

Depressed mood or anhedonia

Psychotic Disorders

1.  Schizophrenia

  • severe, persistent, psychotic disorder
  • neurochemical abnormality
  • hallucinations, delusions, disorganized thinking/behavior

2.  Psychosis due to medical condition

 

3.  Medication-Induced (corticosteroids)

 

4.  Substance-Induced Psychotic Disorders (cocaine, LSD, amphetamines)

 

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