MENTAL STATUS EXAMINATION
The mental status examination is underway as soon as the physician begins observing and talking with the pt. The goal is to evaluate attention, orientation, memory, insight, judgment, and grasp of general information. Attention: ask pt to respond every time a specific item recurs in a list. Orientation: ask about the day, date, and location. Memory: ask pt to immediately recall a sequence of numbers and test recall of a series of objects after defined times (e.g., 5 and 15 min). Remote memory is also evaluated by assessing pt’s ability to provide a cogent chronologic history of the illness or personal life events. Recall of historic events or dates of current events can be used to assess knowledge. Evaluation of language function should include assessment of spontaneous speech, naming, repetition, reading, writing, and comprehension. Additional tests such as ability to draw and copy, perform calculations, interpret proverbs or logic problems, identify right versus left, name and identify body parts, etc., are also important.
A useful screening examination of cognitive function is the mini-mental status examination (MMSE), a 30-point test of cognitive function, with each correct answer being scored as 1 point. It includes tests in the areas of orientation (e.g., identify season/date/month/year/floor/hospital/town/state/country); registration (e.g., name and restate 3 objects); recall (e.g., remember the same three objects 5 minutes later); and language (e.g., name pencil and watch; repeat “no if’s and’s or but’s”; follow a three-step command; obey a written command; and write a sentence and copy a design).
CRANIAL NERVE (CN) EXAMINATION
The bare minimum: Check the fundi, visual fields (VFs), pupil size and reactivity, extraocular movements, and facial movements.
Occlude each nostril sequentially and ask pt to gently sniff and identify a mild test stimulus, such as toothpaste or coffee.
Check visual acuity with eyeglasses or contact lens correction using a Snellen chart or similar tool. Map VFs by confrontation testing in each quadrant of VF for each eye individually. The best method is to sit facing pt (2–3 ft apart) and then have pt cover one eye gently and fix uncovered eye on examiner’s nose. A small white object (e.g., a cotton-tipped applicator) is then moved slowly from periphery of field toward center until seen. Pt’s VF should be mapped against examiner’s for comparison. Formal perimetry and tangent screen examination are essential to identify small defects. Optic fundi should be examined with an ophthalmoscope, and the color, size, and degree of swelling or elevation of the optic disc recorded. The retinal vessels should be checked for size, regularity, arteriovenous (AV) nicking at crossing points, hemorrhage, exudates, and aneurysms. ...