Whats "pen" in MMSE? - nikamo

[ArchivalUser]

whats PEN in MMSE?

[ArchivalUser]

nobody knows?

[ArchivalUser]

pls someone explain.

[ArchivalUser]

read this about MMSE, i dont know waht PEN means, but i think this is the standrad way everyone does MMSE , got this from nanaki's notes posted by ramri

When to do an MMSE ? In cases of non-focal-deficit CNS Cases like memory Loss / dementia, Delirium / Confusion, Delusions / Schizophrenia.
Would you do it for every CNS Case?Not really - use priority + time judgement. If patient has a symptoms suggestive of Focal Neurological Lesion/s - Its more important to do a complete CNS exam + gait and then think about MMSE.
Note: Sometimes the Case Description on the door may mentioned that the MMSE has already been performed and may indicate the score or say it was normal - in such cases, DO NOT DO THE MMSE and waste time ( All data provided by the test center is to be assumed to be correct)

So, how do we do a MMSE ? Its basically a series of questions to ask the SP to test various basic brain functions to assess the degree of its dysfunction. If you practice talking this with your practice buddy or even with yourself while having that great warm water bath, after a while - trust me on this - it becomes very easy to rattle it out! The titles in blue tell you which quality is being tested.
Before you begin the MMSE, use a statement like this,
"Mr. Watson, I will now ask you simple questions to test your memory and thinking, shall we begin ?"
ORIENTATION
1. Which state or city are u in ?
2. What's your name OR Do you know who I am ?
3. Can you guess what time it is now ?
REGISTRATION
Mention three objects slowly and clearly - ask the patient to repeat once u are done. (e.g. Pen, Watch, Ball)
ATTENTION AND CALCULATION
1. Ask patient to say "WORLD" backwords
2. Ask patient to count back from 7
RECALL
Ask the patient to repeat again those 3 words u told him before (To not forget these yourself in the heat of the exam, practice with three standard words ready)
LANGUAGE
Show him ur pen - ask him wut color is it
COMMAND FOLLOWING
On a piece of paper, draw intersecting pentagons, each side about one inch and ask him to copy it exactly as it is. To score correctly, all ten angles must be present AND two must intersect. Tremor and rotation are ignored.

[ArchivalUser]

thank u,i got it.

[ArchivalUser]

very helpful Flanker- thanks
I was wondering if we could make a sort of list of exams for some of these cases that need HEENT/ CNS, MMSE Psychiatric assessment..

you suggested that:
When to do an MMSE ? In cases of non-focal-deficit CNS Cases like memory Loss / dementia, Delirium / Confusion, Delusions / Schizophrenia.
Would you do it for every CNS Case?Not really - use priority + time judgement. If patient has a symptoms suggestive of Focal Neurological Lesion/s - Its more important to do a complete CNS exam + gait and then think about MMSE.


For Delusion, Schizo cases after the MMSE , we would go ahead and do the psychiatric assessment right?
Delirium and Confusion may be due to chronic subdural bleeds esp in elderly and alcohol/ drugs , so we need to do HEENT (Maybe palpate head and check Pupils) and do MMS and some CNS like plantars, reflexes ...

Do you have any suggestions regarding how to remember correct exam Physical exam for CNS/ Psychi/mixed cases ?

Something like this... please add to the list :
For cases like headache,migraine ,dizziness, vertigo= HEENT and CNS exam
For fatigue /depression= thyroid, psychiartic assessment..check reflexes
For Dementia, Parkinsonism = MMSE, CNS
limb weakness, , tingling, claudication pain = CNS, reflexes, local pulses important for claudication eg, popliteal artery for leg, temporal artery for jaw claudication , headache
Hypertension/ Diabetic with headache = CNS, vibration sense and pupil/ fundus important here

[ArchivalUser]

For Delusion, Schizo cases after the MMSE , we would go ahead and do the psychiatric assessment right?>>>>>>>>>>>> yes, we should do psychitric assesment soon after MMSE. but psychitric assessment like judgement, reasoning is a part of MMSE right, ofcourse we dont do it for evry case , but for these cases we should definitely do it.

we should do HEENT in taruma cases even if pt gives some complaint of pain in extremities with no complaint of head region

as for the list, u got it right, but somehow i feel that each case has to be decided upon at the time of exam itself. all we can do is to keep everything in mind right now. but the examination part will have to be decided in a split second at the time of exam itself (during hand washing). things are quite different during actual cs, both of us can surely agree on that now after having been there once. best thing is to 1st go for the most obvious system, no matter what it is. we should avoid the 'head to toe ' exam temptation. cs is not about perfection , it about relevance.

CVS and RS have to be done in almost all cases. atleast the auscultation part is a must. even skin has to be checked in almost all cases for sweating, bruises(makeup) or any other visible marks. same goes for nails especially in CVS / RS cases to rule out clubbing. and always make sure that u tell the pt to extend his hands forwards while examining the nails. it will serve 2 purposes, 1st we will see the nails and 2nd the presence of tremors ( in cirrhosis and thyroid cases) . and one thing i read in kaplan, dont know how right it is, but in cns cases , if suppose we are running out of time then the 2 best physicals to be done are 1: gait( we can also see the motor strenght during this time) and 2:MMSE . thats it. forget sensation,nerves and other things.

hope i could help........

[ArchivalUser]

I agree Flanker
CS is more than just mugging up
you have to be prepared to deal with situations...
appreciate your inputs- keep em coming!