1 History Taking 2 Mental Status Examination 3
- Slides: 77
1. 병력청취(History Taking) 2. 정신기능검사(Mental Status Examination) 3. 뇌신경검사(Cranial Nerve Examination) 4. 운동계검사(Motor System Examination) 5. 감각계검사(Sensory System Examination) 6. 반사(Reflexes)
Mental Status & Behavior n General appearance and behavior (including level of consciousness & affection) n Attention and concentration n Memory n Orientation n Thought process (abstract thought, judgement, insight) n Thought content n Calculations n Language and speech
Functional Anatomy of Brain Cortex n Frontal lobe Dominant, Nondominant, Bilateral n Parietal lobe Dominant, Nondominant, Bilateral n Temporal lobe Dominant, Nondominant, Bilateral n Occipital lobe Dominant, Nondominant, Bilateral
Speech Examination n Fluency of speech n Comprehension n Naming letters, numbers, and objects n Repetition n Reading n Writing n Graphic
Classification of Aphasia n Global aphasia n Motor aphasia (Broca) n Sensory aphasia (Wernicke) n Conduction aphasia n Transcortical motor aphasia n Transcortical sensory aphasia
뇌신경검사(Cranial Nerve Examination) n n Olfactory nerve Optic nerve n n Oculomotor, Trochlear, and Abducens nerve n n n Eye lids, pupils, extraocular movement Trigeminal nerve : Facial sensory, corneal reflex Facial nerve : Movement of forehead and cheek, taste Vestibulocochlear nerve : Weber, Rinne test Glossopharyngeal, Vagus nerve n n Fundus, visual field, visual acuity, color vision Soft palate elevation, gag reflex(CN 9 CN 10) Spinal Accessory nerve : SCM, Trapezius muscle Hypoglossal nerve : Tongue movement
n Olfactory Nerve n Aromatic, nonirritative substance n Test when 1. The patient complains of loss of smell or taste 2. Suspect frontal pathology n Trauma n Headache n Personality change n Dementia
n Optic nerve n Fundus, visual field, visual acuity, color vision Confrontation Test
n Not Cooperated or Stuporous Patient 1. Watch the patient’s eyes to see 2. Starting from behind the patient Your face or money, no sounds ! 3. Visual Threat (threatening test)
n Oculomotor, Trochlear, and Abducens nerve n Eye lids, pupils, extraocular movement Primary Gaze Red-Glass Test
Pupillary Reflex Arc Afferent Pupillary Pathway Light Optic nerve Optic chiasm Optic tract Lateral geniculate body Pretectal nucleus Bilateral Edinger-Westphal nucleus Efferent Pupillary Pathway Edinger-Westphal nucleus Oculomotor nerve Ciliary ganglion Direct or Indirect Light Reflex
Direct reflex Indirect reflex Optic nerve Optic tract Lateral geniculate Optic radiation Visual cortex + or + + + Oculomotor nerve - +
Pupil Examination “PERRL & A” n P : Pupil n E : Equal (Symmetricity) n R : Round (Shape) R : Reflex to L : Light A : Acommodation n
Eye Movement Examination 1. Observe the eyes for their position at rest. 2. Observe the spontaneous movement of the eye. 3. Ask the patient to follow a stimulus, such as penlight. 4. The test for convergence of the eyes. 5. Look for any adventitious (extraneous) movement, such as nystagmus
탐구사항 1. The pathway of eye movement n Frontal eye field n PPRF(paramedian pontine reticular formation) n MLF(medial longitudinal fasciculus) 2. Internuclear ophthalmoplegia 3. One-and-a-half syndrome
뇌신경검사(Cranial Nerve Examination) n Trigeminal nerve : Facial sensory, corneal reflex V 1, V 2, V 3 division of trigeminal nerve
Corneal Reflex Arc Afferent Pupillary Pathway Trigeminal nerve Efferent Pupillary Pathway Facial nerve
Corneal stimulus 1. 2. 3. 4. Rt. stimulus Lt. stimulus 1. 2. 3. 4. Right blink Left blink + - Right Afferent lesion Normal of Left Afferent and Both efferent Right efferent lesion + + +
뇌신경검사(Cranial Nerve Examination) n Facial nerve : Movement of forehead and cheek, taste
탐구사항 1. Peripheral Facial Palsy 2. Central Facial Paralysis 3. Facial nerve function n Nerve to stapedius n Chorda tympani n Etc…
뇌신경검사(Cranial Nerve Examination) n Vestibulocochlear nerve : Weber, Rinne test Weber test Rinne test
탐구사항 1. Nylen-Balani Test 2. Caloric test
뇌신경검사(Cranial Nerve Examination) n Glossopharyngeal, Vagus nerve n Soft palate elevation, gag reflex(CN 9 CN 10)
뇌신경검사(Cranial Nerve Examination) n Spinal Accessory nerve : SCM, Trapezius muscle Shoulder Elevation Power Check
뇌신경검사(Cranial Nerve Examination) n Hypoglossal nerve : Tongue movement Tongue Deviate or Not
운동계검사(Motor System Examination) n n 시진(Inspection) n Muscle bulk n Abnormal movement 근긴장도(Muscle tone) : spasticity, rigidity, hypotonia n 근력(Muscle power) n Screening tests for hemiparesis n Pronator drift n Rapid finger taps n Arm-rolling test
Functional Anatomy of Motor System
Abnormal Movements n Fasciculation n Tremor n Myoclonus n Asterixis(Negative myoclonus) n Chorea n Athetosis n Ballism
Abnormal Movements n Fasciculation
Abnormal Movements n Tremor
Abnormal Movements n Myoclonus
Abnormal Movements n Asterixis(Negative myoclonus)
Abnormal Movements n Choreoathetosis
Abnormal Movements n Ballism
근긴장도(Muscle Tone) n Spasticity
근긴장도(Muscle Tone) n Rigidity
근긴장도(Muscle Tone) n Hypotonia
근력(Muscle Power) 0 No muscle contraction detected 1 A barely detectable flicker or trace of contraction 2 Movement occurs only in the plane of gravity 3 Active movement against gravity but not against resistance 4 Active movement against resistancebut less than normal strength (may be graded as 4+, 4, or 4 -) 5 Normal strength
Screening Tests for Hemiparesis n Pronator drift
Screening Tests for Hemiparesis n Rapid finger taps
Screening Tests for Hemiparesis n Arm-rolling test
감각계검사(Sensory System Examination) n Primary sensory modalities n n n Light touch Pinprick, Temperature Vibration Joint position(proprioception) Cortical sensory modalities n n n Simultanagnosia Graphesthesia Stereognosis Two-point discrimination Baresthesia
Functional Anatomy of Sensory System
Cortical Sensory Modalities n Graphesthesia
Cortical Sensory Modalities n Stereognosis
Cortical Sensory Modalities n Two-point discrimination
Cortical Sensory Modalities n Baresthesia
반사(Reflexes) n 심부건반사(Deep tendon reflexes) n 족부반사(Plantar reflexes) n 피부반사(Cutaneous reflexes) n 전두엽 해체징후(Frontal releasing signs)
심부건반사(Deep tendon reflexes) n Jaw jerk
심부건반사(Deep tendon reflexes) n Biceps
심부건반사(Deep tendon reflexes) n Triceps
심부건반사(Deep tendon reflexes) n Finger flexion (Hoffman’s) reflex
심부건반사(Deep tendon reflexes) n Knee jerk
심부건반사(Deep tendon reflexes) n Ankle jerk
족부반사(Plantar reflexes) n Babinski’s sign n Chaddock’s sign n Oppenheim’s sign n Gordon’s sign
족부반사(Plantar reflexes) n Babinski’s sign
족부반사(Plantar reflexes) n Chaddock’s sign
족부반사(Plantar reflexes) n Oppenheim’s sign
족부반사(Plantar reflexes) n Gordon’s sign
피부반사(Cutaneous reflexes) n n 복부반사(Abdominal reflexes) n T 8 -9 n T 11 -12 고환올림근반사(Cremasteric reflex) n n L 1 -2 S 1 구해면체근반사(Bulbocavenous reflex and anal wink) n S 2 -4 S 3 -4
전두엽 해체징후(Frontal releasing signs) n Snout, suck, and root reflexes n Palmomental reflex n Grasp reflex n Glabellar reflex
전두엽 해체징후(Frontal releasing signs) n Snout reflex
전두엽 해체징후(Frontal releasing signs) n Palmomental reflex
전두엽 해체징후(Frontal releasing signs) n Grasp reflex
전두엽 해체징후(Frontal releasing signs) n Glabellar reflex
운동조화(Coordination) n n Coordination of movement n Dysmetria : finger-to-nose test, heel-to-shin test n Dysdiadochokinesia : rapid alternating movement Maintenance of muscle tone n n Hypotonia : pendular knee jerk Equilibrium n Gait and Stance ataxia : tandem gait
Functional Anatomy of Cerebellum n Embryologic classification of cerebellum n n Functional classification of cerebellum n n Archcerebellum, Paleocerebellum, Neocerebellum Vestibulocerebellum, spinocerebellum, cerebrocerebellum Deep nuclei of cerebellum n Dentate, Interposed(emboliform, globose), fastigial
Coordination of Movement n Dysmetria finger-to-nose test heel-to-shin test
Coordination of Movement n Dysdiadochokinesia Rapid alternating movement
Maintenance of Muscle Tone n Hypotonia Pendular knee jerk
Equilibrium n Gait and Stance ataxia Tandem gait
Abnormal Gait n Cerebellar gait n Gait of sensory ataxia n Hemiplegic gait n Festinating gait n Steppage gait n Waddling gait n Staggering or Drunken gait n Hysteric gait (Astasia-abasia) n Gait in Normal Pressure Hydrocephalus
Meningeal Irritation Signs n Neck stiffness n Kernig sign n Brudzinski sign
- Mse report sample
- Mental.status exam
- Jarvis chapter 5 mental status assessment
- Nnsdo
- Vamc slums
- Overvalued ideas
- Mmse test romana
- Sneezing
- Contoh pemeriksaan status mental
- Aktivitas motorik grimasen adalah
- Linear thought process mental status
- Heidi combs
- Dismetria
- Coastmap ems
- Perubahan status mental
- Mental status coastmap
- Chapter 20 mental health and mental illness
- Jeopardy mental health
- Pain history taking
- Abcde approach
- History taking respiratory system
- Paediatric history osce scenarios
- Abdominal pain socrates
- Thought content examples
- Fever history taking
- Fatulance
- Hypogastric pain causes
- Lordcraft pain
- Principles of physical examination
- Orthopedic history taking
- History taking paediatrics
- The art of history taking
- Components of history taking
- Principles of history taking
- Lodcraft pain
- Lodcraft history taking
- General history taking of patient
- Marcus gunn pupil
- Dysphagia vs odynophagia
- Cern icterus
- Smoking history taking
- Eluxodoline
- Systematic review in history taking
- Lodcraft history taking
- Also history physical
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- Grading of reflexes
- Respiratory sce
- London letters for handwriting examination
- Stool exam normal values
- Physical examination tray
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- Low fowler's position
- Objective examination of patient
- Nutrition assessment
- Nutrition focused physical findings
- Entered apprentice obligation
- Epitrochlear
- Stool microscopic examination
- Csf appearance
- Diploma of secondary education
- Hkdse examination online services
- Bates guide to physical examination
- The examination of sarah good
- Higher function examination
- Examination day by henry slesar
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- Transmitted light examination in questioned document
- Cross examination in a debate
- Container examination facility
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- Pre analytical considerations in phlebotomy