kavetha
Forum Senior
Topics: 28
Posts: 53
|
hi friends,
could someone list the items to cover in MMSE and how to score please? i am not able to get a clear idea from the books.thanks!
|
| drmihas
Forum Newbie
Topics: 3
Posts: 10
|
hi, this is how mmse goes,
1)orientation in time-5points & place-5points
2)registration of three objects-3 points
3)attention and calculation: go on adding 7 or spell the word "world" backwards-5points
4)recall of three objects-3points
5)language-naming of two objects-2points,repitition-1point, obeying three step commands-3points
6)read & obey: close your eyes, write down spontaneous sentence, copy down a simple figure like a circle each 1point i.e. total 3 points
total 30 points
|
| CSobsessed
Forum Senior
Topics: 6
Posts: 144
|
I do not think it is necessary to memorize all those things on MMSE. If they literally want you to count points they will give you an official form where all things you should ask patient listed and it is also listed there how much points for what. You will simply read what to do from the form in front of you. On the other hand, if you feel you need MMSE (as in case of dementia, depression), you need only three things to ask.
First,before you go to wash your hands, tell the patient that you are going to check how is his/her memory today; name three objects to the patient ( he has to repeat each one after you);excuse yourself and go wash your hands; after you return ask the patient to name those three objects. It is advised to write down on the blue sheet those three objects so the doctor in stress would not forget it him/herself;0)
Second, ask the name, the date, the place.(orientation)
Third, ask to count 7s from 100 or 3s from 20 or spell backwards word "world".(that's for concentration). You are done.
|
| kavetha
Forum Senior
Topics: 28
Posts: 53
|
thanks to drmihas and CSobsessed!!finally clear with that.
another few questions r:
1)if a newly HIV diagnosed patient comes for education,how do we answer if they ask 'HOW OFTEN DO WE DO THE CD COUNT?.....how long before i get sick?.......who am i/you obliged to tell.....immunisations?....if i have kids,will they get it too?
2)how to check nasal septum patency?
3)in a case of normal enuresis,do we advise mom to bring in child or advise alarms and bahaviour methods first?
4)what is the 'get up and go' test?
5)what is fundal grip/leopald's manoevers?
6)in 3-step command,should we just tell patient what to do or actually demonstrate?
sorry for the long list.....if anyone knows even 1 of the above,please do give ur input.thanks in advance and GL to all 
|
| CSobsessed
Forum Senior
Topics: 6
Posts: 144
|
1) As much as I know it takes from 3 to 10 years to develop AIDS in untreated HIV-positive patient. The average fall down in CD4 is 50/100 a year, so it will take that much time for CD4 to fall from around healthy 700 to 200 cutout which considered AIDS. The monitoring of CD4 and viral load is every 3 to 6 months. Antiviral therapy begins when CD4 drops 350 or viral load is 55,000. HIV positive patients are counseled do not eat raw meat, eggs, be very carefull with a cat litterbox or avoid this choir completely; do not engage in activity where they can be scratched or bitten by a cat. It is advised for them to use bottled water instead of tap water. They have to use a general precautions do not exchange bodily fluids. They have to use only latex condoms. If it is an HIV-positive woman--man has to use special dental protectors so there is no direct contact between mucosa and vaginal discharge. Drug addicts are offered rehab. There have to be syphilis screening every 3-6 months, as well as PPD(do not know how frequently). I think it is differ from state to state whther it is mandatory to tell the patiens's partner but the doctor's task is to convience the patient to tell his /her partner. The appointment with the patient and his/her partner has to be arranged in the doctor's office. With general precautions the kids are not going to get it.
2) Please, do not check for nasal septum patency!!! The patient will be very grateful if you do not;0) Just say that you need to inspect nasal cavity for any signs of redness or inflammation with the light source. Tilt the nose tip up a little bit and inspect each nastril with the light from otoscope. Do not insert the otoscope in to the nostril;0) I mean, what is the chance that SP has a hole in NS?  
3) Do not advice anything!!! You MUST see the child ( you tell mother) before you can make any suggestions. This is for any child case. Unless she cries on the phone that the baby just spilled all over himself a caustic substance. Then you advice to rinse the child with water in shower, then bring him in. Or if it is simple diarea, you can advice to give the baby oral solution like pedialite on the way to the hospital.
Do not know about 4 and 5. To evaluate the integrity of the lower extr muscles you can ask the patient to squat with fully flexed hips and knees, holding him by his palms. Then you ask him to stand up. Some patients with hip griddle problems and hip problems have difficulties to stand up from sitting position. So, you just ask the patient to stand up frm the table and walk a few steps. Do not forget to extend the foot step on the table. Be close to the patient, especially when he walks, all the time. This exam is about safety practicing, so ,if your patient falls ( they can simulate it)-- this is total failure of this case.
6) As I said before, do not bother with three step command unless you are asked specifically.
You do not demonstrate, you tell the patient what to do: take the paper in your hand, fold it in half, put it on the floor.
BTW, not a simple circle has to be copied. It has to be two pentagons which intersect with each other. And only if the patient intrecross two figures--he/her is given a point.
|
| CSobsessed
Forum Senior
Topics: 6
Posts: 144
|
About kids and HIV positive mother. I meant the kids who was born before seroconversion. If she is pregnant that is a totally different story.
|
| drvic
Forum Elite
Topics: 10
Posts: 181
|
nice summary of HIV infection by CSobsessed.
PPD testing is once a year.
Get up and go test is for testing gait stability in elderly - it is performed like this: ask the patient to be seated in a straight back chair. ask them to get up without using armrests (if possible), stand still for a moment and then walk for a distance of atleast 3m, then turn back and walk back to the chair, turn, and then sit down on the chair again.
the points to be noted on this test are: sitting balance, ability to stand from sitting position, gait in general, ability to turn wihtout staggering.
Leopold's maneuvers are the technique of examination of the pregnant woman with respect to the lie and orientation of the baby in the uterine cavity. don't think its important to remember the FOUR maneuvers for Step 2CS, coz i don't think you'd get a pregnant woman as an SP. here they are anyway:
First Maneuver (Upper pole)
- Examiner faces woman's head Palpate uterine fundus Determine what fetal part is at uterine fundus
Second Maneuver (Sides of maternal abdomen)
- Examiner faces woman's head Palpate with one hand on each side of abdomen Palpate fetus between two hands Assess which side is spine and which extremities
Third Maneuver (Lower pole)
- Examiner faces woman's feet Palpate just above symphysis pubis Palpate fetal presenting part between two hands
- assess for fetal descent
Fourth Maneuver (Presenting part evaluation)
Examiner faces woman's head Apply downward pressure on uterine fundus Hold presenting part between index finger and thumb Assess for cephalic versus breech presentation
i think for the 3-step command it could be anything simple but the patient should be made to do some thinking before carrying it out. like writing on a piece of paper a simple command like lifting the pen from left hand and hand it to you with their right hand. then hand that piece of paper to the SP. he/she should be able to read, understand and then execute it. these are the three steps being tested here.
hope this helps.
___________________
say what you mean... and mean what you say...
|
| kavetha
Forum Senior
Topics: 28
Posts: 53
|
thanks so much to CSobsessed and drvic......very informative replies and i really appreciate ur time and effort.thanks again!
|
|
| |
| | | | | | | | |
