MCQ Quiz: The Mental Status Exam

The Mental Status Examination (MSE) is a critical component of any neurological or psychiatric assessment. It is the psychological equivalent of a physical exam, providing a structured way to evaluate a patient’s cognitive functioning and mental state at a specific point in time. Pharmacists, particularly those working in neurology or psychiatry, must be familiar with the components of the MSE to understand clinical notes and assess the effects of CNS-acting medications. This quiz will test your knowledge on the key domains evaluated in a Mental Status Examination.

1. The Mental Status Examination (MSE) is best described as:

• a. A test to determine a patient’s IQ.
• b. A physical examination of the brain.
• c. A structured assessment of a patient’s psychological and cognitive functioning at one point in time.
• d. A questionnaire that the patient fills out on their own.

Answer: c. A structured assessment of a patient’s psychological and cognitive functioning at one point in time.

2. Which component of the MSE assesses the patient’s level of consciousness (e.g., alert, drowsy, stuporous)?

• a. Mood and Affect
• b. Appearance and Behavior
• c. Sensorium and Cognition
• d. Thought Content

Answer: c. Sensorium and Cognition

3. A patient describes their mood as “depressed,” but the clinician observes that they are laughing and smiling throughout the interview. The patient’s observed emotional state is referred to as their:

• a. Mood
• b. Affect
• c. Insight
• d. Judgment

Answer: b. Affect

4. When a patient’s affect is described as “incongruent,” it means:

• a. Their emotional expression is appropriate for the situation.
• b. Their emotional expression does not match their stated mood.
• c. They show a very limited range of emotion.
• d. They show no emotional expression.

Answer: b. Their emotional expression does not match their stated mood.

5. “Tangentiality” is a disturbance in thought process where the patient:

• a. Repeats the same words or ideas over and over.
• b. Suddenly stops speaking in the middle of a sentence.
• c. Wanders off topic and never returns to the original point.
• d. Creates new words (neologisms).

Answer: c. Wanders off topic and never returns to the original point.

6. A patient reports hearing voices that no one else can hear. This is an example of what type of perceptual disturbance?

• a. An illusion
• b. A delusion
• c. An auditory hallucination
• d. A loose association

Answer: c. An auditory hallucination

7. A “delusion” is a disturbance in thought content best described as:

• a. A misinterpretation of a real external stimulus.
• b. A fixed, false belief that is resistant to reason or evidence to the contrary.
• c. A sensory perception without an external stimulus.
• d. A rapid, pressured pattern of speech.

Answer: b. A fixed, false belief that is resistant to reason or evidence to the contrary.

8. The Mini-Mental State Examination (MMSE) is a tool used to screen for:

• a. Schizophrenia
• b. Bipolar disorder
• c. Cognitive impairment or dementia
• d. Anxiety disorders

Answer: c. Cognitive impairment or dementia

9. Asking a patient to repeat three unrelated words immediately and then again after five minutes is a test of:

• a. Attention and concentration.
• b. Immediate recall and short-term memory.
• c. Long-term memory.
• d. Abstract thinking.

Answer: b. Immediate recall and short-term memory.

10. “Insight” in the context of the MSE refers to the patient’s:

• a. Ability to make safe decisions.
• b. Level of intelligence.
• c. Awareness and understanding of their own illness.
• d. Fund of knowledge.

Answer: c. Awareness and understanding of their own illness.

11. A patient with schizophrenia who believes they are a historical figure and does not believe they are ill is said to have:

• a. Good insight and judgment.
• b. Poor insight.
• c. A blunted affect.
• d. A learning disability.

Answer: b. Poor insight.

12. Which of the following describes a patient’s “thought process”?

• a. What the patient is thinking about.
• b. How the patient’s thoughts are organized and expressed.
• c. Whether the patient is having hallucinations.
• d. The patient’s mood.

Answer: b. How the patient’s thoughts are organized and expressed.

13. A patient whose speech is rapid, jumps from one topic to another, and is difficult to interrupt is demonstrating:

• a. Poverty of speech
• b. Flight of ideas
• c. Thought blocking
• d. Circumstantiality

Answer: b. Flight of ideas

14. A patient’s general appearance, motor activity, and attitude toward the examiner are documented under which section of the MSE?

• a. Mood and Affect
• b. Thought Content
• c. Cognition
• d. Appearance and Behavior

Answer: d. Appearance and Behavior

15. A pharmacist notes that a patient on an antipsychotic medication is exhibiting a shuffling gait and a pill-rolling tremor. This observation would be part of the “motor activity” component of the MSE and is relevant to:

• a. The patient’s mood.
• b. A potential medication side effect (extrapyramidal symptoms).
• c. The patient’s thought process.
• d. The patient’s cognitive function.

Answer: b. A potential medication side effect (extrapyramidal symptoms).

16. “Judgment” in the MSE is assessed by:

• a. Asking the patient to interpret a proverb.
• b. Asking the patient what they would do in a hypothetical situation (e.g., “What would you do if you found a stamped, addressed envelope on the street?”).
• c. Observing the patient’s past decisions and behaviors.
• d. Both b and c.

Answer: d. Both b and c.

17. “Mood” is the patient’s subjective, self-reported emotional state, while “affect” is the clinician’s objective observation of the patient’s emotional expression.

• a. True
• b. False

Answer: a. True

18. Asking a patient to spell “world” backwards is a test of:

• a. Long-term memory
• b. Attention and concentration
• c. Abstract thought
• d. Insight

Answer: b. Attention and concentration

19. A patient is asked to explain the meaning of the proverb, “People who live in glass houses shouldn’t throw stones.” An inability to understand the abstract meaning and giving a literal answer (e.g., “The glass would break”) demonstrates difficulty with:

• a. Abstract thinking
• b. Memory
• c. Attention
• d. Perception

Answer: a. Abstract thinking

20. A patient believes that the television news anchor is sending them secret, personal messages. This is an example of what type of delusion?

• a. A grandiose delusion
• b. A persecutory delusion
• c. A somatic delusion
• d. A delusion of reference

Answer: d. A delusion of reference

21. The MSE is not a standalone diagnostic tool but a part of a comprehensive patient assessment.

• a. True
• b. False

Answer: a. True

22. “Circumstantiality” is a thought process where the patient:

• a. Wanders off topic and never returns.
• b. Includes excessive, unnecessary detail but eventually gets to the point.
• c. Suddenly stops talking.
• d. Makes up new words.

Answer: b. Includes excessive, unnecessary detail but eventually gets to the point.

23. An “illusion” is a perceptual disturbance where:

• a. There is a sensory perception without any external stimulus.
• b. A real external stimulus is misinterpreted.
• c. The patient has a fixed, false belief.
• d. The patient feels that things are not real.

Answer: b. A real external stimulus is misinterpreted.

24. The Montreal Cognitive Assessment (MoCA) is another tool often used to screen for:

• a. Psychosis
• b. Anxiety
• c. Mild cognitive impairment
• d. Depression

Answer: c. Mild cognitive impairment

25. A pharmacist’s interaction with a patient in the community or hospital provides an opportunity to informally assess several components of the MSE.

• a. True
• b. False

Answer: a. True

26. A patient’s affect is described as “blunted” or “flat.” This means their emotional expression is:

• a. Exaggerated and dramatic.
• b. Rapidly shifting.
• c. Severely restricted or absent.
• d. Appropriate to their mood.

Answer: c. Severely restricted or absent.

27. Asking a patient who the current president is and what the date is assesses their:

• a. Insight
• b. Judgment
• c. Orientation
• d. Mood

Answer: c. Orientation

28. Which of the following is NOT a primary domain of the Mental Status Exam?

• a. Appearance and Behavior
• b. Thought Process and Content
• c. Sensorium and Cognition
• d. Family Medical History

Answer: d. Family Medical History

29. A patient’s speech is very fast and difficult to interrupt. This is described as:

• a. Latent speech
• b. Pressured speech
• c. Poverty of speech
• d. Aphasia

Answer: b. Pressured speech

30. A pharmacist notices a patient appears disheveled, has poor hygiene, and is talking to themself in the aisle. These observations are part of the:

• a. Patient’s permanent record.
• b. Mental Status Examination.
• c. Medication reconciliation.
• d. Insurance verification.

Answer: b. Mental Status Examination.

31. “Word salad” refers to a thought process that is:

• a. Highly logical and organized.
• b. A random mixture of words and phrases that lacks any meaning.
• c. The repetition of a single word.
• d. A focus on a single, negative idea.

Answer: b. A random mixture of words and phrases that lacks any meaning.

32. “Suicidal ideation” is assessed under which component of the MSE?

• a. Appearance and Behavior
• b. Thought Content
• c. Sensorium and Cognition
• d. Mood and Affect

Answer: b. Thought Content

33. The MSE provides a “snapshot” of the patient’s mental state at the time of the interview.

• a. True
• b. False

Answer: a. True

34. A patient with delirium would be expected to have a disturbance in which MSE domain?

• a. Level of consciousness and attention.
• b. Cognition.
• c. Perception.
• d. All of the above.

Answer: d. All of the above.

35. Asking a patient to name 5 large cities is a test of their:

• a. Fund of knowledge.
• b. Short-term memory.
• c. Judgment.
• d. Mood.

Answer: a. Fund of knowledge.

36. A patient’s mood is their sustained, internal emotional state.

• a. True
• b. False

Answer: a. True

37. A patient with Wernicke’s encephalopathy would likely have significant impairment in:

• a. Long-term memory.
• b. Attention and concentration.
• c. The ability to form new memories (anterograde amnesia).
• d. Judgment.

Answer: c. The ability to form new memories (anterograde amnesia).

38. The assessment of which of the following is NOT typically part of the MSE?

• a. Insight
• b. Judgment
• c. Intelligence (IQ)
• d. Memory

Answer: c. Intelligence (IQ)

39. A “loose association” is a thought process where:

• a. The patient’s ideas are all logically connected.
• b. The patient’s ideas shift from one subject to another that is unrelated or only vaguely related.
• c. The patient cannot stop talking.
• d. The patient repeats what the examiner says.

Answer: b. The patient’s ideas shift from one subject to another that is unrelated or only vaguely related.

40. Assessing a patient’s mental status is important for determining:

• a. Their capacity to make medical decisions.
• b. The effects or side effects of their medications.
• c. Changes in their condition over time.
• d. All of the above.

Answer: d. All of the above.

41. A patient believes that bugs are crawling under their skin, but there is no evidence of this. This is a _____ hallucination.

• a. visual
• b. auditory
• c. olfactory
• d. tactile

Answer: d. tactile

42. The MSE is a standardized, copyrighted test with a specific score.

• a. True
• b. False

Answer: b. False

43. A pharmacist counseling a patient who seems confused and unable to repeat instructions should recognize this as a potential impairment in:

• a. Cognition (attention and memory).
• b. Mood.
• c. Thought content.
• d. Perception.

Answer: a. Cognition (attention and memory).

44. “Poverty of speech” is when a patient:

• a. Speaks very loudly.
• b. Uses elaborate, flowery language.
• c. Provides brief, unelaborated, one-word answers.
• d. Speaks very quickly.

Answer: c. Provides brief, unelaborated, one-word answers.

45. Which of the following is an example of assessing “constructional ability”?

• a. Asking a patient to name the past three presidents.
• b. Asking a patient to draw a clock face with the hands at a specific time.
• c. Asking a patient to spell a word backwards.
• d. Asking a patient to interpret a proverb.

Answer: b. Asking a patient to draw a clock face with the hands at a specific time.

46. A “labile” affect is one that is:

• a. Flat and unresponsive.
• b. Appropriate and stable.
• c. Rapidly shifting and unstable.
• d. Exaggerated and dramatic.

Answer: c. Rapidly shifting and unstable.

47. A pharmacist is responsible for monitoring for changes in mental status that could be caused by medications.

• a. True
• b. False

Answer: a. True

48. A patient is “oriented x 3” if they know:

• a. Their name, the date, and the time.
• b. Person, place, and time.
• c. Who the president is, what city they are in, and their own name.
• d. Three random facts.

Answer: b. Person, place, and time.

49. The overall goal of the MSE is to:

• a. Obtain a comprehensive, cross-sectional description of the patient’s mental state.
• b. Diagnose a specific psychiatric disorder.
• c. Determine the patient’s IQ.
• d. Assess the patient’s physical health.

Answer: a. Obtain a comprehensive, cross-sectional description of the patient’s mental state.

50. The ultimate reason for a pharmacist to be familiar with the MSE is to:

• a. Better understand clinical notes from other providers and to recognize potential medication-related changes in a patient’s mental state.
• b. Be able to perform a full psychiatric evaluation.
• c. Bill for mental health services.
• d. Replace the need for a psychiatrist.

Answer: a. Better understand clinical notes from other providers and to recognize potential medication-related changes in a patient’s mental state.