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Motor speech Final Exam > Differential diagnosis > Flashcards

Differential diagnosis Flashcards

1
Q

What is differential diagnosis?

A

The process of narrowing possibilities and reaching conclusions about the nature of a deficit.

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2
Q

When doing a speech evaluation, what should do you always try to make?

A

A diagnosis

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3
Q

What should a clinician do if clinician can’t make a definitive diagnosis?

A

You must describe what you find and state why a definitive diagnosis can’t be made.

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4
Q

What are reasons for not being able to make a diagnosis?

A
  • Non-cooperative patient

- equivocal/uncertain findings

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5
Q

If you cannot make a diagnosis, what would be helpful?

A

It is helpful to state what it is not or even be able to establish that a dysarthria is present but that can’t specify the type.

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6
Q

What should the clinician do if a diagnosis is not determined?

A

Do not offer a diagnosis. You can state that the diagnosis is undetermined. Also, using words such as “equivocal, probably”, “possible” give indications of how confident you are in your diagnosis.

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7
Q

Is it possible for more than one speech disorder to exist at the same time?

A

Yes, identifying a single disorder isn’t always sufficient. You must be able to account for all of the deviant characteristics- if the disorder you identified does not do this, then another disorder may be present.

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8
Q

An evaluation does not always have to find _____ _____ – it may indicate ______ ____ or speech within normal range.

A

deviant speech

normal speech

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9
Q

In the initial stages of some _______, speech may have changed but not significantly enough to be judges _____.

A

diseases

deviant

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10
Q

It is also possible that the clinician may be incorrectly identifying a ________ problem of articulation as related to a ________ ________.

A

developmental problem

neurological disease

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11
Q

What happens when the clinician provides a label for a diagnosis?

A

Clinician is providing a composite of information associated with that label. It is a kind of shorthand for communicating information about disorders.

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12
Q

There is ______ among dysarthrias in terms of certain characteristics. For example, many have _____ ______ as a characteristic, so the presence of ______ ____ doesn’t help you in distinguishing between dysarthrias.

A

overlap
imprecise articulation
imprecise articulation

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13
Q

Look for anatomy and vascular lesions in book.

A

Table 15-1 pg 137

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14
Q

What etiologies can cause any type of dysarthria?

A
  • vascular
  • degenerative disease
  • TBI
  • demyelinating diseases
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15
Q

______ can cause any type of dysarthria, but most often causes spastic, UUMN, and ataxic dysarthria.

A

Vascular

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16
Q

Vascular can cause any type of dysarthria, but most often causes which dysarthrias?

A

spastic dysarthria
UUMN
ataxic dysarthria

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17
Q

_______ ________ is the most common cause of dysarthrias.

A

Hemorrhagic stroke

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18
Q

Degenerative disease can cause any type of dysarthria, but most often causes which dysarthrias?

A

spastic
ataxic
hypokinetic
flaccid

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19
Q

_______ disease can cause any type of dysarthria, but most often causes spastic, ataxic, hypokinetic and flaccid dysarthrias.

A

Degenerative

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20
Q

Parkinson’s diesease is only associated with what type of dysarthria?

A

Hypokinetic dysarthira

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21
Q

What is a frequent cause of flaccid & spastic dysarthria?

A

ALS

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22
Q

______ is a frequent cause of flaccid & spastic but other types of dysarthrias are not usually seen in ____, so if there is another type of dysarthria existing, there may be another disease or the diagnosis may be in error.

A

ALS

ALS

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23
Q

_____ can cause any type of dysarthria but in closed head injury the most common type is spastic.

A

TBI

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24
Q

What is the most common type of dysarthria in a closed head injury?

A

spastic dysarthria

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25
Q

Open head injuries do not usually cause ______ _____ but can cause the other ______ dysarthrias. Name them.

A

Flaccid

CNS: spastic, ataxic, UUMN

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26
Q

What kind of dysarthrias can skull fracture and neck trauma injuries causes?

A

flaccid dysarthrias

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27
Q

What dysarthrias can surgical trauma cause?

A

Any type of dysarthrias except hypokinetic

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28
Q

Which surgeries are only involved with flaccid dysarthria?

A

Surgeries involved with ear, nose, throat, chest/cardiac areas.

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29
Q

Surgeries involved with ear, nose throat, chest/cardiac areas are only associated with what type of dysarthria?

A

flaccid dysarthria

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30
Q

What kind of dysarthrias can a neurosurgery cause?

A

CNS dysarthrias as well as flaccid dysarthria

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31
Q

Toxic and metabolic conditions typically do not causes which dysarthrias?

A

flaccid or UUMN

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32
Q

________ and _______ conditions typically do not cause flaccid or UUMN dysarthria but can cause other types.

A

Toxic and metabolic conditions

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33
Q

Toxic conditions associated with drugs/medications cause _____ and _____ dysarthrias most often.

A

hyperkinetic

ataxic

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34
Q

Toxic conditions associated with _________ cause hyperkinetic and ataxic dysarthrias most often.

A

drugs/medications

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35
Q

_________ and _________ conditions– rarely cause dysarthrias although they sometimes occur. The type of dysarthria depends on the condition.

A

Infectious

inflammatory

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36
Q

Which condition rarely causes dysarthrias?

A

Infectious and inflammatory

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37
Q

_______ diseases can cause any type of dysarthria but hypokinetic is rare. The type of disorder depends on the disorder.

A

Demyelinating

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38
Q

Name two demyelinating diseases.

A

Guillian Barre disease

multiple sclerosis

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39
Q

Which dysarthria is Guillian Barre disease usually associated with?

A

flaccid

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40
Q

Multiple Sclerosis is usually associated with which dysarthria?

A

ataxic

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41
Q

Which dysarthria is most often associated with Anatomic malformations such as Arnold-Chiari (malformation of the brain)?

A

Flaccid dysarthria

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42
Q

Why do neuromotor junction disorders, muscle disease and neuropathies only cause flaccid dysarthria?

A

Neuromomtor junction disorders are PNS diseases

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43
Q

Neuromotor junction disorders only cause what type of dysarthria?

A

flaccid dysarthria

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44
Q

______ can be present in the absence of a neurologic diagnosis.

A

Dysarthria

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45
Q

Dysarthria can be present in the absence of what?

A

A neurologic diagnosis

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46
Q

Sometimes the etiology of a dysarthria is undetermined particularly for which dysarthrias?

A
  • hyperkinetic
  • spastic
  • ataxic
47
Q

Certain findings in the _____ _____ are not required for MSD but are used as confirmatory signs.

A

oral mechanism

48
Q

Oral mechanism findings that are not required for MSD, may be used as what?

A

confirmatory signs

49
Q

What are the two characteristics that often occur in flaccid dysarthria and do not occur in other dysarthrias or apraxia?

A

atrophy and fasiculations

50
Q

_____ and a ______ gag reflex occur more often in flaccid dysarthria than other dysarthrias.

A

hypotonia

hypoactive

51
Q

Rapid loss of intelligibility is indicative of what?

A

Myasthenia gravis

52
Q

Nasal regurgitaion may be seen in what kind of dysarthria?

A

flaccid dysarthria

53
Q

Name oral mechanism findings for flaccid dysarthria:

A
  • atrophy and fasiculations
  • hypotonia
  • hypoactive gag reflex
  • nasal regurgitation
54
Q

Oral mechanism findings of spastic dysarthira:

A
  • pathological oral reflexes
  • hyperactive gag reflex
  • pseudobulbar effect
  • more problems exists with dysphagia and drooling than other MSDs
55
Q

Pathological oral reflexes, hyperactive gag reflex and pesudobulbar effect are found most often in what kind of dysarthria?

A

Spastic dysarthria

56
Q

In _____ dysarthria, more problems exist with dysphagia and drooling than other MSDs.

A

Spastic

57
Q

What are the oral mechanism findings of ataxic dysarthria?

A
  • May have dysmetria in non-speech, jaw, face, and tongue movements
  • other oral mechanism findings may be normal
58
Q

What are the oral mechanism findings of hypokinetic dysarthria?

A

orofacial tremors

-masked face is common and not seen with other MSDs

59
Q

What are the oral mechanism findings of hyperkinetic dysarthria?

A

Abnormal movements may be seen both at rest and in speech that are not seen in other dysarthrias.

60
Q

What are the oral mechanism findings of UUMN?

A

unilateral facial and lingual weakness without atrophy or fasiculations is common, but not typically seen in other dysarthrias.

61
Q

What are the most common distinguishing speech characteristics of flaccid dysarthria?

A

Phonatory and resonatory abnormalities

62
Q

Which characteristics may be more prominent in flaccid dysarthria if the Xth nerve is affectes?

A

breathiness
diplophonia
audible inspiration
short phrases

63
Q

Breathiness occurs in what two dysarthrias?

A

flaccid and hypokinetic

64
Q

What can differentiate flaccid dysarthria from hypokinetic dysarthria?

A

There is greater hoarseness and the presence of diplophonia in flaccid dysarthria.

65
Q

Hypernasality occurs in other dysarthrias, most often ____ and _____, but still is most pronounced in _____ dysarthria.

A

spastic
hypokinetic
flaccid

66
Q

________ occurs in other dysarthrias, most often in spastic and hypokinetic but still is most pronounced in flaccid dysarthria.

A

Hypernasality

67
Q

What occurs only in connections with flaccid dysarthria in myasthenia gravis?

A

rapid deterioration of speech

68
Q

Rapid deterioration of speech occurs only in connection with ____ dysarthria in _____ ______.

A

flaccid

myasthenia gravis

69
Q

What are the most common features of spastic dysarthria that aren’t typically seen in other dysarthrias?

A

Slow rate combined with slow but regular AMRs, strained voice quality.

70
Q

A client may have a strained voice quality in hyperkinetic dysarthria but it usually isn’t accompanied by the ____ ______.

A

slow rate

71
Q

A strained voice quality may also be present in what other dysarthria besides spastic?

A

hyperkinetic

72
Q

What differentiates spastic dysarthria from hyperkinetic?

A

Spastic will have a combination of slow rate with slow regular AMRs and strained voice quality, while hyperkinetic will only have one of those features, strained voice quality.

73
Q

What are the primary distinguishing speech characteristics of ataxic dysarthria?

A
  • irregular articulatory breakdowns
  • irregular AMRs
  • dysprosody
74
Q

Irregular articulatory breakdowns, irregular AMRs, and dysprosody are the main speech characteristics of _____ dysarthria but may also be present in ______ and ______ dysarthria.

A

ataxic
UUMN
hyperkinetic

75
Q

How does a clinician distinguish between ataxic dysarthria and UUMN dysarthria?

A

Patient with UUMN will have unilateral lower facial and tongue weakness

76
Q

How does a clinician distinguish between ataxic dysarthria and hyperkinetic dysarthria?

A

Patient with hyperkinetic dysarthria will have abnormal movements

77
Q

______ dysarthira is the only dysarthira in which rapid and blurred speech and AMRs occur but it doesn’t have to occur, but it doesn’t have to occur.

A

Hypokinetic

78
Q

What are speech characteristics that can be present in hypokinetic dysarthria?

A

rapid and blurred speech and AMRs

79
Q

Palialia only occurs in what kind of dysarthria?

A

Hypokinetic

80
Q

______ only occurs in hypokinetic dysarthria/

A

Palialia

81
Q

What is particular to hyperkinetic dysarthria?

A

abnormal movements

82
Q

What helps differentiate UUMN?

A

Its mildness and transient duration

83
Q

Why is UUMN confused for ataxic dysarthria?

A

Irregular breakdowns

84
Q

What are speech characteristics of UUMN?

A
  • AMRs are usually normal but can be mildly irregular
  • voice may sound somewhat spastic because of strained voice, but it is usually milder in degree than spastic dysarthria.
  • It rarely has hypernasality.
85
Q

What are the differences between dysarthria and apraxia in regards to location of lesion?

A
  • Apraxia

- Dysarthria occurs with damage to supratentorial, posterior fossa, spinal or peripheral lesion.

86
Q

_______ occurs with left hemisphere lesions except when there is right hemisphere language dominance or mixed dominance, It occurs with supratentorial damage.

A

Apraxia

87
Q

_______ occurs with damage to supratentorial, posterior fossa, spinal or peripheral lesion.

A

Dysarthria

88
Q

Dysarthria occurs with damage in what structures?

A
  • supratentorial
  • posterior fossa
  • spinal
  • peripheral lesion
89
Q

______ occurs primarily with lesions to the carotid system.

A

Apraxia

90
Q

________ occurs not only with carotid lesions but with other vascular system lesions.

A

Dysarthria

91
Q

Dysarthria occurs not only with carotid lesions but with other ______ ______ lesions.

A

vascular system

92
Q

Which dysarthria is the most difficult to differentiate from apraxia of speech?

A

UUMN

93
Q

Look at oral mech findings in book that differentiate apraxia and dysarthria.

A

See table 15-3 pg 361

94
Q

Name the 3 speech characteristics that differentiate AOS and dysarthria.

A
  1. In dysarthria, all subsystems are affected. AOS - mainly articulation and prosody are affected.
  2. AOS is more often associated with aphasia than dysarthria.
  3. Apraxic speakers grope, dysarthria speakers do not.
95
Q

_______ speakers grope, _______ speakers do not. Patients with _______ _____ may also present with groping behaviors.

A

Apraxic
dysarthria
phonemic paraphasias

96
Q

_____ is more often associated with aphasia than dysarthria.

A

AOS

97
Q

What subsystems are affected in dysarthria?

A

All sub-systems

98
Q

What subsystems are affected in apraxia?

A

mainly articulation and prosody

99
Q

_______ patients can have normal oral mech exam, _______ usually do not.

A

Aphasia

dysarthria

100
Q

________ patients do not have language problems, _____ patients do.

A

Dysarthria

aphasia

101
Q

AOS vs Aphasia see book.

A

pg 366 table 15-6

102
Q

Write down main diagnostic indicators from handout 18.

A

Six indicators

103
Q

Write down main diagnostic indicators for apraxia.

A

six indicators

104
Q

________ related to apraxia can be associated with normal findings in oral mech exam.

A

Mutism

105
Q

_____ ____ patients usually try to speak and show frustration when they can’t.

A

Mute apraxic

106
Q

What is anarthria?

A

lack of speech. Usually have significant neuromotor deficits in bulbar muscles that cause mutism. It’s sometimes present without limb motor deficits.

107
Q

_______ is lack of speech.

A

Anarthria

108
Q

Anarthria usually has significant _______ and other _____ abnormalities and this helps in dx.

A

dysphagia

oromotor

109
Q

What happens when people with anarthria attempt to speak?

A

Their restricted articulatory ROM, reduced loudness and strained, groaning quality is diagnostic.

110
Q

What type of conditions are more likely to be associated with mutism due to cognitive-affective disturbances than with anarthria, AOS, aphasia?

A

Conditions that have diffuse or multifocal damage

111
Q

What difficulties do people with mutism due to aphasia present?

A

Similar to mute apraxic pts except they may have problems following instructions. If mutism is present, aphasia is usually severe so they do poorly on language tests.

112
Q

What is cognitive-affective disturbances?

A

May be due to reduced arousal and alertness. If speech does eventually occur, there are delays with brief unelaborated speech.

113
Q

Distinguishing motor speech disorders from other neurologic speech disorders. See book.

A

pg 369 15-7

114
Q

Review handouts of differential diagnosis of dysarthria and apraxia

A

three handouts.

Motor speech Final Exam (6 decks)

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