PMR 4 - speech Flashcards
The major voluntary pathway for speech, as well as all voluntary movement, is:
a. Corticocerebellar tract
b. Autonomic nervous system
c. Pyramidal svstem
d. Peripheral nervous system
C) The pyramidal system includes the corticopontine, corticobulbar, and corticospinal pathways. This pathway provides the network of neural connections necessary to ensure that communication between the speech planning centers in the frontal lobe is relaved to the various subsystems of speech to create a verbal message. Those subsystems include the respiratory, phonatory, resonatory, and articulatory subsystems.
In some cases, aphasia may:
a. Progress due to recurrent neurogenic pathology
b. Be a static condition
c. Be further influenced by coexisting medical problems
d. All of the above
D) Aphasia is the language disorder that results from damage in the left hemisphere of the brain. The condition can remain unchanged, worsen in the face of additional neurogenic or medical conditions, or improve with medical and therapeutic intervention.
Aphasia traditionally has been attributed to cortical lesions of the:
a. Parietal lobe
b. Occipital lobe
c. Left hemisphere
d. Cerebellum
C) The left hemisphere is traditionally viewed as the language center of the brain.
When lesions occur in the left hemisphere, the result could be different types of aphasia spanning a continuum from nonfluent to fluent, based on site of lesion. The frontal lobe itself is associated with voluntary movements in the body, which includes speech production. If a lesion were to occur there, a particular type of aphasia may result from among the nonfluent varieties. But in general, any aphasia that occurs in a patient population would be the direct result of cortical damage to the left hemisphere.
Voluntary movement, intellect, and speech are located in the
a. Parietal lobe
b. Frontal lobe
c. Temporal lobe
d. Occipital lobe
B) It has long been known that different regions of the brain are responsible for different functions. The frontal lobe is known as the motor cortex. As such, it is responsible for voluntary movements, as well as intellect and speech-language. The parietal lobe is the sensory cortex, the temporal lobe is the auditory cortex, and the occipital lobe is the visual cortex.
A patient presents with inappropriate commenting, left field neglect, and reduced affect. This patient has recently suffered from a:
a. Right hemispheric stroke
b. Brainstem infarct
c. Left hemispheric stroke.
d. Trauma to the temporal lobe
A) Whereas the left hemisphere is considered the language hemisphere for the majority of all individuals, the right hemisphere is considered the center for visuospatial orientation and constructional skills. Right hemisphere brain damage (RHBD) results in a variety of symptoms, as noted, although on the surface an overt language problem that compromises the ability of the patient to speak in a grammatically correct manner is not one of them. Rather, they may exhibit a lack of awareness concerning their subtle problems in social interactions, have difficulty navigating their way around a room, and do poorly on drawing tasks.
A patient with a brainstem lesion is likely to experience all of the following except:
a. Poor anterior-posterior transport of a food/liquid bolus
b. Decreased masseter tension
c. Wet hoarseness
d. Rigidity
D) Brainstem lesions will affect the function of cranial nerves, which, in turn, controls such things as chewing, bolus movement, and swallowing. Muscle rigidity, on the other hand, is typically associated with either an upper motor neuron lesion in the cortex or damage to the basal ganglia, a subcortical structure.
Hypokinetic dysarthria is a result of:
a. Parkinson’s disease
b. Alcohol toxicity
c. Depletion of dopamine
d. A and C
D) Hypokinetic dysarthria is the motor speech problem typically seen in patients who suffer from Parkinson’s disease. This results directly from a depletion of dopamine in the substantia nigra of the basal ganglia. The disease is characterized by bradykinesia or akinesia, rigidity, tremors, and a loss of postural reflexes. Patients characteristically have a “masked” and inexpressive face. Their speech is hypokinetic (less articulatory movement), monotone, and monoloud.
The transcortical aphasias result from lesions involving:
a. Broca’s area
b. Wernicke’s area
c. Border zone
d. Cerebellum
C) The border zone refers to a region of the cortex that takes in Broca’s area in the frontal lobe and Wernicke’s area in the temporal lobe, as well as the arcuate fasciculus (a connecting bundle of association fibers that joins the two. Damage within that zone could L result in either trans cortical motor aphasia (more anterior lesion) or transcortical sensory aphasia (more posterior lesion).
A patient’s signs and symptoms include effortful speech and difficulties with verbal 9. expression, difficulty in organizing verbal responses, phonemic and global paraphasias, and verbal perseverations. The patient can be diagnosed as:
a. Wernicke’s aphasia
b. Global aphasia
c. Transcortical motor aphasia
d. Conduction aphasia
C) These symptoms describe the condition called transcortical motor aphasia, a disorder that results from a lesion within the anterior aspect of the speech zone in the frontal lobe.
Because of the dysprosody and effortful speech that the patient exhibits, it is considered a nonfluent type of aphasia.
A patient demonstrates paraphasic speech with semantic substitutions.
Most striking is 10. the patient’s echolalia, or repetition of phrases that are heard. Comprehension is poor in this patient, whereas verbal repetition is considered good. Reading and writing skills are also poor. This individual may be diagnosed as:
a. Wernicke’s aphasia
b. Transcortical sensory aphasia
c. Broca’s aphasia
d. Conduction aphasia
B) These symptoms describe the condition called transcortical sensory aphasia, a disorder that results from a lesion within the posterior aspect of the speech zone in the temporal lobe. Because such patients display disordered verbal abilities, marked by echolalia and paraphasias, it is considered a fluent type of aphasia.
The upper motor neuron consists of:
a. Corticopontine, corticobulbar corticospinal fibers
b. Cranial and spinal nerves
c. Both of the above
A) The upper motor neuron is associated with the central nervous system that structurally includes the brain and spinal cord, or neuraxis. The pathways indicated help to create the neural connections between the cortex and pons, medulla oblongata, and spinal cord. The upper motor neuron (UMN) is the first-order neuron, meaning that it functions to plan out and organize the instructions needed to carry out voluntary movements seen in speech, swallowing, or limb motion. The cranial and spinal nerves are part of the peripheral nervous system, which comprises the lower motor neuron (LMN). The LMN is considered the second-order neuron, which actually carries out the commands sent to it by the UMN.
The specific aphasic symptom of lexical (word) retrieval deficit seen in patients is known as:
a. Jargon
b. Dyslexia
c. Amnesia
d. Anomia
D) Anomia comes from Latin, which is “no name.” Jargon is a different speech characteristic that is marked by excessive, nonsensical verbiage. Dyslexia is a reading disorder. Amnesia is a generalized loss of memory for people, places, and things.
The response elicited in a neurologically impaired patient where the sole of the foot is firmly scratched and the toes fan out is called:
a. Babinski reflex
b. Rooting reflex
c. Moro reflex
d. Cough reflex
A) The Babinski reflex is typically seen in
Infateh cortical controllising trom e
through cortical control arising from progressive myelinization of the corticospinal tract. This reemergent reflex is associated with upper motor neuron (UMN) lesions.
A nonprogressive disorder of motion and posture due to brain injury or insult that occurs during early brain growth is:
a. Dystonia
b. Cerebral palsy (CP)
c. Ataxia
d. Dyskinetic
B) Cerebral palsy may result from lack of oxygen to the brain and can manifest as spastic CP if the cortical region of the brain is affected, athetoid CP if the basal ganglia is affected, or ataxic CP if the cerebellum is affected.
In cerebral palsy, the syndrome that impairs one leg and one arm on the same side of the 15. body is:
a. Spastic hemiplegia
b. Spastic diplegia
c. Spastic triplegia
d. Spastic quadriplegia
A) Hemiplegia refers to one symmetrical half of the body, either the left or the right side. Diplegia affects all four extremities, but the legs are more affected than the arms or hands. Triplegia involves three extremities, usually both legs and one arm. Quadriplegia affects the entire body, including the trunk and all four extremities.
The main branch of the arterial system that feeds the anterior portion of the brain comes from:
a. Vertebral artery
b. Basilar artery
c. Internal carotid artery
d. Posterior carotid artery
C) The two internal carotid arteries each branch off into the anterior and middle cerebral arteries. The two vertebral arteries join together in the ventral brainstem to form the basilar artery and then split again to form the posterior vertebral arteries.
The type of language disorder that results from a lesion in the frontal lobe and is charac-17. terized by relatively good comprehension but decreased verbal output, effortful speaking, “ dysprosody, difficulty in performing verbal repetitions, poor oral reading and writing, and right hemiparesis is called:
a. Broca’s aphasia
b. Wernicke’s aphasia
c. Conduction aphasia
d. Global aphasia
A) Typically the result of damage to the frontal lobe of the left hemisphere, this nonfluent type of aphasia is marked by all the symptoms noted, as well as (possibly) an accompanying motor speech problem, such as apraxia or dysarthria. Both Wernicke’s and conduction aphasia are considered fluent types of aphasia, as the site of lesion is more posterior in the brain and so articulation is generally intact. Global aphasia often results from more diffuse types of lesion and usually affects both comprehension and production.
The language disorder that results from damage to the arcuate fasciculus and results in good comprehension, good articulation but poor repetitions, word-finding difficulties, and oral reading that is paraphasic is called:
a. Broca’s aphasia
b. Wernicke’s aphasia
c. Conduction aphasia
d. Global aphasia
C) The arcuate fasciculus is a neural association pathway that connects Broca’s area in the frontal lobe to Wernicke’s area in the temporal lobe. As such the patient with this condition can generally understand routine conversational interactions and demonstrate good comprehension, but has word-finding problems marked by pausing and hesitations. In addition, this patient may exhibit poor spelling as well as poor writing skills.
A patient who has been diagnosed with Huntington’s disease is likely to experience:
a. Hypokinetic dysarthria
b. Hyperkinetic dysarthria
c. Ataxic dysarthria
d. Apraxia of speech
B) Persons with Huntington’s disease often display psychiatric conditions as the first manifestation of their illness. Sometimes psychosis develops and depression is common. Movements may appear fidgety, but ultimately a choreoathetoid movement disorder develops. Speech rate and loudness become variable, and articulation becomes increasingly imprecise (hyperkinetic dysarthria).
Sustained, rhythmic jerky motions that are elicited when a muscle or tendon is held in extension are called:
a. Tremor
b. Athetosis
c. Clonus
d. Fasciculation
C) Clonus occurs in cases of upper motor neuron (UMN) disease where muscles become spastic due to increased tone. Athetosis is a slow writhing type of motion associated with damage to the basal ganglia. Fasciculations are small local, involuntary muscle contractions that may be visible under the skin. A tremor is an involuntary, somewhat rhythmic, muscle contraction involving to-and-fro movements of one or more body parts. It is differentiated from clonus by the fact that a tremor may occur without being elicited by holding a muscle or tendon in extension.
Aphasia may be seen in:
a. Adults
b. Children
c. Persons across the lifespan
C) Aphasia, the language deficit that results from cortical damage to the speech-language centers of the brain, may affect persons both young and old. Unfortunately, there is no protection against the devastation that is wrought by such a condition on the basis of one’s age.
Aphasia is a disorder of:
a. Speech
b. Language
c. Both speech and language
d. Swallowing
B) Following a stroke or brain injury, a person may undergo dramatic changes in how they are able to communicate. Aphasia is the language-based disorder that may occur as a result of such neurological events.
Speech disorders, on the other hand, are considered different types of ailments, where either the planning centers for formulating the correct sequence of movements to form speech sounds (phonemes) are hampered (known as the motor speech disorder of apraxia) or the different subsystems that combine to create verbal speech (the respiratory, phonatory, resonatory, and articulatory systems) are unable to complete the tasks that are programmed, resulting in the motor speech disorder of dysarthria.
Dysphagia is a swallowing disorder.
The valve that divides the airway into upper and lower regions is the:
a. Esophagus
b. Trachea
c. Larynx
d. Epiglottis
C) The larynx divides the airway into upper and lower regions. Any condition that affects the functionality of the larynx may result in either swallowing problems, voice problems, or both. The trachea is the airway that actually extends from the larynx inferiorly to the lungs.
The esophagus is the tube that carries nutrition to the stomach. The epiglottis, which is part of the larynx, serves a protective function by folding over the vocal fold area during swallowing to protect the airway from infiltration.
A patient was brought to the emergency department after a sudden onset of difficulty speaking. A neurological exam indicated that the patient was experiencing a subcortical aphasia. This would indicate that the patient possibly experienced a lesion in the:
a. Thalamus
b. Precentral gyrus
c. Postcentral gyrus
d. Occipital lobe
A) The thalamus is a subcortical structure, located in the diencephalon at the top of the brainstem. Both precentral and postcentral gyri are located adjacent to the central sulcus on the surface of the cortex, whereas the occipital lobe is located in the posterior aspect of the cortex.
The three phases of swallowing are:
a. Oral, pharyngeal, esophageal
b. Tracheal, nasal, pharyngeal
c. Esophageal, tracheal, epiglottic
d. Oral, tracheal, pulmonary
A) When we eat, food is formed into a bolus, which must then pass through the oral, pharyngeal, and esophageal cavities before depositing into the stomach.
Where is the pharyngeal stage of swallowing triggered?
a. In the oral cavity
b. Anterior to the epiglottis
c. At the anterior faucial pillars
d. In the esophagus
C) As the food bolus leaves the oral cavity and moves backward, it must pass the faucial pillars (where tonsils are located). This region contains sensory receptors that detect the presence of the bolus, which sets into motion a chain of events that result in the bolus moving through the pharynx and entering the esophagus.
Where can residue pool in the pharynx?
a. In the buccal cavity
b. In the vallecular space
c. In the pyriform sinuses
d. A and B but not C
e. B and C but not A
E) Both the valleculae and the pyriform sinuses are regions within the pharynx where residue can accumulate if the patient is not able to pass the bolus cohesively. Although food may also pool in the buccal cavities or cheeks, this is considered part of the oral cavity, not the pharynx.
In a normal, healthy individual, esophageal motility takes how long to transport a bolus from the esophagus to the stomach?
a. 1 second
b. 3 to 5 seconds
c. 8 to 20 seconds
d. More than 60 seconds
C) The average time it takes for a healthy person to clear the food through the esophagus is between 8 and 20 seconds.
What happens during the pharyngeal stage of swallowing?
a. Vocal folds adduct
b. Epiglottis folds over
c. Larynx elevates and moves anteriorly
d. All of the above
D) In addition to these physical movements, the velopharyngeal port closes to prevent nasal regurgitation of food and the upper esophageal sphincter relaxes to allow movement of the bolus into the esophagus.
All these things occur in the space of a single second, upon the triggering of the pharyngeal swallow stage with the passage of the bolus by the faucial pillars.
Dysphagia may be due to:
a. Neurological dysfunction
b. Cancer
C. Aging
d. All of the above
D) Swallowing disorders affect a wide range of people in different situations. It can occur throughout the lifespan, from infancy to advanced age.
With right-sided weakness that accompanies a left hemispheric stroke, what maneuver can be employed to prevent pooling of food or liquid in the right pyriform sinus?
a. Chin tuck
b. Mendelsohn maneuver
c. Head turn to the right
d. Head turn to the left
C) Advances in swallow therapy over the years have shown the benefit of having patients with right hemiparesis turn their heads to the weaker side (in this case, the right) to prevent food buildup that could cause penetration and/or aspiration if left unchecked.
The procedure whereby the stomach is pulled up around the lower esophageal sphincter 32. to control acid reflux is called:
a. Esophageal dilation
b. Gastrostomy
c. Jejunostomy
d. Fundoplication
D) Dilation is performed to help increase the lumen of the esophageal tube, whereas gastrostomy and jejunostomy procedures are performed to help provide nutrition to a patient nonorally. Fundoplication is a surgical procedure employed to help control severe reflux.
When the head and the tail of the bolus do not pass through the pharyngeal segment cohesively, this is:
a. Cervical auscultation
b. Piecemeal swallow
c. Esophageal dysmotility
d. A problem with mastication
B) Piecemeal refers to the noncohesive manner in which people sometimes swallow food and liquid. It may take/them several attempts, gulp after gulp after gulp, before what they have put into their mouths has been completely cleared.
