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Motor speech Final Exam > Differential diagnosis > Flashcards

Differential diagnosis Flashcards

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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
Open head injuries do not usually cause ______ _____ but can cause the other ______ dysarthrias. Name them.
Flaccid | CNS: spastic, ataxic, UUMN
26
What kind of dysarthrias can skull fracture and neck trauma injuries causes?
flaccid dysarthrias
27
What dysarthrias can surgical trauma cause?
Any type of dysarthrias except hypokinetic
28
Which surgeries are only involved with flaccid dysarthria?
Surgeries involved with ear, nose, throat, chest/cardiac areas.
29
Surgeries involved with ear, nose throat, chest/cardiac areas are only associated with what type of dysarthria?
flaccid dysarthria
30
What kind of dysarthrias can a neurosurgery cause?
CNS dysarthrias as well as flaccid dysarthria
31
Toxic and metabolic conditions typically do not causes which dysarthrias?
flaccid or UUMN
32
________ and _______ conditions typically do not cause flaccid or UUMN dysarthria but can cause other types.
Toxic and metabolic conditions
33
Toxic conditions associated with drugs/medications cause _____ and _____ dysarthrias most often.
hyperkinetic | ataxic
34
Toxic conditions associated with _________ cause hyperkinetic and ataxic dysarthrias most often.
drugs/medications
35
_________ and _________ conditions-- rarely cause dysarthrias although they sometimes occur. The type of dysarthria depends on the condition.
Infectious | inflammatory
36
Which condition rarely causes dysarthrias?
Infectious and inflammatory
37
_______ diseases can cause any type of dysarthria but hypokinetic is rare. The type of disorder depends on the disorder.
Demyelinating
38
Name two demyelinating diseases.
Guillian Barre disease | multiple sclerosis
39
Which dysarthria is Guillian Barre disease usually associated with?
flaccid
40
Multiple Sclerosis is usually associated with which dysarthria?
ataxic
41
Which dysarthria is most often associated with Anatomic malformations such as Arnold-Chiari (malformation of the brain)?
Flaccid dysarthria
42
Why do neuromotor junction disorders, muscle disease and neuropathies only cause flaccid dysarthria?
Neuromomtor junction disorders are PNS diseases
43
Neuromotor junction disorders only cause what type of dysarthria?
flaccid dysarthria
44
______ can be present in the absence of a neurologic diagnosis.
Dysarthria
45
Dysarthria can be present in the absence of what?
A neurologic diagnosis
46
Sometimes the etiology of a dysarthria is undetermined particularly for which dysarthrias?
- hyperkinetic - spastic - ataxic
47
Certain findings in the _____ _____ are not required for MSD but are used as confirmatory signs.
oral mechanism
48
Oral mechanism findings that are not required for MSD, may be used as what?
confirmatory signs
49
What are the two characteristics that often occur in flaccid dysarthria and do not occur in other dysarthrias or apraxia?
atrophy and fasiculations
50
_____ and a ______ gag reflex occur more often in flaccid dysarthria than other dysarthrias.
hypotonia | hypoactive
51
Rapid loss of intelligibility is indicative of what?
Myasthenia gravis
52
Nasal regurgitaion may be seen in what kind of dysarthria?
flaccid dysarthria
53
Name oral mechanism findings for flaccid dysarthria:
- atrophy and fasiculations - hypotonia - hypoactive gag reflex - nasal regurgitation
54
Oral mechanism findings of spastic dysarthira:
- pathological oral reflexes - hyperactive gag reflex - pseudobulbar effect - more problems exists with dysphagia and drooling than other MSDs
55
Pathological oral reflexes, hyperactive gag reflex and pesudobulbar effect are found most often in what kind of dysarthria?
Spastic dysarthria
56
In _____ dysarthria, more problems exist with dysphagia and drooling than other MSDs.
Spastic
57
What are the oral mechanism findings of ataxic dysarthria?
- May have dysmetria in non-speech, jaw, face, and tongue movements - other oral mechanism findings may be normal
58
What are the oral mechanism findings of hypokinetic dysarthria?
orofacial tremors | -masked face is common and not seen with other MSDs
59
What are the oral mechanism findings of hyperkinetic dysarthria?
Abnormal movements may be seen both at rest and in speech that are not seen in other dysarthrias.
60
What are the oral mechanism findings of UUMN?
unilateral facial and lingual weakness without atrophy or fasiculations is common, but not typically seen in other dysarthrias.
61
What are the most common distinguishing speech characteristics of flaccid dysarthria?
Phonatory and resonatory abnormalities
62
Which characteristics may be more prominent in flaccid dysarthria if the Xth nerve is affectes?
breathiness diplophonia audible inspiration short phrases
63
Breathiness occurs in what two dysarthrias?
flaccid and hypokinetic
64
What can differentiate flaccid dysarthria from hypokinetic dysarthria?
There is greater hoarseness and the presence of diplophonia in flaccid dysarthria.
65
Hypernasality occurs in other dysarthrias, most often ____ and _____, but still is most pronounced in _____ dysarthria.
spastic hypokinetic flaccid
66
________ occurs in other dysarthrias, most often in spastic and hypokinetic but still is most pronounced in flaccid dysarthria.
Hypernasality
67
What occurs only in connections with flaccid dysarthria in myasthenia gravis?
rapid deterioration of speech
68
Rapid deterioration of speech occurs only in connection with ____ dysarthria in _____ ______.
flaccid | myasthenia gravis
69
What are the most common features of spastic dysarthria that aren't typically seen in other dysarthrias?
Slow rate combined with slow but regular AMRs, strained voice quality.
70
A client may have a strained voice quality in hyperkinetic dysarthria but it usually isn't accompanied by the ____ ______.
slow rate
71
A strained voice quality may also be present in what other dysarthria besides spastic?
hyperkinetic
72
What differentiates spastic dysarthria from hyperkinetic?
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
What are the primary distinguishing speech characteristics of ataxic dysarthria?
- irregular articulatory breakdowns - irregular AMRs - dysprosody
74
Irregular articulatory breakdowns, irregular AMRs, and dysprosody are the main speech characteristics of _____ dysarthria but may also be present in ______ and ______ dysarthria.
ataxic UUMN hyperkinetic
75
How does a clinician distinguish between ataxic dysarthria and UUMN dysarthria?
Patient with UUMN will have unilateral lower facial and tongue weakness
76
How does a clinician distinguish between ataxic dysarthria and hyperkinetic dysarthria?
Patient with hyperkinetic dysarthria will have abnormal movements
77
______ 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.
Hypokinetic
78
What are speech characteristics that can be present in hypokinetic dysarthria?
rapid and blurred speech and AMRs
79
Palialia only occurs in what kind of dysarthria?
Hypokinetic
80
______ only occurs in hypokinetic dysarthria/
Palialia
81
What is particular to hyperkinetic dysarthria?
abnormal movements
82
What helps differentiate UUMN?
Its mildness and transient duration
83
Why is UUMN confused for ataxic dysarthria?
Irregular breakdowns
84
What are speech characteristics of UUMN?
- 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
What are the differences between dysarthria and apraxia in regards to location of lesion?
- Apraxia | - Dysarthria occurs with damage to supratentorial, posterior fossa, spinal or peripheral lesion.
86
_______ occurs with left hemisphere lesions except when there is right hemisphere language dominance or mixed dominance, It occurs with supratentorial damage.
Apraxia
87
_______ occurs with damage to supratentorial, posterior fossa, spinal or peripheral lesion.
Dysarthria
88
Dysarthria occurs with damage in what structures?
- supratentorial - posterior fossa - spinal - peripheral lesion
89
______ occurs primarily with lesions to the carotid system.
Apraxia
90
________ occurs not only with carotid lesions but with other vascular system lesions.
Dysarthria
91
Dysarthria occurs not only with carotid lesions but with other ______ ______ lesions.
vascular system
92
Which dysarthria is the most difficult to differentiate from apraxia of speech?
UUMN
93
Look at oral mech findings in book that differentiate apraxia and dysarthria.
See table 15-3 pg 361
94
Name the 3 speech characteristics that differentiate AOS and dysarthria.
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
_______ speakers grope, _______ speakers do not. Patients with _______ _____ may also present with groping behaviors.
Apraxic dysarthria phonemic paraphasias
96
_____ is more often associated with aphasia than dysarthria.
AOS
97
What subsystems are affected in dysarthria?
All sub-systems
98
What subsystems are affected in apraxia?
mainly articulation and prosody
99
_______ patients can have normal oral mech exam, _______ usually do not.
Aphasia | dysarthria
100
________ patients do not have language problems, _____ patients do.
Dysarthria | aphasia
101
AOS vs Aphasia see book.
pg 366 table 15-6
102
Write down main diagnostic indicators from handout 18.
Six indicators
103
Write down main diagnostic indicators for apraxia.
six indicators
104
________ related to apraxia can be associated with normal findings in oral mech exam.
Mutism
105
_____ ____ patients usually try to speak and show frustration when they can't.
Mute apraxic
106
What is anarthria?
lack of speech. Usually have significant neuromotor deficits in bulbar muscles that cause mutism. It's sometimes present without limb motor deficits.
107
_______ is lack of speech.
Anarthria
108
Anarthria usually has significant _______ and other _____ abnormalities and this helps in dx.
dysphagia | oromotor
109
What happens when people with anarthria attempt to speak?
Their restricted articulatory ROM, reduced loudness and strained, groaning quality is diagnostic.
110
What type of conditions are more likely to be associated with mutism due to cognitive-affective disturbances than with anarthria, AOS, aphasia?
Conditions that have diffuse or multifocal damage
111
What difficulties do people with mutism due to aphasia present?
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
What is cognitive-affective disturbances?
May be due to reduced arousal and alertness. If speech does eventually occur, there are delays with brief unelaborated speech.
113
Distinguishing motor speech disorders from other neurologic speech disorders. See book.
pg 369 15-7
114
Review handouts of differential diagnosis of dysarthria and apraxia
three handouts.

Motor speech Final Exam (6 decks)

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