Speech and Aphasia Flashcards Preview

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Flashcards in Speech and Aphasia Deck (14):
1

What subspecialty of medicine does aphasia seem to highlight?

• Behavioral neurology
• If the brain is an organ, than abnormal behavoir is a symptom of organ dysfunction

2

What is the pathway of diagnostics using the mental status exam?

• Cognitive deficits found
○ Syndrome diagnosis
• Explore for etiology with rest of neuro exam
○ Site of pathology determination
○ Etiology diagnosis
• Explore for appropriate treatment
○ Based off of site and on etiology
• For behavioral neurology the neuro exam and mental status exam is more specific and sensitive than any scan or image

3

What is MMSE?

• Mini-mental state examination
• 30 point measures often used for brief assessment of mental status

4

What is MoCA?

• Montreal cognitive assessment
• 30 point measures often used for brief assessment of mental status

5

What are the major cognitive domains that are tested in mental status examinations?

• Arousal and attention
○ Level of consciousness
○ Digit span
○ Serial sevens
• Memory
○ Orientation
○ Three words at five minutes
○ Remote events
• Language
○ Fluency
○ Comprehension
○ Repetition
○ Naming
○ Reading
○ writing
• Visuospatial fluctuation
○ Clock drawing
○ Tests for hemineglect
• Mood and affect
○ Inquires about feelings
○ Observations of affect
• Complex cognition
○ Executive function
○ Similarities
○ Proverbs
○ Judgment
○ insight

6

What are the syndromes that can be ID'd by bedside examination?

• Acute confusional state
○ Common and often reversible disorder of attention
• Amnesia
○ Impaired recent memory
○ Deficit in new learning
• Aphasia
○ Acquired disorder of language
• Apraxia
○ Impairment of learned movement, often associated with aphasia
• Agnosia
○ Impaired recognition in the visual, auditory, or tactile modality
• Visuospatial impairment
○ Difficulty interpreting spatial relationships
• Hemineglect
○ Failure to attend to one side of the body or extrapersonal space
*personalitiy change
*dementia

7

What is the definition of aphasia?

• Acquired disorder of language
• Resulting from brain damage in the areas subserving linguistic capacity
○ PET and fMRI are helpful in further defining


8

What are three complications to the differential dx of aphasia?

• Dysarthria - muscle problem with speech
• Mutism (can be aphasia but can also be:)
○ Anarthria
○ Aphonia

9

What is the definition of speech?

• Mechanical act of uttering words
• Using neuromuscular apparatus responsible for phonation and articulation
• Depends on motor cortices, corticobulbar tracts, basal ganglia, cerebellum, LMNs to pharynx and larynx, pharyngeal and laryngeal muscles
• Aphasia is NOT disarthria, which is motor-system loss of speech

10

Using handedness as an example, what is the cerebral dominance of language?

• A bit misleading to say any hemisphere is just "dominant" but it's better to say "dominant for language"
• Vast majority of population is left dominant for language
• 99% of RH people have left dominant language brains
• 67% of LH people have left dominant language brains

11

What are the elements of the aphasia examination?

• Assess:
• Speech
• Auditory comp
• Repetition
• Naming
• Reading/writing (literate people)
○ Agraphia and alexia accompany aphasia much of the time

12

What are the varieties of aphasia?

• Naming is impaired in all forms, so inability to name common items is the most sensitive indicator of language impairment
• First and more important 4:
○ Broca's aphasia
§ Nonfluent speech good comp
○ Wernicke's aphasia
§ Fluent speech, bad comp
○ Conduction aphasia
§ Loss of repetition in the presence of preserved fluency and comp
○ Global aphasia
§ Disabling disruption of ALL aspects of language

13

How does sensory hearing loss typically manifest?


• Changes in pure tone hearing thresholds
Inner hair cell loss is considered what type of hearing loss?
• Neural (they consider it the same as the nerves)
How does neural hearing typically present?
• Changes in word recognition scores or the clarity of hearing

14

How do you make the dx of acute otitis media?

• Rapid onset of signs and symptoms
○ Inflammation of TM
○ Drainage
○ Perforation
○ Pain
○ Fullness/pressure
○ Hearing loss
• Ear infection
• Presence of middle ear effusion

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