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WorksheetsMSD Final
Total questions: 64
Worksheet time: 37mins
a patient in an acute care hospital presents with a new onset of lower left-sided facial weakness and slow imprecise speech. Which of the following is most likely?
the patient has had a cerebellum stroke
the patient has had a stroke in the right motor cortex or internal capsule on the right side
the patient has PD and these symptoms would be consistent with this dz
both b and c
during a presentation at a conference, a neurologist states that a patient has a brain tumor involving the corticobulbar tract. The patient is reported to have significant dysarthria b/c
the corticobulbar tract supplies the afferent fibers (sensory signals) from the brainstem to the cerebellum
the corticobulbar tract supplies the efferent fibers (motor signals) from the cortex to only the spinal
the corticobulbar tract supplies the efferent fibers (motor signals) from the cortex to the brainstem and therefore to the CNs
the corticobulbar tract is the blood supply to the motor strip
A unilateral upper motor neuron lesion might result in deficits
weakness in the muscles on both sides of the face
muscle wasting and atrophy in the tongue
no significant changes in innervation
weakness on the contralateral side of the face (lower face) to the side of the lesion
A unilateral lower motor neuron lesion to the facial or 7th CN will probably result in...
no significant weakness since it is a LMN lesion
weakness and possible atrophy in the muscles of facial expression on the contralateral side of the face
significant resonance and vocal changes resulting in limited speech production
muscular weakness of the entire side (upper and lower) of the face on the same side as the lesion
Pt has a symmetrical smile and no obvious facial weakness. However, when the pt answers questions, her speech is imprecise and slow, especially when saying words like "take". When the pt protrudes her tongue, her tongue deviates to one side and seems asymmetrical. The SLP states the pt had a suspected brainstem infarct. When CN seems to be involved?
facial VII
hypoglossal XII
Vagus X (nucleus ambiguous)
trigeminal V
Dopamine is often decreased in PD resulting in impaired motor movements. Which of the following is true?
dopamine is a structure in the motor cortex
dopamine is a neurotransmitter in the basal ganglia that facilitates control of motor movements
dopamine is the motor nucleus for CN XII
none of the above
the extrapyramidal or indirect pathway is thought to regulate which of the following?
the primary voluntary motor response
the sensory response
posture and muscle tone
a and b
A patient presents with a stroke in the primary motor cortex on the left side of his brain. This patient could present with both aphasia and dysarthria.
true
false
Oligodendroglia and Schwann cells, like myelin, are
part of the vascular system of the brain
the insulation that surrounds the axons of the central and peripheral nervous system
connective tissue within the CNS
part of the nucleus of a CN
a neurotransmitter is...
a glial cell in the CNS
a part of the axon of a peripheral nerve
a chemical substance that inhibits or excites a nerve impulse across a synapse
a type of neuron in the CNS
What is the corticobulbar tract?
the corpus callosum connects the two primary hemispheres of the brain
a pathway that is composed of upper motor neurons that connect the cortex to the brainstem motor nuclei of the CNs
the interneurons connecting the right and left frontal lobes
this tract connects CNs IX and X to the brainstem
voluntary motor movement for speech movements is initiated in which area of the cortex?
the basal ganglia
the primary motor cortex of the frontal lobe
the right temporal lobe
the bilateral visual cortex
Which is accurate about the corticobulbar tract and the internal capsule of the brain?
they both are considered LMNs
both structures are in the basal ganglia
the corticobulbar tract provides innervation to the muscles of speech and the internal capsule inhibits movement
both contain the neural fibers (motor or efferent fibers) that conduct the neural signal from the primary motor cortex through these areas (structures) to the brainstem
a patient presents with a large lesion in the left internal capsule. Which is true?
bilateral innervation to CN V is impaired and the pt will have significant jaw weakness
this is a LMN lesion and atrophy will result
this is an UMN lesion and there may be weakness on the contralateral side
the axons of the CNs that exit the brainstem and travel to the muscle will be impacted
A pt presents with significant trauma to the face and neck as a result of a motorcycle accident. The trauma doctor notes in the pt's medical chart that there is significant damage to the peripheral branches (LMNs) of CN X. Which of the following is (are) true?
this damage will result in weakness and possibly atrophy of the involved muscles innervated by this nerve
this damage will result in spasticity of the involved muscles innervated by this nerve
the pt will most likely present with tongue deviation
the pt may present with vocal changes as a result of this damage
bilateral innervation to the CNs means...
there are bilateral nuclei in the cerebellum
the CN nucleus receives input from both cortical hemispheres
if there is a lesion on one side of the brain, the CN continues to receive input from the other side of the brain
both B and C
Which is true about the basal ganglion?
it is in the motor cortex of the frontal lobe and contributes to tone regulation
it is a gray matter subcortical structure and contributes to tone regulation
it is located behind the brainstem and contributes to motor planning
it is located behind the brainstem and contributes to tone regulation
the cerebellum is...
a structure that has interconnections to several areas of the brain and forms a circuit that contributes can result in bilateral vocal cord weakness
is a structure located above the brainstem that contributes to sensory integration
a structure that has interconnections to several areas of the brain and forms a circuit that contributes to the timing and force of movements
both A and B
Damage to the hypoglossal nerve axons on the right side (LMNs) will lead to
atrophy and weakness as well as tongue deviation to the right side
no tongue deviation b/c of the bilateral innervation to the brainstem nuclei
deviation of the tongue toward the opposite side of the lesion
bilateral weakness of the tongue
the mvmt of the upper portion of the face is not changed with a unilateral lesion to the primary motor cortex. Choose the best explanation for why this is true.
the upper portion of the face is innervated by CN VII and receives input from only the contralateral motor cortex
the upper portion of the face is innervated by a branches of CN VII and receives input from the motor cortex from both hemispheres
the upper portion of the face is innervated by CN VII and receives input from the ipsilateral motor cortex
the upper portion of the face is innervated by a second brainstem nuclei in the medulla
In diseases like MS and Guillain-Barre syndrome, the underlying pathology contributes to the breakdown of the myelin sheath. Why does this affect speech production?
the neural input traveling to the muscle is interrupted and this can result in weakness in the muscles of speech
lack of the myelin sheath increases spasticity in the muscles
the breakdown of the myelin causes mini-strokes in the primary motor area
all of the above
the reason a lesion in the primary cortex can result in similar deficits as a lesion in the corticobulbar tract is b/c
they are the same structure but called 2 different names
all lesions in the motor cortex results from a lesion in the corticobulbar tract
the corticobulbar tract provides the connection b/t the primary motor cortex and the brainstem
speech motor movements are influenced only by the primary cortex and the corticobulbar tract
An UMN lesion of CN V would result in which and why?
lower facial weakness only since this is an UMN lesion
possibly no significant weakness of the muscles of mastication or jaw strength, since there is no bilateral innervation of this CN
possibly no significant weakness of the tongue, since there is no bilateral innervation of this CN
a significant weakness of the muscles of mastication or jaw strength, since the final neuron pathway to the muscles is interrupted
motor speech deficits are typical in PD due to decreased dopamine. These deficits occur therefore b/c
the resulting LMN lesion causes changes in the neural control of the muscles of speech
the resulting UMN lesion causes changes in the neural control of the muscles of speech
a decrease in a neurotransmitter in the basal ganglia, can cause changes in the neural control of the muscles of speech
several small strokes in the basal ganglia cause changes in the neural control of speech muscles
If a patient presents with ALS and has primary pathology in the corticospinal tracts, the patient will initially present with speech deficits
true
false
What is useful to know about the patient's medical history?
prior diagnosis of PD or stroke
is the change in this speech new, has it been a gradual or sudden change?
does the pt think he has had any changes to this speech?
all of the above
pt stops to wipe his mouth, now think about the CN exam you will soon give, what CN do you think you think you might find involved?
CN XII hypoglossal only
CN VII facial - decreased lip seal
CN X Vagus, superior laryngeal nerve
all of the above
during the eval, you notice a wet, and weak voice. What else do you think you might find involved?
CN XII Hypoglossal
CN X Vagus - superior laryngeal nerve, internal laryngeal branch
CN X vagus - recurrent laryngeal nerve
both B and C
during the eval, decreased tongue strength and limited tongue movements are observed. What CN do you think you might find involved based on these findings?
CN XII Hypoglossal
CN VII facial
CN X recurrent laryngeal nerve
CN V trigeminal
the pt's speech is slow and has many speech distortions. Although the pt had some drooling from the mouth, there is not a obvious asymmetry in his facial movement. Which underlying diagnosis could be excluded?
ALS
PD
left frontal (primary motor area) CVA
MS
Which are the primary characteristics of flaccid dysarthria? (multi-select)
precise speech production
atrophy of the muscles
hypotonia
spastic muscles
Which underlying diagnoses are associated with flaccid dysarthria? (multi-select)
unilateral stroke
Guillian-Barre syndrome
brainstem stroke
myasthenia gravis
which are the primary characteristics of spastic dysarthria? (multi-select)
hyperactive reflexes
weakness
atrophy of the muscles
increased muscle tone
Which underlying diagnoses are associated with spastic dysarthria? (multi-select)
brainstem stroke
bilateral cortical stroke
unilateral stroke
lacunar infarcts
Which are the primary characteristics of ataxia? (multi-select)
dysmetria - inability to control movement range
imprecise movement
poorly coordinated movement
increased muscles tone
Which underlying diagnoses are associated with ataxia (multi-select)
degenerative cerebellar dz
brainstem stroke
MS
cerebellar tumors
which are the primary characteristics of hyperkinetic dysarthria? (multi-select)
involuntary movements
resting tremor
increased muscle tone
myoclonus - quick jerks of a body part
Which are the primary characteristics of unilateral UMN dysarthria? (multi-select)
lower facial weakness on the contralateral side of the lesion
aphonia
imprecise articulation
mono-pitch
which underlying diagnoses are associated with unilateral UMN dysarthria? (multi-select)
unilateral cortical non-hemorrhagic stroke
unilateral cortical non-hemorrhagic stroke
myasthenia gravis
unilateral subdural hematoma
What are the primary characteristics of mixed dysarthria? (multi-select)
slow rate of speech
strained-strangled voice quality
nasal emissions
imprecise consonants
Which are the primary speech characteristics of apraxia (multi-select)
distorted sound prolongations
consonant and vowel distortions
monotone
fast rate of speech especially on multi-syllabic words
Which underlying diagnoses are associated with apraxia? (multi-select)
LMN impairment
frontal lobe tumor
stroke
degenerative disease
acquired neurogenic mutism can be associated with which of the following?
brainstem stroke
minimally conscious state
unilateral small cortical stroke
neurotoxic state (drug-induced)
acquired neurogenic stuttering can result from TBI
true
false
all of the following are common characteristics cs of hypokinetic dysarthria EXCEPT:
difficulty initiating/stopping speech
monopitch/monoloudness
abnormal tongue movements
reduced range of motion and precision
what is the most common neurological cause of UUMN dysarthria? (multi-select)
non-hemorrhagic stroke
hemorrhagic stroke
TBI
PD
Which underlying medical diagnoses is typically associated with hypokinetic dysarthria?
Unilateral frontal lobe stroke
PD
Bilateral frontal lobe strokes
Brainstem hemorrhage
The presentation of spastic dysarthria could result from a lesion in both the direct and indirect motor pathways
True
False
Apraxia of speech is different from other motor speech disorders in that the patient often is observed to
Have a monotone prosody
Exhibits groping to produce the target word
Has weakness
Has strained vocal quality
Which of the following are true of patient’s presenting with apraxia of speech? (Multi-select)
Repetition of nonsense words is easier than meaningful speech
A high-frequency word “hello” might be easier to say than a low-frequency word “gallow”
A word with many syllables “benefactor” would be easier to say than a word with fewer syllables “benefit”
Counting or automatic speech is easier than volitional speech
Intensive and systematic drills
Are not recommended with AOS
May be appropriate with apraxia b/c this disorder results from inefficiency in speech planning or programming
May be appropriate with apraxia b/c this method is consistent with principles of motor learning
Both B and C
The use of feedback in apraxia of speech tx
Is useful to facilitate the pt’s ability to judge their speech and self-correct errors
Can facilitate retention and generalization of learning
Should be only used with mild disorders
Both A and B
Articulatory kinematic approaches to treatment include
Imitation of a target stimulus (sound or word)
Intensive drill
Using meaningful communication
All the above
Which of the following use rate or rhythm to facilitate articulation
Metronome or pacing techniques
Melodic intonation therapy
Singing
All the above
Which of the following is true regarding respiration and speech breathing (multi-select)
Attention to speech breathing may be necessary in some patient presenting with dysarthria to ensure consistent breath support for speech
There is strong evidence that EMST facilitates increased volume in PD
Postural support can facilitate improved speech breathing in some patients
Even with biofeedback patients can rarely improve in their control of speech breathing
Palatial lift prosthesis is a device used to
Increase vocal intensity
Manage velopharyngeal dysfunction
Lift the palate and improve velopharyngeal closure
B and c
What is true regarding no speech strength training?
These exercises should be used with all pts presenting with dysarthria
These exercises should be used primarily with hyperkinetic dysarthria
These exercises should be used only when weakness is present and this weakness is related to speech impairment
These exercises should be used primarily w/ ataxia
Clear speech primarily promotes
Loudness
Speed
Exaggeration of articulation
Minimizing stress
Rate modification is often used with dysarthria to
Facilitate articulatory precision
Increase utterance length
Improve intelligibility
A and C
What are the salient neuromuscular features of MSDs?
Accuracy of speech produced
Strength, speed
Range, steadiness, tone
Utterance
History taken during a motor speech exam should include…
When did the changes in speech begin
What are the patients goals
What is the underlying medical history
What is the patient’s age, occupation
All the above
During the speech Eval, the SLP’s exam should include the speech mechanism during non-speech tasks. Facial symmetry and oral motor mvmt should be examined (multi-select)
At rest
During sustained postures
During movement
Only during speech
What are some of the tasks used for speech assessment?
Saying “ah” for as long as the pt can
Saying /puh/ for several seconds
Having the pt engage in a conversation
Having the pt read a passage
All the above
Which of the following are tests used to evaluate speech? (Multi-select)
Boston naming test
Frenchay dysarthria assessment
Speech intelligibility test
A word intelligibility test
