Equal and excess stress Description:

List all subsystems that are noted as affected in this patient. Include at least one symptom for each subsystem that you note is affected.

Exam overview There are four sections in this exam:  Etiologies and confirmatory signs Speech symptoms and neural circuits Nanocases Case study (choose ONE)   

Case study option 2 Watch the following video, then do a case study writeup where you answer the following questions:  1. Describe this person’s speech in precise clinical terms, and referencing specific examples. Use sufficient detail that another clinician could recognize their speech from another recording. Pay particular attention to PHONATION, ARTICULATION, and RESONANCE (10 points).  2. Provide your diagnostic hypothesis (choose from control circuit dysarthrias only). Be specific–in particular, remember that there are many kinds of hyperkinetic dysarthrias. (5 points)  3. Justify your hypothesis above. Make sure to follow our class rules for case studies! Consider the whole person; explain all symptoms; keep it simple. (10 points) 4. This person mentions an injection of botulism toxin. Do you think this could help for their condition? Explain your answer, making reference to both the diagnosis and the mechanism of action of botox. (10 points) BONUS QUESTION (up to 2 points): Another SLP suggests that you coach them to whisper in order to alleviate symptoms. Do you agree that whispering would help this person’s symptoms? Why or why not?

Section 6: Case Study 2 The next 5 questions refer to the following information (case also provided under Section 6 in paper exam).  — A 66-year-old man was referred for a speech evaluation by a neurologist to “see if there were any hints in his speech as to the type of problem he has”. When the patient comes to your office, you note that he has somewhat decreased facial expression, and doesn’t blink very often. During your intake conversation, you note that he has:  Equivocally fast speech rate Slightly quiet, hoarse voice  Occasional repeated phonemes at the beginning of words Slightly decreased intelligibility, especially near the ends of sentences.  You then conduct an oral mechanism exam. You note:  Symmetrical face with defined nasolabial folds Mild tremulousness of tongue, lips, and jaw during sustained postures Good strength when resisting tongue and cheek pressure Slightly decreased palatal elevation during repeated “ah”  You then ask the patient to complete the DDK tasks. You note:  Accelerated rate during AMRs Normal rate during SMRs Decreased articulatory distinction between consonant and vowel intervals  You then ask the patient to say ah as long as they possibly can. You observe:  12 seconds sustained voicing, but quiet  Mild vocal flutter You asked the patient to take a deep breath and try to produce ah as loud as they can. He produces a noticeably louder ah, but still can’t sustain it for very long. 

What speech diagnosis would you give this patient? Explain your answer, using speech symptoms to both support your diagnosis and rule out other diagnoses. You may also include confirmatory signs to lend additional support to your diagnosis. Remember to briefly discuss the function of the neurological components you think are involved, and how they would lead to the symptoms you observe. 

Which sounds of the following phrase do you think would contribute to the imprecise articulation observed during the grandfather passage? Explain your answer, and give specific examples.  “A long beard clings to his chin.”  

Calculate the drip rate per 15 seconds for a cat that is receiving 15ml/hr with a 60gtt/mL drip set.  Round to the nearest whole number. 

Hemiballismus: Thalamic stroke

Case study 3 The following questions are based on the information below. First preview the questions for this case. Then watch the video of the speech examination.  — A 72-year-old woman was referred to SLP by a neurologist for suspected ALS. The neurologist noted marked weakness and dysarthria.