Summary of Common Conditions Seen in OSCEs
Dysphasia: Language Problem
| Conditions | Specific signs | Lesion |
| Broca’s expressive dysphasia (BED) | Non-fluent speech Can understand Cannot answer appropriately and is aware of this (naming objects) – may become frustrated Word-finding difficulty Reading and writing affected | Inferolateral dominant frontal lobe |
| Wernicke’s receptive dysphasia | Fluent speech Confident in responses Paraphasias (incorrect words) Neologisms (made-up words) Does not understand questions Reading and writing affected | Posterior superior dominant temporal lobe |
| Global aphasia | Unable to speak or understand | Dominant lobe infarction |
| Conduction aphasia | Repetition affected | Connecting fibres (arcuate fasciculus) between Wernicke’s and Broca’s areas |
| Nominal dysphasia | Only naming objects is affected | Posterior dominant temporoparietal lesion |
Dysarthria: Articulation (Difficulty Coordinating Muscles of Speech)
| Conditions | Specific signs | Cause |
| Cerebellar disease | Slow and deliberate speech Slurring Scanning/‘staccato’ speech | Multiple sclerosis Stroke |
| Pseudobulbar palsy (UMN) | ‘Donald Duck’ speech Slow Indistinct Jaw jerk increased | Tongue cannot protrude, is ‘stuck’ at base of mouth Tongue is ‘spastic’ Disease of corticobulbar tracts Motor neurone disease (UMN and LMN signs) Multiple sclerosis Stroke |
| Bulbar palsy (LMN) | Nasal quality Quiet Slurred Jaw jerk decreased/normal | Tongue hangs out Motor neurone disease Guillain–Barré syndrome Myasthenia gravis Brainstem tumour |
| Myogenic (muscular) defect | Features of underlying condition | Hypothyroidism Any myopathy |
Dysphonia: Speech Volume (Weak Respiratory Muscles and Vocal Cords)
| Conditions | Specific signs | Cause |
| Myasthenia gravis | Fatigability (ask patient to say letters of alphabet/count to 100) Nasal quality Poor swallow Sternotomy scar | Antibodies to acetylcholine receptor Thymoma |
| Guillain–Barré syndrome | History of infection (gastroenteritis) Ascending weakness | Various infections Autoimmune Idiopathic |
| Vagal nerve palsy | Dysphonia Uvula dropping away from side of lesion | Trauma Compression Medullary pathology |
| Vocal cord weakness/paralysis | Recurrent laryngeal nerve damage:
| |
| Hypothyroidism | Signs of hypothyroidism | Causes of hypothyroidism |
Hints and Tips for the Exam
The speech station is can be tricky. Having a speedy system that covers all possible causes is key. The algorithm outlined in Figure 8.1 will allow you to diagnose any defect.
Figure 8.1 Quick algorithm to identify where a lesion is located
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