Summary of Common Conditions Seen in OSCEs
Dysphasia: Language Problem
| Broca’s expressive dysphasia (BED) |
Non-fluent speechCan understandCannot answer appropriately and is aware of this (naming objects) – may become frustratedWord-finding difficultyReading and writing affected |
Inferolateral dominant frontal lobe |
| Wernicke’s receptive dysphasia |
Fluent speechConfident in responsesParaphasias (incorrect words)Neologisms (made-up words)Does not understand questionsReading 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)
| Cerebellar disease |
Slow and deliberate speechSlurringScanning/‘staccato’ speech |
Multiple sclerosisStroke |
| Pseudobulbar palsy(UMN) |
‘Donald Duck’ speechSlowIndistinctJaw jerk increased |
Tongue cannot protrude, is ‘stuck’ at base of mouthTongue is ‘spastic’Disease of corticobulbar tractsMotor neurone disease (UMN and LMN signs)Multiple sclerosisStroke |
| Bulbar palsy(LMN) |
Nasal qualityQuietSlurredJaw jerk decreased/normal |
Tongue hangs outMotor neurone diseaseGuillain–Barré syndromeMyasthenia gravisBrainstem tumour |
| Myogenic (muscular) defect |
Features of underlying condition |
HypothyroidismAny myopathy |
Dysphonia: Speech Volume (Weak Respiratory Muscles and Vocal Cords)
| Myasthenia gravis |
Fatigability (ask patient to say letters of alphabet/count to 100)Nasal qualityPoor swallowSternotomy scar |
Antibodies to acetylcholine receptorThymoma |
| Guillain–Barré syndrome |
History of infection (gastroenteritis)Ascending weakness |
Various infectionsAutoimmuneIdiopathic |
| Vagal nerve palsy |
DysphoniaUvula dropping away from side of lesion |
TraumaCompressionMedullary 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.
