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The psychological theme most associated with aging is the significant fears regarding _______________.
Loss of autonomy
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What are common reasons for a normal elderly person's voice to change?
- calcification of laryngeal cartilages
- bowing of the body of the vocal fold
- atrophy of muscles used to produce speech
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What are the normal changes expected in the physical structures of the brain as individuals age?
- brain weight and volume decreases
- gyri narrow; sulci widen
- atrophy of the corpus callosum
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Research shows that elderly individuals produce fewer syllables per breath while actually using greater air volume per syllable. The most likely explanation for this would include...
- decreased elasticity of lung tissue
- weakness and atrophy of respiratory muscles
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"The um uh last time my uh um my wife and I went um dating, oh, no, um dancing was on our 5th, um 45th wedding anniversary." This utterance best characterizes the normal types of disfluencies evidenced by the aging adult which is predominated by what types of disfluencies?
- interjections
- revisions (formulation nonfluencies)
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Articulation for speech doesn't change significantly with aging unless a significant injury to the central or peripheral nervous systems occurs. What's the most viable explanation for this?
The neuromotor system for speech structures provides bilateral innervation resulting in built-in redundancy.
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With regard to the emotional stability of the elderly, what is the statement associated with being troubled?
Fewer elderly people become suddenly troubled than do troubled people become elderly.
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What changes occur in elderly people's sensory loss?
- Deterioration of neural units might occur anywhere from the peripheral system to the central mechanisms in the brainstem and cortex.
- Reduced sensitivity may contribute to excessive "cautiousness" in the elderly resulting in apparently greater reduction in responsiveness than might actually be present.
- Deterioration in several systems may actually combine into a greater overall loss than the individual losses might otherwise suggest (had they been isolated losses).
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Mr. H was admitted to the hospital w/ complaints of severe headaches and signs of general lethargy and unresponsiveness. The physician ordered clotting agents to be administered immediately for Mr. H. What is the most likely dx?
Intracerebral hemorrhage
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When evaluating a patient, the SLP may find Personal Hx info supplied by the patient (occupation, family/marital status) to be directly helpful in determining the status of the patient's ________ & _______.
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While reviewing a stroke patient's medical chart, you find that he has also has had lung cancer for 2 yrs & has recently been noted to exhibit early signs of diabetes. This info would most directly influence the SLP's ____________.
Prognosis for Long-Term Recovery
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In examining a patient's medical chart, you note that the doctor has NOT ordered anticoagulant for the patient. The most likely etiology implicated in this case is ____________.
a hemorrhage
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Mrs. B (who is known to be R. hand dominant), had very suddenly lost consciousness while sitting in church. She has a hx of hypertension. A CAT scan suggested the presence of a large hematoma deep in the posterior right temporal lobe. What 2 things can likely be expected?
- Embolic stroke
- may exhibit left side weakness of muscles
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What is at least a probable outcome for Mrs. B? (R. handed, lost consciousness, hypertension, hematoma posterior right temporal lobe)
Mrs. B may exhibit difficulty in auditory comprehension
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Mr. Q has been admitted w/ an apparent CVA. His medical chart indicates apraxic speech, & severe R. side hemiplegia. Based on just this info, what may be true in regard to Mr. Q's stroke?
- Embolic stroke
- Symptoms may resolve (could be having a TIA)
- Reading may not be affected
- Comprehension may be better than his expression
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Mr. Q. (CVA, apraxic, severe R. side hemiplegia)might be expected to exhibit....
- Right facial drooping
- Higher skills in receptive speech areas than expressive speech areas.
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A patient has been admitted w/ an extensive lesion in the mid-region of the left temporal lobe. What's a task that generally would be expected to pose the least difficulty for him?
Matching Objects & Pictures
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Functional outcomes (as in FIM's Functional Independence Measures) as used in hospitals and medical facilities are...
- Measures taken at the beginning and end of tx?
- Based on the extent of assistance required by patient to carry out daily living activities.
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In a research sense, a "sensitive" aphasia or language test would include...
- adequate variety and range of tasks/items
- flexible qualitative scoring w/ notations for variations
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An individual who exhibits significantly greater difficulty in the Auditory Disturbances (comprehension) section of the Minnesota test as compared to his performance on other sections of the test migh also be dx as exhibiting...
- Receptive aphasia
- Wernicke's aphasia
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"Finish these sentences. You clean your teeth with a _______." This task would be most difficult for....
R. handed dominant left CVA patient w/ comprehension deficits
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Given that 2 patients experience the same kind of stroke, their apparent potentioal for recovery would be most influenced by....
- Location and Size of their Lesions
- Age of patient
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Patients who have damage in the frontal lobes (L. or R.) would be expected to have difficulty with...
- Self-monitoring Speech & Behaviors
- Sequencing Activities
- Emotional Lability
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Patients who have damage in the frontal lobes (L. or R.) would NOT be expected to have difficulty with...
Comprehensive Language Deficits
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During tx, Mr. Smith answers questions very quickly and incorrectly. What are correct statements regarding this?
- This is called Impulsive Cognitive Style
- Proper management would be to slow the patient down & his accuracy should improve.
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A patient that repeats behaviors or words when it is no longer appropriate is an example of _________.
Perseveration
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Describe the recovery curves of each: TBI, Ischemic stroke, and Hemorrhagic strokes.
- TBI--slow, stairsteps
- Ischemic stroke--most recovery w/in first 3 mos.
- Hemorrhagic stroke--most recovery after 2 mos.
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What rates adequacy in social communication, communicating basic needs, daily planning, and reading/writing/number skills?
ASHA FACS (Functional Assessment of Communication Skills)
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Mr. S is a 55 yr old R. handed male who's one day post-status w/ a left MCA CVA. Medical hx lists diabetes and hypertension. What is likely to be true regarding this patient?
- He is likely aphasic
- His hypertension and diabetes may complicate his recovery
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A common consequence of brain injury is "concreteness." Describe something that best describes this deficit?
Difficulty understanding the figurative meaning of idioms and metaphors
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Mrs. F watched a sad movie in her room and cried at the ending. Later that day, someone told her she looked "wonderful" & she began crying without warning. While in group, she laughed continuously. What's true regarding this scenario? & what's the SLP most likely to determine using info from the patient's medical hx?
- Both the laughing and crying were emotional lability
- Etiology of the current neurological insult & Long-term prognostic factors
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In selecting cases which will benefit most from S-L services, the prognosis will be most directly influenced by...
Extent & Location of Brain Damage
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Which of the following etiologic groups would generally have the poorest long-term prognosis for improvement?
-occlusive strokes
-hemorrhagic strokes
-brain damage due to trauma
-brain infections
-CNS degenerative disease
CNS degenerative disease
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Your patient takes a long time to initiate tasks. He seems content to sit without responding. This is called __________ cognitive style.
Reflective
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If your patient responds slowly and has a high error rate, how should you modify the task? your patient
Level down the task--give more prompts
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If your patient responds quickly and has a low error rate, how should you modify the task?
Level up the task--give less prompts
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If your patient responds slowly and has a high error rate, how should you modify the task?
Level down the task
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If your patient responds quickly and has a high error rate, how should you modify the task?
Have the patient slow down maybe by holding up a stop sign until an adequate amount of time has passed.
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Which of the following is NOT located deeper in the brain beneath the cerebrum?
-Thyroid
-Basal Ganglia
-Thalamus
Thyroid
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Broca's area is usually thought to control what?
Speech production
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Wernicke's area is usually thought to control what?
Listening and comprehension
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Which portion of the brain is directly above the brainstem (damage to this area may affect person's balance, among other things)?
Cerebellum
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What is the name of the bundle of fibers which is thought to be a "loop" for feedback from Broca's area to Wernicke's?
Arculate Fasciculus
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If a patient is disinhibited, impulsive, has difficulty self-monitoring, and problems with sequencing activities (R. hand dominant) following a CVA, which hemisphere would we predict is the affected side?
Right side
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Would a R. hand dominant person who has a L. CVA near the motor strip be more likely to have fluent speech or good speech comprehension?
Good speech comprehension
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Would a R. hand dominant person who has a L. CVA in the posterior temporal and/or parietal lobes be more likely to have poor speech comprehension or dysfluent speech?
Poor Speech Comprehension
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Which of the following recovery rates and cerebral events is correct?
-TBI: fast 3-6 week recovery
-Hemorrhagic strokes: recovery starts about 2 months after occurence
Hemorrhagic strokes: recovery starts about 2 months after occurrence.
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Which structure communicates info from L. to R. and R. to L. hemispheres?
Corpus Callosum
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Name all 4 lobes of the brain.
- Frontal
- Parietal
- Occipital
- Temporal
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