Exam 1

Question 1

You began testing a toddler in the soundfield using VRA at 30 dB, but there was no response. Your next step is

Answer 1

increase the level by 20 and try again

Question 2

You are testing a 14-month-old baby using VRA. The child has been cooperative, and you have obtained the results right ear at 500 at 20dB and 2000 at 20 and left ear at 500 at 25 and at 2000 at 70. Assuming that the next threshold will be the last one you can obtain from this baby, what would be your next step?

Answer 2

test 1000 Hz in the left ear

Question 3

Which of the following is a true advantage of the BOA procedure?
It allows the audiologist to obtain valuable behavioral responses in infants, supporting the cross-check principle.
It can be conducted in sound fields, with earphones, bone oscillators, hearing aids, or cochlear implants.
It can be used to verify access to speech sounds with amplification

Answer 3

all

Question 4

To obtain a more realistic assessment of the child’s ability to perceive speech in everyday situations, which of the following speech tests would you select for a 6-year-old child with an auditory language age of 3.9 years?

Answer 4

NU-CHIPS closed set

Question 5

When testing a 13-month-old baby, which of the following stimuli would provide more frequency-specific information?
Speech
Music
Ling-6 sounds
BBN

Answer 5

ling 6 sounds

Question 6

An infant with severe to profound hearing loss will exhibit less babbling as he/she grows older due to:

Answer 6

lack of auditory feedback

Question 7

Children with minimal to mild hearing loss may benefit from which of the following:
Preferential seating
Personal FM system
Hearing aid

Answer 7

all

Question 8

The first-time parents of a 2-month-old infant are concerned that their baby may have a hearing loss because she does not turn her head when they enter the room or call out her name. You should:
Counsel the parents that the baby is too young to be tested and besides she seems fine to you
Share the parents concern and refer to an otologist for an MRI to ensure that the baby is not deaf
Perform an audiologic assessment using soundfield behavioral observation audiometry at 65 dB HL demonstrating to the concerned parents that the baby
startied to the sound and, theretore, all is well
Perform an audiologic assessment using OAEs and diagnostic ABR and let the parents know all is well
Perform an audiologic assessment using OAEs and diagnostic ABR; counsel the parents that children younger than 3-months generally are unable to localize but do not minimize the parents’ concerns

Answer 8

Perform an audiologic assessment using OAEs and diagnostic ABR; counsel the parents that children younger than 3-months generally are unable to localize but do not minimize the parents’ concerns

Question 9

Your patient is a 9-month-old baby boy who is accompanied by his mother. In the case history, it was reported that he was born 8-weeks premature. All developmental milestones are delayed. What is his corrected age?

Answer 9

7 mos

Question 10

You have identified a five-year-old as having severe unilateral sensorineural hearing loss. As you discuss the potential impact of this hearing loss on the child’s educational development, you would tell the parents:
With preferential seating, hearing loss will probably have no impact on the child’s educational development
A hearing aid for the affected ear would be the best strategy for alleviating problems that hearing loss may cause.
A much higher risk for educational difficulties exists for this child than for children with two normal hearing ears.
A binaural FM system would be the best strategy for alleviating problems that the hearing loss may cause.

Answer 10

A much higher risk for educational difficulties exists for this child than for children with two normal hearing ears.

Question 11

Since many children do not respond at threshold during auditory tests, their responses are often referred to as

Answer 11

Minimum response levels

Question 12

Head lateral turn towards the sound source are expected in infants by

Answer 12

4-7 mos

Question 13

Language and speech will not develop spontaneously when very young children have

Answer 13

severe SNHL

Question 14

KJ is an 18-month-old baby girl who was brought to the clinic by her mom, who is concerned about the possibility of hearing loss. Which of the following information in her case history is not considered a red flag?
Apiar score of 3 at 1 minutes and 5 at 5 minutes
KJ can only say 3 words: mama, baba, dada
KJ did not start babbling until she turned 7 months old
KJ consistently reacts to loud sounds but less often to softer levels

Answer 14

KJ did not start babbling until she turned 7 months old

Question 15

When using the sucking response method as the primary procedure for behavioral observation audiometry, all of the following can be accepted as a response except:
Cessation of sucking
Increased sucking rate
Eye widening
Responding only at stimulus offset

Answer 15

eye wideing

Question 16

If a significant sensorineural hearing loss is suspected, behavioral testing in infants should begin with ..; otherwise, it is reasonable to start at

Answer 16

500; 2000

Question 17

A 4-week-old infant’s startle response or Moro reflex to a loud sound in the soundfield may indicate:
Normal hearing in both ears
normal or near normal in one ear
A unilateral moderate hearing loss in the better ear
A mild hearing loss in both ears

Answer 17

all

Question 18

Which of the following should not be included in the test protocol when evaluating infants younger than 6 months?
Case history
Visual reinforcement audiometry
OAES
ABR

Answer 18

VRA

Question 19

Which of the following is not recommended when counseling parents on strategies to encourage language development in children with hearing impairment?
Using infant-directed speech that incorporates high pitch, varied intonation, and simple, concrete words.
Regularly speaking and reading to the infant to promote language development.
Introducing the infant to multiple languages early to speed up language acquisition.
Providing consistent emotional and physical support to boost the infant’s motivation to communicate.
Frequently naming objects during interactions to aid vocabulary development.

Answer 19

Introducing the infant to multiple languages early to speed up language acquisition.

Question 20

Jamie, an eight-year-old boy, has recently been diagnosed with mild hearing loss. His parents are hesitant about using hearing aids, concerned that such a mild loss may not warrant the use of these devices. Given Jamie’s condition and his parents’ concerns, which recommendation would you provide to best explain the impact of his hearing loss on his ability to participate in classroom activities?
Assure the parents that children with mild hearing loss do not require any form of hearing assistance and can manage well without any modifications.
Inform the parents that while Jamie may face some challenges, mild hearing loss generally does not significantly affect academic performance or peer interactions.
Explain to the parents that mild hearing loss can pose substantial challenges in noisy environments, and that hearing aids can help Jamie better follow classroom discussions and alleviate his frustration.
Suggest that the parents monitor Jamie’s academic and social progress for six months before deciding on any intervention, as children often adapt to mild hearing impairments naturally.
All of the above

Answer 20

Explain to the parents that mild hearing loss can pose substantial challenges in noisy environments, and that hearing aids can help Jamie better follow classroom discussions and alleviate his frustration.

Question 21

You are reviewing the case history of a 3-month-old infant, Alex, brought in after failing the newborn hearing screening. Alex was born full-term via C-section after prolonged labor. The birth weight was 3.2 kg (7.05 lbs), and the Apgar scores were 7 at 1 minute and 8 at 5 minutes. Post-delivery, Alex developed mild respiratory distress and spent 48 hours in the NICU for observation but required no mechanical ventilation. The initial newborn hearing screening was inconclusive. Alex’s parents noted that they are concerned because Alex does not startle at loud noises and seems not to respond to their voices consistently. Which of the following is not a risk factor for hearing loss in this case?
Stay in the NICU
Lack of startling to noise
Apgar scores
Failing initial newborn hearing screening
None of the above

Answer 21

apgar

Question 22

Which of the following speech tests would you use for a 6-year-old child with an auditory language age equivalent to 4 years?

Answer 22

nu chips closed

Question 23

Sylvia, a 5-year-old, is being evaluated. By case history report, Sylvia started kindergarten this year. She is in the process of having her speech and language evaluated by the school speech-language pathologist. According to her parent, they can understand approximately half of Sylvia’s speech.
The parents feel she understands them when they talk to her. You find a mild bilateral sensorineural hearing loss. You now want to test word recognition for Sylvia. Which of the following is the best option:
PBK words
WIPI, open set
BKB-SIN
WIPI, closed set

Answer 23

wipi closed

Question 24

The auro-palpebral reflex and Moro reflex are unconditioned responses observed in infants younger than 6 months in response to sounds. Which of the following is a limitation of using the auro-palpebral reflex and Moro reflex for determining auditory thresholds in infants?
Responses are obtained at supra-thresholds
Responses are not repeatable
Infants can habituate to stimuli fast
They do not provide frequency specifc information
All of the above

Answer 24

all

Question 25

Mia, a 4-year-old child, is undergoing a hearing assessment with play audiometry. The audiologist assistant trains Mia to place blocks in a basket whenever she hears a tone. Despite multiple training trials and attempts at reinforcement, Mia consistently hesitates and waits for visual prompts before completing the task. Instead of independently responding to the auditory stimulus, she frequently looks up at the audiologist for approval before proceeding. Which of the following statements best describes Mia’s response pattern?
Mia is a false responder.
Mia is a reluctant responder.
Mia is an off responder.
Mia is showing typical behavior for a 3-year-old.

Answer 25

Mia is a reluctant responder.

Question 26

What strategy should the audiologist use to address Mia response pattern?
Place an open hand in front of Mia’s hand holding the block, requiring Mia to go around the audiologist’s hand to complete the task once a tone is heard.
Observe if Mia shows any facial response when the tone is presented and assist her in completing the task with the block while watching for her reaction to the next stimulus.
Use a continuous tone to help her feel more confident in responding.
Use a vibrotactile response to condition Mia

Answer 26

Observe if Mia shows any facial response when the tone is presented and assist her in completing the task with the block while watching for her reaction to the next stimulus.

Question 27

Obtaining behavioral thresholds are not always possible in very young children. List three specific patient-related factors that would require the patient to return to the clinic for a follow-up/repeat session using VRA.

Answer 27

One factor that would cause a patient to need to return to the clinic for a follow up or repeat session would be that they habituate really fast and you are not able to continue to get the information you still need from them.
Another factor that would yield a repeat session with VRA is if you need to get ear specific information using headphones and despite multiple attempts and different strategies, you cannot get them on the child. It would be best then to have the parents work with the child to get headphones on them and come back at a different time to try again after the parents have gotten the child acclimated to the headphones.
A third factor that may cause a patient to need to return for a repeat session is if the child has a conductive loss and we need to do repeat testing once the middle ear pathology is resolved to compare the hearing results from before and after.

Question 28

List three strategies that you can use to delay habituation when testing infants using VRA.

Answer 28

One strategy to delay habituation during testing with VRA is to use two reinforcers as opposed to one. Even though we can get results by using one reinforcer, it keeps their attention longer if we use two. Another strategy that could be used to delay habituation during VRA testing is to switch back and forth with speech or the Ling 6 sounds to keep their attention for longer in order to test what we need to test. A third strategy could be to change the reinforcement to keep their attention or even changing the test assistant. For example, instead of using the same light up toys, use a video without the sound as a reinforcer to change it up for them and with a new assistant, it could be enough to get their attention back on the task

Question 29

A 2.5-year-old child has been brought in for a hearing assessment. During VRA testing, you and your test assistant began conditioning the child to respond to sounds. The child turns his head toward the visual reinforcer only when the test assistant directs his attention to it during sound presentation, but he fails to demonstrate a response to the auditory stimulus alone.
Describe the two approaches that can be used to condition the child to pair the auditory stimulus with the visual reinforcer. (2 pt)
There are two possible scenarios that could explain why the child is not responding to the auditory stimulus alone. Discuss these two potential reasons and concisely outline the steps you would take to determine the underlying cause. (3 pt)
Young children are likely to produce a number of false responses during a clinical assessment. What test strategy can an audiologist use to ensure that responses are true responses and not false positive? (2 pt)

Question 30

Juan is a 3.5 - year-old child scheduled for an audiological evaluation. You have planned to test him using CPA. When seen for the appointment.
Juan’s parents report that he started walking 4 months ago and that he is just beginning to say his first words. He is scheduled for a comprehensive development evaluation by a developmental pediatrician next week. Would this information change your choice of testing procedure? Justify

Answer 30

Yes, this information would change the procedure needed to test this child. His developmental age doesn’t match his chronological age. Therefore.
CPA would not be appropriate to choose to test this child and the results would not be indicative of his capabilities. If he just began walking not long ago, the chances of him being able to perform a motor task is very slim, which is required in CPA testing. Therefore, a different test, like VRA, is more appropiate for this child’s developmental age.
based on his reported developmental milestones that include delay in both speech and motor development that might impact his ability to understand instructions and make appropriate motor reaction in response to the sound and how these delayed milestones relate to cognitive development.

Question 31

Sam is is a 6 years and 4 months male. Jamie’s mother brings him for an audiological evaluation and reports the history. Pregnancy and birth histories are normal. Early development was within normal limits. There is no significant medical history and no history of middle ear disease. In kindergarten and first grade, Sam seemed to be struggling with some aspects of academic learning, and his teachers are concerned. Hearing testing was recommended as a way to begin identifying the problem(s). His mother’s observation at home is that hearing is not a concern.
Today’s audiologic evaluation revealed that his otoscopic examination was unremarkable; tympanometry indicated normal middle ear system peak pressure and mobility (type-A curve), bilaterally. His audiogram is shown below.

What is the likely behavioral procedure used to obtain the pure tone thresholds? (2 pts)
List two questions, not already addressed in the provided case history, you would like to ask Sam’s parent to gather more information about the potential causes of his hearing loss? (2 pts)
What type of SRT and WRS speech tests would you use? What additional test(s) would you perform? Justify your choices. (3 pts)

Answer 31

The behavioral procedure most likely done with Sam was a conventional hearing test like what is used with adults. He is at an age where he could perform the normal audiological evaluaiton that we use with the adult population.
One question that I would ask is whether or not hearing loss runs in the family. This could be helpful in determing the cause of his hearing loss or whether or not we could expect it to progress as he gets older. It would also be important to know if he has any speech and language delays or if he receives any speech and language intervention at school. These delays could be associated with his hearing loss as well and could help determine which tests are best to assess him.
For SRT, I would use the normal spondee word list used with adults since his development is not a concern and he is at the appropriate age to repeat words back. For WRS, I would perform PBK-50 first because he is at a developmental age where this test would be appropriate to use on him. I would also perform BKB-SIN to see what effect background noise has on him as his teachers show a concern in the classroom with his hearing and it could also help with counceling the parents as to why he is a candidate and should wear hearing aids.