Group B

Question 1

A 55-year-old female presents for a speech evaluation because of concerns with recent changes in the clarity of her speech. She has also noticed occasional coughing when drinking, and her friends have commented that her voice sounds different. A recent visit to her primary care doctor could not determine the cause of her speech changes or coughing. Select the THREE most important factors for the SLPS L P to explore during the patient interview.

A.Difficulties with hearing, vision, and fine or gross motor skills
B.History of a psychological or psychiatric disorder
C.Employment history and current stressors in her life
D.Onset and duration of her speech changes
E.Consistency of the symptoms

Answer 1

Options (A), (D), and (E) are correct. This patient scenario is strongly suggestive of a late-onset or acquired neurological disorder based on the combination of speech changes across multiple subsystems and swallowing problems. In this case, the most important information for the SLPS L P to obtain includes whether changes in other motor skills and vision and hearing accompany the changes in the duration, onset, course, and consistency of the changes in swallowing, voice, and resonance. This would help the SLPS L P determine the most important procedures to include in the evaluation and referrals regarding the etiology of the symptoms.

Question 2

Which of the following statements best explains why thickened liquids for adult patients with dysphagia should be used with caution?

A.Patients dislike thickened liquids and therefore do not drink enough, resulting in dehydration.
B.The thickened liquid becomes thinner as it sits at the bedside, negating the liquid’s benefit as a compensatory diet modification.
C.Patients need twice as much thickened liquid because it provides half the hydration that thin liquid provides.
D.Thickened liquids are aspirated more frequently than thin liquids.

Answer 2

Option (A) is correct. Research indicates that patients do not like thick liquids, and there is evidence that this leads to dehydration. A beginning clinician should be well aware of this and use caution when recommending thickened liquids to adult patients with dysphagia.

Question 3

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSMD S M-5™) criteria for autism spectrum disorder (ASDASD) and social communication disorder (SCDSCD), which of the following characteristics best helps an SLPS L P provide a differential diagnosis for ASDA S D instead of SCDS C D?

A.Deficits in communication appropriate for a social context
B.Deficits that result in functional limitations in social participation
C.Difficulty following rules for storytelling
D.Repetitive and restrictive patterns of behavior

Answer 3

Option (D) is correct. Restricted and repetitive behaviors are indicative of ASDA S D and set ASDA S D apart from SCDS C D.

Question 4

An aphasia evaluation of a 68-year-old retired woman reveals utterances of one to two words, no apraxia of speech, and relatively good comprehension. When the patient makes production errors, they are typically semantic errors and she attempts to correct them, often with success. Her goal is to use more words to convey ideas using complete sentences. She is active and wants to communicate in various settings, such as at her volunteer job, with her family, and when traveling. Which of the following treatments best prioritizes the patient’s language needs and personal goals?

A.Providing a script for the patient to recite that allows her to tell people about her stroke
B.Starting Verb Network Strengthening Treatment (VNeSTV N e S T) to increase word retrieval in untrained discourse
C.Engaging the patient in semantic feature analysis (SFAS F A) to teach her self-cuing techniques and aid with word retrieval
D.Having the patient use melodic intonation treatment (MITM I T) to increase fluency of commonly uttered phrases

Answer 4

Option (B) is correct. The patient’s language impairment is related to word-retrieval impairments that affect the ability to produce complete utterances. VNeSTV N e S T has been shown to increase word-retrieval abilities in untrained tasks, which could potentially aid in various functional scenarios.

Question 5

sMiss. Malone, a 65-year-old retired attorney, presents with severe nonfluent aphasia secondary to a stroke that occurred more than a year ago. Speech-language intervention helped her regain the ability to answer simple questions but not initiate speech. Citing MsMiss. Malone’s frustration at her limitations, her family requests that she be evaluated for an augmentative and alternative communication (AACA A C) device.

During MsMiss. Malone’s assessment, the SLPS L P determines that she could potentially benefit from AACA A C services and initiates discussion of intervention goals. Once goals are established and MsMiss. Malone has her device, she begins to learn how to operate her device to produce common spoken messages. Over the course of intervention, MsMiss. Malone is ultimately able to produce novel sentences.

Regarding MsMiss. Malone’s proposed AACA A C assessment, which of the following statements is true?

A.Her choice of devices will be severely limited by her difficulties with speech onset.
B.Her family should be involved in the AACA A C assessment as well as any subsequent therapy.
C.Given her advanced level of education, only high-tech devices should be considered.
D.Given the severity of her impairment, only low-tech devices should be considered.

Answer 5

Option (B) is correct. The success of AAC intervention success is largely dependent upon the support of people close to the patient.

Question 6

Which of the following statements reflects the best strategy for the development of MsMiss. Malone’s intervention goals?

A.The SLPS L P must decide which goals are appropriate, because the SLP is the communication expert.
B.As the patient determines what she needs and wants to say, she must determine the goals.
C.Goal setting should be a collaborative process involving the patient and the SLPS L P.
D.A number of individuals including, the patient, SLPS L P, and close family members, should collaborate to set goals.

Answer 6

Option (D) is correct. AACA A C intervention works best when regular communication partners are involved along with the patient and SLPS L P.

Question 7

Which THREE of the following are additional communication strategies that are valid for MsMiss. Malone?

A.Incorporating multimodal communication strategies, such as gestures and writing
B.Teaching regular communication partners how to listen and best respond to her
C.Limiting social engagements, since language demands are beyond the severely impaired AACA A C user
D.Encouraging her to take an active role in initiating communication
E.Phasing out device use to increase the rate of spoken-language recovery

Answer 7

Options (A), (B), and (D) are correct. Option (A) is correct because multimodal strategies augment the entirety of communication. Option (B) is correct because AACA A C intervention works best when regular communication partners are involved. Option (D) is correct because taking an active role in initiating communication will help MsMiss. Malone incorporate the AACA A C intervention into her daily life and result in improved confidence and less frustration.

Question 8

Which of the following statements best reflects the role of stimulability in generating a prognosis for remediation of gliding in a 9-year-old child?

A. A child who is not stimulable for /r/r, as in the word run will require treatment for the sound to be acquired.
B. Even if the child is not stimulable for /r/r, as in the word run, the sound will still develop without treatment.
C. If the child is stimulable for /l/l, as in the word last, the SLPS L P can expect the /r/r, as in the word run to improve at the same rate.
D. Stimulability does not play a role in determining a prognosis for remediation of speech sound disorders.

Answer 8

Options (A), (B), and (D) are correct. Option (A) is correct because multimodal strategies augment the entirety of communication. Option (B) is correct because AACA A C intervention works best when regular communication partners are involved. Option (D) is correct because taking an active role in initiating communication will help

Question 9

According to current research, which of the following is most contributing to a rise in oropharyngeal cancers in the United States?

A.Cigarettes
B.Human papillomavirus (HPVH P V)
C.Alcohol
D.Smokeless tobacco

Answer 9

Option (B) is correct. Research shows that oropharyngeal cancer caused by HPVH P V is increasing.

Question 10

According to research, which of the following structural factors has the most adverse effect on articulation?

A.Short labial frenulum
B.Micrognathia
C.Unilateral facial palsy
D.Class III malocclusion

Answer 10

Option (D) is correct. Class III malocclusion is known to cause obligatory distortions of sibilants and affricates due to placement of the tongue relative to the maxilla.

Question 11

Which THREE of the following statements are true regarding the treatment of swallowing disorders?

A.Thickened liquids cause dehydration because they require more water to be metabolized.
B.The chin-down posture eliminates thin-liquid aspiration from the pyriform sinuses.
C.Supraglottic swallow may cause cardiac arrhythmia in patients with coronary artery disease or stroke history.
D.Mass practice and task specificity are important principles of exercise therapy.
E.Periodontal disease due to poor oral hygiene increases aspiration risk in people with dysphagia.
F.Shaker and jaw-opening exercises are designed to increase the upper esophageal sphincter opening.

Answer 11

Options (C), (D) and (F) are correct. Studies have found that patients with strokes or coronary artery disease who perform the supraglottic swallow maneuver can develop cardiac arrhythmia, the definition of motor learning theory states mass practice and task specificity are important principles of exercise therapy, and Shaker and jaw-opening exercises are designed to increase upper esophageal sphincter opening.

Question 12

To best apply the multiple oppositions method for phonological errors when treating a child, an SLPS L P should use pairs of words such as

A. “son” and “ton,” “fun” and “pun,” and “zoo” and “do” to help discriminate stops from fricatives
B. “torn” and “sore,” “soup” and “two,” and “fast” and “pat” to help produce final consonants
C. “doe” and “go,” “doe” and “though,” and “doe and Joe” to address using /d/d, as in the word dog for various sounds
D. “key” and “tea,” “cone” and “tone,” and “cap” and “tap” to address the use of velar fronting

Answer 12

Option (C) is correct. In multiple oppositions treatment, targets are selected that will address all phonemes affected by a phoneme collapse, not just the target phoneme and the phoneme produced in substitution.

Question 13

Which of the following treatments is most appropriate to promote expressive and receptive language performance in conversation for an individual with aphasia?

A.Melodic intonation therapy
B.Promoting Aphasics’ Communication Effectiveness
C.Response elaboration training
D.Semantic feature analysis

Answer 13

Option (B) is correct. This therapy approach targets communication using any means necessary (talking, gestures, pointing, vocalizations, drawing) as opposed to targeting a specific language modality such as written expression, verbal expression, reading comprehension, or auditory comprehension.

Question 14

Studies of the anatomy of human vocal folds and of mucosal behavior during phonation have led to the current cover-body characterization of the vocal fold.

Which of the following is included in the vocal-fold transition?

A.The epithelium and superficial lamina propria
B.The epithelium and deep lamina propria
C.The intermediate and deep layers of the lamina propria
D.The lamina of the thyroid cartilage

Answer 14

Option (C) is correct. The intermediate and deep layers are considered transitional because of where they are located anatomically.

Question 15

A 42-year-old male teacher is referred for a voice evaluation. History and perceptual voice assessments reveal an eight-month history of progressive dysphonia, which is currently characterized by a rough and breathy voice. Acoustic and aerodynamic assessments reveal aperiodic voice signal, reduced frequency range, increased subglottal air pressure, and increased transglottal airflow. The patient complains of voice fatigue at the end of the day and pain during phonation. The patient reports moderate alcohol use but is not currently a smoker. He has no previous history of chronic voice problems, surgery, or neurological disease.

Based on the patient’s history, which of the following assessments will best allow the SLP to assess vocal fold vibratory dynamics during phonation?

A.Videofluoroscopic assessment
B.Laryngeal videostroboscopy
C.Nasoendoscopy
D.Ultrasound

Answer 15

Option (B) is correct. The patient’s history does not lead to a clinical hypothesis of a specific etiology, and the vocal folds must always be visualized as part of the process of differential diagnosis. Vocal fold vibration is occurring too quickly for the human eye to perceive individual cycles of vibration and the vibratory dynamics of the vocal fold tissue during vibration. A stroboscopic light source is needed in conjunction with the endoscope to visualize vocal fold vibration. If vibration and the vibratory dynamics are not of interest for the assessment, laryngeal videostroboscopy is not needed.

Question 16

A speech language pathologist evaluated Sophia Allen, a 6-year-old girl. The SLPS L P completed a case history with Sophia’s mother and conducted a comprehensive speech and language assessment.

During the case study the SLPS L P learned that Sophia has had a normal developmental history and is currently healthy with no known neurological deficits.

Sophia’s mother first became concerned when Sophia could not describe her school day. Sophia’s sentences lacked detail or were composed of very basic words and consisted of simple sentence structures. Sophia’s first-grade teacher reported that her speech sounds immature compared to that of her classmates and that she frequently does not follow directions.

During the assessment Sophia passed the oral mechanism examination and hearing screening. Sophia received a standard score of 99, placing her in the 47thforty seventh percentile on a commonly used receptive vocabulary test.

To obtain the most valuable information related to Sophia’s future reading skills, the SLPS L P should assess which of the following?

A.Receptive vocabulary
B.Morphological awareness
C.Articulation skills
D.Comprehension of one-step directions

Answer 16

Option (B) is correct. Researchers have documented that morphological awareness skills significantly contribute to literacy development and are positively related to successful vocabulary, sight-word reading, decoding, reading comprehension, and spelling abilities.

Question 17

Based on Sofia’s case history and presenting problem, which of the following is most likely the etiology of her suspected language disorder?

A.A developmental disorder
B.A psychogenic disorder
C.An auditory processing disorder
D.An acquired disorder

Answer 17

Option (A) is correct. Sofia’s history is unremarkable for any sensory impairment or neurological disorder. There is no history of an emotional disorder or mention of intellectual disability. With most language disorders the cause is not known.

Question 18

Which of the following methods will best measure Sophia’s progress on her language goals and objectives?

A.Completing a language sample analysis
B.Administering a standardized receptive and expressive language battery
C.Administering a vocabulary assessment tool
D.

Answer 18

Option (A) is correct. Language sample analysis is an appropriate measure to assess progress toward meeting intervention goals and objectives because it is a naturalistic approach to measurement, whereas standardized measures and the scores derived from them are invalid for treatment progress monitoring purposes.

Question 19

Elisions and transpositions are referred to as phoneme

A.additions
B.blending
C.deletions
D.manipulations

Answer 19

Option (D) is correct. Phoneme manipulations change or modify the individual sounds in words. Elisions are the omissions of sounds in spoken words, and transpositions occur when the order of sounds in a word is switched.

Question 20

Which of the following groups of phonemes can best be described as the Six-Sound Test by Ling?

A. /u/u, as in the word ooze, /e/e, as in the word way, /o/o, as in the word own, /a/a, as in the word path, /æ/latin small letter a e, as in the word hat, /ə/latin small letter schwa, as in the word again
B. /f/, /s/, /θ/, /ʃ/, /z/, /h/f, as in the word fast, s, as in the word sit, greek small letter theta, as in the word thumb, latin small letter esh, as in the word she, z, as in the word zebra, h, as in the word hot
C. /m/, /a/, /u/, /i/, /s/, /ʃ /m, as in the word mat, a, as in the word path, u, as in the word ooze, i, as in the word he, s, as in the word sit, latin small letter esh, as in the word she
D. /d/, /g/, /e/, /o/, /s/, /ʃ/d, as in the word dog, g, as in the word go, e, as in the word way, o, as in the word own, s, as in the word sit, latin small letter esh, as in the word she

Answer 20

Option (C) is correct. The six phonemes that are part of Ling’s Six-Sound Test are /m/, /a/, /u/, /i/, /s/, /ʃ /m, as in the word mat, a, as in the word path, u, as in the word ooze, i, as in the word he, s, as in the word sit, latin small letter esh, as in the word she.

Question 21

A school-age patient being assessed for a language disorder listens to a short passage and is asked “whw h” questions based on the passage. The SLPS L P reviews the patient’s responses, records any errors, and then teaches the patient strategies to answer “who” and “what” questions. The SLPS L P makes careful notes about how much assistance the client requires to achieve a correct response. After several sessions, the SLPS L P reassesses the patient’s responses to “whw h” questions. Which of the following types of assessment is primarily exemplified in the scenario?

A.Standardized assessment
B.Criterion-referenced assessment
C.Dynamic assessment
D.Curriculum-based assessment

Answer 21

Option (C) is correct. Dynamic assessment employs a test-teach-retest procedure; it is not a static assessment in which the client has only one chance to select the correct answer.

Question 22

When completing an oral mechanism examination on a patient presenting with stroke-like symptoms, which of the following findings would be most likely to predict aspiration during an instrumental swallow evaluation?

A.Inability to swallow on command
B.Facial droop
C.Absent gag reflex
D.Breathy phonation

Answer 22

Option (D) is correct. Studies have demonstrated that breathy phonation would indicate possible vocal fold and/or pharyngeal paralysis.

Question 23

A mother reports that her three-year-old son’s speech seems normal at school, but at home his speech is either loud or fast, or he stops talking altogether. The mother further reports that she, her husband, and their two older children speak quickly and interrupt each other frequently. She is concerned that her son is not developing the speech and language skills to keep up. Which of the following statements is most accurate with respect to the mother’s concern?

A.Based on the child’s age, speech is typically intermittent and thus he is very likely developing language skills normally.
B.The child’s speech neuromotor system can keep up with the language systems of children his own age but not with the more advanced systems in his household.
C.The child’s situational lack of language is more consistent with a cognitive delay than a speech or language deficit.
D.The child is employing compensatory speech production techniques at school but not at home.

Answer 23

Option (B) is correct. Young children, particularly those with frequent disfluency, often have difficulty competing with more advanced speech systems.

Question 24

Which of the following approaches most accurately helps an SLPS L P know if a treatment plan for an adolescent with language disorders is having an impact on academic learning?

A. Reviewing the results of state standards-based assessments
B. Administering the Peabody Picture Vocabulary Test (PPVTP P V T)
C. Analyzing performance on classroom-based assessments
D. Using the Clinical Evaluation of Language Fundamentals (CELFC E L F-5) assessment

Answer 24

Option (C) is correct. An adolescent with language disorders would best show academic progress through performance on classroom assessments.

Question 25

When an SLPS L P assesses the communication skills of a bilingual child, it is important for the SLPS L P to evaluate both languages primarily to

A.establish a baseline of skills in order to track changes
B.determine which language to treat
C.establish rapport with the child
D.diagnose a communication disorder

Answer 25

Option (D) is correct. Diagnosis is required prior to initiating therapy, and a diagnosis of a communication disorder cannot be established without evaluating skills in both languages.

Question 26

Match each treatment strategy with the type of dysarthria for which the strategy is most effective.

Spastic -

a. Using rhythmic or metered cueing
b. Implementing sensory tricks.
c. Performing pushing-pulling exercises
d. Practicing relaxation exercises

Answer 26

D. Practicing relaxation exercises

People with spastic dysarthria need to practice relaxation exercises to reduce muscle tone and increase flexibility.

Question 27

Match each treatment strategy with the type of dysarthria for which the strategy is most effective.

Ataxic -

a. Using rhythmic or metered cueing
b. Implementing sensory tricks.
c. Performing pushing-pulling exercises
d. Practicing relaxation exercises

Answer 27

A. Using rhythmic or metered cueing

Those with ataxic dysarthria benefit from rhythmic or metered cueing due to inability to adequately pace their speech production.

Question 28

Match each treatment strategy with the type of dysarthria for which the strategy is most effective.

Hyperkinetic -

a. Using rhythmic or metered cueing
b. Implementing sensory tricks.
c. Performing pushing-pulling exercises
d. Practicing relaxation exercises

Answer 28

B. Implementing sensory tricks.

People with hyperkinetic dysarthria benefit from sensory tricks to reduce involuntary movements. Any other order is incorrect because the treatment strategies cannot interchangeably treat other types of dysarthria and would be ineffective if applied to the wrong dysarthria type.

Question 29

Match each treatment strategy with the type of dysarthria for which the strategy is most effective.

Flaccid -

a. Using rhythmic or metered cueing
b. Implementing sensory tricks.
c. Performing pushing-pulling exercises
d. Practicing relaxation exercises

Answer 29

C. Performing pushing-pulling exercises

Flaccid dysarthria is effectively treated with pushing and pulling exercises to help strengthen muscles and increase tone.

Question 30

When completing a videofluoroscopic swallow study on a geriatric patient, which of the following findings is most appropriately considered typical development?

A.Vallecular retention of more than 50 percent of vallecular height
B.Nasopharyngeal regurgitation
C.Liquid bolus enters pharynx before hyolaryngeal excursion begins
D.Oral pocketing

Answer 30

Option (C) is correct. There is known variability in initiation of pharyngeal swallow, notably in the geriatric population. Research indicates that the initiation of the pharyngeal is not necessarily at the ramus of the mandible in the geriatric patient population.

Question 31

A 9-year-old child is one year post tonsillectomy and adenoidectomy and presents with moderate hypernasality and consistent nasal emission. The child was referred for assessment, and velopharyngeal incompetency was identified.

Which of the following would be the next appropriate step for the SLPS L P to take?

A.Continue to monitor resonance as the child still may spontaneously improve
B.Discuss surgical management options with the craniofacial team
C.Initiate therapy to discriminate between hypernasal speech and oral speech
D.Slow down rate of speech to help velopharyngeal closure

Answer 31

Option (B) is correct. Nasopharyngoscopy will be conducted to visualize the velopharyngeal mechanism and provide information for possible surgical management.

Question 32

An SLPS L P evaluates the speech of a child with suspected velopharyngeal dysfunction. Loading sentences with which of the following types of stimuli would be most helpful to include in the speech evaluation?

A. Nasal phonemes
B. High-pressure oral stops and fricatives
C. Sustained /α/greek small letter alpha, as in the word hot sounds
D. Liquids and glides

Answer 32

ption (B) is correct. High-pressure consonants are most sensitive to the effects of velopharyngeal dysfunction (VPDV D P), which involves a potential for weak pressure and nasal emission, both being obligatory features of VPDV D P. In addition, sentence-level stimuli are needed to include a variety of vowels that allow the listener the opportunity to perceive hypernasal resonance, which is also associated with velopharyngeal dysfunction.

Question 33

A kindergarten teacher requests a speech screening for a student who is 5 years, 2 months old. The teacher observes that the student has a lisp during conversation and reading activities. Results of the screening note an interdental sound production for /s/s, as in the word sit and /z/z, as in the word zebra in all positions of words. The oral peripheral screening appears unremarkable and adequate for speech production. Which of the following summary recommendations is most appropriate based on the student’s screening results?

A. Interdental production of /s/s, as in the word sit and /z/z, as in the word zebra sounds are within range of typical development. Continue to monitor and reassess in one year.
B.Interdental production of /s/s, as in the word sit and /z/z, as in the word zebra sounds are not within the range of typical development. An evaluation is recommended.
C. Interdental production of the /s/s, as in the word sit sound is within the range of typical development, while /z/z, as in the word zebra sound errors are not. RTIR T I intervention is recommended.
D.Correct production of /s/s, as in the word sit and /z/z, as in the word zebra sounds is emerging, and the student should be rescreened in three months.

Answer 33

Option (A) is correct. The /s/s, as in the word sit and /z/z, as in the word zebra sounds are not mastered until age 7 or later.

Question 34

Which of the following plans is most appropriate when assessing a patient with a history of traumatic brain injury (TBI) to characterize cognitive aspects of communication that affect functional abilities?

A.Administering an aphasia battery to form a comprehensive assessment of the patient’s linguistic abilities
B.Conducting an assessment to evaluate for the presence and severity of dysarthria
C.Observing a conversation between the patient and a familiar individual for difficulties in functional communication
D.Using standardized tests as needed and supplementing with discourse samples and dynamic assessment

Answer 34

Option (D) is correct. Combining carefully interpreted standardized tests with discourse and dynamic assessment is recommended to achieve the most representative view of a patient’s cognitive and linguistic abilities.

Question 35

A 75-year-old man presents with conversational speech characterized by prolonged silent intervals and hypophonia. Resonance is normal, but voice quality is rough and tremulous. Pitch is relatively unaffected. There is no evidence of speech deterioration over time. Which of the following diagnoses is the most reasonable based on the patient’s data?

A.Hypokinetic dysarthria
B.Ataxic dysarthria
C.Hyperkinetic dysarthria
D.Flaccid dysarthria

Answer 35

Option (A) is correct. Inappropriate silences, imprecise consonants, variable rate, short rushes of speech, increased rate in segments, and hoarse and tremulous voice quality are common characteristics of hypokinetic dysarthria. Speech deterioration over time and resonance are not typically affected.