Group D

Question 1

Doing which of the following would likely yield the most useful information about the effectiveness of an intervention strategy?

A.Reviewing the results of standardized assessment instruments
B.Utilizing a single-subject design (ABAB) or a reversal procedure (ABA)
C.Utilizing the subjective, objective, assessment, and plan (SOAP) format
D.Requesting that a colleague reevaluate the clientO==

Answer 1

Option (B) is correct. An ABAB or ABA design shows changes when intervention is applied. Single-subject design using ABAB or ABA design is the best method to determine whether intervention has succeeded.

Question 2

ndividuals diagnosed as having hemifacial microsomia are also most likely to have

A.laryngeal dysfunction
B.ear malformation
C.webbed fingers and toes
D.widely spaced eyes

Answer 2

Option (B) is correct. Ear malformation is the only symptom of those listed that is typical of hemifacial microsomia, a genetic diagnosis within the oculo-auricular-vertebral (OAV) spectrum.

Question 3

A child repeatedly inserts an inappropriate sound in certain environments; for example, [fpɪʃ] for [fɪʃ] . Which of the following would likely be most helpful for the child as a target for treatment?

A.Bisyllabic words for which a minimal-contrast pair can be easily identified
B.Words containing phonemes that have distinctive features in common with the sound the child inserts inappropriately
C.Repeated practice with the combinations of phonemes that the child finds particularly easy to produce
D.Words that contrast the child’s error pattern with the target pattern in the word

Answer 3

Option (D) is correct. Words that contrast the child’s error pattern with the target pattern would be most helpful for this child.

Question 4

The sensorimotor integration of the muscles of the lower face depends on which two of the cranial nerves?

A.The accessory and hypoglossal
B.The trigeminal and facial
C.The vagus and glossopharyngeal
D.The phrenic and facial

Answer 4

Option (B) is correct. The trigeminal nerve has a motor component which is involved in mastication (and thus the lower face) and a sensory component, which provides sensory information from the entire face (including the lower face). The facial nerve provides motor innervation to several muscles that are found in the lower face, including the orbicularis oris and the buccinator.

Question 5

For which of the following reasons would the therapy for a client whose language loss is due to brain injury differ from the therapy for a client whose language loss is due to a progressive disorder?

A.There is a much higher chance of spontaneous recovery for the client with brain injury.
B.There is a much higher chance of spontaneous recovery for the client with a progressive disorder.
C.The client with brain injury typically has problems with fatigue and mental confusion, whereas the client with a progressive disorder does not.
D.The client with a progressive disorder typically has problems with attention and memory, whereas the client with brain injury typically does not.

Answer 5

Option (A) is correct. Brain injury is typically characterized by some degree of spontaneous improvement over a period of several days to weeks, which may be evidenced through gradual improvement in language abilities, whereas a progressive disorder is characterized by gradual loss/reduction in language skills.

Question 6

Which of the following treatment goals related to pragmatics best addresses a young child’s use of language?

A.In a play situation, the child will request a turn, either verbally or through gestures, 90 percent of the time.
B.In a treatment session, the child will produce a two-word combination 90 percent of the time.
C.In conversation, the child will produce correct velars 90 percent of the time.
D.When telling a story, the child will use the standard dialect’s irregular past tense forms of five specific verbs 90 percent of the time.

Answer 6

Option (A) is correct. Pragmatics is the study of language in realistic contexts, and the treatment goal describes a real-life, naturalistic use of communication skills.

Question 7

A 42-year-old client with upper-and lower-extremity weakness and a diagnosis of amyotrophic lateral sclerosis is referred for a speech-language evaluation. The evaluation reveals a progressive severe dysarthria that is characterized by imprecise articulation secondary to bilateral facial and lingual weakness, atrophy, and fasciculations; mild-to-moderate hypernasality and weak pressure consonants with associated nasal emission during speech; and strained, harsh, groaning voice quality with occasional inhalatory stridor. Speech intelligibility is poor. Which of the following will most effectively improve this client’s ability to communicate?

A.Teflon injection into one or both vocal cords
B.Palatal-lift prosthesis
C.Amplification device
D.Augmentative communication system

Answer 7

Option (D) is correct. The client has an advanced stage of amyotrophic lateral sclerosis with consequent progressive deterioration of communication abilities. An augmentative-communication system is the best option for improving or maintaining communication for this client.

Question 8

Which of the following communication disorders is most frequently associated with significant dysphagia?

A.Aphasia
B.Ataxic dysarthria
C.Flaccid dysarthria
D.Organic voice tremor

Answer 8

Option (C) is correct. Flaccid dysarthria and dysphagia are both disorders likely to be characterized by flaccidity or weakness of the oromotor and laryngeal mechanisms that results from cranial nerve damage. These two disorders frequently coexist.

Question 9

Language impairment in a child with Down syndrome is often determined by comparing performance on one or more standardized language tests with the child’s mental age, rather than with the child’s chronological age. Although mental age should not be used to specify the need for treatment, mental age can legitimately be used as a performance criterion because

A.using chronological age would overidentify language disorders
B.using chronological age would underidentify language disorders
C.mental age always correlates with verbal performance
D.language performance is expected to exceed mental age

Answer 9

Option (A) is correct. Using chronological age as a performance criterion for a child with Down syndrome would make the child’s language disorders seem more pronounced than they are.

Question 10

Which of the following is the ratio of reinforcement that will most quickly cause a newly acquired behavior to be habituated?

A.A random ratio of tokens to correct responses
B.A ratio of 1 token to 1 correct response
C.A ratio of 1 token to 4 correct responses only
D.A ratio of 1 token to 10 correct responses only

Answer 10

Option (A) is correct. When the goal is to reinforce a behavior that has already been acquired, a random ratio of tokens to correct responses creates an intermittent reinforcement schedule and is the most effective. Such a reinforcement schedule decreases the client’s dependence on the token reward.

Question 11

Mr. Charles, age 78, has had Alzheimer’s disease for the past nine years. A recent speech and language evaluation at his nursing home indicated severe deficits in verbal reasoning, memory, word finding, discourse, pragmatics, phonology, semantics, and syntax. Which of the following should the speech-language pathologist do next?

A.Recommend individual treatment to improve his receptive and expressive language skills, beginning with the areas where he is least deficient
B.Recommend individual treatment to improve his receptive and expressive language skills, beginning with the areas where he is most deficient
C.Initiate group treatment with other adults with language impairments to improve spontaneous conversational speech and pragmatic skills
D.Examine his living conditions and, if necessary, educate the nursing staff concerning ways to help him communicate more effectively

Answer 11

Option (D) is correct. Mr. Charles has Alzheimer’s disease with loss of memory and deteriorating language skills. The best that can be done for him is to help his caregivers improve the conditions related to his basic communication needs. Speech-language treatment itself is very unlikely to be effective and thus is not appropriate.

Question 12

An adult client exhibits visuospatial disorganization, an inability to initiate interactions, left-side neglect, and lack of facial expression. This combination of symptoms is most likely associated with which of the following?

A.Right-hemisphere traumatic brain injury
B.Left-hemisphere cerebrovascular accident
C.Bilateral traumatic brain injury
D.Alzheimer’s dementia

Answer 12

Option (A) is correct. The symptoms listed are indicative of deficits that are generally associated with right-hemisphere dysfunction.

Question 13

A physician told the spouse of a client that melodic intonation therapy (MIT) would improve the client’s speech considerably. The most appropriate next action by the SLP would be to

A.provide MIT, as recommended
B.tell the physician that it is inappropriate for the physician to make recommendations for a speech treatment
C.consider the potential value of incorporating MIT into the client’s treatment
D.explain MIT to the client’s spouse to assist in the decision-making process about the type of therapy to use

Answer 13

Option (C) is correct. MIT is a procedure appropriately used by SLPs to promote certain results. The SLP has responsibility for determining the value of this procedure in relation to the objectives of the speech-language treatment program.

Question 14

Which of the following muscles is primarily responsible for vocal fold abduction?

A.Posterior cricoarytenoid
B.Cricothyroid
C.Interarytenoid
D.Lateral cricoarytenoid

Answer 14

Option (A) is correct. The posterior cricoarytenoid muscle has its origin on the posterior wall of the cricoid lamina, and courses anterolaterally and then anteriorly to insert onto the lateral aspect of the arytenoid cartilage. Given the anatomy of the cricoarytenoid joint, posterior cricoarytenoid contraction (shortening) can only produce rotation of the arytenoid cartilages such that the vocal processes are displaced laterally, abducting the true vocal folds.

Question 15

Which of the following factors contributes to UES opening?

Select all that apply.

A.Partial relaxation of the cricopharyngeal portion of the inferior constrictor muscle
B.Superior and anterior hyolaryngeal excursion
C.Velopharyngeal closure
D.Posterior and inferior hyolaryngeal excursion

Answer 15

Options (A) and (B) are correct. Partial relaxation of the cricopharyngeal portion of the inferior constrictor muscle is part of the neurological sequence. Superior and anterior hyolaryngeal excursion provides a mechanical opening.

Question 16

A client has been determined to have poor upper esophageal sphincter opening secondary to decreased hyolaryngeal excursion, following a lateral medullary stroke. Cognitive functions are within normal limits. Which of the following interventions would be the most appropriate recommendation for this client as an initial course of treatment for the underlying disorder?

A.Thermotactile stimulation
B.Mendelsohn maneuver
C.Thickened liquids
D.Chin-down posture (head/neck flexion)

Answer 16

Option (B) is correct. The Mendelsohn maneuver is the only one of the listed interventions designed and shown in research to prolong the duration and diameter of upper esophageal sphincter opening.

Question 17

The figure shows a midsagittal view of the oral and pharyngeal structures. The top and bottom lip are located one above the other, with a small opening in between. The top central incisors and lower central incisors are both tipped forward labially; however, the lower central incisors appear to rest behind the top central incisors. The tongue is not in contact with the hard or soft palate. The soft palate is not in contact with the posterior pharyngeal wall.
An individual attempting to sustain /f/ is shown in the midsagittal view above. The most important reason why this speaker will not produce an acceptable /f/ is that

A.the upper central incisors are tipped too far labially
B.the lower central incisors tipped too far labially
C.intraoral air pressure will be insufficient
D.lip placement is inadequate

Answer 17

Option (C) is correct. The midsagittal section shows that the speaker’s velopharyngeal port is open, allowing a flow of air into the nasal cavity; the resulting intraoral air pressure would be insufficient to sustain normal production of the phoneme.

Question 18

If a child’s language exhibits the phonological process of gliding, the child might say [wɛd] for “red.” When asked, “Do you mean wed?” the child may respond, “No! [wɛd]!” Such a response demonstrates which of the following?

A.Phonological development lags behind semantic development.
B.Semantic development lags behind phonological development.
C.Linguistic competence lags behind linguistic performance.
D.Linguistic performance lags behind linguistic competence.

Answer 18

Option (D) is correct. Linguistic performance typically lags behind linguistic competence.

Question 19

Of the following sentences, which represents the greatest degree of syntactic complexity?

A.Is John helping Bill?
B.Why isn’t John helping Bill?
C.John isn’t helping Bill.
D.Why is John helping Bill?

Answer 19

Option (B) is correct. The sentence involves inversion, adding negation, and adding a question word, so with three transformations, this option has the greatest degree of syntactic complexity.

Question 20

Establishment of which of the following is most important in ensuring that the results of any diagnostic test of speech or language are replicable?

A.Content validity
B.Interjudge reliability
C.Split-half reliability
D.Face validity

Answer 20

Option (B) is correct. A test that has interjudge reliability is one whose results are replicable, even if different people administer the test.

Question 21

Linguistic approaches to the treatment of sound-production errors in children are based on the notion that the errors are systematic and rule-based and that the goal of treatment is to modify a child’s rule system to approximate the rule system used by adults. Which of the following is a treatment objective that reflects a linguistic approach to treatment?

A.The child will contrast alveolar stops with velar stops in meaningful word pairs.
B.The child will produce voiceless alveolar sibilants correctly in unstructured conversation.
C.The child will coarticulate stop plus liquid clusters as easily as other children of the same age.
D.The child will recognize and identify phonetic distortions of his or her error sound.

Answer 21

Option (A) is correct. The objective refers to speech sounds in terms of general distinctive-feature classes, rather than in terms of isolated phonemes or overly specific classifications.

Question 22

Which of the following is the most reasonable standard to apply when judging whether a client has achieved generalization of a targeted skill?

A.The client uses the targeted skill under stimulus conditions that were not present during the training process and without reinforcement.
B.The client maintains the correct production of the targeted skill when the reinforcement schedule is changed.
C.The client correctly produces the targeted skill effortlessly and without hesitation.
D.The client is able to monitor errors and correct them with only a minimal number of cues from the clinician.

Answer 22

Option (A) is correct. When judging whether a client has achieved generalization of a targeted skill it is a reasonable standard to apply. It shows that the client is exhibiting the skill independently in situations not covered during training.

Question 23

A child who is 4 years and 4 months old is referred for assessment of speech sound development, with the following results.

Phonological error pattern Sounds in error Error frequency (# of errors/# of opportunities to produce error)
Stopping ​Observed only on ð 85%
Fronting /k/ → [t]
/g/ → [d]
/ng/ → [n] 90%
100%
20%
Gliding /r/ → [w] 100%
Final consonant deletion Obstruents à null 80% (The only phonemes the child used correctly in the word-final position were /n, m/.)
Epenthesis Insertion of ə into stop /s/ clusters 10%
Which of the following phonological error patterns is most appropriate to address in a treatment program?

Select all that apply.

A.Stopping
B.Fronting
C.Gliding
D.Final consonant deletion
E.Epenthesis

Answer 23

Options (B) and (D) are correct. Fronting and final consonant deletion should be suppressed earlier, as they make the biggest difference in intelligibility.

Question 24

Which of the following indicates the goal of the Health Insurance Portability and Accountability Act (HIPAA) ?

A.To ensure a patient’s privacy and confidentiality of health-care information
B.To maximize health insurance coverage for speech-language pathology services
C.To ensure a free and appropriate education
D.To ensure a patient’s knowledge of health insurance

Answer 24

Option (A) is correct. Protecting patient privacy and the confidentially of health-care information is the main purpose of HIPAA.

Question 25

A 3-year-old child presents for an evaluation of communication skills. When the SLP says “Sit in your seat,” the child responds by saying [tɪ ɪ ti]. When the SLP asks the child to “put the big block in the box,” the child responds by saying [bɪ bɑ ɪ bɑ].

Based on the responses, the child’s primary problem with communication is most likely which of the following?

A.Oral-motor weakness
B.Poor auditory discrimination
C.A fluency disorder
D.A receptive and/or expressive language impairment

Answer 25

Option (D) is correct. The child is imitating what the SLP is saying but not adding new information to the conversation. This may be due to difficulty comprehending what is said (receptive language) and difficulty with producing sounds and words (expressive language).

Question 26

Laborious, halting, telegraphic utterances are typical of clients with which of the following types of aphasia?

A.Conduction
B.Anomic
C.Wernicke
D.Transcortical motor

Answer 26

Option (D) is correct. Transcortical motor aphasia is characterized by dysfluent, telegraphic utterances, and none of the distractors are characterized by this pattern of production.

Question 27

A videofluoroscopic study of a client with dysphagia revealed post-swallow vallecular residue occupying more than 50 percent vallecular height. Which of the following is the most likely overt symptom that the client will experience?

A.Watery eyes during swallowing
B.Oral pocketing of foods
C.Coughing after swallowing
D.Esophageal reflux

Answer 27

Option (C) is correct. The valleculae are depressions that lie lateral to the median epiglottal folds. Pooling of liquids in the valleculae gives a person the feeling that there is material remaining in the respiratory pathway, so coughing would be a natural reaction to expect in this case.

Question 28

When treating a client who is using an electronic augmentative-communication device, the speech-language pathologist’s primary goal should be to

A.ensure that the client develops skill in using every technical aspect of the aid
B.ensure that the client’s caregivers learn how to modify the aid’s hardware and any applicable software to meet the client’s communication needs
C.train the client to use the aid as independently and interactively as possible in a variety of settings
D.help the client develop the skills necessary for moving on to a more sophisticated device

Answer 28

Option (C) is correct. The primary goal of any intervention is to effect the best functional outcome for the client. Generalization with respect to the environments in which the augmentative device is used effectively would help accomplish this goal.

Question 29

An SLP sees a college-educated 22-year-old man who has sustained a brain injury as a result of a motor vehicle accident eighteen months earlier. The man was unconscious for five days and had posttraumatic amnesia for three months. In the last year he has held three unskilled jobs, from which he was released for unspecified reasons. Based on the information given, the man’s most pervasive condition is most likely impaired

A.visual construction
B.attention and memory
C.speech
D.language

Answer 29

Option (B) is correct. Impaired attention and impaired memory are consistent with the brain injury sustained by the client. There is no evidence for any of the other areas of potential deficit listed in the other choices.

Question 30

A 4-year-old child presents with general speech patterns that include liquid gliding, stridency deletion, final-consonant deletion, and consonant-cluster reduction. Which of the following is the speech-language pathologist’s most appropriate recommendation for the child?

A.Treatment is not needed, because the child’s speech will improve during the next year.
B.Treatment should focus on the production of /p/, because /p/ is one of the earliest acquired phonemes.
C.Treatment should use a phonological approach and focus initially on the production of final consonants.
D.Formal treatment is not needed not, but the parents should be counseled to read aloud to the child, correct the child’s errors, elicit correct repetitions, and, when needed, interpret to other people what the child is trying to say.

Answer 30

Option (C) is correct. A 4-year-old child should have already developed final consonants.

Question 31

third-party reimburser asks the speech-language pathologist to demonstrate in a diagnostic statement that a child’s communication problems have a physiological cause. Which of the following observations, if included in the statement, would best satisfy the request?

A.The child’s dentition is not yet fully developed but is within normal limits for a child of that age.
B.The child has developmental delay, exhibiting speech that is not appropriate for a child of that age.
C.The child demonstrates a motor-speech disorder and is unable to perform voluntarily the oral movements required for speech production.
D.The child exhibits stridency deletion, consonant cluster reduction, stopping, and fronting.

Answer 31

Option (C) is correct. The wording represents a well-written diagnostic statement for a child with communication problems that are physiological, or functional, in nature. None of the other answer choices demonstrates the presence of a physiological problem.

Question 32

A 412-year-old boy has significant speech and language difficulties exemplified by poor oral-motor control, slight difficulty in swallowing, high palate, poor tongue mobility, and fasciculation on protrusion. During an evaluation, the speech-language pathologist notes very poor paper-and-pencil grasp, poor posture, and an inability to complete performance tasks requiring fine motor control. To which of the following should the child be referred in order to obtain additional diagnostic information?

A.An otolaryngologist
B.A physical therapist
C.A neurologist
D.A physiologist

Answer 32

Option (C) is correct. The boy’s deficits as noted are most indicative of a neurological disorder, and a neurologist can best provide the additional diagnostic information needed.