Review 1

Question 1

Tongue protrusion forms part of any oral examination. Which muscles and nerves are responsible here?

Answer 1

Intrinsic tongue muscles innervated by CN XII, the hypoglossal nerve.

• specifically, styloglossus draws tongue tip back, hyoglossus retracts and depresses the tongue, chondroglossus depresses the tongue

Question 2

When a pt has parkison’s disease, what do you expect see at the tongue protrusion part of the OME?

Answer 2

Tremor at rest (in PD, the tremor may also affect the tongue)

Question 3

Hypokinetic dysarthria is most commonly associated with what condition?

Answer 3

Parkinson’s Disease

Question 4

What is a common feature of hypo kinetic dysarthria?

Answer 4

hurried spurts of speech are inter-twined with periods of slow labored speech.

Question 5

Typically a patient with dysphagia as a result of Parkinson’s Disease will demonstrate:

Answer 5

Reduced swallow frequency, delayed pharyngeal swallow, inadequate laryngeal elevation/closure and reduced laryngeal sensitivity to penetration

Question 6

flaccid dysarthria is most associated with what condition?

Answer 6

myasthenia gravis (LMN)

Question 7

Damage to the basal ganglia resulting in hyperkinetic dysarthria is associated with what condition?

Answer 7

Huntington’s disease

Question 8

Spastic dysarthria results from …

Answer 8

bilateral damage to upper motor neurons

Question 9

Ataxic dysarthria results from…

Answer 9

damage to the cerebellum

Question 10

What are the classic symptoms of Parkinson’s disease?

Answer 10

• tremor or shaking, bradykinesia and rigidity. This is a progressive disease that may also affect communication and swallowing ability

Question 11

Describe Multiple Sclerosis (MS)

Answer 11

tends to have periods of remission and no associated tremor

Question 12

Describe myasthenia gravis (MG)

Answer 12

typically presents as muscle fatigue causing intermittent weakness, especially after exercise.

Question 13

How do you calculate MLU?

Answer 13

MLU = number of morphemes (divided by) number of utterances

Question 14

What is the research on stuttering in families?

Answer 14

There have been reports in the literature that the likelihood of childhood stuttering is increased when a member of the family reports stuttering during childhood, however male children of mothers who stutter are more at risk.

Question 15

When asked to write a report, what assessment would you use and why?

Answer 15

A standardized assessment would be the best option. You will need quantitative data, showing the norm for this child’s age if you are to write a report. By Federal or State Law you may need to show this data if you were to request any special services for this child.

Question 16

Describe how you would use Minimal Pair Contrast approach in a child who is doing fronting /ti/ for ‘key’ and FCD (final consonant deletion) /tou/ for ‘goat’.

Answer 16

Minimal Pair Contrast approach would be used to target both final consonant deletion (fcd) and velar fronting (vf) by means of pictures and words showing both a toe -v- goat and then the letter T -v- key (this reinforces in a concrete manner the idea that the sounds we make represent different meanings).

Question 17

What is the purpose of Milieu Therapy?

Answer 17

MT uses functional communication techniques to train children in the correct use of verbal responses.

Question 18

What does the research suggest about targeting language vs articulation?

Answer 18

Hoffman and Norris (2002) suggest that with a child who has a language disorder and articulation/phonological difficulties that the clinician should target both areas simultaneously. This includes increasing more phonosyntactic skills (Rob has deficits in both speech and language).

Question 19

difference b/w articulation and phonological processes assessments?

Answer 19

Articulation assessments will only examine the production of phonemes in one phonetic context and will not focus on patterns of speech processes.

Question 20

Velar fronting and Final consonant deletion usually disappear by the age

Answer 20

3;0

Question 21

difference between dysarthria and dyspraxia

Answer 21

Speech errors are consistent. There are no episodes of clear speech observed when Dysarthria is present. Dysarthria affects all speech, automatic included. Errors of speech are predictable and it is muscle weakness that is responsible for poor intelligibility. Dysarthria only manifests as a speech disorder. vs Dyspraxia which is a motor programming disorder

Question 22

Describe CN VIII

Answer 22

is the Acoustic nerve, it is a sensory nerve and is linked with hearing and equilibrium

Question 23

Describe CN IX

Answer 23

IX - The Glossopharyngeal nerve is mixed and is linked with taste, gag, elevation of the palate and larynx.

Question 24

Describe CN XII

Answer 24

XII (Hypo-glossal nerve) is a motor nerve and is responsible for movement of the tongue.

Question 25

A pt has unilateral facial weakness. Which CN is responsible?

Answer 25

VII (the Facial nerve). It is a mixed nerve carrying both sensory and motor signals and is linked with taste and movement of facial muscles

Question 26

The medical records you receive from Mrs. Howley’s neurologist detail damage to the areas that would confirm your diagnosis of Ataxic Dysarthria with mild to moderate non-fluent Aphasia. What areas are damaged?

Answer 26

damage to the cerebellar system (ataxic dysarthria) and Brodmanns areas 44 & 45 (Broca’s aphasia)

Question 27

If a pt had presented with Hypernasality, Imprecise Consonants, Breathiness, Monopitch and Nasal emissions you would diagnose which type of Dysarthria?

Answer 27

Flaccid

Question 28

Flaccid dysarthria results from ____ and is associated with ______

Answer 28

Flaccid Dysarthria results from damage to the lower motor neurons and is associated with CVA, disease, palsies and tumor

Question 29

A pt presents with Imprecise consonants, irregular articulatory breakdowns, distorted vowels, harsh voice, loudness control problems, variable nasality and equal and even stress patterns. What kind of dysarthria?

Answer 29

Ataxic Dysarthria is a result of damage to the cerebellar system and typical symptoms are: Imprecise consonants, Excess and equal stress patterns, a Harsh voice quality with Loudness control problems.

Variable nasality and Distorted vowels along with Irregular articulatory breakdowns. (You may find the acronym HI LIVED a useful way of remembering these ataxic features)

Question 30

the most common form of TBI associated with road traffic accidents.

Answer 30

Acceleration-Deceleration injury

Question 31

Non acceleration injury occurs when

Answer 31

the head is trapped and either crushed or impacted by a heavy object.

Question 32

Type of head injuries refer to closed head injuries usually caused by a blow to the head (professional fighters usually suffer this type of injury).

Answer 32

Both coup and contre coup

Question 33

what is xerostomia

Answer 33

abnormal dryness in mouth

Question 34

What dysphagia treatments are most often recommended for patients diagnosed with Parkinson’s disease?

Answer 34

Compensatory strategies
These strategies could include: increasing sensory awareness, changing posture, modifying food consistency, chin tucking, double swallow, effortful swallow and adaptive utensils.

Question 35

How many components are typically included in an aural rehabilitation program?

Answer 35

There are typical components of an aural rehabilitation program. These include detection of sound, discrimination of sounds, identification, and comprehension, in that order. Each sequential component is more difficult than the one before it.

Question 36

What are the basic principles of intervention with motor speech disorders?

Answer 36

Target the speech components that will yield the most functional benefits, reduce the severity of impairment, specific motor movements can be taught at any level, linguistic approaches. Both rate specific and linguistic approaches can be used together. Use AAC method if needed.

Question 37

describe adverb development in children

Answer 37

While adverbs rarely occur in the speech of very young children, the earliest adverbial modifiers to be observed usually include “here” and “there”. Even by 3 or 4 years of age, the proportion of adverb use compared to nouns, verbs, pronouns and adjectives is modest with the use of adverbs remaining fairly consistent at 7% of total words across all ages. Research shows that expressive and receptive knowledge of adverbial form and function may not be complete until late adolescence.

Question 38

What is a quick preschool speech/language screening tool?

Answer 38

The Fluharty-2 is a quick screening tool for preschoolers that includes articulation, sentence repetition, direction following, and sequencing. It provides standardization and should pick up those children who will require a full speech/language evaluation.

Question 39

Explain the difference between a hearing aid and cochlear implant

Answer 39

Hearing aids amplify sound so they can be heard, a cochlear implant sends signals to the brain through the auditory nerve. Cochlear implants bypass damaged portions of the ear and directly stimulate the auditory nerve. Signals generated by the implant are sent by way of the auditory nerve to the brain, which recognizes the signals as sound. Hearing through a cochlear implant is different from normal hearing and takes time to learn or relearn.

Question 40

explain what cochlear implant is

Answer 40

It is a small and complex electronic device that can help provide a sense of sound. It does not restore hearing but gives a representation of sounds. The implant consists of an external portion that sits behind the ear and a second portion that is surgically placed under the skin

Question 41

the speech banana is located between ___ and ____ dB

Answer 41

20 to 60 dB, depending on the sound

Question 42

air conduction refers to sounds given through

Answer 42

headphones

Question 43

in bone conduction, a black box (attached to a headband) is placed on the _____ bone

Answer 43

mastoid

Question 44

bone conduction bypasses the outer ear and middle ear and goes straight to the __

Answer 44

cochlea

Question 45

common causes of conductive hearing loss

Answer 45

was in middle ear
otosclerosis
otitis media

Question 46

define presbycusis

Answer 46

hearing loss in the elderly

Question 47

______ _____also called a vestibular schwannoma, is a benign primary intracranial tumor of the myelin-forming cells of the vestibulocochlear nerve (CN VIII).

Answer 47

acoustic neuroma

Question 48

what are the earliest symptoms of acoustic neuromas?

Answer 48

• unilateral sensorineural hearing loss/deafness
• disturbed sense of balance and altered gait
• vertigo with associated nausea and vomiting
• pressure in the ear
  (all of which can be attributed to the disruption of normal vestibulocochlear nerve function)
• Additionally more than 80% of patients have reported tinnitus

Question 49

tinnitus

Answer 49

high pitched ringing

Question 50

acoustic neuromas can affect nearby cranial nerve VII (facial nerve) leading to…

Answer 50

Involvement of the nearby facial nerve (CN VII) may lead to unilateral facial weakness, sensory impairment, and impairment of glandular secretions

Question 51

acoustic neuromas can affect nearby cranial nerve V (trigeminal nerve) leading too…

Answer 51

involvement of the trigeminal nerve (CN V) may lead to loss of taste and loss of sensation in the involved side’s face and mouth

Question 52

treatment options for acoustic neuromas are

Answer 52

surgery and radiation therapy

Question 53

pros and cons for surgery vs radiation for acoustic neuromas

Answer 53

Microsurgery for acoustic neuroma is the only technique that removes the tumor. Radiation treatment does not remove the tumor, but has the potential to slow or stop its growth.

Surgery is the only treatment that will definitively treat balance symptoms associated with tumor growth, as the vestibular nerves are removed at surgery.

Question 54

Risks of radiation tx for acoustic neuroma

Answer 54

Two risks of radiation treatment are carcinogenic progression of the acoustic neuroma (conversion from benign to malignant) or induction of other tumors (such as glioblastoma) in the nearby irradiated brain tissue.

Question 55

levels of HL

Answer 55

0-20 dB HL - Normal range - Adults
 21-25 dB HL - Slight
 26-40dB HL - Mild
41-55dB HL - Moderate
56-70dB HL - Moderately Severe
 71-90dB HL - Severe
91dB+ - Profound.

Question 56

typical symptoms of Noise induced hearing loss

Answer 56

hearing loss
tinnitus
poor speech discrimination

Question 57

When exposed to harmful sounds that are too loud or loud sounds that last a long time, what structures in the ear are damaged?

Answer 57

hair cells

Question 58

When a client presents with a disability and needs to find work, where should you refer?

Answer 58

Rehabilitation Counseling is focused on helping people who have disabilities achieve their personal, career, and independent living goals through a counselling process

Question 59

Maternal rubella causes hearing loss in babies during

Answer 59

during her first trimester

Question 60

congenital rubella can cause the following

Answer 60

hearing loss, heart defects, eye problems; Intellectual Disability also often accompanies these defects.

Question 61

If there is a 15 decibel or greater difference between two or more air conduction thresholds between the two ears, the loss is considered ___________

Answer 61

asymmetrical (disimilar)

Question 62

The hearing loss is considered symmetrical (similar) when

Answer 62

the thresholds in both ears at each frequency are approximately equal.

Question 63

A unilateral hearing loss is always, by definition, ________

Answer 63

asymmetrical

Question 64

Meniere’s disease is a disorder of the inner ear that can affect hearing and balance. What is thought to be a cause of Meniere’s disease?

Answer 64

Excess fluid in the inner ear

Question 65

Since there are other disorders which have symptoms similar to Meniere’s disease, how is a diagnosis established?

Answer 65

There is no definitive test. It is diagnosed when other causes have been ruled out. Audiometry and head magnetic resonance imaging (MRI) scan should be performed to exclude a tumor of the cranial nerve VIII (vestibulocochlear nerve) which would cause similar symptoms.

Question 66

How is Meniere’s disease treated?

Answer 66

reatment for individual symptoms, salt-restriction and/or surgical intervention

Question 67

Otosclerosis is

Answer 67

a hardening of the stapes (or stirrup) in the middle ear and causes conductive hearing loss.

Question 68

_______ _________ is one of the autoimmune conditions that may precipitate hearing loss.

Answer 68

Wegener’s granulomatosis

Question 69

What is Word Recognition?

Answer 69

The percentage of one-syllable words a patient can identify at a comfortable hearing level

Question 70

children with _______ hearing loss generally have poor speech discrimination

Answer 70

sensorineural

Question 71

During a hearing evaluation, you ask Tommy to repeat familiar words as they are named. You make note of the weakest intensity that Tommy is able to recognize these familiar words. What are you evaluating?

Answer 71

Speech Reception Threshold

Question 72

During a hearing evaluation, you say one-syllable words at a comfortable loudness for Tommy and calculate the percentage of those words that he can identify. What are you measuring?

Answer 72

Speech Discrimination Score or Word Recognition Score

Question 73

Whenever there is an indication of family history of hearing loss, it is recommended that patients seek _____ counseling

Answer 73

genetic

Question 74

A teacher has nodules. How will her fundamental frequency sound?

Answer 74

decreased

Question 75

A teacher has nodules. How will her voice sound?

Answer 75

Breathy and hoarse

Question 76

aphonia is

Answer 76

loss of voice

Question 77

dysphonia is

Answer 77

abnormal voice (hoarse voice)

Question 78

organic etiology means

Answer 78

there is an observable and measurable disease process, such as inflammation or tissue damage; there are detectable physical changes or biomarkers

Question 79

functional voice disorders are

Answer 79

voice disorders that result from improper or inefficient use of the vocal mechanism when the physical structure is normal (e.g., vocal fatigue; muscle tension dysphonia or aphonia; diplophonia; ventricular phonation

Question 80

What is an organic cause found in patients with aphonia?

Answer 80

Bilateral disruption of the recurrent laryngeal nerve

Question 81

What are some probable causes of bilateral disruption of the recurrent laryngeal nerve resulting in aphonia

Answer 81

A primary cause of aphonia is bilateral disruption of the recurrent laryngeal nerve, which supplies nearly all the muscles in the larynx. The nerve is best known for its importance in thyroid surgery, as it runs immediately posterior to this gland. If it is damaged during surgery, the patient will have a hoarse voice. Similar problems may also be due to invasion of the nerve by a tumor or after trauma to the neck.

Question 82

If you have a patient with diagnosed damage to the recurrent laryngeal nerve who is experiencing breathing difficulties and aphonia, what would you suspect about the nature of the nerve damage

Answer 82

That there is bilateral nerve damage

Question 83

If the damage to the recurrent laryngeal nerve is unilateral, the patient may present with

Answer 83

voice changes including hoarseness.

Question 84

Bilateral damage to the recurrent laryngeal nerve can result in

Answer 84

breathing difficulties and aphonia

Question 85

The ___________ is more susceptible to damage during thyroid surgery due to its relatively medial location.

Answer 85

right recurrent laryngeal nerve

Question 86

If you have a patient who presents with bilateral vocal fold edema with a low-pitched, husky voice, what benign vocal lesion do you suspect?

Answer 86

Reinke’s edema

Question 87

Reinke’s Edema, also known as polypoid degeneration, is

Answer 87

the swelling of the vocal folds due to fluid collection (edema).

Question 88

Individuals with Reinke’s Edema typically have what kind of voice?

Answer 88

low-pitched, husky voices.

Question 89

Vocal Nodules are referred to as a benign vocal lesion. What are some other benign vocal lesions?

Answer 89

Reinke’s edema, polyps, and cysts

Question 90

Symptoms of vocal nodules

Answer 90

Symptoms include chronic or recurrent hoarseness, loss of ability to sing high notes softly, frequent voice breaks, increased breathiness, and vocal fatigue.

Question 91

Vocal nodules usually result from

Answer 91

overuse, poor vocal technique

Question 92

Factors that contribute to chronic irritation of the larynx with excessive throat clearing can include:

Answer 92

Chronic sinusitis (post-nasal drip), pulmonary disease (which may lead to poor breath support), and tobacco use/abuse (exposure to irritants)

Question 93

Vocal nodules can occur as the result of chronic vocal use/misuse, acute vocal misuse or trauma resulting from infection. What is another cause of vocal nodules?

Answer 93

Trauma from gastric reflux– Trauma resulting from infection, or trauma from gastric reflux (GERD) injuring the laryngeal mucosa (protective cover of the vocal folds).

Question 94

What type of symptoms would you expect in a child diagnosed with Rett Syndrome?

Answer 94

Poor eye contact, lack of reciprocity, language impairment and cognitive impairment

Question 95

Most individuals with Rett Syndrome are female or male?

Answer 95

female

Question 96

If a child had been diagnosed with Klinefelter’s Syndrome what kind of symptoms would you have expected?

Answer 96

Flat affect in combination with language impairment

Question 97

If a child had Landau-Kleffner syndrome what kind of symptoms would you have expected?

Answer 97

Sudden or gradual loss of receptive and expressive skills

Question 98

What language areas would you suspect a child with WIliams Syndrome would have difficulty with?

Answer 98

Problem-solving, perspective and inferencing (Because of the probable low cognitive scores and difficulty with Theory of Mind)

Question 99

Williams Syndrome is sometimes called:

Answer 99

The cocktail-party syndrome (Persons with Williams generally possess very good social skills, )

Question 100

Williams syndrome is characterized by

Answer 100

• a distinctive, “elfish” facial appearance, along with a low nasal bridge;
• an unusually cheerful demeanor and ease with strangers, coupled with unpredictably occurring negative outbursts;
• Intellectual Disability coupled with an unusual facility with language;
• a love for music;
• and cardiovascular problems, such as supravalvular aortic stenosis and transient hypercalcaemia.

Question 101

How will scarring on a vocal fold will affect the mucosal wave?

Answer 101

decreased

Question 102

How will scarring on a vocal fold affect the amplitude of vibration?

Answer 102

decreased

Question 103

The most prevalent cause of a missed diagnosis of laryngeal cancer is a belief that persistent hoarseness is due to

Answer 103

laryngitis

Question 104

Should hoarseness last for more than 3 weeks, one should consult an

Answer 104

ENT (otolaryngologist)

Question 105

Paula, a 46-year-old female was referred for videostroboscopy secondary to complaints of laryngitis and dysphonia. She is employed as a sales clerk and reports using her voice on a daily basis to communicate with customers. A flexible scope was used to view vocal fold vibratory behavior. The flexible scope revealed severe medial compression of the false vocal folds bilaterally. Why might it be difficult to study patterns of vocal fold vibration in this patient via a stroboscopic assessment?

Answer 105

Stroboscopic results will be inconclusive because of severe medial compression of the false vocal folds obstructing view of the glottis during voicing

Question 106

You’re examining a patient. The flexible scope revealed severe medial compression of the false vocal folds bilaterally. How will this affect the patient’s fundamental frequency?

Answer 106

False vocal folds are coming together, causing fundamental frequency to be higher

Question 107

what is a bifid uvula

Answer 107

cleft uvula (a uvula that is split in 2 or forked)

Question 108

What are some neurogenic causes of velopharyngeal insufficiency

Answer 108

Dysarthria, tumors, stroke, traumatic injury or cranial nerve damage

Question 109

A child has velopharyngeal insufficiency, what speech sounds would you expect to be affected?

Answer 109

Because of the velopharyngeal insufficiency you would likely see difficulties in the production of Fricatives and Affricates.

Question 110

What is Velopharyngeal insufficiency

Answer 110

When the velum and the lateral/posterior pharyngeal walls fail to separate the oral cavity from the nasal cavity during speech..

Velopharyngeal insufficiency (VPI) is defined as the failure to close the velopharyngeal sphincter, resulting in an inability to adequately separate the nasal cavity from the oral cavity (Armour et al., 2005)

Question 111

Describe Velopharyngeal insufficiency to a parent

Answer 111

When the back of the palate and the sides and back of the walls of the throat don’t fully close, the sound and air pressure go through the nose instead of the mouth

Question 112

VPI is most commonly caused by a cleft of the secondary palate, but other causes may include

Answer 112

submucous clefts, neuromuscular abnormalities, and congenital VPI of unknown cause (Sloan, 2000).