Swallowing
Which of the following is the best action to take initially with a client who presents with poor oral control of liquids and solids, coughing and choking while eating and drinking, and a history of hospitalizations associated with pneumonia?
A.Thickening liquids so that the client will be better able to control oral movements for swallowing
B.Obtaining a modified barium-swallow study to determine appropriate interventions
C.Evaluating the client's ability to eat a variety of foods in order to determine which foods are safest
D.Prescribing that the client be NPO, since aspiration is present
Option (B) is correct. An assessment of the problem must be undertaken before treatment is provided, and the best way to do this is to obtain a modified barium-swallow study.
Ms. Brown, a 70-year-old retired female, was admitted to the hospital following a CVA. The SLP conducted a comprehensive evaluation that revealed the presence of left-side neglect, anosognosia (denial of impairment), and visuospatial problems, including prosopagnosia (difficulty recognizing familiar faces). Although her auditory comprehension and repetition skills were good, she experienced difficulty with topic maintenance and turn taking. Based on the clinical features described, Ms. Brown's diagnostic classification would most likely be
A.Wernicke's aphasia
B.Conduction aphasia
C.Cognitive-communicative disorder consistent with right hemisphere damage
D.Cognitive-communicative disorder consistent with left hemisphere damage
Option (C) is correct. The symptoms described in the scenario are consistent with damage to the right hemisphere.
Before an SLP initiates voice intervention, it is most important that the SLP gather information about the
A.cause of the client's voice problem
B.client's breathing patterns
C.client's oral motor skills
D.fundamental frequency of the client's laryngeal tone
It is essential to know the cause of a voice problem prior to commencing voice intervention, because some voice problems are symptoms of diseases/disorders (e.g., laryngeal cancer) that do not respond to the types of voice interventions that an SLP typically provides, and can only be treated through medical intervention.
Which of the following describes an important diagnostic distinction between apraxia of speech and dysarthria?
A.Apraxia of speech is a result of lower motor neuron lesions, whereas dysarthria is the result of upper motor neuron lesions.
B.Clients with apraxia of speech lack the ability to monitor reactive speech, whereas clients with dysarthria lack the ability to sequence volitional speech movements.
C.Strength and coordination of the speech musculature are intact in clients with apraxia of speech, whereas slowness, weakness, incoordination, or altered tone of the speech musculature are associated with dysarthria.
D.Apraxia of speech is characterized by distortions, omissions, and substitutions, whereas dysarthria is characterized by inconsistent, highly variable misarticulations.
Option (C) is correct. Dysarthria is a motor speech disorder characterized by slowness, weakness, incoordination, or altered tone of the speech production mechanism. The definition of apraxia includes the absence of any deficits in strength, tone, or coordination and rather is characterized by deficits in motor planning and/or programming of speech.
A 67-year-old male patient with no history of swallowing problems has undergone a cardiothoracic surgical procedure. Postoperatively, he is found to be aspirating while swallowing and is diagnosed with a left vocal-fold paralysis and left pharyngeal paresis. Which of the following is the most likely etiology?
A.An intraoperative CVA in the right pons
B.Damage to the right recurrent laryngeal nerve
C.Damage to the left recurrent laryngeal nerve
D.A left hemispheric stroke
Option (C) is correct. The left recurrent laryngeal nerve courses under the aortic arch in its course back to innervate the left larynx and the inferior pharynx. The nerve can be damaged in cardiothoracic operations including aortic arch or valve repairs. Only the left (and not the right) recurrent laryngeal nerve has this course.
A 70-year-old female has dysphagia characterized by poor posterior oral containment of the bolus during the oral preparatory stage, causing aspiration before the swallow. Cognition and the pharyngeal stage of the swallow are intact. Which of the following is the most appropriate treatment approach for the client?
A.Providing a puree diet with thickened liquids
B.Having the client flex her head forward (perform the chin-down posture) during oral preparation and transit stages of the swallow
C.Having the client turn (rotate) her head to the right when swallowing
D.Providing a diet that consists of thin liquids
B.Having the client flex her head forward (perform the chin-down posture) during oral preparation and transit stages of the swallow
--- This treatment alters oral configuration to place the base of the tongue superior to the bolus inside the oral cavity. Since liquid cannot flow uphill against gravity, this intervention compensates for impaired palatoglossus contraction, which is causing impaired posterior oral containment.
A client exhibits weakness, atrophy, and fasciculations of the right side of the tongue and lower face. The client also has right vocal-fold weakness and nasal regurgitation of fluid when swallowing. These problems are the result of damage to which part of the nervous system?
A.Brain stem
B.Cerebellum
C.Left cerebral cortex
D.Right cerebral cortex
A.Brain stem
***Why? -- Weakness, atrophy, fasciculations, and the other described symptoms are all consistent with a lower motor neuron locus and suspected cranial nerve abnormalities (primarily CN X and XII). These cranial nerves emerge directly from the brain stem and help mediate the transfer of messages from the brain to the brain stem and to the structures of the head and neck.
Immediately following removal of a benign tumor from the base of the brain, a 76-year-old client exhibits severe nasalization and a weak, breathy voice. A four-month postsurgical assessment reveals no improvement. At this time, the remediation strategy for this client should focus on
A.evaluation for prosthetic or surgical intervention
B.strengthening exercises for the oral articulators
C.a trial period using the yawn-sign technique
D.complete vocal rest
Option (A) is correct. The client has a resonance and phonation disorder indicative of velopharyngeal and laryngeal problems. The velopharyngeal problem could be assisted by prosthetic or surgical intervention.
Which of the following would be most likely to help a client who has aphonia?
A.Development of phonation through coughing or throat clearing
B.Pairing the production of /s/ and /z/
C.Respiratory exercises
D.Easy initiation of phonation
Option (A) is correct. Development of phonation through coughing or throat clearing is an effective technique in the treatment of aphonia.
Which of the following muscles produces the opposing action to those that produce velopharyngeal closure?
A.Musculus uvulae
B.Levator veli palatini
C.Palatoglossus
D.Stylopharyngeus
Option (C) is correct. Velopharyngeal closure is largely produced by soft palate elevation, and the only muscle in the list that produces soft palate depression (the opposite of soft palate elevation) is the palatoglossus.
Following anoxic encephalopathy, clients are likely to experience the most significant long-term impairments in the area of
A.prosody
B.resonance
C.aphonia
D.memory
Option (D) is correct. Anoxic encephalopathy, or brain damage resulting from oxygen deprivation, typically leads to global impairment that affects memory. It is difficult to reverse the effects of memory loss, so the impairment is usually long-term.
The brain regions most sensitive to this type of injury are parts of the hippocampus, the dorsolateral caudate nucleus and the reticular nucleus of thalamus.
After sustaining a CVA, Ms. Williams, age 75, was referred to an SLP for a speech and language evaluation. While Ms. Williams was describing the cookie-theft picture, the SLP observed that her grammatical structure appeared to be intact and her prosody was normal but that many of her sentences were meaningless, did not fit the context, and included nonsensical paraphasic errors. Additional testing also revealed that Ms. Williams exhibited poor repetition and naming skills, did not respond appropriately to many simple commands, and had difficulty reading. Ms. Williams appeared happy and talked excessively. She did not appear to be aware of her communication deficits. What is the most likely location of the lesion?
A.Left posterior superior temporal gyrus
B.Left inferior frontal gyrus
C.Left superior frontal gyrus
D.Left inferior parietal gyrus
The symptoms that are described in the scenario are consistent with damage to the left posterior superior temporal gyrus.
A prospective client is described as a man in his forties who is under chronic stress. He uses his voice extensively in daily life has a hard-driving personality, and exhibits glottal fry. The client has the classic profile of a person at high risk for
A.spastic dysphonia
B.acute laryngitis
C.vocal nodules
D.contact ulcers
Option (D) is correct. The symptoms exhibited by this patient represent a classic profile of a person who has contact ulcers.
In terms of communication impairment, an adult with Alzheimer's-type dementia tends to differ from an adult with aphasia associated with a CVA in that
A.repetition abilities are typically more seriously impaired in the adult with dementia
B.the adult with dementia generally experiences greater dysfluency
C.the adult with dementia is generally more aware of any disruptions in communication
D.the capacity of the adult with aphasia to make appropriate comments about recent events is generally better
Option (D) is correct. Adults with dementia typically have impaired short-term memory abilities. Adults with aphasia are more likely to recall recent events and consequently would be more likely to make appropriate comments about recent events when compared to those with dementia.
For a patient with communication and swallowing disorders secondary to acquired immunodeficiency syndrome (AIDS), a speech-language pathologist will most appropriately
A.serve only as a consultant to others who are directly involved in the patient's care
B.provide treatment on a monthly basis
C.provide treatment only as prescribed by the patient's physician
D.provide treatment in consultation with the patient's primary-care physician or medical team
Option (D) is correct. Treatment in consultation with the patient's primary-care physician or medical team would provide the information needed to determine the best management of the patient.
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
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.
A 60-year-old man says that he has "trouble thinking of names and words" and that it is interfering with his job performance. The problem began three months ago after he had a minor cerebrovascular accident. He does not report any other problems. His conversation is characterized by some hesitancies, latencies, repetitions, interjections, and self-corrections. On the basis of an interview and the results of an aphasia battery, it is concluded that he has a mild aphasia. The most appropriate course of action is to
A.advise the client to wait for three more months in order to allow spontaneous recovery to take place
B.begin a treatment program designed to decrease dysfluencies in his speech
C.offer a treatment program designed to improve word-retrieval skills
D.encourage the client to increase his reading of information related to his profession in order to facilitate recall of professional terminology
Option (C) is correct. The client's language reflects the word-finding difficulties of an individual with aphasia. Treatment to remediate his difficulties is appropriate.
Which of the following is an accurate statement about whispered speech?
A.It is produced by approximating the arytenoid cartilages so that their medial surfaces are in direct contact.
B.It is composed largely of aperiodic sounds.
C.Spectrographic analysis of it reveals no discernible formants for the vowels.
D.Most people can produce longer utterances per breath using it than they can using conventional phonation.
Option (B) is correct. Whispered speech is composed largely of aperiodic sounds, as the vocal folds do not vibrate while whispering is taking place.
Which of the following is a typical symptom of cerebellar involvement?
A.Overshooting or undershooting an intended target
B.Rigidity during voluntary motions
C.Spasticity during involuntary action
D.Word-finding difficulty
Option (A) is correct. The overshooting or undershooting of an intended target is typical of individuals with deficits related to a lesion of the cerebellum.
Intervention from an SLP for a nursing-home resident who is in a late stage of progressive dementia will most effectively focus on
A.conversational intelligibility
B.recall of salient vocabulary words
C.comprehension of social discourse
D.assisting in communication routines
Option (D) is correct. Intervention from an SLP for a nursing-home resident in a late stage of progressive dementia would most effectively focus on assisting the resident with daily communication functions.
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.
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.
Ms. Helene, a 60-year-old woman with a suspected neurological disorder, is referred for speech-language evaluation. She achieves a score of 35/50 on a measure of confrontation object-naming ability. This score is below norms established for individuals of her age and educational level. Based on these results alone, which of the following statements can most reliably be made about Ms. Helene's disorder?
A.She has anomic aphasia, which might or might not be associated with other language deficits.
B.She has aphasia, but the type of aphasia cannot be specified on the basis of this test score alone.
C.She does not have aphasia but probably does have a memory disturbance.
D.She has difficulty with naming, but the precise nature of the deficit cannot be determined on the basis of this test score alone.
Option (D) is correct. Ms. Helene has a suspected neurological disorder and she achieves a score that is below the norms for individuals her age. Given this information alone, the most that can be said is that she has difficulty with naming; the precise nature of her deficit cannot be determined.
An otolaryngologist has referred a 45-year-old man for voice treatment following medialization thyroplasty for a paralyzed vocal fold. Which of the following is the most appropriate therapeutic strategy for the SLP to use?
A.Assisting the patient to produce a soft glottal attack
B.Digitally manipulation of the patient's neck to reduce strap-muscle tension
C.Assisting the patient to produce a hard glottal attack
D.Employing techniques aimed at increasing airflow
Option (C) is correct. Medialization thyroplasty moves the paralyzed vocal fold closer to the mid-glottis to allow better compensation by the unaffected fold. Only the production of a hard glottal attack addresses the compensatory behavior.
To provide greater independence for a client who has a brain injury and is in a late stage of speech-language treatment, which of the following techniques is most appropriate?
A.Increasing memory-retention span
B.Using word-repetition drills
C.Teaching compensatory strategies
D.Training visual-perceptual skills
Option (C) is correct. Functional independence is a main goal for a client shortly before dismissal from treatment. It can be achieved by teaching compensatory strategies to minimize any remaining deficits.
In the treatment of acute Wernicke's aphasia, the initial focus should be on
A.encouraging self-monitoring of the adequacy of verbal output
B.increasing the rate of speech
C.improving the client's ability to elaborate verbally
D.increasing the complexity of sentence structures
Option (A) is correct. Wernicke's aphasia results in deficits related to the ability to recognize the adequacy of one's verbal production.