Dysphasia
During videofluoroscopic evaluation of an adult patient, the SLP notices material in both pyriform sinuses after the patient swallows. Upon review, the SLP sees that both pyriform sinuses clear during the pharyngeal swallow but then refill quickly as the structures return to rest. Which of the following statements best explains this observation?
A.Pharyngeal stripping was not adequate to fully clear the pyriform sinuses, so there was material in the pyriform sinuses after each swallow.
B.The patient had small pharyngeal pouches (pharyngoceles) that filled with barium during the swallow and then emptied into the pyriform sinuses after each swallow.
C.Hyolaryngeal elevation was not sufficient, leaving material in the pyriform sinuses after each swallow.
D.The patient had a tracheoesophageal fistula, and contrast was deposited in the pyriform sinuses after each swallow.
Option (B) is correct. Pharyngoceles emptying into the sinuses after each swallow could be diagnosed by analyzing slow-motion videofluoroscopic images.
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 (VNeST) to increase word retrieval in untrained discourse
C.Engaging the patient in semantic feature analysis (SFA) to teach her self-cuing techniques and aid with word retrieval
D.Having the patient use melodic intonation treatment (MIT) to increase fluency of commonly uttered phrases
Option (B) is correct. The patient's language impairment is related to word-retrieval impairments that affect the ability to produce complete utterances. VNeST has been shown to increase word-retrieval abilities in untrained tasks, which could potentially aid in various functional scenarios.
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 (VNeST) to increase word retrieval in untrained discourse
C.Engaging the patient in semantic feature analysis (SFA) to teach her self-cuing techniques and aid with word retrieval
D.Having the patient use melodic intonation treatment (MIT) to increase fluency of commonly uttered phrasesOption (B) is correct. The patient's language impairment is related to word-retrieval impairments that affect the ability to produce complete utterances. VNeST has been shown to increase word-retrieval abilities in untrained tasks, which could potentially aid in various functional scenarios.Ms. 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 Ms. Malone's frustration at her limitations, her family requests that she be evaluated for an augmentative and alternative communication (AAC) device.
During Ms. Malone's assessment, the SLP determines that she could potentially benefit from AAC services and initiates discussion of intervention goals. Once goals are established and Ms. Malone has her device, she begins to learn how to operate her device to produce common spoken messages. Over the course of intervention, Ms. Malone is ultimately able to produce novel sentences.
Option (B) is correct. The success of AAC intervention success is largely dependent upon the support of people close to the patient.
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
Option (C) is correct. The intermediate and deep layers are considered transitional because of where they are located anatomically.
Match each treatment strategy with the type of dysarthria for which the strategy is most effective.
Spastic, Ataxic, Flaccid, Hyperkinetic
A.Using rhythmic or metered cueing
B.Practicing relaxation exercises
C.Implementing sensory tricks
D.Performing pushing-pulling exercises
When an SLP assesses the communication skills of a bilingual child, it is important for the SLP 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 disorderOption (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.Match each treatment strategy with the type of dysarthria for which the strategy is most effective.
Spastic, Ataxic, Flaccid, Hyperkinetic
A.Using rhythmic or metered cueing
B.Practicing relaxation exercises
C.Implementing sensory tricks
D.Performing pushing-pulling exercisesThe correct matches are Spastic - Practicing relaxation exercises, Ataxic - Using rhythmic or metered cueing, Flaccid - Performing pushing-pulling exercises, and Hyperkinetic - Implementing sensory tricks. People with spastic dysarthria need to practice relaxation exercises to reduce muscle tone and increase flexibility. Those with ataxic dysarthria benefit from rhythmic or metered cueing due to inability to adequately pace their speech production. Flaccid dysarthria is effectively treated with pushing and pulling exercises to help strengthen muscles and increase tone. 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.
Which of the following risk factors has the highest independent predictive value for pneumonia in elderly people with dysphagia?
A.Drinking more than six glasses of water per day
B.Experiencing aspiration of saliva at night
C.Depending on others for feeding and oral care
D.Having a history of acute hemispheric stroke more than one year ago
Option (C) is correct. The landmark study done by Susan Langmore, et. al and others, showed that dependence on others for feeding and oral care was most highly correlated with pneumonia.
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
PLAYMatchGravityTo best apply the multiple oppositions method for phonological errors when treating a child, an SLP 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 frontingOption (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.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 analysisOption (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.
Ms. 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 Ms. Malone's frustration at her limitations, her family requests that she be evaluated for an augmentative and alternative communication (AAC) device.
During Ms. Malone's assessment, the SLP determines that she could potentially benefit from AAC services and initiates discussion of intervention goals. Once goals are established and Ms. Malone has her device, she begins to learn how to operate her device to produce common spoken messages. Over the course of intervention, Ms. Malone is ultimately able to produce novel sentences.
Which of the following statements reflects the best strategy for the development of Ms. Malone's intervention goals?
A.The SLP 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 SLP.
D.A number of individuals including, the patient, SLP, and close family members, should collaborate to set goals.
Option (D) is correct. AAC intervention works best when regular communication partners are involved along with the patient and SLP.
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
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.
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
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.
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.
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.
An SLP plans cognitive treatment for a patient with right-hemisphere disorder due to a stroke. Which of the following patient characteristics is most likely to have an impact on the patient's engagement in treatment and outcomes?
A.Moderate anosognosia for identified deficits
B.Hemiparesis of the left arm and hand
C.Mild word-finding difficulties
D.Moderate expressive aprosodia
Option (A) is correct. Anosognosia is likely to have the greatest impact on treatment engagement and outcomes, because if patients do not acknowledge their impairments, they are not likely to see the need for treatment or to engage meaningfully in it.
Ms. 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 Ms. Malone's frustration at her limitations, her family requests that she be evaluated for an augmentative and alternative communication (AAC) device.
During Ms. Malone's assessment, the SLP determines that she could potentially benefit from AAC services and initiates discussion of intervention goals. Once goals are established and Ms. Malone has her device, she begins to learn how to operate her device to produce common spoken messages. Over the course of intervention, Ms. Malone is ultimately able to produce novel sentences.
Which THREE of the following are additional communication strategies that are valid for Ms. 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 AAC 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
Options (A), (B), and (D) are correct. Option (A) is correct because multimodal strategies augment the entirety of communication. Option (B) is correct because AAC intervention works best when regular communication partners are involved. Option (D) is correct because taking an active role in initiating communication will help Ms. Malone incorporate the AAC intervention into her daily life and result in improved confidence and less frustration.
A 28-year-old classroom teacher complaining of frequent voice loss is seen by an SLPS L P and an otolaryngologist. It is determined the patient's symptoms are linked to significant vocal demands. Which of following recommendations is the most appropriate first step to treat the underlying disorder?
A.Advising the patient to undergo complete voice rest until the nodules improve or resolve
B.Educating the patient on the importance of hydration and behavioral antireflux strategies
C.Recommending voice amplification with resonant voice therapy
D.Training strategies to increase vocal loudness
Option (C) is correct. Voice amplification and voice therapy exercises that alter vibratory impact (like vocal function exercises and resonant voice therapy) have been shown to be more effective courses of treatment in heavy voice users as compared to vocal hygiene strategies or respiratory retraining strategies.
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
Correct Answer: D
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.
PLAYMatchGravityA 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 SLP reviews the patient's responses, records any errors, and then teaches the patient strategies to answer "who" and "what" questions. The SLP makes careful notes about how much assistance the client requires to achieve a correct response. After several sessions, the SLP 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 assessmentOption (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.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
D.Breathy phonation Option (D) is correct. Studies have demonstrated that breathy phonation would indicate possible vocal fold and/or pharyngeal paralysis.
Joe, an 18-year-old male, sustained a severe traumatic brain injury following a motorcycle accident. He was in a coma for approximately four weeks before being transferred to a rehabilitation program. Joe demonstrates severe attention deficits, anomia, disorientation, and poor short-term memory. Which of the following should be the initial target area in the treatment plan?
A.Retraining attention as a discrete cognitive process
B.Using declarative memory as an active learning strategy
C.Using implicit memory as a passive learning strategy
D.Reality orientation training
Option (A) is correct. Retraining attention is the most appropriate initial target area in this situation; all the other responses require attention as a prerequisite.
After an evaluation of a patient's communication needs, an SLP pursues acquisition of a high-tech AAC device. The patient's private health insurance rejects the request, stating that the device is "not medically necessary." The SLP can best advocate for the patient by immediately appealing
A.to the insurance company to determine a lower-technology device that is covered by the payer
B.the denial and providing a review of how the patient's quality of life is impacted by the device
C.the denial and providing data regarding the medical necessity for the device
D. to a member of the state government for coverage of high-tech AAC devices
Option (C) is correct. Appealing the denial and providing the insurance company with data indicating the device is medically necessary in advocacy for the patient is the most direct response to the denial of the claim.
An SLP works at a voice clinic and learns that a patient, who has arrived for an initial voice evaluation, has not received medical evaluation by a laryngologist. Which of the following actions is the best plan for referring the patient to a laryngologist for a medical evaluation?
A.Completing the voice evaluation and referring the patient to a laryngologist for a medical evaluation prior to initiating therapeutic intervention
B.Completing the voice evaluation and treatment plan, as the SLP is not required to obtain medical information from a physician and can diagnose and treat voice disorders without referring the patient
C.Completing the voice evaluation and referring the patient to a laryngologist while initiating therapeutic intervention, knowing that the patient will see the laryngologist soon
D.Deferring the voice evaluation until after the patient has seen a laryngologist for a medical evaluation
Option (A) is correct. When voice evaluation by an SLP occurs before a physician's evaluation, the SLP should defer SLP treatment planning to after the medical evaluation information is received and reviewed.
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
Correct Answer: D
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.
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
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.
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
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.
When assessing the ability of a student with cerebral palsy to access an augmentative and alternative communication device, which of the following physical factors must be evaluated first?
A.Upper extremity range of motion
B.Lower extremity strength
C.Trunk stability and control
D.Fine motor dexterity
Option (C) is correct. Trunk stability will guide the clinician in making an appropriate recommendation for the type of device a client can access as it influences more distal movements.
A 75-year-old patient is referred from a laryngologist with a diagnosis of presbylaryngis/presbyphonia. The patient complains of reduced vocal loudness and increased vocal effort while speaking. Which of the following treatments is most appropriate for the patient?
A.Using sigh phonation with soft glottal attacks
B.Generating vowel sounds with inhalatory phonation
C.Completing voice rest for one week then gradually reintroducing voice use
D.Producing vowel sounds and phrases using high vocal intensity phonation
Option (D) is correct. The patient requires voice building; however, many clinicians approach every dysphonic voice as needing rest or protection. Even a new SLP during the Clinical Fellowship Year seeing voice patients should be aware of this common diagnosis and appropriate treatment for it. The evidence-based treatment is one that includes good quality phonation with high vocal intensity.
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
Correct Answer: D
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.