Quiz 1 - 🧠 SLP Graduate Final Review — Case Scenarios

1. Respiratory Control

Case: A client presents with reduced vocal intensity and reports feeling “out of breath” mid-sentence. During assessment, you note weak inhalation and minimal rib expansion.
Question: Which muscles are likely underactive, and how does this impact phonation?

Weak diaphragm and external intercostals reduce breath support and subglottal pressure, causing low vocal intensity

2. Expiratory Support

Case: During sustained /s/ and /z/ tasks, airflow drops quickly and voice fades out.
Question: What respiratory pattern or muscle weakness could cause this, and what would therapy target?

Weak internal intercostals or abdominals cause poor breath control; therapy targets sustained exhalation and breath support

3. Airway Protection

Case: A patient with a stroke shows aspiration on thin liquids. FEES shows incomplete epiglottic inversion.
Question: Which structure is impaired, and what is its normal function?

Epiglottis is impaired; it normally covers the airway during swallowing to prevent aspiration.

4. Phonation Absence

Case: After thyroid surgery, a client’s voice is breathy and weak, with incomplete VF closure on stroboscopy.
Question: Which nerve is likely damaged and why does this cause these symptoms?

Recurrent laryngeal nerve damage causes VF paralysis and weak, breathy voice.

5. Pitch Range Reduction

Case: A singer reports difficulty raising her pitch but can still speak at normal levels.
Question: Which muscle or nerve is likely affected? CTM SLN

Cricothyroid muscle or superior laryngeal nerve (external branch); they lengthen and tense the VF for higher pitch.

6. Breathiness with High Pitch

Case: During high-pitch attempts, the client produces a strained but breathy voice. Acoustic data show incomplete closure and elevated subglottal pressure.
Question: Explain the physiological mismatch occurring here.

Cricothyroid increases tension for pitch, but weak adduction prevents full closure, causing breathy strain.

7. Aging Voice

Case: An 80-year-old client presents with a shaky, weak, higher-pitched voice. Laryngoscopy shows bowed, thin vocal folds.
Question: What structural and physiological age changes explain this?

Vocal fold atrophy and cartilage stiffening reduce closure and elasticity, causing weak, higher-pitched voice

8. Phonation Quality

Case: A teacher’s voice sounds rough and low after prolonged speaking.
Question: Which vocal fold layer is most affected and why? SLP

The superficial lamina propria (Reinke’s space) — repetitive vibration causes edema or nodules, altering mucosal wave and quality.

9. Voice Onset Control

Case: During /ha/ repetitions, a client has inconsistent onset and glottal fry.
Question: Which laryngeal mechanisms control onset quality?

Balanced subglottal pressure and VF adduction timing control smooth voice onset

10. Pitch–Pressure Interaction

Case: A patient increases pitch but loudness also rises unexpectedly.
Question: Why do pitch and loudness often co-vary physiologically?

Higher pitch requires increased subglottal pressure and medial compression, which naturally increases loudness.

11. Unilateral VF Paralysis

Case: After cardiac surgery, a client’s left vocal fold is immobile and paramedian.
Question: Which nerve’s pathway explains this, and what compensations might occur?

Left RLN loops around the aortic arch and can be damaged; opposite VF may cross midline for partial compensation, causing breathy/hoarse voice.

12. Resonance–Phonation Link

Case: A child presents with hypernasality but normal articulation strength.
Question: Which physiological mechanism is impaired?

Velopharyngeal closure (soft palate elevation) → excessive nasal airflow during speech.

13. Effortful Phonation

Case: During sustained phonation, a client exhibits excessive neck tension and pressed voice.
Question: Which intrinsic and extrinsic muscle behaviors contribute? LCA IA

Overactivation of lateral cricoarytenoids and inter-arytenoids (over-adduction) plus extrinsic strap muscle tension, reducing vibratory flexibility.

14. Mucosal Wave Disruption

Case: Stroboscopy reveals stiff vibration on one VF side after trauma.
Question: Which layer is likely scarred, and how does this affect voice quality?

Damage to superficial lamina propria or BMZ reduces flexibility → harsh, rough, or diplophonic voice.

15. Inspiratory–Phonatory Coordination

Case: A client inhales shallowly and begins phonation immediately with no preparatory pause.
Question: Which respiratory or laryngeal patterns should therapy address?

Inadequate inspiratory support and poor timing between breath and onset; train diaphragmatic breathing and easy onset coordination.