SLP 476 Study Questions Exam 2 Part two

81. For a symptomatic adult vocal-fold hemangioma, which procedure is the treatment of choice?

Answer: A. Microlaryngoscopic carbon dioxide laser excision. Why: Microlaryngoscopic carbon dioxide laser excision is the treatment of choice for symptomatic adult vocal-fold hemangioma.

82. True or False: A patient's report that relatives discourage voice behavior changes is most useful for identifying what caused the disorder; its relevance to adherence is secondary.

Answer: False. Correct statement: A report of limited family support may be relevant to maintaining behavior changes, but it does not establish what caused the voice disorder. Why: Family reactions may inform support for behavior change; they do not show what caused the voice disorder.

83. Name two pathways by which diabetes could affect vocal effort or quality, and explain why these effects should not be treated as inevitable in every patient.

Answer: Possible pathways include dry mouth, respiratory or muscle effects that alter airflow, and diabetic myopathy or neuropathy affecting muscles and nerves. These are possible mechanisms; evidence is mixed, and they should not be treated as inevitable or diagnostic for an individual. Why: Diabetes may affect voice through several pathways, but mechanisms and acoustic effects are not inevitable; evidence includes mixed findings.

84. A patient with acute laryngeal symptoms develops dyspnea, audible stridor, and drooling. Which response best reflects the significance of this combination?

Answer: C. Arrange urgent medical evaluation because the symptoms may signal airway compromise. Why: Dyspnea, stridor, and drooling can indicate airway compromise and require urgent medical evaluation.

85. True or False: When a patient and family member give different accounts of vocal strain, the family member's report should be treated as more objective, while the patient's report is recorded separately.

Answer: False. Correct statement: Record and clarify both reports, including the situations and communication effects each person describes; neither report automatically replaces the other. Why: Patient and observer reports offer complementary perspectives; neither should automatically be treated as more objective.

86. True or False: If a patient looks down and clenches the jaw while phonating with strain, those observations are enough to document anxiety-related muscle tension dysphonia.

Answer: False. Correct statement: Document the observable actions, such as looking down or clenching the jaw, and keep interpretation separate from the observation. Why: Observed behavior should be documented without inferring intent, emotional state, or diagnosis from that behavior alone.

87. Congenital laryngeal webs most commonly develop at the ______ level of the vocal folds.

Answer: Anterior. Why: Congenital laryngeal webs most commonly occur at the anterior vocal-fold level.

88. A clinician plans a phonoscopic examination and wants to document voice across ranges, modes, contexts, and durations. Which set of observations is most complete?

Answer: B. Fundamental-frequency and intensity ranges, phonatory modes, phonetic contexts, and voicing tasks of variable duration. Why: The examination can sample fundamental-frequency and intensity ranges, phonatory modes, phonetic contexts, and voicing tasks of varying duration.

89. A child with RRP develops new inspiratory stridor in addition to dysphonia. Which complication makes it important to assess more than voice quality?

Answer: C. Papillomas can obstruct airflow and cause respiratory symptoms, so airway status matters in addition to voice. Why: Papillomas can obstruct airflow and cause respiratory symptoms, so airway status matters in addition to voice.

90. Reduced estrogen at menopause is linked to what vocal-fold tissue change, and what direction of habitual pitch change may follow? State the possible mechanism without treating the effect as inevitable.

Answer: Reduced estrogen may contribute to vocal-fold atrophy, which can lower habitual pitch. This is a possible contribution, not an inevitable outcome for every person. Why: Reduced estrogen may contribute to vocal-fold atrophy and lower habitual pitch, but individual outcomes vary.

91. True or False: Menopausal voice changes may take several years after menopause begins to become noticeable; a delayed onset alone does not exclude a hormonal contribution.

Answer: True. Why: Voice changes may become noticeable years after menopause begins, so delayed onset alone does not rule out a hormonal contribution.

92. A patient says that an earlier course of voice therapy did not help. What information about that experience should be gathered before interpreting the prior outcome, and how could it inform the current case history?

Answer: Ask which approaches were used, what the patient experienced, and what changed or did not change. Those details help the clinician understand the prior outcome and shape a relevant current evaluation. Why: Reviewing prior approaches and outcomes avoids assumptions about adherence or treating the prior report alone as a diagnosis.

93. Endocrine conditions can affect voice through different physiological mechanisms. Which physiological change is associated with hypothyroidism?

Answer: D. Hypothyroidism may involve mucopolysaccharide accumulation in the lamina propria and cricothyroid muscle edema or weakness. Why: Hypothyroidism may involve mucopolysaccharide accumulation in the lamina propria and edema or weakness of the cricothyroid muscle, among other possible laryngeal effects.

94. An adult with acute laryngitis asks whether antibiotics routinely improve voice recovery. Summarize the evidence and name two findings or conditions that may prompt consideration of antibiotic treatment.

Answer: The Cochrane review of two trials involving 206 adults found no benefit in objective voice scores at one and two weeks from routine antibiotic treatment. Signs that prompt consideration include persistent fever for more than 48 hours, purulent sputum, membrane formation, or associated distant disease; any two are sufficient. Why: Routine antibiotics have not shown objective voice-score benefit in the cited adult trials. Persistent fever, purulent sputum, membrane formation, or associated distant disease may prompt consideration of treatment.

95. Vocal fold polyps and nodules lie at different depths within the fold cover. Which relative-depth relationship is described?

Answer: C. A polyp is thought to lie slightly deeper within the superficial lamina propria than a nodule. Why: Both lesions lie in the superficial lamina propria, but a polyp is thought to lie slightly deeper than a nodule.

96. Which clinical pattern is most characteristic of Grade III or IV subglottic stenosis?

Answer: E. Marked narrowing may present with stridor or tracheal dependence and may require intervention. Why: Grades III and IV involve the greatest narrowing and may be associated with serious airway findings, including stridor or tracheal dependence, and need for intervention.

97. After repeated surgical management of RRP, a patient's laryngeal mechanics remain altered. Name two voice-therapy targets that may help the person use the available voice, and explain the functional aim of each.

Answer: Targets include respiratory control, such as voicing with larger lung volumes, and work on pitch or loudness. These approaches aim to improve functional voice use with the altered mechanism, not to remove papillomas or restore anatomy by therapy alone. Why: Respiratory control and pitch and loudness work can help a person use the available voice when laryngeal mechanics are altered.

98. True or False: A clinic sample may not reflect voice use under a patient's usual demands; observing the relevant setting can add context, but should be interpreted with the rest of the assessment.

Answer: True. Why: A clinic sample may not represent voice use in settings such as a classroom or playground; contextual observation adds information when interpreted with the rest of the assessment.

99. Several members of a patient's family use similarly rough, effortful voices. What is the most defensible reason to ask about this pattern during the case history?

Answer: D. It may point to shared voice-use patterns or a family history worth exploring, but does not establish cause. Why: Family history and shared voice-use patterns are useful context to explore, but neither proves a genetic cause or replaces evaluation of the patient.

100. A patient with reduced visual acuity is asked to use a visual feedback display during an evaluation. Which additional difficulty may be relevant?

Answer: A. Reduced visual access may make the display harder to use and may affect accurate electrolarynx placement. Why: Reduced visual acuity may limit access to feedback displays and affect accurate electrolarynx placement.

101. A clinician sees one discrete nodule-like lesion in one patient and three smaller lesions in another. What variation in nodule number, size, or location is possible, and what should the clinician avoid assuming from the classic bilateral pattern?

Answer: Nodules may range from one to two, three, or even four in number, and can vary in size and location. The clinician should not assume that every nodule presentation is a symmetric pair, while recognizing that the classic bilateral midmembranous pattern remains generally accurate. Why: Nodules can vary in number, size, and location. Bilateral midmembranous lesions are the classic pattern, not a requirement.

102. An older adult has changes in pitch, vocal volume, and voice quality. Name two processes that may contribute to presbyphonia and explain why the pattern is considered multifactorial.

Answer: Contributors include hormonal changes, muscle atrophy, and reduced lung capacity. Multiple age-related changes can affect pitch, volume, and quality, so presbyphonia is not explained by one factor alone. Why: Hormonal, muscular, and respiratory changes may all contribute, so presbyphonia is not explained by a single factor.

103. The human papillomavirus types most commonly associated with recurrent respiratory papillomatosis are ______ and ______.

Answer: HPV 6 and HPV 11. Why: HPV types 6 and 11 are the types most commonly associated with RRP.

0-50% narrowing

Answer: A. Grade I Why: The Myer-Cotton grades correspond to the stated percentage ranges: Grade I, 0-50%; Grade II, 51-70%; Grade III, 71-99%; Grade IV, no detectable lumen.

51-70% narrowing

Answer: B. Grade II Why: The Myer-Cotton grades correspond to the stated percentage ranges: Grade I, 0-50%; Grade II, 51-70%; Grade III, 71-99%; Grade IV, no detectable lumen.

71-99% narrowing

Answer: C. Grade III Why: The Myer-Cotton grades correspond to the stated percentage ranges: Grade I, 0-50%; Grade II, 51-70%; Grade III, 71-99%; Grade IV, no detectable lumen.

100% narrowing / no detectable lumen

Answer: D. Grade IV Why: The Myer-Cotton grades correspond to the stated percentage ranges: Grade I, 0-50%; Grade II, 51-70%; Grade III, 71-99%; Grade IV, no detectable lumen.

105. A patient with hearing loss does not notice a voice change that clinicians can hear. Which interpretation is most appropriate?

Answer: B. Hearing loss may affect auditory self-monitoring and awareness; clarify the patient's perception alongside clinician observations. Why: Hearing acuity can affect self-monitoring and awareness of voice changes, but that does not make a patient's report meaningless.

Alters anatomy at the gastroesophageal junction.

Answer: A. Hiatal hernia Why: Hiatal hernia alters anatomy at the gastroesophageal junction, obesity increases intra-abdominal pressure, and delayed gastric emptying prolongs retention; the fourth option is unused.

Increases intra-abdominal pressure.

Answer: B. Obesity Why: Hiatal hernia alters anatomy at the gastroesophageal junction, obesity increases intra-abdominal pressure, and delayed gastric emptying prolongs retention; the fourth option is unused.

Prolongs gastric retention before contents move onward.

Answer: C. Delayed gastric emptying Why: Hiatal hernia alters anatomy at the gastroesophageal junction, obesity increases intra-abdominal pressure, and delayed gastric emptying prolongs retention; the fourth option is unused.

107. A family hears that juvenile-onset recurrent respiratory papillomatosis often becomes less active around puberty and assumes it is then permanently gone. State the typical course, including the approximate proportion that may persist beyond puberty, and explain why permanent resolution should not be assumed.

Answer: Recurrence often decreases around puberty, but approximately 20% of cases may persist beyond puberty. The decrease is a common course, not a guarantee of permanent resolution. Why: Recurrence often decreases around puberty, but about 20% of juvenile-onset cases may persist beyond puberty; reduced activity does not guarantee resolution.

108. Refluxate is already in the esophagus and may move upward toward the throat. Which upper-esophageal-sphincter function normally helps limit that extension?

Answer: B. It helps act as a barrier against refluxate entering the pharynx and larynx. Why: The upper esophageal sphincter helps limit refluxate from extending out of the esophagus into the pharynx and larynx.

109. True or False: Calibrated equipment and standardized recording conditions strengthen measurement validity; once these requirements are met, instrumental results can be interpreted independently of clinical impressions and auditory-perceptual findings.

Answer: False. Correct statement: Interpret instrumental data alongside clinical impressions and auditory-perceptual judgments, even when calibration and recording procedures are standardized. Why: Instrumental measures benefit from calibration and standardized recording, but their interpretation still depends on clinical impressions and auditory-perceptual findings.

110. True or False: Laryngeal hemangiomas may range from bright red to deep purple, and color variation reflects lesion depth and vessel type; therefore, color alone identifies the lesion's precise anatomic site.

Answer: False. Correct statement: Hemangioma color may range from bright red to deep purple and can vary with lesion depth and blood-vessel type; color alone does not identify the precise anatomic site. Why: Color variation reflects lesion depth and vessel type; it does not identify a precise anatomic site by itself.

111. Two people develop a vocal fold lesion: one after a single forceful vocal event and the other after prolonged, repeated irritation. Contrast the lesion more typically associated with each history.

Answer: A single traumatic event is more characteristic of a polyp; prolonged, repeated phonotrauma is more characteristic of nodules. Why: A single traumatic event is more characteristic of a polyp, whereas nodules more often follow repeated phonotrauma.

112. Stridor is unusual with a laryngeal web. In the exception, where is the web located?

Answer: D. In the posterior interarytenoid region. Why: Stridor is unusual with laryngeal webs, but a posterior interarytenoid web is an exception.

113. Contrast the voice effects of growth-hormone excess and deficiency. Include the tissue or vocal-tract effect and expected pitch or voice-quality direction for each.

Answer: Excess growth hormone can thicken laryngeal tissues, lower pitch, and may contribute to arytenoid cartilage dislocation or altered voice quality. Deficiency can limit oral and pharyngeal cavity growth, contributing to higher pitch and a prepubertal voice quality. Why: Excess growth hormone can thicken laryngeal tissue and lower pitch, while deficiency can limit oral and pharyngeal cavity growth and contribute to higher, prepubertal voice quality.

114. A patient with sulcus vocalis recalls no single injury. Describe two possible etiologies and name two factors that may contribute to the acquired form.

Answer: Sulcus vocalis may be congenital or acquired. Vocal abuse/phonotrauma and laryngopharyngeal reflux may contribute to some acquired cases. Why: Sulcus vocalis may be congenital or acquired, and possible contributors to acquired cases do not establish the cause in a particular person.

115. The pediatric voice-related quality-of-life measure used in voice assessment is ______.

Answer: Pediatric Voice-Related Quality of Life (PVRQOL). Why: PVRQOL is a pediatric voice-related quality-of-life measure.

116. A patient with hyperthyroidism reports vocal fatigue, but examination finds no focal vocal-fold lesion. What systemic mechanism could affect voice, and why does the absence of a focal lesion not rule out this contribution?

Answer: Hyperthyroidism may involve muscle weakness that can impair laryngeal muscle function and affect voice parameters. A systemic effect on muscle function does not require a focal vocal-fold lesion. Why: Systemic muscle weakness can affect laryngeal muscle function without a focal lesion; this is a possible mechanism, not a certain cause.

117. During laryngoscopy, a clinician sees an irregularity along the vocal fold's medial edge. Which features should be described as part of this observation?

Answer: A. The medial free edge's smoothness and straightness, and whether a mass or other pathology is present. Why: Medial-edge observation includes smoothness, straightness, and the presence of masses or other pathology.

118. An infant with laryngomalacia has inspiratory stridor and feeding or swallowing difficulty. What co-occurring condition can contribute to the feeding or swallowing symptoms, and why should it be considered in addition to the airway findings?

Answer: Concomitant gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux disease (LPRD) may contribute to feeding- and swallowing-related symptoms. Reflux should therefore be considered as a co-occurring contributor rather than attributing all feeding difficulty to the airway findings alone. Why: GERD or LPRD can contribute to feeding and swallowing symptoms in severe laryngomalacia, so airway findings may not explain the full presentation.

119. The ______-to-noise ratio (HNR) compares harmonic energy with noise; a lower ratio indicates relatively more ______ in the signal.

Answer: Harmonic; noise. Why: HNR compares harmonic energy with noise; a lower ratio indicates relatively more noise and does not by itself diagnose a lesion.

120. Fill in the reported estimates: laryngomalacia represents about ______% of congenital laryngeal anomalies and about ______% of congenital stridor cases.

Answer: 75% and 60%. Why: The estimates use different denominators: congenital laryngeal anomalies and congenital stridor cases.

121. An examiner is rating phase symmetry during vocal-fold vibration. Which relationship does this parameter address?

Answer: D. The degree to which the two folds abduct and adduct at the same time. Why: Phase symmetry concerns whether both folds abduct and adduct at the same time; timing similarity across successive cycles is a different parameter.

122. What tradeoff does direct laryngoscopy offer compared with indirect laryngoscopy?

Answer: C. It offers unparalleled detail but is invasive and has limited functionality during speech. Why: Direct laryngoscopy offers exceptional detail, but it is invasive and limits functional observation during speech.

123. A patient with sulcus vocalis has not improved sufficiently with conservative management. Name two surgical approaches and state their intended functional purposes.

Answer: Options include microflap surgery, fat injection, or another augmentation procedure. These approaches may be considered to improve glottic closure and vocal-fold vibration by filling the sulcus or creating a smoother edge. Why: The response names at least two listed approaches and relates them to the goal of improving closure or vibration.

124. A speaker with reduced vision misjudges how far away a listener is and changes vocal intensity during conversation. Which explanation best accounts for this change?

Answer: E. Visual access may affect distance judgment and how the speaker adjusts voice toward the listener. Why: Visual access can influence distance judgment and how a speaker adjusts voice intensity toward a listener.

125. Vocal-fold nodules show different prevalence patterns before puberty and in adolescence or adulthood. State both patterns, then explain why this population trend should inform a case history without determining an individual diagnosis.

Answer: The reported pattern is that nodules are more common in boys before puberty and more prevalent among females in adolescence and adulthood. It is a population pattern to consider alongside the individual presentation, not a diagnosis by itself. Why: Nodules are reported more often in boys before puberty and more often among females in adolescence and adulthood; this population pattern cannot diagnose an individual.

126. Refluxate is moving from the stomach toward the esophagus. Which lower-esophageal-sphincter function normally helps limit this first step?

Answer: A. It forms a barrier that helps restrict stomach contents from entering the esophagus. Why: The lower esophageal sphincter forms a barrier between stomach and esophagus; weakness or inappropriate relaxation can permit gastric contents to enter the esophagus.

Trained and untrained listeners judge the voice extremely abnormal; communication is consistently affected, and phonation may be mostly absent or very effortful.

Answer: C. Severe Why: The labels reflect both perceptual abnormality and its effect on communication: severe is consistently disruptive, mild has little impact, and moderate falls between those patterns.

A trained listener detects an abnormality, but an untrained listener may find the voice unusual yet still within a typical range; communication impact is slight.

Answer: A. Mild Why: The labels reflect both perceptual abnormality and its effect on communication: severe is consistently disruptive, mild has little impact, and moderate falls between those patterns.

Trained and untrained listeners hear a clear abnormality that is distracting at times and affects communication in some circumstances.

Answer: B. Moderate Why: The labels reflect both perceptual abnormality and its effect on communication: severe is consistently disruptive, mild has little impact, and moderate falls between those patterns.

128. A patient's cultural and linguistic background differs from the clinician's. Explain how this information should inform the voice case history and name one conclusion it cannot establish by itself.

Answer: It provides context for interpreting the patient's voice use and communication patterns. It does not by itself determine laryngeal anatomy or establish a specific voice disorder. Why: Cultural and linguistic context informs interpretation of voice use and case history; it does not establish a disorder or cause by itself.

129. A patient's voice is too irregular to sustain steady pitch and loudness on a long vowel, but connected speech is available. Which acoustic analysis is most appropriate?

Answer: A. Use cepstral peak prominence for continuous speech; jitter and shimmer are generally more useful with stable, sustained phonation. Why: Cepstral peak prominence can be applied to continuous speech, whereas jitter and shimmer are more useful when phonation is sufficiently stable.

130. Name all medication groups that may reduce lower-esophageal-sphincter tone. Explain how their use should inform a reflux-focused case history.

Answer: Antihistamines, calcium-channel blockers, and pain relievers. Their use is relevant history to consider as a possible contributor; medication use alone does not diagnose reflux or prove causation. Why: Medication history may identify contributors to reduced LES tone; use alone does not establish reflux or prove causation, and the item does not ask for medication advice.

131. Two infants have laryngomalacia. Which pattern most strongly supports a severe course rather than a mild one?

Answer: B. Persistent stridor with retractions, feeding difficulty, and poor growth. Why: Severe laryngomalacia is associated with persistent stridor, retractions, feeding difficulty, and poor growth; the other patterns lack this combination of red flags.

132. A singer has abrupt, major voice loss immediately after a forceful vocal event; vocal fold hemorrhage is a concern. Which response is most appropriate?

Answer: D. Stop strenuous voice use and arrange prompt medical evaluation. Why: Sudden major voice loss after vocal trauma can signal vocal-fold hemorrhage, which requires stopping strenuous voice use and prompt medical evaluation.

133. In unilateral vocal-fold paralysis, the immobile fold may rest in a ______ position off midline.

Answer: Paramedian. Why: In unilateral vocal-fold paralysis, the immobile fold may rest in a paramedian position off midline.

134. Which combination of factors is associated with adult laryngeal hemangiomas?

Answer: B. Smoking, vocal abuse, and laryngeal intubation trauma. Why: Smoking, vocal abuse, and laryngeal intubation trauma are associated with adult laryngeal hemangiomas.

135. Chronic laryngitis is defined as symptoms lasting at least ______ weeks.

Answer: 3 weeks. Why: Chronic laryngitis is defined by symptoms lasting three weeks or more.

136. True or False: Recurrent respiratory papillomatosis is usually benign, but malignant transformation has been reported; this is a possible complication rather than the expected course of every case.

Answer: True. Why: RRP is usually benign, although malignant transformation has been reported as a possible complication rather than an expected outcome.

137. True or False: Compared with children diagnosed after age 3, those diagnosed at age 3 or younger are reported to be more likely to need more than four surgeries per year and to have multiple anatomic sites involved; this is an association, not a certainty for an individual child.

Answer: True. Why: Younger age at diagnosis is associated with more frequent surgeries and multiple anatomic sites, but this group-level association does not predict an individual course.

138. As vocal fold nodules become larger, what two voice effects may intensify as glottic closure becomes less complete? ______ and ______.

Answer: Breathiness; air wastage. Why: Larger nodules can reduce glottic closure, increasing breathiness and air wastage.

139. Fill in the three cause categories of chronic laryngitis: allergic cause ______; reflux-related cause ______; systemic cause ______.

Answer: Allergies; laryngopharyngeal reflux disease (LPRD); autoimmune disorders. Why: Common categories include allergic causes, reflux-related disease, and systemic causes such as autoimmune disorders.

140. During microflap removal of a vocal fold polyp, which surgical priority best explains preserving the superficial lamina propria and free edge?

Answer: E. Preserve the pliable vibratory cover and limit disruption of the glottal margin. Why: Microflap surgery removes the lesion while preserving as much pliable superficial lamina propria as possible and minimizing disturbance of the glottal margin.

The patient sustains /a/.

Answer: A. Sustained-vowel sample Why: CAPE-V samples sustained vowels, specified sentences, and spontaneous speech about the patient's voice problem.

The patient produces the specified CAPE-V sentences.

Answer: B. Standardized connected-speech sample Why: CAPE-V samples sustained vowels, specified sentences, and spontaneous speech about the patient's voice problem.

The patient speaks spontaneously about the voice problem.

Answer: C. Spontaneous connected-speech sample Why: CAPE-V samples sustained vowels, specified sentences, and spontaneous speech about the patient's voice problem.

142. A patient has a unilateral vocal fold polyp and a smaller lesion directly opposite it at the contact point. Which explanation best accounts for the smaller lesion?

Answer: E. A reactive lesion may have formed on the opposite fold because of contact with the polyp. Why: Repeated contact with a polyp may produce a reactive lesion on the opposing fold at the contact point.

143. A patient describes the voice as "tired and unreliable." Give two follow-up questions that would clarify the patient's perceived problem and understanding of its cause, and state why the patient's wording alone is not a diagnosis.

Answer: Ask what "tired and unreliable" means to the patient and when or in what situations it occurs; ask what the patient thinks may be causing it. The description is valuable case-history information, but it does not by itself establish a medical diagnosis. Why: Follow-up questions clarify the patient's experience and understanding; descriptive wording alone is not a diagnosis.

144. A rating form includes a parameter called "nonvibrating portion." Which finding belongs under this parameter?

Answer: E. Any portion of the vocal fold that does not participate in vibration. Why: Nonvibrating portion refers to any segment of a vocal fold that does not participate in vibration.

145. In which age group is acquired subglottic stenosis the most common abnormality necessitating tracheotomy, and how does its prognosis compare with congenital stenosis?

Answer: In infants younger than one year, acquired subglottic stenosis is the most common abnormality necessitating tracheotomy. Its prognosis is significantly poorer than that of congenital stenosis. Why: Acquired subglottic stenosis is especially consequential in infants younger than one year and has a poorer prognosis than congenital stenosis.

146. Two patients receive similar auditory-perceptual severity ratings, but one has medical-history findings that may indicate urgency. How should these different types of information be interpreted together?

Answer: A. Consider auditory ratings together with medical history when judging urgency; similar perceptual ratings can occur with different risk contexts. Why: Auditory-perceptual ratings capture voice severity, while medical history adds information relevant to urgency; they answer related but distinct questions.

147. Which set best describes four clinical uses of instrumental measures?

Answer: E. Detect a voice problem, assess its severity or progression, identify its differential source, and support behavioral treatment, biofeedback, or patient education. Why: Instrumental measures can help detect a voice problem, assess severity or change, identify differential sources, and support treatment, biofeedback, or education.

148. About ______ of children with laryngeal webs have an associated respiratory-tract anomaly; the most common associated anomaly is ______.

Answer: About one third; subglottic stenosis. Why: About one third of children with laryngeal webs have respiratory-tract anomalies; subglottic stenosis is the most common associated anomaly.

149. What two qualifications should a clinician have to use indirect laryngoscopy to assess voice production and vocal function?

Answer: Expertise in voice disorders and specialized training in laryngoscopy. These qualifications support use of the procedure for assessing voice production and vocal function. Why: The clinician should have expertise in voice disorders and specialized training in laryngoscopy.

150. A patient reports hearing difficulty and repeatedly asks for instructions to be repeated. When should hearing screening be considered?

Answer: D. When the patient reports difficulty or the clinician observes behavior suggesting possible hearing loss. Why: Reported or observed signs of possible hearing difficulty can warrant consideration of screening.

151. True or False: For an infant with mild laryngomalacia, typical feeding, and expected growth, observation can be reasonable because many children improve as the larynx grows and outgrow the condition by about age 2.

Answer: True. Why: Many mild cases improve as the larynx grows, often by around age 2, although the course varies.

152. A young child with obstructive RRP has a tracheostomy. The family worries that communication development must wait until airway treatment is complete. Which SLP priority is most appropriate?

Answer: C. Support functional communication and language now; consider finger occlusion or a one-way valve when medically appropriate. Why: Communication and language support remain SLP priorities. Voicing options such as tracheostomy occlusion or a one-way valve require medical approval.

153. Extended GRBAS adds ______ perceptual parameters to the standard GRBAS scale, aiming for a more complete assessment, particularly after ______.

Answer: Eight; phonosurgery. Why: Extended GRBAS adds eight perceptual parameters and can provide a fuller voice assessment, particularly after phonosurgery.

154. JORRP is commonly diagnosed between ages 2 and 4, with an average delay of about one year from symptom onset to diagnosis. If a child is diagnosed at age 3, what symptom-onset age would that average suggest, and why cannot the diagnosis date establish that child's true onset?

Answer: The reported average suggests symptoms may have begun around age 2. This is only a population average; an individual child's onset should be established from the history and records rather than inferred from the diagnosis date alone. Why: An average one-year diagnostic delay would suggest onset around age 2 for a child diagnosed at 3, but an average cannot establish an individual's actual onset.

155. A patient is unsure about changing daily voice behaviors. Which clinician response best reflects motivational interviewing during the voice case history?

Answer: E. Use open questions to explore the patient's reasons for and against change and what might make change worthwhile. Why: Motivational interviewing uses open questions to elicit the patient's own reasons for and against change in a nonthreatening, autonomy-supportive manner.

156. Phonoscopic examination may include observation of ______ voicing alongside respiratory behavior and speech tasks.

Answer: Vegetative. Why: Phonoscopic examination may include vegetative voicing along with respiratory behavior and speech tasks.

157. Once refluxate has entered the esophagus, how can impaired esophageal motility or clearance increase the risk of proximal extension? Explain the link between retention time and exposure.

Answer: Ineffective or slow clearance leaves refluxed material in the esophagus longer. This prolongs exposure and increases the opportunity for refluxate to move upward toward the pharynx and larynx. Why: Slow esophageal clearance prolongs exposure to refluxate and increases the opportunity for proximal movement.

158. A child has had surgical repair of esophageal atresia with tracheoesophageal fistula but continues to have respiratory problems. Name one persistent problem that may occur.

Answer: Examples include tracheomalacia or recurrent respiratory infections. Why: Persistent tracheomalacia or recurrent respiratory infections may occur after repair.

159. A patient with hearing loss has reduced access to auditory feedback. Which combination of production domains may be affected?

Answer: C. Respiration, phonation, resonance, and prosody. Why: Auditory feedback contributes to regulation across respiration, phonation, resonance, and prosody.

160. An infant's subglottic vascular lesion grows during early infancy and then begins to regress without intervention. Which course best matches the typical pattern of infantile laryngeal hemangiomas?

Answer: B. It typically has a growth phase during the first year followed by spontaneous regression. Why: Infantile laryngeal hemangiomas typically grow during the first year and may then regress spontaneously.