🧩 SLP Anatomy — Concise Scenario Exam

1️⃣ Hypernasal Child After Cleft Repair

Scenario: 10-year-old has hypernasality and nasal air escape. Scope shows poor back-wall movement but normal palate length.
Question: What structure is weak, and what’s the result?

Answer: Weak posterior pharyngeal wall (CN X) → incomplete VP closure → hypernasality & nasal emission.

2️⃣ Fatigue-Based VP Problem

Scenario: 22-year-old with mild TBI sounds normal early in sessions but develops nasal emission when tired.
Question: What type of VP dysfunction is this?

Answer: Velopharyngeal incompetence — neuromotor fatigue of the levator veli palatini.

3️⃣ Limited Jaw Opening

Scenario: After jaw surgery, a client can’t open wide; /k g/ are fine but /t d/ are distorted.
Question: Which nerve is involved and why alveolars are harder?

Answer: CN V (mandibular branch); reduced jaw control affects tongue-tip precision for alveolars.

4️⃣ Tongue Deviates Left

Scenario: Post-stroke, tongue turns left on protrusion with slurred /t s l/.
Question: Which nerve is damaged?

Answer: Left CN XII (Hypoglossal) → same-side tongue weakness.

5️⃣ Palatal Droop and Breathy Voice

Scenario: One side of soft palate lifts, the other droops; voice is breathy and nasal.
Question: Which nerve is affected?

Answer: Unilateral CN X (Vagus) lesion → palatal & vocal-fold weakness.

6️⃣ Missing Front Teeth

Scenario: After dental trauma, /s z/ sound dull though tongue placement is correct.
Question: What landmark change causes this?

Answer: Altered alveolar ridge contour → wider air channel → distorted fricatives.

7️⃣ Nasal Regurgitation on Swallow

Scenario: Post-brainstem stroke, liquids exit the nose during swallow.
Question: Which muscle and nerve are weak?

Answer: Levator veli palatini (CN X/XI) → velum fails to seal.

8️⃣ Strained, Low Voice

Scenario: Teacher with throat tension has low, pressed voice but normal palate.
Question: Likely cause?

Answer: Laryngeal hyperfunction → excess tension, not VP issue.

9️⃣ Numb Face & Weak Chew

Scenario: Client has cheek numbness and poor jaw closing.
Question: Which nerve branches are affected?

Answer: Maxillary (V₂) for sensation, Mandibular (V₃) for chewing.

10️⃣ Pharyngeal Fricatives After Cleft Surgery

Scenario: Adult uses throat sounds for /s ʃ/.
Question: What’s the diagnosis and treatment?

Answer: VP mislearning → needs articulation therapy, not surgery.

11️⃣ Limited Sidewall Motion

Scenario: Endoscopy shows good velar lift, little sidewall movement.
Question: What closure pattern is this?

Answer: Coronal VP closure — mainly velum + PPW.

12️⃣ Repeated Ear Infections Post-Palate Surgery

Scenario: Middle-ear fluid keeps returning.
Question: Which muscle isn’t working?

Answer: Tensor veli palatini (CN V) → can’t open Eustachian tube.

13️⃣ Delayed VP Timing

Scenario: VP closure occurs too late in rapid speech.
Question: What movement feature is abnormal?

Answer: Timing of closure → brief nasal leakage.

14️⃣ Muffled, Nasal-Blocked Voice

Scenario: Child with enlarged tonsils sounds “stuffy.”
Question: What resonance disorder is this?

Answer: Hyponasality from blocked nasal airflow.

15️⃣ Evening Hypernasality

Scenario: Client with myasthenia gravis becomes nasal later in the day.
Question: Why?

Answer: Velar muscle fatigue → incomplete VP seal.