Cleft Palate Praxis Practice Questions

An SLP evaluates the speech of a child with suspected velopharyngeal dysfunction. Loading sentences with which of the following types of stimuli would be most helpful to include in the speech evaluation?

A. Nasal phonemes
B. High-pressure oral stops and fricatives
C. Sustained /α/
D. Liquids and glides

B. High-pressure oral stops and fricatives

An SLP will be working with a new mother to evaluate a term infant's feeding and swallowing skills to determine the infant's readiness for oral feeding. The infant has been diagnosed with a unilateral, complete cleft lip without cleft palate. The mother asks the SLP about what caused the infant's cleft lip. The SLP explains that while we know that both genetic and environmental factors are likely involved with this congenital birth abnormality, there is no consensus in research about a single cause of cleft lip.

The SLP completes a comprehensive oral sensorimotor and behavioral observation examination prior to initiating an oral-feeding trial. The following is documented in the SLP's assessment notes:

Right-sided complete cleft lip; otherwise unremarkable oral peripheral mechanism examination; medical chart notes no associated neurological difficulties or diagnosed syndromes; primitive reflexes present (e.g. for example, rooting); normal observation of posture, positioning, tone, and motor activity; infant presents awake, alert, and calm; baseline vital signs at rest are normal and no changes in respiratory rate, heart rate, or oxygen saturation noted with nonnutritive sucking; no respiratory stridor noted; mild external support needed to increase lip closure at introduction of pacifier nipple, and mother with strong desire to breastfeed. The mother expressed some anxiety and concern surrounding feeding an infant with a cleft lip.

During which of the following weeks of pregnancy did the infant's craniofacial structures not develop completely?

A. 4-7
B. 8-11
C. 12-15
D. 16-19

A. 4-7

An SLP will be working with a new mother to evaluate a term infant's feeding and swallowing skills to determine the infant's readiness for oral feeding. The infant has been diagnosed with a unilateral, complete cleft lip without cleft palate. The mother asks the SLP about what caused the infant's cleft lip. The SLP explains that while we know that both genetic and environmental factors are likely involved with this congenital birth abnormality, there is no consensus in research about a single cause of cleft lip.

The SLP completes a comprehensive oral sensorimotor and behavioral observation examination prior to initiating an oral-feeding trial. The following is documented in the SLP's assessment notes:

Right-sided complete cleft lip; otherwise unremarkable oral peripheral mechanism examination; medical chart notes no associated neurological difficulties or diagnosed syndromes; primitive reflexes present (e.g. for example, rooting); normal observation of posture, positioning, tone, and motor activity; infant presents awake, alert, and calm; baseline vital signs at rest are normal and no changes in respiratory rate, heart rate, or oxygen saturation noted with nonnutritive sucking; no respiratory stridor noted; mild external support needed to increase lip closure at introduction of pacifier nipple, and mother with strong desire to breastfeed. The mother expressed some anxiety and concern surrounding feeding an infant with a cleft lip.

Based on information from the oral sensorimotor and behavioral observation assessments, which of the following plans for continuing with an oral-feeding trial is most appropriate with the infant?

A. An oral-feeding trial should not be attempted until the infant's cleft lip is repaired.
B. An oral-feeding trial should not be attempted until a VFSS or FEES instrumental examination is completed.
C. An oral-feeding trial should be postponed until the infant's airway is examined by a physician.
D. An oral-feeding trial by the SLP can proceed during this initial feeding and swallowing assessment

D. An oral-feeding trial by the SLP can proceed during this initial feeding and swallowing assessment.

There is no evidence from the case review and oral sensorimotor/behavioral observations to suggest a neurological abnormality, respiratory disorder, or syndrome associated with feeding and swallowing disorders in infants. In the absence of a respiratory and neurological signs, an instrumental evaluation or referral to a physician for a respiratory evaluation would not be indicated prior to an oral-feeding trial at bedside. Many infants with an isolated cleft lip are successful oral feeders prior to surgical repair of the cleft lip. All the evidence presented in the case supports the SLP proceeding with the oral-feeding trial piece of the comprehensive feeding and swallowing assessment.

An SLP will be working with a new mother to evaluate a term infant's feeding and swallowing skills to determine the infant's readiness for oral feeding. The infant has been diagnosed with a unilateral, complete cleft lip without cleft palate. The mother asks the SLP about what caused the infant's cleft lip. The SLP explains that while we know that both genetic and environmental factors are likely involved with this congenital birth abnormality, there is no consensus in research about a single cause of cleft lip.

The SLP completes a comprehensive oral sensorimotor and behavioral observation examination prior to initiating an oral-feeding trial. The following is documented in the SLP's assessment notes:

Right-sided complete cleft lip; otherwise unremarkable oral peripheral mechanism examination; medical chart notes no associated neurological difficulties or diagnosed syndromes; primitive reflexes present (e.g. for example, rooting); normal observation of posture, positioning, tone, and motor activity; infant presents awake, alert, and calm; baseline vital signs at rest are normal and no changes in respiratory rate, heart rate, or oxygen saturation noted with nonnutritive sucking; no respiratory stridor noted; mild external support needed to increase lip closure at introduction of pacifier nipple, and mother with strong desire to breastfeed. The mother expressed some anxiety and concern surrounding feeding an infant with a cleft lip.

Which THREE of the following treatment strategies is most appropriate for the patient if the SLP finds the infant is safe for continued oral breastfeeding and follows up with the infant and mother with therapy and education prior to discharge home from the hospital?

A. Introducing external pacing with the infant's intake rate to support airway protection
B. Providing the mother with contact information for the local cleft lip and palate team for ongoing care and support
C. Incorporating adaptive seating for the infant during oral feedings
D. Positioning the infant in the optimal feeding position at the mother's breast
E. Completing education with the infant's mother about feeding interactions, strategies, and oral care

B. Providing the mother with contact information for the local cleft lip and palate team for ongoing care and support
D. Positioning the infant in the optimal feeding position at the mother's breast
E. Completing education with the infant's mother about feeding interactions, strategies, and oral care

Kelli is a 10-year-old patient with velopharyngeal dysfunction. She presents with hypernasality, audible nasal emission, and weak pressure for oral consonants. She also displays glottal stops and pharyngeal fricatives. She is in speech therapy, and her parents would like to know what to expect after she has pharyngeal flap surgery next week. Which of the following outcomes is most appropriate for the SLP to counsel Kelli's parents to expect?

A. Surgery should eliminate the glottal stops but not the pharyngeal factors.
B. Surgery should decrease the hypernasality and audible nasal emission.
C. Surgery should eliminate the need for ongoing speech therapy.
D. Surgery should decrease hypernasality and nasal emission and eliminate articulation errors.

B. Surgery should decrease the hypernasality and audible nasal emission.

Which of the following recommendations to a parent of an infant with cleft lip and palate should an SLP make to best optimize feeding for adequate nutrition and appropriate growth?
A. Providing a bottle rather than breast-feeding the infant
B. Positioning the infant in a supine position during feeding times
C. Allowing the infant to take as much time as needed to feed
D. Using a bottle with a modified nipple during feedings

D. Using a bottle with a modified nipple during feedings

Which of the following strategies to treat compensatory articulation errors is most appropriate for a child with hypernasality and glottal stop substitutions following surgery for velopharyngeal insufficiency?

A. Using oral motor exercises
B. Using a straw to elicit /s/forward slash s forward slash
C. Using tactile cues to elicit phonemes
D. Using negative practice

C. Using tactile cues to elicit phonemes

Which of the following speech-sampling contexts best assesses hyponasality?

A. Producing sentences with oral sonorants
B. Counting in numerical order from 60 to 70
C. Saying single words with nasal consonants
D. Repeating words with oral-pressure consonants

C. Saying single words with nasal consonants

Infants with cleft lip and palate are susceptible to middle ear disease because which of the following muscles is commonly impaired?

A. The superior constrictor muscle
B. The levator veli palatini muscle
C. The palatopharyngeus muscle
D. The tensor veli palatini muscle

D. The tensor veli palatini muscle

Two months after undergoing surgery to improve velopharyngeal function, a client continues to exhibit nasal airflow only on the production of /s/ and /sh/, and also exhibits glottal stops for several pressure consonants. The most appropriate next action for the SLP to take is to

A. request consideration of prosthetic management
B. request a nasoendoscopic study
C. inform the surgeon that the client is not making satisfactory progress
D. provide speech treatment to correct compensatory articulation errors

D. provide speech treatment to correct compensatory articulation errors

Which of the following strategies is most appropriate for an SLP to try in an effort to minimize the perception of mild nasal emission in a patient?

A. Increasing fundamental frequency
B. Using light articulatory contacts
C. Reducing mouth opening
D. Increasing rate of speech

B. Using light articulatory contacts

Which of the following conditions is primarily characterized by premature closure of the sutures of the skull?

A. Craniosynostosis
B. Craniopharyngioma
C. Deformational plagiocephaly
D. Positional plagiocephaly

A. Craniosynostosis

Which of the following instrumental assessment tools provides the most direct dynamic view of velopharyngeal movement during speech?

A. Nasopharyngoscopy
B. Lateral-view x-ray
C. Nasometry measurements
D. Aerodynamics

A. Nasopharyngoscopy