Resonance Disorders
Chapter Exam Questions
Course Introduction
This course offers a comprehensive exploration of resonance disorders, focusing on the assessment, diagnosis, and treatment of conditions affecting the normal balance of oral and nasal sound energy during speech. Students will examine the anatomical and physiological bases of resonance, with particular emphasis on velopharyngeal dysfunction and its etiologies, including cleft palate and neurological disorders. Through lectures, case studies, and practical activities, participants will learn evidence-based approaches to therapy, diagnostic instrumentation techniques, and multidisciplinary management strategies. The course is designed to equip students with the knowledge and skills necessary to identify and manage resonance disorders in diverse clinical populations.
Recommended Textbook
Cleft Palate and Craniofacial Anomalies Effects on Speech and Resonance 3rd Edition by Ann W.
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Chapter 1: Anatomy and Physiology
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Sample Questions
Q1) What separates the two plates of the palatine process of the maxilla?
A)Incisive suture lines
B)Median palatine suture
C)Transverse palatomaxillary suture lines
D)Nasal aspect of palatine suture
E)Incisive foramen
Answer: B
Q2) What are the ridges that run horizontally on the palate called?
A)Faucial pillars
B)Medium Raphe
C)Rugae
D)Mucoperiosteum
E)Alveolar ridge
Answer: C
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3
Chapter 2: Clefts of the Lip and Palate
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Sample Questions
Q1) A bilateral complete cleft of the lip only not the alveolus) results in the complete separation of the tissue that would normally form which structure?
A)Premaxilla
B)Prolabium
C)Philtrum
D)Columella
E)Alar base
Answer: C
Q2) Embryological development of the face and palate is dependent on the timely migration of which type of cells?
A)Osteocyte cells
B)Neuron Cells
C)Neural crest cells
D)Stem cells
E)Squamous cells
Answer: C
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4
Chapter 3: The Genetics Evaluation and Common
Craniofacial
Syndromes
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Sample Questions
Q1) Cleft palate rather than cleft lip) is more likely to be associated with which of the following?
A)Deformations
B)Malformations
C)Disruptions
D)Associations
E)Other congenital anomalies
Answer: B
Q2) What is failure of the brain to divide into two separate hemispheres called?
A)Hydrocephaly
B)Macrocephaly
C)Holoprosencephaly
D)Microcephaly
E)Unicephaly
Answer: C
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Chapter 4: Genetics and Patterns of Inheritance
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Sample Questions
Q1) What is the possibility that their offspring will be carriers of the condition?
A)0%
B)25%
C)50%
D)75%
E)100%
Q2) In a case in which two individuals who are heterozygous carriers of an autosomal recessive condition have a child, what is the probability that the child is a carrier of a single copy of the mutation?
A)50%
B)25%
C)100%
D)0%
E)75%
Q3) Which of the following is not a rule of inheritance that Mendel described?
A)All alleles are dominant
B)Variations of genes are referred to as alleles
C)We get one gene from each parent
D)Alleles segregate from each other at meiosis
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Chapter 5: Feeding Problems of Infantswith Clefts or Craniofacial
Anomalies
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Q1) The size of a newborn's larynx is approximately what proportion to that of an adult's larynx?
A)1/2
B)1/3
C)1/4
D)1/5
E)1/8
Q2) Which of the following describes the pacing strategy?
A)Providing oral feeding at defined intervals during a 24-hour period
B)Decreasing the rate of intake during feeding by imposing periodic pauses during feeding
C)Alternating feeding and burping at a predetermined schedule
D)Providing assistive squeezing at a certain rate per minute
E)Burping the infant every minute, regardless of oral intake
Q3) What is the purpose of a nonnutritive stimulation?
A)To heighten sensory awareness
B)To facilitate oral motor action
C)To help prevent development of oral aversion
D)To elicit a sucking response
E)All of the above
Page 7
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Chapter 6: Developmental Aspects:speech, Language, and Cognition
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Sample Questions
Q1) Which of the following will increase the child's motivation to learn and use verbal language?
A)Gestures, which are effective in communicating
B)The family responding to gestures and grunts
C)An older sibling speaking for the child
D)The family not responding to gestures and grunts
E)Intelligibility of speech being poor
Q2) Which of the following is not true about children with palate only?
A)They are more likely to have deficits in prelanguage skills than their peers.
B)They tend to have the same scores in verbal performance as in nonverbal performance on standardized tests.
C)They may receive more early stimulation than their unaffected peers.
D)They are at increased risk for syndromes.
E)They often have language and learning problems.
Q3) What is the most important requirement for speech and language learning?
A)Environmental stimulation
B)Motivation
C)Intelligence
D)Adequate hearing
E)Normal oral structure
Page 8
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Chapter 7: Resonance Disorders Andvelopharyngeal
Dysfunction Vpd
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Sample Questions
Q1) Which of the following occurs during the production or pressure-sensitive sounds?
A)Hyponasality
B)Hypernasality
C)Nasal air emission
D)Mixed resonance
E)Cul-de-sac resonance
Q2) Which cause of velopharyngeal dysfunction cannot be corrected or improved with surgery?
A)Dysarthria
B)Status post adenoidectomy
C)Cranial nerve damage
D)Hypotonia
E)Apraxia
Q3) Hyponasality is most noticeable on which of the following:
A)Affricates
B)Vowels
C)Fricatives
D)Plosives
E)Nasals
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Chapter 8: Facial, Oral and Pharyngeal Anomalies
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Sample Questions
Q1) Which of the following has a potential to have a negative effect on resonance?
A)Tonsillectomy
B)Adenoidectomy
C)Frenulectomy
D)Glossectomy
E)Mandibular advancement
Q2) Which of the following is not a typical characteristic of the adenoid facies?
A)An open-mouth posture
B)Downward position of the mandible
C)Suborbital coloring
D)The appearance of pinched nostrils
E)Red, bloodshot eyes
Q3) What syndrome causes facial nerve paralysis?
A)Crouzon syndrome
B)Down syndrome
C)Moebius syndrome
D)Treacher Collins syndrome
E)Orofaciodigital syndrome
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10
Chapter 9: Dental Anomalies
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Sample Questions
Q1) Which of the following occurs when one or more maxillary teeth fail to occlude with the opposing mandibular teeth?
A)Protruding maxilla
B)Crossbite
C)Posterior Crossbite
D)Open Bite
E)Ectopic Teeth
Q2) What is the term for when the upper teeth are lingual to the lower teeth?
A)Labioversion
B)UnderJet
C)OverJet
D)Overbite
E)Diastema
Q3) During which stage of dental development would palatal orthopedics be done?
A)Infant stage 0 to 12 months)
B)Primary dentition 1 to 6 years)
C)Early mixed dentition 6 to 9 years)
D)Late mixed dentition 9 to 12 years)
E)Adolescent dentition 12 to 18 years)
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Chapter 10: Psychosocial Aspects Ofcleft Lippalate and
Craniofacial Anomalies
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Sample Questions
Q1) Which syndrome is not typically associated with intellectual impairment relative to unaffected peers?
A)Apert's syndrome
B)Smith-Lemli-Opitz syndrome
C)Treacher Collins syndrome
D)Velocardofacial syndrome
E)Fetal alcohol syndrome
Q2) Which of the following is true about children and teens with cleft lip and palate, compared to their unaffected peers?
A)They have a characteristic personality type.
B)They are at greater risk of developing psychopathology.
C)They are more aggressive with peers.
D)They have more difficulty with peer relationships.
E)All of the above
Q3) Which is not true about adults with clefts, compared to their unaffected peers?
A)They tend to marry later.
B)They have higher levels of depression.
C)They tend to end their education earlier.
D)They make less money in their jobs.
E)All of the above
Page 12
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Chapter 11: Speech and Resonance Assessment
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Sample Questions
Q1) Which series of numbers is best to use when testing for nasal emission?
A)50s
B)60s
C)70s
D)80s
E)90s
Q2) What is the appropriate recommendation for treatment of compensatory productions?
A)Surgery and then speech therapy
B)Surgery only
C)Speech therapy for obligatory distortions first
D)Speech therapy and then surgery
E)Speech therapy only
Q3) To an inexperienced listener, a pharyngeal fricative can sound similar to which of the following?
A)Lateral lisp
B)Frontal lisp
C)Palatal-dorsal production
D)Bilabial fricative
E)Labiodental fricative
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Chapter 12: Orofacial Examination
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Sample Questions
Q1) Which of the following is an abnormal finding in the palate?
A)Torus palatinus
B)Median palatine raphe
C)Velar dimple
D)Zona pellucida
E)Palatal rugae
Q2) What is the term for too little spacing between the eyes?
A)Hypotelorism
B)Hypertelorism
C)Facial cleft
D)Macro-optical focus
E)Micro-optical focus
Q3) When do tonsils create a concern for speech production?
A)When they extend beyond the faucial pillars
B)When they are absent
C)When they are asymmetrical
D)When they are size 2 on the rating scale
E)When they are visible
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14
Chapter 14: Nasometry
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Sample Questions
Q1) Which of the following is not true about interpretation of nasalance?
A)Normal oral resonance is typically under 20 percentage points.
B)If lingual-alveolars and bilabials are significantly higher than velars, this could be due to an oronasal fistula.
C)Articulation errors can affect the nasalance score.
D)The higher the contour is on the screen, the more hyponasality to expect.
E)The nasalance score can be in the normal range with mild nasal emission.
Q2) Using the following choices, fill in the letter in the left column of the assumed diagnosis based on the nasometry scores.
\(\begin{array}{ll}
\hline \text { a. Normal velopharyngeal function}&\text { e. Phoneme-specific nasal emission}\\
\text {b. Mild velopharyngeal insufficiency }&\text {f. Phoneme-specific hypernasality }\\
\text {c. Moderate velopharyngeal insufficiency }&\text { g. A symptomatic oromasal fistula}\\
\text {d. Severe velopharyngeal insufficiency }&\text { h. Hyponasality}\\ \hline \end{array}\)
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Page 15
Chapter 15: Speech Aerodynamics
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Sample Questions
Q1) Velopharyngeal closure is considered adequate in children if differential oral-nasal air pressure is greater than which of the following during the production of the word "hamper"?
A)1.0 cm H<sub>2</sub>O
B)2.0 cm H<sub>2</sub>O
C)3.0 cm H<sub>2</sub>O
D)4.0 cm H<sub>2</sub>O
E)5.0 cm H<sub>2</sub>O
Q2) To estimate velopharyngeal orifice size, which of the following aerodynamic measures are needed?
A)Oral air pressure, nasal air pressure, oral airflow
B)Oral air pressure, nasal air pressure, nasal airflow
C)Oral airflow, nasal airflow, oral air pressure
D)Oral airflow, nasal airflow, nasal air pressure
E)Oral air pressure, nasal air pressure, differential pressure
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16
Chapter 16: Videofluoroscopy
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Sample Questions
Q1) What term refers to the use of roentgen ray X-ray) to image internal body parts?
A)Radiography
B)MRI
C)Videofluoroscopy
D)Attenuation
E)Cineradiography
Q2) In comparison with nasopharyngoscopy, videofluoroscopy is superior in showing which of the following?
A)The length of the velum and the point of contact on the pharyngeal wall
B)The adenoid pad and irregularity of the surface
C)The nasal surface of the velum and evidence of a submucous cleft
D)The lateral pharyngeal wall movement and symmetry
E)The basic pattern of closure
Q3) On the base view, a black horizontal line during closure indicates which of the following?
A)Passavant's ridge
B)Adenoid pad
C)Coronal pattern
D)Sagittal pattern
E)Circular pattern
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Chapter 17: Nasopharyngoscopy
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Sample Questions
Q1) Which of the following suggests the presence of a small velopharyngeal opening?
A)Bubbling of secretions
B)Irregularity of the posterior part of the velum
C)Irregular adenoid tissue
D)A small black circle
E)Visible airflow through the valve
Q2) Where should you insert the scope when evaluating velopharyngeal function?
A)Inferior meatus because it will come out on top of the velum
B)Inferior meatus because it is the largest and therefore causes the least discomfort
C)Superior meatus because it will allow visualization from the highest point of the nasopharynx
D)Middle meatus because it allows a view from above
E)Superior meatus because its smaller size will keep the scope from "wiggling" around too much
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Chapter 18: Surgical Management of Clefts and
Velopharyngeal
Insufficiencyincompetence
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Sample Questions
Q1) Why is the alveolar arch cleft left unrepaired until the age of 6 or 7?
A)It is technically difficult to close at an earlier age.
B)It allows anterior facial growth without restriction.
C)It does not affect speech or feeding.
D)Early closure can cause a risk of dental abnormalities.
E)The alveolar cleft will eventually close on its own.
Q2) Patients with a history of cleft palate and surgical repair often demonstrate which of the following?
A)Midface retrusion
B)Class III malocclusion
C)Class II malocclusion
D)a and b
E)a and c
Q3) With regard to the timing of cleft lip repair, the "rule of 10s" includes which of the following?
A)10 months old and 10 pounds
B)10 weeks of age and 10 pounds
C)10 grams of hemoglobin
D)b and c
E)a and b
Page 19
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Chapter 19: Orthognathic Surgery for Craniofacial
Conditions
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Sample Questions
Q1) Which is not a method of mandibular reconstruction?
A)Distraction osteogenesis
B)Le Fort I
C)Rib graft reconstruction
D)Free tissue microsurgical reconstruction
E)Mandibular osteotomies
Q2) What is the purpose of a genioplasty?
A)To advance the maxilla
B)To advance the chin
C)To close an oronasal fistula
D)To correct a prognathic mandible
E)To correct an anterior crossbite
Q3) At what ages is the facial skeleton usually mature enough for secondary orthognathic surgery?
A)Girls: 11 years; boys: 13 years
B)Girls: 12 years; boys: 14 years
C)Girls: 13 years; boys: 15years
D)Girls: 14 years; boys: 16 years
E)Girls: 15 years; boys: 17 years
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Chapter 20: Prosthetic Management
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Sample Questions
Q1) What is the most appropriate prosthetic choice for the patient who has had ablative surgery for oral cancer?
A)Palatal lift
B)Head gear
C)Speech bulb obturator
D)Quad helix device
E)Dentures
Q2) When working directly with the prosthodontist to modify an appliance for best results, what procedure is most effective to use?
A)Perceptual assessment
B)Nasopharyngoscopy
C)Nasometry
D)Intraoral examination
E)Videofluoroscopy
Q3) A feeding obturator is not capable of which of the following?
A)Helping an infant to achieve suction
B)Keeping the tongue from resting inside of the cleft
C)Covering an infant's unrepaired cleft during feeding
D)Separating the oral cavity from the nasal cavity
E)Reducing regurgitation into the nasal cavity
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Chapter 21: Speech Therapy
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Sample Questions
Q1) What is the most appropriate method of therapy for children with a history of VPI?
A)Blowing exercises
B)Oral-motor exercises
C)Articulation therapy
D)Increasing oral activity
E)Sucking exercises
Q2) Which of the following is true about obligatory distortions?
A)They commonly occur with structural anomalies in the vocal tract.
B)They can be corrected with speech therapy.
C)Manner is maintained, but placement is altered.
D)One type of obligatory distortion is the glottal stop.
E)They always cause nasal emission.
Q3) Which of the following is not a therapy technique used to treat hypernasality, nasal emission, or compensatory productions?
A)Auditory feedback
B)Tactile feedback
C)Oral-motor exercises
D)Visual feedback
E)Nose pinch
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Page 22
Chapter 22: The Team Approach
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Q1) Based on ACPA recommendations, which professionals must be on a Cleft Palate Team as a very minimum?
A)Plastic surgeon, ENT, pedodontist
B)Surgeon, dental professional, speech-language pathologist
C)Plastic surgeon, ENT, speech-language pathologist
D)Plastic surgeon, oral surgeon, speech-language pathologist
E)Dental professional, orthodontist, plastic surgeon
Q2) The team's primary contact person for the family is usually which of the following?
A)Primary care physician
B)Pediatrician
C)Family doctor
D)Managing surgeon
E)Team coordinator
Q3) Most of the managed care organizations exist as which of the following?
A)For-profit corporations
B)Not-for-profit organizations
C)Third-party administrators
D)Preferred providers PPOs.
E)Government-run providers
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Page 23
Chapter 23: Cleft Care in Developing Countries
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Q1) Which of the following statements is true?
A)The prevalence of clefts varies with ethnic background.
B)The prevalence of clefts varies with socioeconomic status.
C)The prevalence of clefts is not affected by malnutrition.
D)a and b
E)b and c
Q2) In 1997, the International Task Force on Volunteer Cleft Missions outlined recommendations for volunteer cleft missions based on which of the following?
A)Mission objectives
B)Organization
C)Personal health and liability
D)Funding
E)All of the above
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Chapter 24: Velopharyngeal Dysfunction and Speech Disorders
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Q1) A child presents for an evaluation with a complaint of "nasality." An evaluation reveals abnormal resonance on vowels and the following consonants: m, n, ng.Which condition is present?
A)Hypernasality
B)Hyponasality
C)Oral cul-de-sac resonance
D)Nasal cul-de-sac resonance
E)Assimilated resonance
Q2) Which syndrome is most likely to include hearing loss?
A)Apert syndrome
B)Treacher Collins syndrome
C)Velocardiofacial syndrome
D)Down syndrome
E)Beckwidth-Weidemann syndrome
Q3) What procedure is best for identifying an occult submucous cleft?
A)A visual inspection of the velum
B)Palpation of the velum
C)Videofluoroscopy
D)Nasopharyngoscopy
E)Nasometry
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