Cleft Palate and Craniofacial Anomalies Effects on Speech and Resonance 3rd Edition Test Bank

Type:

Test Bank

Cleft Palate and Craniofacial Resource: Anomalies Effects on Speech and Resonance Edition:

3rd Edition

Author(s):

Ann W. Kummar

Test Questions: Chapter 1. Anatomy and Physiology

TEST QUESTIONS Chapter 1: Anatomy and Physiology

From Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance, 3rd Edition Ann W. Kummer, Ph.D., CCC-SLP

1. Where are the palatine tonsils located? a. Between the faucial pillars b. Behind the choanae c. Above the velum d. In the nasopharynx e. At the base of the tongue 2. What structure supports the nasal tip? a. Ala b. Nasion c. Nasal root d. Nasal tip e. Columella

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Test Questions: Chapter 1. Anatomy and Physiology

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3. At what vertical level is the greatest medial displacement of the lateral pharyngeal walls during oral speech production? a. Vocal folds b. Epiglottis c. Base of tongue d. Hard palate e. Upper esophageal sphincter 4. Where is the Passavant’s ridge located? a. Hard palate b. Posterior pharyngeal wall c. Nose d. Tongue e. Upper lip 5. Which of the turbinates is the largest? a. Superior turbinate b. Anterior turbinate c. Middle turbinate d. Inferior turbinate e. Lateral turbinate 6. Which of the following is not found in the velum? a. Tensor tendon b. Cartilage c. Adipose tissue d. Glandular tissue e. Palatine aponeurosis © 2014 Cengage Learning. All Rights Reserved.

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Test Questions: Chapter 1. Anatomy and Physiology

7. Which structure is a ridge that is caused by a projection of the cartilaginous portion of the Eustachian tube? a. Torus tubarius b. Alveolar ridge c. Median palatine raphe d. Torus palatinus e. Passavant’s ridge 8. 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 9. Which of the following is considered a pneumatic activity? a. Swallowing b. Sucking c. Gagging d. Vomiting e. Chewing 10. The philtrum runs between which two structures? a. The nasal tip and the tubercle b. The nasal tip and the columella c. The columella and the tubercle d. The columella and the upper lip e. The cupid’s bow and the tubercle © 2014 Cengage Learning. All Rights Reserved.

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Test Questions: Chapter 1. Anatomy and Physiology

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11. The velum rests against which structure while inactive? a. Tip of the tongue b. Base of the tongue c. Dorsum of the tongue d. Posterior pharyngeal wall e. Adenoid pad 12. The lateral pharyngeal walls move in which direction to contribute to velopharyngeal closure? a. Medially b. Laterally c. Posteriorly d. Anteriorly e. Superiorly 13. What shelf-like ridge projects from the posterior pharyngeal wall during velopharyngeal closure? a. Passavant’s ridge b. Pharyngeal plexus c. Tensor veli palatini d. Bulge of the musculus uvulae e. Posterior nasal spine

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Test Questions: Chapter 1. Anatomy and Physiology

14. What are the ridges that run horizontally on the palate called? a. Faucial pillars b. Medium Raphe c. Rugae d. Mucoperiosteum e. Alveolar ridge 15. Which of the following types of phonemes are considered “pressure sensitive”? a. Fricatives, nasals, glides b. Fricatives, nasals, plosives c. Glides, nasals, plosive d. Plosives, fricatives, affricates e. Alveolars, glides, nasals

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Test Questions: Chapter 1. Anatomy and Physiology

ANATOMICAL STRUCTURES Match the letter of the answer with each item. Note: Not all answers in the word banks are used, and some may be used more than once. a. Adenoids

k. Palatine tonsils

b. Ala wing

l. Palpebral fissures

c. Choana

m. Philtral ridges

d. Foramen

n. Posterior nasal spine

e. Incisive foramen

o. Prolabium

f. Incisive suture

p. Premaxilla

g. Lingual tonsils

q. Torus palatinus

h. Median palatine suture

r. Velar dimple

i. Median raphe

s. Uvula

j. Nasal bridge c. Opening on either side of the vomer which leads from the nasal cavity to the nasopharynx j. Bony structure between the eyes and corresponds to the middle nasofrontal suture a. Lymphoid tissue that can cause hyponsality g. Lymphoid tissue between the anterior and posterior faucial pillars in the oral cavity q. A prominent longitudinal ridge or bump on the bone of the hard palate, seen primarily in certain populations e. A hole in the bone just behind the central incisors n. Bony projection on the back edge of the hard palate r. The area on the oral side of the velum where it bends during phonation p. Bordered by the incisive suture lines i. Embryological suture line on the mucosa of the hard and soft palate © 2014 Cengage Learning. All Rights Reserved.

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Test Questions: Chapter 1. Anatomy and Physiology

MUSCLES Match the letter of the answer with each item. Note: Not all answers in the word banks are used and some may be used more than once. a. Levator veli palatini

e. Palatopharyngeus

b. Musculus uvulae

f. Superior constrictors

c. Orbicularis oris

g. Tensor veli palatini

d. Palatoglossus b. Forms the velar eminence (knee cap) on the nasal surface of the velum a. Acts as a sling to pull the velum up and back toward the posterior pharyngeal wall g. Opens the Eustachian tube during swallowing a. Contraction of this muscle results in a velar dimple e. Brings the velum down for nasal consonants e. Located within the posterior faucial pillars a. Attaches to the hard palate when there is a cleft d. Is most affected by a cleft palate f. Results in a Passavant’s ridge during phonation b. May be hypoplastic as seen through nasopharyngoscopy a. Is most important for velar elevation c. Is most affected by a cleft palate

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Test Questions: Chapter 1. Anatomy and Physiology

Match the letter of the answer with each item. Note: Not all answers in the word banks are used and some may be used more than once. a. Base pattern b. Circular pattern

c. Coronal pattern

d. Sagittal pattern

c. A pattern of velopharyngeal closure that is accomplished primarily by the posterior movement of the velum against a broad area of the posterior pharyngeal wall d. A pattern of closure that occurs primarily due to lateral wall motion c. The most common pattern of closure b. A pattern of closure where all structures contribute equally

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Test Questions: Chapter 1. Anatomy and Physiology

FACIAL LANDMARKS

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Write the letter of the structure next to its correct term.

A Ala base

E Nasal tip

B Ala rim

D Tubercle

F Columella

G Philtral ridges

C Cupid's box

H Philtrum

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Test Questions: Chapter 1. Anatomy and Physiology

NASAL SEPTUM AND RELATED STRUCTURES

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Write the letter of the structure next to its correct term.

C Alar cartilage

D Quadrangular septal cartilage

E Anterior nasal spine

F Sphenoid sinus

I

B Upper lateral cartilage

Choana

A Nasal bone

H Vomer

G Perpendicular plate of ethmoid

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Chapter 1: Anatomy and Physiology

LATERAL WALL OF NOSE

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Write the letter of the structure next to its correct term.

J

Eustachian tube

F Olfactory nerves

B Middle nasal meatus

C Inferior meatus

H Middle turbinate

I

D Nasal vestibule

G Superior turbinate

E Olfactory bulb

A Superior nasal meatus

Inferior turbinate

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Test Questions: Chapter 1. Anatomy and Physiology

ORAL CAVITY

Courtesy Robin T. Cotton; M.D.Cincinnati Children’ s Hospital Medical Center & University of Cincinnati College of Medicine

Write the letter of the structure next to its correct term.

E Alveolar ridge

G Posterior faucial pillar

F Anterior faucial pillar

C Uvula

H Dorsum of the tongue

B Velum (soft palate)

A Hard palate

I

Ventral surface of the tongue

D Palatine tonsil

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Chapter 1: Anatomy and Physiology

NASAL, ORAL, & PHARYNGEAL CAVITIES

Copyright © Cengage Learning®. All Rights Reserved.

Write the letter of the structure next to its correct term.

F Adenoid (pharyngeal tonsil)

D Middle turbinate

L Epiglottis

I

M Esophagus

C Sphenoid sinus

G Eustachian tube opening

B Superior turbinate

A Frontal sinus

H Torus tubarius

E Inferior turbinate

J

K Lingual tonsils

N Trachea

Salpingopharyngeal fold

Tonsil (palatine tonsil)

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Test Questions: Chapter 1. Anatomy and Physiology

HARD PALATE

Copyright © Cengage Learning®. All Rights Reserved.

Write the letter of the structure next to its correct term.

F Incisive foramen

J

Posterior nasal spine

G Incisive suture

E Premaxilla

H Median palatine suture

I

B Palatine bone

D Uvula

A Palatine process of maxilla

C Velum

Transverse palatine suture

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Test Questions: Chapter 1. Anatomy and Physiology

HARD PALATE

© Cengage Learning 2014

Write the letter of the structure next to its correct term.

A Hamulus

C Medial pterygoid plate

F Horizontal part of palatine bone

E Palatine process of maxillary bone

D Incisive foramen

G Posterior nasal spine

B Lateral pterygoid plate

H Vomer bone

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Test Questions: Chapter 1. Anatomy and Physiology

POSITION OF THE PHARYNGEAL PLEXUS

© Cengage Learning 2014

Write the letter of the structure next to its correct term.

B Carotid artery D Palate A Pharyngeal plexus E Tongue C Tympanic nerve

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Test Questions: Chapter 2. Clefts of the Lip and Palate

TEST QUESTIONS Chapter 2: Clefts of the Lip and Palate

From Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance, 3rd Edition Ann W. Kummer, Ph.D., CCC-SLP

1. Match the letter of the answer with each item. Note: Not all answers in the word banks are used, and some may be used more than once. a. Forme fruste

e. Bilateral cleft lip/palate

b. Cleft lip only

f. Overt submucous cleft

c. Cleft palate only

g. Occult submucous cleft

d. Unilateral cleft lip/palate

h. Bifid uvula

c. Often bell-shaped and occurs with Pierre Robin sequence e. Often causes a protruding premaxilla h. Slightest form of cleft of the secondary palate that can be seen from an oral exam a. Slightest form of cleft of the primary palate g. Can only be seen with nasopharyngoscopy d. Often associated with a deviated septum e. Will isolate the prolabium from the surrounding structures © 2014 Cengage Learning. All Rights Reserved.

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Test Questions: Chapter 2. Clefts of the Lip and Palate

2. Match the letter of the answer with each item. Note: Not all answers in the word banks are used, and some may be used more than once. a. Primary palate b. Secondary palate

c. Tertiary palate

a. Contains the premaxilla b. Includes the posterior nasal spine a. Is first to form with embryological development b. Can be affected by glossoptosis a. Includes the lip and alveolus 3. Which race has the highest prevalence of clefts? a. Africans b. Asians c. Caucasians d. Native Americans e. Indians 4. Which race has the lowest prevalence of clefts? a. Africans b. Asians c. Caucasians d. Native Americans e. Indians

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Test Questions: Chapter 2. Clefts of the Lip and Palate

5. Which of the following is true about the primary palate? a. It is posterior to the incisive foramen. b. It includes the hard and soft palate. c. It includes the lip. d. It includes the hard palate, but not the soft palate. e. It includes the alveolus only.

6. A cleft of the velum or submucous cleft primarily affects the interdigitation of which muscle? a. Superior constrictor muscle b. Palatoglossus muscle c. Tensor veli palatini muscle d. Levator veli palatini muscle e. Palatopharyngeus muscle 7. Which type of cleft includes the velum and hard palate, but stops at the incisive foramen? a. Complete cleft of the primary palate b. Incomplete cleft of the secondary palate c. Posterior cleft of the secondary palate d. Complete cleft of the secondary palate e. Incomplete cleft of the primary palate

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Test Questions: Chapter 2. Clefts of the Lip and Palate

8. Which of the following describes a complete cleft of the primary palate? a. Cleft that is posterior to the incisive foramen b. Cleft of the alveolus c. Cleft that includes the lip and alveolus d. Cleft that includes the entire lip and prolabium e. Cleft that includes the alveolus and base of the nose 9. Which of the following describes a cleft muscle of Veau? a. The palatoglossus is attached to the velum b. The levator veli palatini and the palatopharyngeus muscles are inserted into the posterior border of the hard palate c. The levator veli palatini and the palatopharyngeus muscles are inserted into the midline of the velum d. The levator veli palatini muscles are inserted into the posterior border of the hard palate e. There is discontinuity of the orbicularis oris muscle 10. A bifid uvula, zona pellucida and a notch in the posterior border of the hard palate indicate which of the following? a. Overt submucous cleft b. Occult submucous cleft c. Cleft of the secondary palate d. Bilateral cleft palate e. Overt cleft of the secondary palate

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Test Questions: Chapter 2. Clefts of the Lip and Palate

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11. What is the correct term for a cleft of the secondary palate that does not extend to the incisive foramen? a. Incomplete cleft lip b. Incomplete cleft palate c. Cleft of the secondary palate only d. Hard palate cleft e. Unilateral incomplete cleft 12. 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 13. In Pierre Robin sequence, what prevents the tongue from dropping down so that palatal closure can occur? a. Cleft palate b. Narrow palate c. Microcephaly d. Glossoptosis e. Micrognathia

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Test Questions: Chapter 2. Clefts of the Lip and Palate

14. For infants with Pierre Robin sequence, what is the first priority? a. Resonance b. Intelligibility c. Feeding d. Articulation e. Breathing 15. Which muscle inserts abnormally into the hard palate when there is a complete cleft palate? a. Levator veli palatini b. Tensor veli palatini c. Palatoglossus d. Palatopharyngeus e. Superior constrictor 16. What is the philtral tissue segment called when there is a bilateral complete cleft of the lip? a. Philtral dimple b. Prolabium c. Simonart’s band d. Philtrum e. Columella

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Test Questions: Chapter 2. Clefts of the Lip and Palate

17. In normal embryological development, where does fusion of the secondary palate begin? a. Median raphe b. Incisive foramen c. Anterior nasal spine d. Posterior nasal spine e. Transverse palatine suture 18. Which muscle is primarily affected by a complete cleft of the lip? a. Superior constrictor b. Myohyoid c. Geniohyoid d. Obicularis oris e. Levator muscle 19. What anatomical structure is not included in the Kernahan “striped Y” for cleft classification? a. Lip b. Hard palate c. Alveolus d. Area between alveolus and incisive foramen e. Posterior pharyngeal wall

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Test Questions: Chapter 2. Clefts of the Lip and Palate

20. Which of the following is not characteristic of an overt submucous cleft palate? a. A bifid uvula b. Zona pellucid c. A hypoplastic uvula d. A protrusive premaxilla e. A notch in the posterior border of the hard palate 21. Embryological development of the lip and alveolus begins at which structure? a. Tubercle of the upper lip b. Cupid’s bow c. Alveolar process d. Incisive foramen e. Anterior nasal spine 22. 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

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Test Questions: Chapter 2. Clefts of the Lip and Palate

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23. At which point during gestation does embryological development of the hard palate and velum typically begin? a. 3 weeks b. 7 weeks c. 9 weeks d. 3 months e. 12 weeks 24. Which of the following is associated with clefts? a. Chromosomal disorders b. Genetic disorders c. Environmental teratogens d. Prenatal exposure to certain medications e. All of the above 25. Which of the following can cause a wide, bell-shaped cleft palate? a. Chromosomal disorders b. Genetic disorders c. Environmental teratogens d. Inadequate folic acid e. Mechanical interference in utero

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Test Questions: Chapter 2. Clefts of the Lip and Palate

26. Which is never associated with a cleft of the primary palate? a. Wide and flattened nose b. Altered orientation of orbicularis muscle c. Nasal cavity deformities d. Reduced size of nasal airway e. Velopharyngeal insufficiency 27. Which of the following accurately describes a Simonart’s Band? a. A partial or arrested form of a cleft lip b. A bilateral incomplete cleft of the lip c. A strand of soft tissue in the area of the cleft palate d. The philtral tissue segment that is isolated due to the bilateral cleft e. A band of placental tissue that disrupts embryological development 28. Which of the following can cause a facial cleft? a. Micrognathia b. Amniotic bands c. Crowding in utero d. Glossoptosis e. Forme fruste

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Test Questions: Chapter 3. The Genetics Evaluation and Common Craniofacial Syndromes

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TEST QUESTIONS Chapter 3: The Genetics Evaluation and Common Craniofacial Syndromes

From Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance, 3rd Edition Ann W. Kummer, Ph.D., CCC-SLP

1. Match the letter of the answer with each item. Note: Not all answers in the word banks are used, and some may be used more than once. a. Association

d. Malformation

b. Deformation

e. Sequence

c. Disruption

f. Syndrome

e. A pattern of multiple anomalies within an individual where one anomaly leads to the development of the other anomalies f. A pattern of multiple anomalies that regularly occur together and are pathogenically related b. Birth defect that arises as a result of abnormal mechanical or physical forces in the fetal environment on an otherwise normal structure d. Anomaly that results from an intrinsically abnormal developmental process and is due to a genetic etiology

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Test Questions: Chapter 3. The Genetics Evaluation and Common Craniofacial Syndromes

c. A morphologic defect due to an extrinsic breakdown or interference with a normal developmental process a. A nonrandom occurrence of a pattern of multiple anomalies in two or more individuals that are not a known syndrome or sequence 2. Match the letter of the answer with each item. Note: Not all answers in the word banks are used, and some may be used more than once. a. Brachydactyly

h. Macrosomia

b. Choanal atresia

i. Macrostomia

c. Clinodactyly

j. Microcephaly

d. Craniosynostosis

k. Micrognathia

e. Fistula

l. Microstomia

f. Glossoptosis

m. Microtia

g. Macroglossia

n. Prognathia o. Syndactyly

i. A large mouth opening, often due to failure of fusion between the maxillary and mandibular process of embryonic development of the face k. An abnormally small mandible o. Fusion or webbing of the digits (fingers and/or toes) f. The posterior displacement of the tongue in the pharynx; can cause airway obstruction d. Abnormal development of the cranial skeleton due to premature ossification of one or more cranial sutures, resulting in malformation of the skull with growth m. Small or dysplastic ears

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Test Questions: Chapter 3. The Genetics Evaluation and Common Craniofacial Syndromes

3. Match the letter of the answer with each item. Note: Not all answers in the word banks are used, and some may be used more than once. a. Apert syndrome

h. Orofacial digital syndrome

b. Beckwith-Wiedemann syndrome

i. Pfeiffer's

c. Crouzon syndrome

j. Pierre Robin sequence

d. Generation X syndrome

k. Stickler’s syndrome

e. Hemifacial microsomia

l. Treacher Collins syndrome

f. Moebius syndrome

m. Trisomy 13

g. Neurofibromatosis 1

n. Van der Woude syndrome o. Velocardiofacial syndrome

j. Is not always due to genetic factors, but can be part of a particular syndrome b. Includes macroglossia f. Involves facial paralysis affecting bilabial movement o. Also called 22q11.2 syndrome a. Due to craniosynostosis and also involves syndactyly e. May include unilateral paralysis of the velum h. Includes a lobulated tongue and is fatal in males a. Includes exopthalmos due to premature closure of the coronal sutures and syndactyly 2 k. Includes cleft palate and myopia o. Includes Pierre Robin sequence; narrow palpebral fissures; short stature; and long, tapered fingers b. Includes macroglossia n. Includes bilateral lip pits and cleft palate c. Craniosynostosis that does not involve the digits

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Test Questions: Chapter 3. The Genetics Evaluation and Common Craniofacial Syndromes

j. Nonsyndromic cause of a wide, bell-shaped cleft palate and glossoptosis m. Includes 47 chromosomes and causes severe brain anomalies, including holoprosencephaly 4. 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 5. What is failure of the brain to divide into two separate hemispheres called? a. Hydrocephaly b. Macrocephaly c. Holoprosencephaly d. Microcephaly e. Unicephaly

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Test Questions: Chapter 4. Genetics and Patterns of Inheritance

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TEST QUESTIONS Chapter 4: Genetics and Patterns of Inheritance

From Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance, 3rd Edition Ann W. Kummer, Ph.D., CCC-SLP

1. Match the number of the answer with each item. Note: Not all answers in the word banks are used, and some may be used more than once. a. Autosomes

d. Somatic cells

b. Gametes

e. “p” arm

c. Sex chromosomes

f. “q” arm

a. Cells in the body with the exception of those for reproduction d. Includes all chromosomes with the exception of the two sex chromosomes b. Sperm cells from the testes and ova cells from the ovaries c. The 23rd pair of chromosomes, identified as X and Y because of their role in gender determination f. Long arm on each side of a chromosome e. Short arm on each side of a chromosome

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Test Questions: Chapter 4. Genetics and Patterns of Inheritance

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2. Match the number of the answer with each item. Note: Not all answers in the word banks are used, and some may be used more than once. a. DNA

e. Polymorphism

b. Chromosome

f. Replication

c. Gene

g. RNA

d. Mutation

h. Transcription

c. Submicroscopic functional unit of heredity located in the nucleus of a cell created as a single complementary strand of a DNA template b. A single, linear double strand of DNA with associated proteins d. Change in the sequence of a molecule of DNA e. Variability in genes common in the general population h. A process where a complementary strand of DNA is created with a single strand a. The substance that carries hereditary information in bacteria g. Created as a single complementary strand of a DNA template f. The process of making two identical DNA molecules from one

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Test Questions: Chapter 4. Genetics and Patterns of Inheritance

3. Match the number of the answer with each item. Note: Not all answers in the word banks are used, and some may be used more than once. a. Cytokinesis

d. Karyotype

b. Genome

e. Pedigree

c. Ideogram

f. Phenotype

e. A pictorial representation of family members and their line of descent a. The separation of the cell cytoplasm to form two distinct cells b. A complete set of genetic instructions for a particular organism or species d. A visual profile of an individual’s chromosomes f. A group of typical characteristics associated with a genetic condition c. A schematic drawing of the banding pattern of a chromosome

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Test Questions: Chapter 4. Genetics and Patterns of Inheritance

4. Match the number of the answer with each item. Note: Not all answers in the word banks are used, and some may be used more than once. a. Deletions

e. Mosaicism

b. Duplications

f. Nondisjunction

c. Inversions

g. Translocations

d. Monosomy

h. Trisomy

e. When the cells have different genetic content in a single individual f. Failure of a pair of chromosomes to separate during cell division h. Occurs with Down syndrome g. When there is a transfer of genetic material between two or more chromosomes a. When a part of a chromosome becomes separated and lost c. When a portion of the chromosome is turned 180º from its original location a. A cause of velocardiofacial syndrome d. When there is a single copy of the chromosome

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Test Questions: Chapter 4. Genetics and Patterns of Inheritance

5. Match the number of the answer with each item. Note: Not all answers in the word banks are used, and some may be used more than once. a. Anticipation

e. Multifactorial

b. Heterogeneity

f. Pleiotropy

c. Imprinting

g. Premeditation

d. Incomplete penetrance

h. Teratogens

f. The phenomenon in which a single mutant gene can affect multiple, unrelated systems d. The lack of a recognizable phenotype in an individual who carries a mutation that may cause an autosomal dominant trait or condition b. Occurs when a specific phenotype can be caused by mutations of different genes a. A tendency to have more severe manifestations or an earlier age of onset in succeeding generations h. Environmental factors known to increase risks for birth defects e. Disorders resulting from an interaction of multiple genes with environmental influences c. When genes function differently, depending on whether they were inherited maternally or paternally 6. What is the recurrence risk for parents of a child with nonsyndromic cleft lip and/or palate with their next pregnancy? a. 3% to 5% b. 25% to 50% c. 30% to 45% d. 10% to 15% e. 5% to 10%

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5

Test Questions: Chapter 4. Genetics and Patterns of Inheritance

6

7. Which of the following describes traits that manifest only when mutations are present in both copies of a gene? a. Dominant traits b. Recessive traits c. Heterogeneous traits d. Homogenous traits e. Autosomal dominant traits 8. Which of the following would be considered a threshold trait associated with multifactorial inheritance? a. Height b. Intelligence c. Blood pressure d. Cleft palate e. Weight 9. 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%

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Test Questions: Chapter 4. Genetics and Patterns of Inheritance

10. What term is used to describe having two different alleles of a gene for a particular trait? a. Homozygous b. Phenotypic c. Autosomal dominant d. Heterozygous e. Multifactorial 11. Which of the following changes in genes does not result in craniofacial anomalies? a. Deletion of one or more nucleotides b. Changing the regulation of gene expression c. Insertion of one or more nucleotides d. Polymorphism e. Change in the function of a protein 12. Which of the following results in Down syndrome? a. Monosomy 22 b. Trisomy 21 c. Trisomy 23 d. Trisomy 13 e. Trisomy 16

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7

Test Questions: Chapter 4. Genetics and Patterns of Inheritance

13. Which factor(s) produce(s) the greatest risk for cleft lip? a. Carrying the rare polymorphism of the TGFA gene b. Having a family history with two affected first-degree relatives with cleft lip c. Heavy maternal smoking plus carrying the high-risk allele of TGF d. Having a family history with one individual with cleft lip e. Heavy maternal smoking 14. 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 15. Which of the following is not characteristic of ‘X-linked inheritance’? a. It is caused by genes on chromosome 23 b. Females are more severely affected c. Affected males pass the gene to 100% of their daughters d. There is no father-to-son transmission e. Affected females can transmit the disorder to their sons

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8

Test Questions: Chapter 4. Genetics and Patterns of Inheritance

16. A woman and her husband are both heterozygous carriers of an autosomal recessive condition.

What is the possibility that their offspring will have the condition? a. 0% b. 25% c. 50% d. 75% e. 100% 17. What is the possibility that their offspring will be carriers of the condition? a. 0% b. 25% c. 50% d. 75% e. 100%

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9

Test Questions: Chapter 5. Feeding Problems of Infants with Clefts or Craniofacial Anomalies

TEST QUESTIONS Chapter 5: Feeding Problems of Infants with Clefts or Craniofacial Anomalies

From Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance, 3rd Edition Ann W. Kummer, Ph.D., CCC-SLP

1. Match the letter of the answer with each item. Note: Not all answers in the word banks are used, and some may be used more than once. a. Mead JohnsonTM Cleft Palate Nurser

d. Angled-neck bottles

b. SpecialNeeds® Feeder

e. Pigeon® Nipple & Bottle

c. Medela® SoftCup Feeder and Bottle b. Delivers fluid by compression of nipple alone a. Pliability of bottle allows assistive squeeze to generate flow of liquid c. Used for infants who cannot tolerate intraoral placement of nipple e. Has a “Y” crosscut in the nipple, with one thin side and one thicker side d. Eliminates the need for the baby to extend its head and neck during feeding

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1

Test Questions: Chapter 5. Feeding Problems of Infants with Clefts or Craniofacial Anomalies

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2. What is the main reason that infants with cleft palate have difficulty with breastfeeding? a. Abnormal swallowing b. Inability to generate adequate suction c. Abnormal compressions d. Abnormal breathing e. Poor coordination of suck-swallow-breathe 3. What is the best way to determine the effectiveness of airway protection during rapid chain swallowing sequences? a. Fiberoptic endoscopic evaluation of swallowing (FEES) b. Assessment of breathing after the swallow c. Videofluoroscopy d. Assessment of coughing after a swallow e. Evaluation of nasal regurgitation 4. 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

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Test Questions: Chapter 5. Feeding Problems of Infants with Clefts or Craniofacial Anomalies

5. As the infant grows, which of the following structures does not descend? a. Velum b. Epiglottis c. Hyoid d. Larynx e. Vocal cords 6. Feeding problems are most likely to occur when the infant presents with which of the following? a. Bilateral cleft lip b. Incomplete cleft of the soft palate c. Complete cleft of the palate d. Glossoptosis e. c and d 7. Which of the following is described as “assisted fluid delivery”? a. Use of nasogastric feeding to supplement volume of intake b. Use of gastrostomy tube feedings following oral intake c. Use of gentle squeezing of a nipple or flexible bottle during feeding to deliver fluid d. Use of a crosscut nipple to increase flow of fluid during sucking e. Use of a tube in addition to breast feeding

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Test Questions: Chapter 5. Feeding Problems of Infants with Clefts or Craniofacial Anomalies

4

8. What is the most effective feeding positioning to decrease nasopharyngeal regurgitation during feeding? a. Supine b. Semi-reclined c. Fully reclined d. Upright e. Prone 9. 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 10. 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

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Test Questions: Chapter 5. Feeding Problems of Infants with Clefts or Craniofacial Anomalies

11. When feeding an infant, a general rule of thumb to follow is that the infant should be burped after how many ounces of intake? a. 1/2 ounce b. 1 ounce c. 2 ounces d. 3 ounces e. 4 ounces 12. Which of the following structures is not actively involved in the physical act of sucking? a. Jaw b. Cheeks c. Lips d. Maxilla e. Tongue 13. Around what age is an infant ready to transition from a bottle to a cup? a. 4 to 6 months b. 8 to 9 months c. 10 to 12 months d. 12 to 13 months e. 15 to 18 months

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5

Test Questions: Chapter 5. Feeding Problems of Infants with Clefts or Craniofacial Anomalies

14. Which of these is a feeding concern in children with Moebius syndrome? a. Timing and coordination of sucking and swallowing b. Achieving and maintaining an adequate lip seal c. Excessive airflow through an open cleft d. Nasal regurgitation e. Airway obstruction 15. What is the main reason that an infant with bilateral complete cleft lip and palate will have feeding difficulty? a. The nipple gets pushed into the open cleft during attempts at feeding b. There is not enough hard palate surface for compression of the nipple c. The open cleft interferes with the ability to build up suction d. The infant cannot purse the lip adequately around the nipple e. The base of the tongue occludes the posterior cleft, making swallowing difficult 16. Which of the following is true about a child with Pierre Robin sequence? a. There are fewer feeding difficulties in comparison to infants with other types of clefts. b. Breastfeeding is easier due to the micrognathia. c. A shorter wider nipple is best for bottle-feeding. d. There are often respiratory difficulties associated with feeding attempts. e. The glossoptosis affects the infant’s ability to latch on to the nipple.

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6

Test Questions: Chapter 5. Feeding Problems of Infants with Clefts or Craniofacial Anomalies

17. What two items must work synchronously to be effective for normal feeding? a. Nipple compression and rooting reflex b. Tongue elevation and cupping of the tongue c. Nipple compression and generation of negative pressure suction d. A and B e. All of the above 18. Which of the following facilitates early suckling? a. The tongue rests in a more anterior position b. The tongue tip protrudes past the alveolar ridge and maintains contact with the lower lip c. The temporomandibular joint does not allow for much movement, causing the mouth opening to be small d. a and c e. a, b, and c 19. Which of the following are essential for normal feeding? a. Nipple compression b. Generation of positive pressure suction c. Generation of negative pressure suction d. a and b e. a and c

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7

Test Questions: Chapter 5. Feeding Problems of Infants with Clefts or Craniofacial Anomalies

20. Breastfeeding is more likely to be possible in which of the following circumstances? a. Anterior cleft (hard palate only) b. Posterior cleft (soft palate only) c. Cleft lip only d. a and c e. b and c

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8

Test Questions: Chapter 6. Developmental Aspects: Speech, Language, and Cognition

TEST QUESTIONS Chapter 6: Developmental Aspects: Speech, Language, and Cognition

From Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance, 3rd Edition Ann W. Kummer, Ph.D., CCC-SLP

1. 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.

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1

Test Questions: Chapter 6. Developmental Aspects: Speech, Language, and Cognition

2

2. Which of the following statements is true? a. There is an undeniable connection between facial development and the brain based on a wide set of evidence. b. There is no connection between the facial development and the brain based on a wide set of evidence. c. The research shows a connection between the brain and facial development, but only when there is both a cleft lip and a cleft palate. d. Some studies have suggested that there may be a connection between the facial development and the brain. e. The research shows a connection between the brain and facial development, but only when there is cleft palate.

3. Which of the following statements is true? a. The infant’s abnormal phonological development as a result of the open palate can persist into early speech, even after the palate is repaired. b. Many children with VPI have reduced expressive language output due to difficulty with speech production. c. Children with a history of cleft lip only are just as likely to have speech sound errors as children with a history of cleft palate. d. a and b e. a and c 4. Which of the following are common phonemic substitutions used by children who have an unrepaired cleft palate? a. Glides for liquids b. Nasals for orals c. Glottal stops for plosive stops d. b and c e. a, b, and c

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Test Questions: Chapter 6. Developmental Aspects: Speech, Language, and Cognition

5. 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 6. Infants associate the physical movement of sound production with auditory results through which of the following? a. Cooing and babbling system b. Taking turns and external stimulation c. Tactile-kinesthetic and auditory feedback loop d. Speech stimulation of the caregivers e. Contrasting voiced and voiceless phonemes 7. Children with a history of cleft palate only, especially those who have other congenital anomalies, are at most risk for which of the following? a. Hearing impairment b. Developmental and intellectual deficits c. Sensory integration disorders d. Autism e. Cerebral palsy

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3

Test Questions: Chapter 6. Developmental Aspects: Speech, Language, and Cognition

8. 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 9. Which of the following is not a big factor for normal language and cognitive development? a. Intelligence b. Attending skills c. Vision d. Education of the parents e. Hearing 10. An infant with a cleft palate will tend to produce a predominance of what type of consonants? a. Glottals and velars b. Plosives c. Fricatives and affricates d. Liquids e. Glides

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4

Test Questions: Chapter 6. Developmental Aspects: Speech, Language, and Cognition

11. Infants with an unrepaired cleft palate demonstrate an alteration in the manner of production, with a predominant use of which types of consonants? a. Stops b. Fricatives c. Liquids d. Nasals e. Glides 12. Which of the following increases the risk for developmental and intellectual deficits? a. Cleft lip only b. Complete clefts of the lip and palate c. Facial clefts d. Cleft palate only e. Bilateral clefts

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5

Test Questions: Chapter 7. Resonance Disorders and Velopharyngeal Dysfunction (VPD)

TEST QUESTIONS Chapter 7: Resonance Disorders and Velopharyngeal Dysfunction (VPD)

From Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance, 3rd Edition Ann W. Kummer, Ph.D., CCC-SLP

1. Match the letter of the answer with each item. a. Velopharyngeal insufficiency (VPI) b. Velopharyngeal incompetence (VPI) c. Velopharyngeal mislearning a. Caused by an anatomical (structural) defect b. Occurs with dysarthria c. Results in phoneme-specific nasal emission c. Occurs due to use of an ŋ/l substitution a. Occurs due to irregular adenoids c. Occurs due to a high tongue position during speech b. Can be caused by a neuromuscular disorder

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1

Test Questions: Chapter 7. Resonance Disorders and Velopharyngeal Dysfunction (VPD)

c. Occurs due to production of a pharyngeal fricative for sibilants only c. Occurs as a result of hearing los a. Most common form of velopharyngeal dysfunction 2. Match the letter of the answer with each item. a. Obligatory error b. Compensatory error c. Mislearning a. Labial or lingual position altered due to structural abnormality a. Nasalized plosives and VPI c. An ŋ/l substitution a. Correct labial or lingual position but interfering structural abnormality b. Class III malocclusion and lateral lisp c. Pharyngeal fricative and no VPI b. Following a history of cleft palate, normal structure and physiology, but still existing nasal emission a. Includes the following substitution: m/b b. Includes the following substitution: n/s a. Cannot be corrected with therapy 3. Hypernasality is most noticeable on which of the following: a. Affricates b. Vowels c. Fricatives d. Plosives e. Nasals

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2

Test Questions: Chapter 7. Resonance Disorders and Velopharyngeal Dysfunction (VPD)

4. Hyponasality is most noticeable on which of the following: a. Affricates b. Vowels c. Fricatives d. Plosives e. Nasals 5. Which of the following best describes cul-de-sac resonance? a. A reduction of nasal resonance during speech due to a blockage in the nasopharynx b. Too much sound in the nasal cavity c. Sound trapped in one of the cavities of the vocal tract d. Nasal air emission e. Too much sound in the oral cavity 6. Which of the following is not caused by significant nasal emission? a. Short utterance length b. Compensatory errors c. Nasal grimace d. Hypernasality e. Weak consonants

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3

Test Questions: Chapter 7. Resonance Disorders and Velopharyngeal Dysfunction (VPD)

7. What type of resonance disorder occurs due to abnormal of the oral and nasal cavities during speech? a. Hyponasality b. Hypernasality c. Nasal air emission d. Mixed resonance e. Cul-de-sac resonance 8. 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 9. Nasal emission is never audible on which of the following types of speech sounds? a. Affricates b. Vowels c. Fricatives d. Plosives a. Pressure-sensitive phonemes

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4

Test Questions: Chapter 7. Resonance Disorders and Velopharyngeal Dysfunction (VPD)

10. What class of sounds is more often distorted by nasal emission? a. Voiced fricatives b. Voiceless fricatives c. Voiced plosives d. Voiceless plosives e. Vowels 11. Hyponasality most affects the production of which type of sounds? a. High vowels b. Stop consonants c. Nasal consonants d. Fricative consonants e. Low vowels 12. What is it called when airflow is released through the nose during production of pressure sensitive consonants? a. Nasal flow b. Nasal fricative c. Nasal emission d. Nasal grimace e. Nasal resonance

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5

Test Questions: Chapter 7. Resonance Disorders and Velopharyngeal Dysfunction (VPD)

13. Which speech characteristics are most likely to occur with a very large velopharyngeal opening? a. Significant audible nasal emission b. Hypernasality and audible nasal emission c. A loud and distorting nasal rustle d. Hypernasality and inaudible nasal emission e. Pharyngeal fricatives 14. Phoneme-specific nasal emission typically occurs on which of the following? a. Low-pressure sounds b. Velar sounds c. Sibilant sounds d. Nasal sounds e. Glides 15. Very large tonsils are most likely to cause which of the following? a. Cul-de-sac resonance b. Hypernasality c. Hyponasality d. Mixed resonance e. Nasal emission

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6

Test Questions: Chapter 7. Resonance Disorders and Velopharyngeal Dysfunction (VPD)

16. A nasal rustle (sometimes called turbulence) usually occurs due to which of the following? a. A small velopharyngeal gap b. A large velopharyngeal gap c. An oronasal fistula d. Nasal emission with a deviated septum e. Nasal obstruction 17. Maxillary advancement may improve which of the following? a. Cul-de-sac resonance b. Hypernasality c. Hyponasality d. Mixed resonance e. Nasal emission 18. Which of the following is an obligatory distortion? a. Generalized backing b. Nasalization of vowels c. Velar fricative d. Nasal sniff e. Pharyngeal fricative

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7

Test Questions: Chapter 7. Resonance Disorders and Velopharyngeal Dysfunction (VPD)

8

19. Compensatory productions usually sacrifice which of the following? a. Manner of production b. Place of production c. Voicing d. Intensity of production e. Air pressure 20. 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 21. Which compensatory production for velopharyngeal insufficiency is often co-articulated with /b/? a. Pharyngeal fricative b. Pharyngeal plosive c. Palatal dorsal production d. Nasal fricative e. Glottal stop

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Test Questions: Chapter 7. Resonance Disorders and Velopharyngeal Dysfunction (VPD)

22. What is the most common cause of velopharyngeal dysfunction in patients with Crouzon syndrome? a. Short velum b. Deep pharynx c. Velar paresis d. Occult submucous cleft e. Dysarthria 23. Cul-de-sac resonance can be due to which of the following? a. Adenoidectomy b. Tonsillectomy c. Enlarged tonsils d. Enlarged adenoids e. A fistula 24. Short utterance length is usually associated with which of the following? a. Hypernasality b. Hyponasality c. Nasal air emission d. Cul-de-sac resonance e. Nasal rustle

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9

Test Questions: Chapter 7. Resonance Disorders and Velopharyngeal Dysfunction (VPD)

25. Velopharyngeal incompetence can be due to which of the following? a. A velar fistula b. A thin velum c. Velar paresis d. Enlarged tonsils e. Irregular adenoids 26. Match the letter of the answer with each item. a. Adenoidectomy b. Frenulectomy c. Glossectomy d. Tonsillectomy e. Maxillary advancement f. Radiation treatment b. Done for ankyloglossia d. Almost never causes problems with speech, but may improve both speech and resonance a. Is usually contraindicated with a submucous cleft e. Improves aesthetics but may exacerbate VPI f. Can cause VPI that is usually not correctable with surgery d. Can eliminate pharyngeal cul-de-sac resonance

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10

Test Questions: Chapter 7. Resonance Disorders and Velopharyngeal Dysfunction (VPD)

27. Match the letter of the answer with each item. a. Cul-de-sac resonance b. Hyponasality c. Hypernasality d. Mixed resonance e. Normal resonance a. Has been called “potato-in-the-mouth speech” d. May be due to a combination of VPI and large adenoids a. When sound resonates in pharynx or nasal cavity and can’t get out c. Is most perceptible on vowels b. Is perceptible on nasal sounds e. Requires velopharyngeal closure on oral sounds a. Can be caused by large, touching tonsils b. Can be caused by maxillary retrusion c. Can be caused by a deep pharynx b. May be caused by large adenoids c. May be caused by an adenoidectomy c. May occur when the back of the tongue remains high during speech

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11

Test Questions: Chapter 7. Resonance Disorders and Velopharyngeal Dysfunction (VPD)

28. Match the letter of the answer with each item. a. Ankyloglossia

g. Fistula

b. Apraxia

h. Irregular adenoids

c. Choanal atresia

i. Hearing loss

d. Dysarthria

j. Hypotonia

e. Enlarged adenoids

k. Maxillary retrusion

f. Enlarged tonsils

l. Mislearning

g. Can cause nasal emission on /t/ and /s/, but not on /k/ l. Cause of consistent nasal emission on certain sounds only and can be corrected by therapy a. Can cause infants to have difficulty latching on to a nipple c. Blocks the entry to the nasal cavity f. Can cause a pharyngeal cul-de-sac resonance e. Can cause hyponasality

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12

Test Questions: Chapter 7. Resonance Disorders and Velopharyngeal Dysfunction (VPD)

13

29. Match the letter of the answer with each item. a. Glottal stop

g. Obligatory distortion

b. Nasalized voiced plosives

h. Pharyngeal fricatives

c. Nasal emission

i. Phoneme-specific nasal emission

d. Nasal grimace

j. Short utterance length

e. Nasal rustle

k. Weak/omitted consonants

f. Nasal snort

l. Velar fricatives

e. High-frequency, high-intensity sound that is associated with a small VP opening c. Not hypernasality, but occurs with hypernasality and is often barely audible b. Occurs on /b/ and /d/ when placement is normal but there is a large VP opening a. Compensatory production that is most often co-articulated g. Type of speech sound error that will self-correct with surgical correction of structure e. Is caused by bubbling of secretions i. Nasal emission that only affects sibilants h. Commonly substituted for sibilants when there is VPI; continues to cause nasal emission after VPI is corrected f. Most likely to occur on /s/ blends

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Test Questions: Chapter 8. Facial, Oral and Pharyngeal Anomalies

TEST QUESTIONS Chapter 8: Facial, Oral and Pharyngeal Anomalies

From Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance, 3rd Edition Ann W. Kummer, Ph.D., CCC-SLP

1. Match the letter of the answer with each item. Note: Not all answers in the word banks are used, and some may be used more than once. a. Aural atresia b. Aural dysplasia c. Mastoiditis d. Microsomia e. Microtia f. Middle ear effusion g. Otitis media f. Condition in which fluids collect within the middle ear space due to the negative pressure g. An infection in the middle ear c. An infection of the mastoid process of the temporal bone

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1

Test Questions: Chapter 8. Facial, Oral and Pharyngeal Anomalies

a. Congenital closure of the external auditory canal e. Malformation of the pinna 2. The Eustachian tube connects which of the following? a. Nasopharynx to the oropharynx b. Oropharynx to the hypopharynx c. Oral cavity to the nasal cavity d. Middle ear to the nasopharynx e. Middle ear to the oropharynx 3. What muscle is responsible for middle ear function? a. Levator veli palatini b. Musculus uvulae c. Palatopharyngeous d. Tensor veli palatini e. Palatatoglossus f. Superior constrictor 4. What treatment for otitis media is often done during a cleft lip repair? a. Adenoidectomy b. Myringotomy c. Pressure-equalizing tubes d. a and c e. b and c

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2

Test Questions: Chapter 8. Facial, Oral and Pharyngeal Anomalies

3

5. What is a common cause of acute otitis media? a. Eustachian tube malfunction b. Enlarged tonsils c. Cleft palate d. Cleft lip e. Tympanic membrane malfunction 6. What is the primary reason that preschool children are more prone to ear infections than adults? a. They often have enlarged tonsils that block the Eustachian tube b. They tend to have poor oral hygiene, making them more prone to infection c. They have a less efficient immune system than adults d. The inclination of the Eustachian tube is less sloped than an adult’s e. They have a smaller middle ear space than an adult 7. Which of the following conditions is not associated with malformations of the external and/or middle ear? a. Treacher Collins b. Pierre Robin c. Hemifacial microsomia d. Crouzon e. Apert

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Test Questions: Chapter 8. Facial, Oral and Pharyngeal Anomalies

8. Inner ear abnormalities typically cause which type of hearing loss? a. Conductive b. Profound c. Sensorineural d. Mild e. Moderate 9. A deviated septum is most likely to cause which type of resonance? a. Cul-de-sac resonance b. Hypernasality c. Hyponasality d. Mixed resonance e. Nasal emission 10. What anomaly, commonly seen in individuals with repaired cleft lip and palate, and is characterized by a small upper jaw (maxilla) relative to the lower jaw (mandible). a. Mandibular occlusion b. Maxillary retrusion c. Maxillary occlusion d. Mandibular retrusion e. Maxillary protrusion

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4

Test Questions: Chapter 8. Facial, Oral and Pharyngeal Anomalies

11. Which of the following is most likely to cause speech problems? a. Macroglossia b. Microglossia c. Macrostomia d. Ankyloglossia e. Microsomia 12. What two sounds should be evaluated when determining whether ankyloglossia is affecting speech? a. /s/ and /z/ b. /l/ and /θ/ c. /s/ and /l/ d. /θ/ and /s/ e. /s/ and /ʃ/ 13. A frenulectomy is most often indicated for which of the following? a. Speech difficulties b. Feeding difficulties c. Dental difficulties d. Cosmetic concerns e. Medical concerns

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Test Questions: Chapter 8. Facial, Oral and Pharyngeal Anomalies

14. What syndrome causes facial nerve paralysis? a. Crouzon syndrome b. Down syndrome c. Moebius syndrome d. Treacher Collins syndrome e. Orofaciodigital syndrome 15. Tonsillar hypertrophy is typically rated on which scale? a. On a 3-point scale b. On a 4-point scale c. On a 5-point scale d. On a 6-point scale e. On a 7-point scale 16. 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

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Test Questions: Chapter 8. Facial, Oral and Pharyngeal Anomalies

17. Which of the following is not used as a treatment for upper airway obstruction in children? a. Tonsillectomy b. Adenoidectomy c. Tracheostomy d. Uvulopalatopharyngoplasty e. CPAP 18. A child who has a maxillary retrusion is likely to have which type of occlusion? a. Class I b. Class II c. Class III d. Anterior open bite e. Underjet 19. Which is the condition where the lingual frenulum is congenitally short and attaches to the anterior tongue tip? a. Microfrenum b. Microglossia c. Ankyloglossia d. Lobulated tongue e. Microsomia

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Test Questions: Chapter 8. Facial, Oral and Pharyngeal Anomalies

20. Which of the following is not a typical feature that accompanies maxillary retrusion? a. Tongue tip being anterior to alveolar ridge and maxillary teeth b. Difficulty producing labiodental sounds c. Base of tongue retruding into oropharynx d. Possible difficulty producing bilabial sounds e. Anterior crossbite 21. Which term refers to the mouth? a. Glossia b. Somia c. Stomia d. Lingual e. Auricle 22. Which of the following statements is not true about a deviated nasal septum? a. It may occur as a result of a cleft palate. b. It may lead to increased risk of ear infections. c. It may occur as a result of birth trauma. d. It may affect nasal resonance during speech. e. It may obstruct airflow through the nose.

23. Macroglossia is characteristic of which of the following syndromes? a. Velocardiofacial syndrome b. Beckwith-Wiedemann syndrome c. Bell’s Palsy d. Van der Woude syndrome e. Stickler’s syndrome

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Test Questions: Chapter 8. Facial, Oral and Pharyngeal Anomalies

24. When there is maxillary retrusion, what kinds of the sounds are unlikely to be affected? a. Sibilants b. Lingual-alveolar sounds c. Labiodentals d. Bilabial sounds e. Velars 25. When a neonate has bilateral choanal atresia, what is the biggest concern? a. The infant can’t breathe while crying b. The infant is unable to swallow efficiently c. The infant is unable to breathe at rest d. The infant can’t hear e. a and b 26. 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

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9

Test Questions: Chapter 9. Dental Anomalies

TEST QUESTIONS Chapter 9: Dental Anomalies

From Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance, 3rd Edition Ann W. Kummer, Ph.D., CCC-SLP

1. Match the letter of the answer with each item. Note: Not all answers in the word banks are used, and some may be used more than once. a. Class I occlusion b. Class II occlusion c. Class III occlusion d. Anterior crossbite c. May cause bilabials to be produced as reverse labiodentals c. May include mandibular prognathism a. A normal skeletal relationship b. Most likely to be associated with micrognathia d. Normal skeletal occlusion, but maxillary incisors are inside the mandibular incisors

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Test Questions: Chapter 9. Dental Anomalies

b. May cause the tongue tip to be under the palate rather than the alveolar ridge c. Abnormal skeletal occlusion that can cause a frontal lisp as an obligatory error c. Skeletal malocclusion that can cause a reverse labiodental placement for f/v 2. Which of the following is not a dental anomaly associated with clefts? a. Diastema b. Rotated teeth c. Missing teeth d. Protruding premaxilla e. Crossbite 3. 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) 4. Which appliance can sometimes be helpful with speech therapy for correction of palatal-dorsal productions? a. Arch appliance b. Quad helix appliance c. Palatal lift d. Rapid palatal expander e. Speech bulb

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Test Questions: Chapter 9. Dental Anomalies

5. Which sounds are most likely to be affected by a protruding premaxilla? a. Labiodentals b. Interdental sounds c. Lingual-alveolars d. Bilabials e. Sibilants 6. Which sounds are most likely to be affected by an anterior crossbite? a. Labiodentals b. Interdental sounds c. Velars d. Bilabials e. Sibilants 7. What is the term for the permanent teeth that replace the baby teeth? a. Deciduous teeth b. Incisor teeth c. Succedaneous teeth d. Wisdom teeth e. Canine teeth 8. How many teeth do children have? How many teeth do adults have? a. 24; 32 b. 18; 26 c. 20; 32 d. 18; 32 e. 20; 28

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Test Questions: Chapter 9. Dental Anomalies

9. Which of the following statements is true of buccal crossbite? a. Occurs when the lingual cusps of all the maxillary posterior teeth are buccal to the mandibular teeth b. Involves any combination of teeth distal to the canines and usually occurs because the maxilla is too narrow c. Occurs when one or more maxillary teeth are positioned buccally such that the maxillary lingual cusps reside buccal to the mandibular cusps d. All of the above e. None of the above 10. Which of the following is most commonly seen in individuals with a history of cleft lip and palate? a. Class I occlusion: normal relationship of the molars and line of occlusion b. Class I malocclusion: normal relationship of the molars, but line of occlusion incorrect c. Class II malocclusion: mandibular retrusion and/or maxillary protrusion d. Class III malocclusion: mandibular protrusion and/or maxillary retrusion e. Class II malocclusion: mandibular protrusion and/or maxillary retrusion 11. Which dental abnormality occurs when the lower teeth overlap the upper teeth buccally? a. Open bite b. Overbite c. Lateral crossbite d. Diastema e. Anterior crossbite

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Test Questions: Chapter 9. Dental Anomalies

12. What is the term for the vertical overlap of the lower incisors over the upper incisors making the bite deep? a. Underbite b. UnderJet c. OverJet d. Overbite e. Diastema 13. 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 14. What is the term for the horizontal relationship of the upper to the lower incisors? a. Labioversion b. UnderJet c. OverJet d. Overbite e. Diastema

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Test Questions: Chapter 9. Dental Anomalies

15. 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 16. What is the term that describes the part of the dental arch that is posterior to the canine teeth? a. Labial b. Buccal c. Mesial d. Distal e. Lingual 17. What is the term for teeth that erupt in an abnormal position? a. Supernumerary b. Ectopic c. Diastema d. Crossbite e. Malocclusion

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Test Questions: Chapter 9. Dental Anomalies

18. Which of the following is true about the effect of missing teeth on speech? a. There is never an effect on speech. b. There is always an effect on speech. c. The effect on speech depends on the size of the oral cavity. d. Missing incisors will always cause a frontal lisp. e. Missing teeth only cause problems with sibilant sounds.

19. At about what age does an infant’s first tooth (primary lower incisors) begin to erupt? a. 4 months b. 6 months c. 8 months d. 10 months e. 12 months 20. In general, at what age is the primary dentition complete? a. 12 to 18 months b. 18 to 24 months c. 24 to 30 months d. 30 to 36 months e. 3 to 4 years 21. What group of sounds is most commonly affected by dental abnormalities? a. Sibilants b. Stops c. Nasals d. Velars e. Glottals

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Test Questions: Chapter 9. Dental Anomalies

22. In which of the following cases is speech therapy always inappropriate? a. When there are articulation placement errors and dental anomalies b. When there are obligatory distortions only c. When there are compensatory errors only d. When there is a Class II malocclusion and there are errors on lingual-alveolar sounds e. When there is Class III malocclusion and there are errors on velar sounds 23. Which of the following would be considered a compensatory error due to a Class III malocclusion? a. Frontal lisp b. Lateral lisp c. Pharyngeal fricative d. Glottal stop e. Velar fricative 24. Which of the following would be considered an obligatory distortion due to a Class III malocclusion? a. Frontal lisp b. Lateral lisp c. Pharyngeal fricative d. Glottal stop e. Velar fricative

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Test Questions: Chapter 10. Psychosocial Aspects of Cleft Lip/Palate and Craniofacial Anomalies

TEST QUESTIONS Chapter 10: Psychosocial Aspects of Cleft Lip/Palate and Craniofacial Anomalies

From Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance, 3rd Edition Ann W. Kummer, Ph.D., CCC-SLP

1. Why is the birth of a child with a craniofacial anomaly more stressful than the birth of an unaffected baby? a. There are many extra demands on parents because of medical appointments and feeding difficulties. b. There are unspoken parental fears that the baby may die. c. There is a higher incidence of psychiatric disorders among parents of affected children. d. There is a resulting change in the parents’ plans for future reproduction. e. All of the above 2. Why is elementary school difficult for children with clefts? a. Teachers tend to reject them more often compared to unaffected classmates. b. They often have communication deficits related to their speech skills. c. They have higher levels of anxiety compared to their unaffected peers. d. They have lengthy absences for surgeries. e. All of the above © 2014 Cengage Learning. All Rights Reserved.

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Test Questions: Chapter 10. Psychosocial Aspects of Cleft Lip/Palate and Craniofacial Anomalies

3. Which of the following is true about teasing of children who have craniofacial anomalies? a. It is correlated with the degree of difference in their facial appearance. b. It appears to be an inevitable part of growing up with facial differences. c. It can be altered by the child’s personality style. d. It persists well into adulthood for most affected individuals. e. All of the above 4. Which of the following is true about a person’s degree of physical attractiveness? a. It influences responses to him or her as a baby. b. It interacts with speech quality to affect social judgments by others. c. It affects the child’s experience of school. d. It changes the likelihood of the person being hired. e. All of the above 5. What causes “stigma” for individuals with craniofacial anomalies? a. The deviation from cultural standards of beauty b. Deliberate negative intent by unaffected people c. Compensatory activities of unaffected individuals, such as being unusually indulgent or helpful d. Extra awareness of the affected individuals by those who are unaffected e. All of the above

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Test Questions: Chapter 10. Psychosocial Aspects of Cleft Lip/Palate and Craniofacial Anomalies

6. Which of the following is true about children with clefts? a. They see themselves as less acceptable than their peers. b. They view themselves as positively as their typical peers if the cleft is invisible, such as in cleft palate only. c. They are more satisfied with their appearance when they are younger than when they are teens. d. They become more socially competent than their peers to compensate for their differences. e. All of the above 7. 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 8. 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

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Test Questions: Chapter 10. Psychosocial Aspects of Cleft Lip/Palate and Craniofacial Anomalies

9. A psychologist can help children with craniofacial anomalies address which of the following? a. Nonadherence to treatment recommendations b. Coping with visible treatments, such as distraction or reverse face mask c. Fear of surgery d. Anxiety during dental visits e. All of the above 10. Which syndrome includes a risk of psychosis as the child becomes a teenager? a. Moebius syndrome b. Velocardiofacial syndrome c. CHARGE syndrome d. Apert syndrome e. Treacher Collins syndrome 11. 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

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Test Questions: Chapter 11.Speech and Resonance Assessment 1

TEST QUESTIONS Chapter 11: Speech and Resonance Assessment

From Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance, 3rd Edition Ann W. Kummer, Ph.D., CCC-SLP

1. Which of the following is an example of a low-pressure sentence for evaluation of hypernasality? a. Many men are in the mine. b. What do you like best, baseball or basketball? c. Go get the wagon. d. Why are you here? e. He has a big horse.

2. What is a recommended procedure to elicit speech in a child that is reticent? a. Have the child repeat single words rather than sentences b. Ask the child to name pictures c. Ask open-ended questions d. Ask either/or questions e. Wait for the child to talk spontaneously

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Test Questions: Chapter 11.Speech and Resonance Assessment 2

3. Which series of numbers is best to use when testing for nasal emission? a. 50s b. 60s c. 70s d. 80s e. 90s 4. Which series of numbers is best to use when testing for hyponasality? a. 50s b. 60s c. 70s d. 80s e. 90s 5. What phoneme is best to use when testing for hypernasality? a. /m/ b. /p/ c. /b/ d. /n/ e. /ɑ/ 6. Which phoneme best to use when testing for nasal emission? a. /p/ b. /s/ c. /g/ d. /l/ e. /z/

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Test Questions: Chapter 11.Speech and Resonance Assessment 3

7. If you use the nasal cul-de-sac test and you hear a difference on production of a vowel, this confirms the diagnosis of which of the following? a. Hypernasality b. Hyponasality c. Cul-de-sac resonance d. Nasal emission e. Normal resonance 8. Which of the following groups of sounds will never have nasal emission as a result of an oronasal fistula in the area of the incisive foramen? a. Velars b. Lingual-alveolars c. Sibilants d. Bilabials e. Plosives 9. Which of the following is not an effective way for assessing hypernasality, nasal emission, and velopharyngeal function? a. A straw b. Listening tube c. Manometer d. Stethoscope e. All of the above

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Test Questions: Chapter 11.Speech and Resonance Assessment 4

10. 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 11. Which of the following has a significant effect on utterance length? a. Range of motion of the oral structures b. Pharyngeal fricatives c. Nasal emission d. Weak consonants e. Hypernasal resonance 12. Which of the following techniques does not use auditory detection of nasality? a. Nose pinch b. Stethoscope c. Straw d. Air paddle e. Tube

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Test Questions: Chapter 11.Speech and Resonance Assessment 5

13. In the first year of life, what are the primary speech pathology concerns for a child with a Pierre Robin sequence? a. Receptive language b. Velopharyngeal function c. Feeding and prerequisites for verbal communication d. Quality of communication e. Quantity of communication 14. Which of the following is recommended as the best no-tech procedure for evaluation of nasal air emission? a. Mirror test b. Straw test c. Air paddle d. See-Scape e. Feeling the sides of the nose 15. When evaluating nasal emission, the speech sample should have many of which type of phonemes? a. High vowels b. Back vowels c. Voiceless consonants d. Voice consonants e. Plosives

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Test Questions: Chapter 11.Speech and Resonance Assessment 6

16. Surgery is never indicated for which of the following? a. Velopharyngeal insufficiency b. Velopharyngeal incompetence c. Velopharyngeal mislearning d. A symptomatic fistula e. An occult submucous cleft 17. What is the appropriate recommendation for treatment of velopharyngeal mislearning? a. Surgery and then speech therapy b. Surgery only c. Speech therapy for obligatory distortions d. Speech therapy and then surgery e. Speech therapy only 18. 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 19. Phoneme specific hypernasality will most likely occur in which of the following words? a. Heat b. Cat c. Sit d. Pay e. Met

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Test Questions: Chapter 11.Speech and Resonance Assessment 7

20. Which of the following words contains the best consonant for testing nasal emission? a. Shoe b. Cheap c. Pass d. Judge e. Bush 21. If the child has a nasal rustle on s/z, but not on any other sounds, what is the probable cause? a. Compensatory productions b. Obligatory productions c. Lateral lisp d. Frontal lisp e. Phoneme-specific nasal emission 22. When voiced plosives sound closer to their nasal cognates (m/b, n/d, and ŋ/g), what does this suggest? a. Phoneme-specific nasality b. A small velopharyngeal opening c. Compensatory productions d. Obligatory distortions e. Hyponasality

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Test Questions: Chapter 11.Speech and Resonance Assessment 8

23. What speech production can cause phoneme-specific nasal emission? a. Glottal stop b. Pharyngeal fricative c. Palatal-dorsal production d. Pharyngeal plosive e. Velar fricative 24. Which of the following misarticulations can be co-articulated with the /b/ sound? a. Pharyngeal plosive b. Palatal-dorsal c. Velar fricative d. Glottal stop e. Pharyngeal fricative 25. Which type of resonance is common with childhood apraxia of speech? a. Hypernasality b. Hyponasality c. Cul-de-sac resonance d. Mixed resonance e. Forward focused resonance

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Test Questions: Chapter 11.Speech and Resonance Assessment 9

DIAGNOSTIC IMPRESSIONS You examine a child who has a history of unilateral complete cleft lip and palate. He has a fistula just behind the alveolar ridge in the area of the incisive foramen. It appears to be about 7 mm in diameter, but you are not sure if it goes all the way through. You evaluate the child’s speech. Answer the following three questions related to this case: 1. 1. If the child demonstrates nasal emission on /p/, /t/, and /k/, but more on the /t/ than the others, what is the probable cause? a. VPI only b. The fistula only c. VPI and the fistula d. Misarticulation causing nasal emission 2. If the child demonstrates nasal emission on /p/ and /t/, but not on /k/, what is the probable cause? a. VPI only b. The fistula only c. VPI and the fistula d. Misarticulation causing nasal emission 3. If the child demonstrates nasal emission on s/z only, what is the probable cause? a. VPI only b. A fistula only c. VPI and the fistula d. Misarticulation causing nasal emission

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Test Questions: Chapter 12. Orofacial Examination

TEST QUESTIONS Chapter 12: Orofacial Examination

From Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance, 3rd Edition Ann W. Kummer, Ph.D., CCC-SLP

1. Which word contains the vowel that is the best to use for an intraoral examination? a. Hot b. Hat c. Heat d. Hit e. Hut 2. What muscle forms the velar dimple during contraction? a. Levator veli palatini b. Musculus uvulae c. Palatopharyngeous d. Tensor veli palatini e. Palatatoglossus

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Test Questions: Chapter 12. Orofacial Examination

3. An individual with a craniofacial syndrome may present with hypertelorism, indicating which of the following? a. Absence of an external auditory canal b. Excess folds of tissue extending from the upper eyelid to the inner corner of the orbit c. Too little space between the eyes d. Excessive spacing between the eyes e. Narrow palpebral fissures 4. A lobulated tongue is most indicative of which syndrome? a. Crouzon’s b. Velocardiofacial c. Orofaciodigital d. Beckwith-Wiedemann e. Trisomy 18 5. 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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2

Test Questions: Chapter 12. Orofacial Examination

6. What are infections acquired in the hospital called? a. Nosocomial infections b. Acquired infections c. Microbial infections d. Septic infections e. Influenzacoccal infections 7. What is the most common cause of the spread of infection in healthcare settings? a. Providers not wearing gloves, when appropriate b. Providers not wearing a mask, when appropriate c. Providers not following proper handwashing guidelines d. Medical equipment that is not properly disinfected e. Medical equipment that is not properly sterilized 8. 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

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Test Questions: Chapter 12. Orofacial Examination

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9. Which of the following can often be viewed in young children during an oral examination, but cannot be seen in adults during this exam? a. Bifid uvula b. Epiglottis c. Median palatine raphe d. Velar dimple e. Zona pellucida 10. What does a white line in the middle of the velum indicate? a. An overt submucous cleft b. An occult submucous cleft c. An inadequate cleft palate repair d. A normal velum e. Velar diastasis 11. An intraoral evaluation reveals a bifid uvula. Which of the following statements is true? a. Resonance will be hypernasal b. A tonsillectomy is contraindicated c. The child will have nasal emission d. The child may have normal velopharyngeal function e. The child will have velopharyngeal incompetence

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Test Questions: Chapter 12. Orofacial Examination

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12. What is the typical cause of asymmetrical movement of the velum during phonation? a. Velar paralysis or paresis b. A submucous cleft c. Adenoid hypertrophy d. Velopharyngeal hypotonia e. Anterior attachment of the levator muscle 13. Which of the following is not an indication of an upper airway obstruction? a. Hypernasality b. Chronic open-mouth posture c. Suborbital coloring d. Strident breathing e. Snoring 14. The absence of a velar dimple is related to structural variation of which of the following muscles? a. Levator veli palatini b. Superior constrictor muscles c. Palatoglossus d. Palatopharyngeus e. Musculus uvulae

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Test Questions: Chapter 12. Orofacial Examination

15. 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 16. If you see evidence of food (e.g., chocolate milk or red sauce) around the nostril area, this is an indication of which of the following? a. Nasolabial fistula b. Bilateral lip pit c. Palpebral fissure d. Oropharyngeal fistula e. Hypertelorism 17. What can cause the velum to “tent up” in an inverted V shape during phonation? a. Levator veli palatini muscles inserting into the aponeurosis b. Paralysis of the posterior part of the velum c. Levator veli palatini muscles inserting onto the hard palate d. Paralysis of the levator veli palatini muscles e. Palatopharyngeus muscle inserting abnormally into the velum

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Test Questions: Chapter 12. Orofacial Examination

18. To determine whether ankyloglossia is affecting the speech of an English speaker, the examiner should test which of the following phonemes? a. /l/ and sibilants b. /l/ and lingual-alveolars c. /r/ and /θ/ d. /r/ and /l/ e. /l/ and /θ/ 19. Long-term upper airway obstruction can cause which of the following? a. Anterior open bite b. Anterior tongue position c. Mandible that grows downward d. b and c e. All of the above 20. Bilateral lip pits is indicative of what syndrome? a. Apert syndrome b. Beckwidth-Weidemann syndrome c. Van der Woude syndrome d. Treacher Collins syndrome e. Crouzon syndrome

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7

Test Questions: Chapter 12. Orofacial Examination

21. The area where the levator veli palatini muscle interdigitates in the velum is known as which of the following? a. Median palatine raphe b. Velar dimple c. Torus palatinus d. Zona pellucida e. Uvula 22. If the velum appears “V” shaped” during phonation, what does this suggest? a. Malformed tensor veli palatini muscle b. Submucous cleft c. Torus palatinus d. Passavant’s ridge e. Abnormal attachment of the musculus uvulae muscle

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8

Test Questions: Chapter 13. Overview of Instrumental Procedures

TEST QUESTIONS Chapter 13: Overview of Instrumental Procedures

From Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance, 3rd Edition Ann W. Kummer, Ph.D., CCC-SLP

1. Match the letter of the answer with each item. Note: Not all answers in the word banks are used, and some may be used more than once. a. Aerodynamics b. Magnetic resonance imaging (MRI) c. Nasometry d. Nasopharyngoscopy e. Videofluoroscopy c. Can compare to normative data for the speech passage c. An indirect measure of acoustics a. An indirect measure of airflow a. Provides objective information to estimate the size of the velopharyngeal orifice d. Allows direct viewing of the velopharyngeal valve from above a. An indirect measure of airflow © 2014 Cengage Learning. All Rights Reserved.

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Test Questions: Chapter 13. Overview of Instrumental Procedures

c. Measures acoustic energy from the oral and nasal cavities e. An X-ray imaging technique with simultaneous audio for speech c. Measures acoustic energy from the oral and nasal cavities during speech b. Can be used to evaluation the morphology of the levator muscle c. Can be used to determine phoneme-specific nasal emission based on the numbers a. Provides information on the intraoral air pressure levels d. Allows the examiner to view the velum and pharyngeal walls from above e. Requires several views to see all velopharyngeal structures e. Can see tongue movements during speech d. Can view the vocal folds and determine the presence of vocal nodules e. Requires radiation d. Can see morphology of the nasal surface of the velum in color c. Can determine the effect of a fistula versus VPI c. Measures resonance, in addition to audible nasal emission d. Can easily view the irregular surface of the adenoid tissue b. Provides a static view of the velum

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Test Questions: Chapter 14. Nasometry

TEST QUESTIONS Chapter 14: Nasometry

From Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance, 3rd Edition Ann W. Kummer, Ph.D., CCC-SLP

1. Match the letter of the answer with each item. Note: Not all answers in the word banks are used, and some may be used more than once. a. Nasalance score b. Nasalance distance c. Nasalance ratio d. Nasogram e. Sensitivity f. Specificity e. The extent to which the score is able to correctly identify individuals with abnormal resonance a. The percentage value of nasal acoustic energy of the total (both nasal and oral) energy f. The extent to which the score correctly excludes individuals with normal speech from the abnormal group © 2014 Cengage Learning. All Rights Reserved.

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Test Questions: Chapter 14. Nasometry

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b. The range between the maximum and minimum nasalance d. A visual display of the data on the computer screen 2. Using the following choices, fill in the letter in the left column of the assumed diagnosis based on the nasometry scores. a. Normal velopharyngeal function

e. Phoneme-specific nasal emission

b. Mild velopharyngeal insufficiency

f. Phoneme-specific hypernasality

c. Moderate velopharyngeal insufficiency

g. A symptomatic orornasal fistula h. Hyponasality

d. Severe velopharyngeal insufficiency

Letter

Bilabials

LingualAlveolars

Velars

Sibilants

Nasals

b.

26

28

27

29

56

e.

10

9

11

31

54

g.

34

34

9

32

57

d.

67

65

67

66

62

h.

3

4

2

4

23

a.

9

9

12

15

56

Letter

pa

ta

pi

ti

sa

e.

8

9

8

9

27

f.

7

8

34

35

8

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Test Questions: Chapter 14. Nasometry

3. Which of the following is not true about nasometry? a. It is an indirect measure. b. It provides objective data regarding resonance. c. It can be used with connected speech. d. It provides a visual representation of resonance in real time. e. It provides direct visualization of the velopharyngeal valve.

4. What does a high nasalance score indicate? a. Nasal emission b. Nasal rustle c. Hypernasality d. Hyponasality e. Cul-de-sac resonance 5. What does a low nasalance score typically indicate? a. Nasal emission b. Nasal rustle c. Hypernasality d. Hyponasality e. Cul-de-sac resonance 6. What is the advantage of using a standardized passage to gather nasometric data? a. The passage can be read by the individual rather than repeated. b. It is easier to administer because it is well-known by the examiner. c. The patient’s score can be compared to normative data. d. The passage is designed to contain only certain sounds to make it easier to produce. e. The passage can be designed to contain only oral sounds.

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Test Questions: Chapter 14. Nasometry

7. What should the nasalance score be for a prolonged /s/ when produced by a normal speaker? a. 0% b. About 5% c. About 10% d. About 15% e. About 20% 8. In normal speech, what is the primary determinant of the nasalance score? a. Type of the vowels in the passage b. Type of oral consonants in the passage c. Percentage of high- versus low-pressure sounds in the passage d. Person’s dialect e. Person’s volume 9. High vowels have more nasal resonance than low vowels due to which of the following? a. Shape of the pharynx b. Frequency of the vowel c. Greater incidence of velopharyngeal insufficiency d. Tongue position in the oral cavity e. Larger oral cavity size

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Test Questions: Chapter 14. Nasometry

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10. During production of an oral passage, typical oral resonance should be in what range? a. Under 10 percentage points b. Under 20 percentage points c. Between 20 and 25 percentage points d. Between 25 and 30 percentage points e. None of the above 11. If a child is orally reading a nasal passage and consistently displays low data points on a nasogram, this might be an indication of which of the following? a. Hypernasality b. Hyponasality c. Upper airway obstruction d. b and c e. Normal resonance 12. What would you expect from a dialect, accent, or language that contains more high vowels or a higher tongue position in vowel production? a. Later voice onset time for vowels b. No effect on the nasalance score c. A slightly higher average nasalance score d. A slightly lower average nasalance score e. Nasalance scores higher than 20%

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Test Questions: Chapter 14. Nasometry

13. What cannot be assessed through nasometry? a. Resonance b. Upper airway obstruction during speech c. Changes in resonance following surgery d. Phoneme-specific nasal emission e. Intraoral air pressure 14. Which of the following tests allows the assessment of nasalance by type of speech sound? a. Zoo Passage b. Nasal Sentences c. SNAP test d. Rainbow Passage e. Turtle Passage 15. 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.

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Test Questions: Chapter 14. Nasometry

16. What is the most important statistic that is obtained through nasometry? a. Threshold percentage b. Maximum percentage c. Mean nasalance score d. Fundamental frequency e. Range 17. Which of the following was the first instrument developed to measure nasal and oral acoustic energy? a. Nasometer b. OroNasal System c. TONAR d. NasalView e. Aerodynamic instrumentation

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Test Questions: Chapter 15. Speech Aerodynamics

TEST QUESTIONS Chapter 15: Speech Aerodynamics

From Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance, 3rd Edition Ann W. Kummer, Ph.D., CCC-SLP

1. Which of the following speech symptoms of velopharyngeal dysfunction is assessed with aerodynamic instrumentation? a. Hypernasality b. Hyponasality c. Glottal stops d. Nasal air emission e. a and d 2. Which of the following causes the rapid displacement of the vocal folds during speech? a. Hypopharyngeal airflow b. Subglottic air pressure c. Vocal fold vibration d. Decrease in air pressure e. Phonation

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Test Questions: Chapter 15. Speech Aerodynamics

3. Which of the following cannot be determined by aerodynamic methods? a. Timing aspects of velopharyngeal function b. Extent of nasal emission c. Patency of the nasal airways during breathing d. Estimates velopharyngeal orifice size e. Severity of hypernasality 4. Transducers convert the detected air pressure or flow into which of the following? a. Electrical signals b. A digital format c. Static electricity d. The aerodynamic equation e. Pressure-flow kinematics 5. Which procedure measures airway resistance in the nasal cavity? a. Nasometry b. Manometry c. Rhinomanometry d. Polysomnography e. Nasendoscopy

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Test Questions: Chapter 15. Speech Aerodynamics

6. 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 7. 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 H2O b. 2.0 cm H2O c. 3.0 cm H2O d. 4. 0 cm H2O e. 5.0 cm H2O 8. What does the orifice equation use to calculate minimal cross-sectional area of the velopharyngeal port? a. Simultaneous measures of the differential pressure across the orifice and rate of airflow b. The correction factor h c. Differential pressure across the orifice divided by the rate of airflow d. The increase in airflow and increase in air pressure across the orifice e. The pressure drop across the orifice and increase in oral airflow

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Test Questions: Chapter 15. Speech Aerodynamics

9. Which of the following should always be considered when assessing the status of the nasal airway in children? a. Size of the child b. Weight of the child c. Age of the child d. Opening to the nasal vestibule e. History of allergies 10. How is the rate of nasal airflow measured? a. mm H2O b. cm H2O c. L/s d. mm/s e. cm/s 11. What does a pneumotachograph measure? a. Volume of airflow b. Rate of airflow c. Air pressure d. Nasal air resistance e. Acoustics of airflow

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Test Questions: Chapter 15. Speech Aerodynamics

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12. The pressure-flow technique is ideally suited to determine the magnitude of which of the following during speech? a. Air pressure from the lungs b. Air pressure from nasal emission c. Intraoral air pressure and nasal air emission d. Subglottic air pressure e. All of the above 13. Aerodynamic techniques do not provide information about which of the following? a. Intraoral air pressure level b. Rates of nasal air emission c. Estimates of VP orifice size during consonant production d. Estimates of VP orifice size during vowel production e. Measurements of nasal airway resistance 14. Gross velopharyngeal insufficiency during production of “hamper” may be indicated by which of the following? a. Nasal airflow less than 80 ml/s during /m/ b. Oral air pressure greater than 3 cm H2O during /p/ c. A lack of temporal overlap of the nasal airflow and oral pressure pulses for /m/ and /p/ d. An estimated VP orifice area during /p/ that exceeds 20 mm2 e. Oral air pressure greater than 4 cm H2O during /p/

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Test Questions: Chapter 15. Speech Aerodynamics

15. Why do pressure-flow estimates of orifice size decrease in accuracy when the orifice area exceeds 80 mm2? a. Limitations of the pneumotachograph to record high rates of airflow b. Limitations of the transducers to detect small pressure changes c. Limitations of the pneumotachograph to record an increase in nasal airflow d. Limitations of the transducers to measure an increase in nasal resonance e. Limitations of the transducers to detect a decrease in oral airflow

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Test Questions: Chapter 16. Videofluoroscopy

TEST QUESTIONS Chapter 16: Videofluoroscopy

From Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance, 3rd Edition Ann W. Kummer, Ph.D., CCC-SLP

1. When there is greater attenuation during radiography, which of the following is true? a. The image is near the black end of the spectrum b. More radiation particles will reach the film c. Fewer radiation particles will reach the image d. There is more exposure e. b and d 2. What is needed to adequately image a three-dimensional volume structure adequately? a. Include three mutually perpendicular planes b. Increase the level of radiation for better resolution c. Include the base plane to see the entire port d. Do a 360º rotation e. b and c

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Test Questions: Chapter 16. Videofluoroscopy

3. Which view shows the velum and posterior pharyngeal wall? a. Lateral view b. Frontal view c. Base view d. Oblique view e. Towne’s view 4. Which view is done to view the lateral pharyngeal walls? a. Lateral view b. Frontal view c. Base view d. Oblique view e. Towne’s view 5. Which view shows most of the port? a. Lateral view b. Frontal view c. Base view d. Oblique view e. Towne’s view 6. Which view shows velar height during phonation? a. Lateral view b. Frontal view c. Base view d. Oblique view e. Towne’s view

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Test Questions: Chapter 16. Videofluoroscopy

7. Which view shows tongue movement during speech? a. Lateral view b. Frontal view c. Base view d. Oblique view e. Towne’s view 8. Which view is typically done without barium? a. Lateral view b. Frontal view c. Base view d. Oblique view e. Towne’s view 9. Simultaneous audio recording of speech is done with which of the following? a. Cephalometric X-ray b. MRI c. Videofluoroscopy d. Ultrasound e. c and d 10. 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

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Test Questions: Chapter 16. Videofluoroscopy

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11. Which view used for videofluoroscopy is most similar to the orientation of nasopharyngoscopy? a. Towne’s view b. Oblique view c. AP view d. Base view e. Lateral view 12. 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 13. 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

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Test Questions: Chapter 16. Videofluoroscopy

14. Which of the following is not easily viewed through videofluoroscopy? a. Relationship between the posterior pharyngeal wall and velum b. Length of the velum and its upward movement c. Pharyngeal flap or sphincter pharyngoplasty d. Posterior wall of the pharynx during closure e. Movement of the tongue

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Test Questions: Chapter 17. Nasopharyngoscopy

TEST QUESTIONS Chapter 17: Nasopharyngoscopy

From Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance, 3rd Edition Ann W. Kummer, Ph.D., CCC-SLP

1. 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 2. For surgical planning, what is the most important finding through nasopharyngoscopy? a. Size of the opening b. Shape of the opening c. Location of the opening d. Timing of closure e. Pattern of closure

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Test Questions: Chapter 17. Nasopharyngoscopy

3. A disadvantage of nasopharyngoscopy is that it does not allow the examiner to see which of the following? a. Adenoid tissue b. Nasal surface of velum c. Length of the posterior pharyngeal wall d. Oronasal fistula e. Vocal cords 4. What is the typical diameter of a pediatric scope? a. 0.5 mm b. 1 mm c. 1.7 mm d. 2.2 mm e. 3.2 mm 5. Which of the following should not be done prior to inserting the scope? a. Have the child blow his nose b. Check the image on the camera c. Put lidocaine gel on the scope d. Put the child in a supine position e. Spray the nose with a decongestant

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Test Questions: Chapter 17. Nasopharyngoscopy

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6. When doing nasopharyngoscopy procedure, what is the narrowest part of the passage to the nasopharynx? a. The entrance to the nasal vestibule b. Just under the inferior turbinate c. Just under the middle turbinate d. Just in front of the choana e. The superior meatus 7. Which of the following cannot be viewed through a nasopharyngoscopy procedure? a. Opening to the Eustachian tube b. Vocal folds during phonation c. Passavant’s ridge during speech d. Oronasal fistula e. Length of the posterior pharyngeal wall during speech 8. Why should the morphology of the posterior pharyngeal wall be carefully examined in patients with velocardiofacial syndrome? a. They often have very irregular adenoids, which can affect velopharyngeal closure b. The carotid arteries can be medially displaced in the pharyngeal wall c. They usually have a Passavant’s ridge d. They often have hypoplasia of the pharyngeal wall e. They often have hyperplasia and irregularity of the posterior pharyngeal wall

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Test Questions: Chapter 17. Nasopharyngoscopy

9. 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 10. How should a scope be stored? a. Hanging from a wall in a cabinet b. In the storage case provided by the manufacturer c. In a disinfected plastic case d. In a cloth bag to allow good ventilation e. In a sterilized metal box

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Test Questions: Chapter 18. Surgical Management of Clefts and Velopharyngeal Insufficiency/Incompetence (VPI)

TEST QUESTIONS Chapter 18: Surgical Management of Clefts and Velopharyngeal Insufficiency/Incompetence (VPI)

From Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance, 3rd Edition Ann W. Kummer, Ph.D., CCC-SLP

1. Match the letter of the answer with each item. Note: Not all answers in the word banks are used, and some may be used more than once. a. Adenoidectomy

i. Sphincter pharyngoplasty

b. Cheiloplasty

j. Tennison-Randall

c. Furlow Z-plasty

k. Tongue flap

d. Intravelar veloplasty

l. Tonsillectomy

e. Le Fort I maxillary advancement

m. Two-flap palatoplasty

f. Pharyngeal augmentation

n. Von Langenbeck procedure

g. Pharyngeal flap h. Pharyngoplasty j. Used to repair a cleft lip n. One of the oldest and most successful means to repair a cleft palate k. Used to close a fistula

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Test Questions: Chapter 18. Surgical Management of Clefts and Velopharyngeal Insufficiency/Incompetence (VPI)

b. General term for lip repair h. General term for a surgery to correct VPI? f. Used for very small velopharyngeal openings l. Often needs to be done before a pharyngeal flap c. Can be used as a primary palate repair, or as a secondary procedure i. Best procedure for a “bowtie” type of velopharyngeal gap with lateral gaps g. Best procedure for a large midline velopharyngeal opening i. Uses the palatopharyngeus muscles e. Done after facial growth has completed, to correct skeletal malocclusion l. Rarely has a negative effect on speech; may correct hyponasality or cul-de-sac resonance a. Is usually contraindicated when there is a history of cleft palate a. Can improve the airway and articulation, but may cause hypernasality 2. What procedure is used for aligning the maxillary segments prior to formal surgery for unilateral and bilateral clefts? a. Taping the lip b. Dental elastics c. Latham appliance d. Lip adhesion e. All of the above

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Test Questions: Chapter 18. Surgical Management of Clefts and Velopharyngeal Insufficiency/Incompetence (VPI)

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3. 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 4. What is the location of an “intentional” fistula? a. Alveolar ridge b. Junction of the hard and soft palate c. Area of the incisive foramen d. Alveolus under the lip e. Upper lip 5. Which of the following is not a major factor that determines the success of a pharyngeal flap in correction of VPI? a. Vertical position of the flap in the nasopharynx b. Extent of lateral pharyngeal wall movement c. Use of compensatory productions d. Closure pattern of the lateral pharyngeal wall movement e. Width of the flap

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Test Questions: Chapter 18. Surgical Management of Clefts and Velopharyngeal Insufficiency/Incompetence (VPI)

6. 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.

7. Why is palate surgery more difficult than lip surgery? a. It is technically more demanding. b. There is a greater risk of dehiscence. c. There is a greater risk of fistula formation. d. b and c e. All of the above 8. Which of the following is true about VPI? a. It is a surgical disorder. b. It can be corrected with speech therapy. c. It requires both speech therapy and surgery. d. It can be corrected with speech therapy if it is mild. e. It sometimes gets better without treatment.

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Test Questions: Chapter 18. Surgical Management of Clefts and Velopharyngeal Insufficiency/Incompetence (VPI)

9. 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 10. The earliest that a pharyngoplasty is usually done is at what age? a. 1 to 2 years b. 2 to 2½ years c. 2½ to 3 years d. 3½ to 4 years e. 5 to 6 years 11. When is a cheiloplasty usually performed? a. Right after birth b. 3 to 4 weeks c. 5 to 6 weeks d. 10 to 12 weeks e. 16 to 18 weeks

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Test Questions: Chapter 18. Surgical Management of Clefts and Velopharyngeal Insufficiency/Incompetence (VPI)

12. What is a common surgical procedure for correction of velopharyngeal insufficiency? a. Palatoplasty b. Pharyngeal flap c. Abbe flap d. Palatal lift e. Intravelar veloplasty

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Test Questions: Chapter 19. Orthognathic Surgery for Craniofacial Conditions

TEST QUESTIONS Chapter 19: Orthognathic Surgery for Craniofacial Conditions

From Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance, 3rd Edition Ann W. Kummer, Ph.D., CCC-SLP

1. Which of the following is not addressed routinely by either the cheiloplasty or the palatoplasty? a. Velum b. Oronasal fistula c. Philtral ridges d. Alveolus e. Incisive foramen 2. What is a cant? a. Surgical cut b. Slant in occlusion c. Protrusion d. Partial cut e. Orthodontic device

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Test Questions: Chapter 19. Orthognathic Surgery for Craniofacial Conditions

3. Which of the following describes the procedure where a partial cut is made in the middle of a bone and then the segments are slowly pulled apart to allow new bone to regenerate in the space? a. Le Fort advancement b. Distraction osteogenesis c. Bone graft d. Osteotomy e. Gingivoperiosteoplasty 4. If an alveolar cleft is left untreated, what can be the result? a. Loss of the permanent lateral incisor b. Loss of the central incisor c. Loss of the canine (cuspid) tooth d. a and b e. a and c 5. What is the procedure to correct an alveolar cleft? a. Distraction b. Corticotomy c. Taping d. Bone graft e. Le Fort I

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Test Questions: Chapter 19. Orthognathic Surgery for Craniofacial Conditions

6. Children with clefts may initially have a fairly normal occlusal relationship, but they usually develop which type of occlusion with growth? a. Class I b. Class II c. Class III d. Open bite e. Occlusal cant 7. What is the primary purpose of mandibular distraction on a young child with micrognathia? a. To improve the airway b. To improve feeding c. To improve the facial profile d. To improve occlusion of the jaws e. To improve the micrognathia 8. 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

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Test Questions: Chapter 19. Orthognathic Surgery for Craniofacial Conditions

9. Which of the following may be improved with maxillary advancement surgery alone? a. Obligatory distortions and hyponasality b. Compensatory errors and obligatory distortions c. Obligatory distortions and hypernasality d. Compensatory errors and hypernasality e. Compensatory errors and hyponasality 10. Which procedure is done to lengthen bone? a. Le Fort I b. Le Fort II c. Le Fort III d. Distraction osteogenesis e. All of the above 11. 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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Test Questions: Chapter 19. Orthognathic Surgery for Craniofacial Conditions

12. 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 13. The timing of the bone graft is dependent on which of the following? a. Type of cleft b. Child’s dental development c. Presence of a crossbite d. Presence of a nasolabial fistula e. Child’s age 14. Which of the following typically causes a cant to the maxilla? a. Crouzon syndrome b. Apert syndrome c. Treacher Collins syndrome d. Hemifacial microsomia e. Stickler’s syndrome 15. Which of the following is not a common problem as a result of a small maxilla? a. Articulation errors b. Sleep apnea c. Hypernasality d. Hyponasality e. Cul-de-sac resonance

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Test Questions: Chapter 19. Orthognathic Surgery for Craniofacial Conditions

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16. Orthognathic surgery of the maxilla cannot be performed until which of the following is well developed? a. Maxilla b. Maxillary sinus c. Dentition d. Mandible e. Palatal arch 17. Which of the following is a common problem associated with a retrodisplaced or a small maxilla? a. Hypernasality b. Sleep apnea and hyponasality c. Class II malocclusion d. Occlusal cant e. Oronasal fistula 18. What is a potential postoperative complication of maxillary advancement surgery? a. Airway obstruction b. Velopharyngeal insufficiency c. Loss of teeth d. Hyponasality e. Anterior open bite

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Test Questions: Chapter 19. Orthognathic Surgery for Craniofacial Conditions

19. What is a potential postoperative benefit of a Le Fort I maxillary advancement? a. Correction of compensatory errors b. Correction of obligatory distortions c. Correction of hypernasality d. Improvement of the airway e. b and d

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7

Test Questions: Chapter 20. Prosthetic Management

TEST QUESTIONS Chapter 20: Prosthetic Management

From Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance, 3rd Edition Ann W. Kummer, Ph.D., CCC-SLP

1. Match the letter of the answer with each item. Note: Not all answers in the word banks are used, and some may be used more than once. a. Augmentative device

d. Speech bulb

b. Palatal lift

e. Overlay dentures

c. Palatal obturator b. Can be used effectively to improve hypernasality due to dysarthria c. Used to occlude an open cleft or fistula d. Used for treatment of velopharyngeal insufficiency b. Appropriate for velopharyngeal incompetence b. Holds the velum against the pharyngeal wall for speech c. Used in some centers to help the infant with feeding

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1

Test Questions: Chapter 20. Prosthetic Management

2. When is it not appropriate to use prosthetic management? a. For patients with a history of cleft who have a delay for surgery due to medical issues b. For patients who have undergone a successful cleft repair without complications or residual effects c. For patients with persistent velopharyngeal insufficiency or incompetence after unsuccessful surgeries d. For patients with other structural disorders not related to cleft palate e. For patients who have cancer affecting the maxilla or velum 3. With a palatal lift, which part of the appliance holds the velum in place? a. Body b. Tail c. Mid-piece d. Prongs e. Bar 4. 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

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2

Test Questions: Chapter 20. Prosthetic Management

5. Which of the following is not true of reduction therapy? a. It aims to improve velopharyngeal function. b. The length of the lift is gradually increased. c. It aims to stimulate movement of the velopharyngeal structures. d. It aims to avoid surgery, or reduce the severity of the surgery. e. The length of time wearing it is gradually decreased.

6. 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 7. In which situations is it most appropriate to consider the use a speech appliance? a. When there is severe velopharyngeal insufficiency b. When the patient has primarily obligatory speech distortions c. When the child is not stimulable for a reduction in nasality with a change in placement d. When surgical correction is not an option e. When the cleft of the palate is very wide

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Test Questions: Chapter 20. Prosthetic Management

8. 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

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4

Test Questions: Chapter 21. Speech Therapy

TEST QUESTIONS Chapter 21: Speech Therapy

From Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance, 3rd Edition Ann W. Kummer, Ph.D., CCC-SLP

1. What is the preferred method of treatment for velopharyngeal insufficiency? a. Surgical intervention b. A prosthetic device c. Articulation placement therapy d. Velopharyngeal exercises e. Depends on the cause 2. Which of the following can be corrected with speech therapy? a. Hypernasality due to VPI b. Compensatory productions secondary to VPI c. Obligatory distortions secondary to VPI d. Nasal emission due to VPI e. Nasal rustle due to VPI

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1

Test Questions: Chapter 21. Speech Therapy

3. What is the best way to correct phoneme-specific nasal emission on /s/? a. CPAP b. Blowing and sucking exercises c. Oral-motor exercises d. Changing articulation placement e. Increasing oral activity 4. 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.

5. The yawn technique is used to correct which of the following? a. Glottal stops b. Lateral sibilants c. Substitution of ŋ/l d. Posterior nasal fricatives e. Pharyngeal plosives 6. Which of the following can be corrected with speech therapy when there is VPI? a. Short utterance length b. Placement errors c. Nasal grimace d. Hypernasality e. Weak consonants

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2

Test Questions: Chapter 21. Speech Therapy

7. Which of the following is often co-articulated with an oral placement? a. Pharyngeal fricative b. Pharyngeal plosive c. Glottal stop d. Palatal-dorsal production e. Velar fricative 8. Pushing under the child’s chin may help the child to achieve appropriate placement for which group of sounds? a. Sibilants b. Lingual-alveolars and /l/ c. Velars and /r/ d. Plosives e. Fricatives 9. Which of the following can be treated by starting with a /t/ sound? a. Pharyngeal fricatives for /s/ and /z/ b. Pharyngeal plosive for velars c. Glottal stop for plosives d. Nasal snort for /s/ blends e. Stopping of sibilants

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3

Test Questions: Chapter 21. Speech Therapy

10. Which of the following can be corrected by starting with the yawn technique? a. Pharyngeal fricative b. Pharyngeal plosive c. Glottal stop d. ŋ/l e. Velar plosive 11. Which of the following will most affect the success of motor learning and motor memory for speech? a. Auditory memory b. Auditory perception and discrimination c. Frequency of speech therapy d. Use of oral-motor exercises e. Feedback and frequent practice 12. Which of the following is appropriate for correction of compensatory errors following correction of VPI? a. Blowing exercises b. Sucking exercises c. Velopharyngeal exercises d. Articulation placement procedures e. Surgical correction

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Test Questions: Chapter 21. Speech Therapy

13. Which of these rules is generally not true for correction of speech sound errors? a. Begin with anterior sounds. b. Start with the voiceless cognate and then add voicing. c. Establish correct placement and manner of productions in isolation. d. Begin with the sound in the final word position. e. Change one feature at a time when moving from one sound in a group to the next sound.

14. In which of the following conditions is speech therapy not appropriate? a. Compensatory articulation b. Hypernasality and nasal emission due to apraxia c. Obligatory errors d. Post-operative nasal emission e. Articulation errors due to mislearning 15. 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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5

Test Questions: Chapter 21. Speech Therapy

16. 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.

17. Which of the following is not caused by significant nasal emission? a. Short utterance length b. Compensatory errors c. Nasal grimace d. Hypernasality e. Weak consonants 18. Which of the following can be corrected with speech therapy? a. Short utterance length b. Phoneme-specific nasal emission c. Nasal grimace d. Hypernasality e. Weak consonants 19. Speech therapy is effective for which of the following? a. Hypernasality due to VPI b. Compensatory productions secondary to VPI c. Obligatory errors secondary to VPI d. Nasal emission due to VPI e. Nasal rustle due to VPI

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6

Test Questions: Chapter 21. Speech Therapy

20. 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 21. What speech sound should be inserted between the consonant and the vowel when trying to eliminate glottal stops? a. /m/ b. /h/ c. /i/ d. /n/ e. /s/

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7

Test Questions: Chapter 22. The Team Approach

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TEST QUESTIONS Chapter 22: The Team Approach

From Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance, 3rd Edition Ann W. Kummer, Ph.D., CCC-SLP

1. 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

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Test Questions: Chapter 22. The Team Approach

2. Match the letter of the answer with each item. Note: Not all answers in the word banks are used, and some may be used more than once. a. Consulting team b. Interdisciplinary team c. Multidisciplinary team d. Transdisciplinary team e. Cleft palate team f. Craniofacial team c. A group of professionals from various disciplines who work independently in evaluating and treating patients with complex medical needs b. A group of professionals from various disciplines who work together to coordinate the care of the patient d. A group of professionals who have learned to understand each other’s disciplines and how they relate to the total care of the patient a. Team members who provide a second opinion as a group regarding the total care of the patient 3. One standard requirement for meeting the ACPA standards is that each Cleft Palate Team must have which of the following: a. Coordinator b. Geneticist c. Psychologist d. Pulmonologist e. Medical records specialist

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2

Test Questions: Chapter 22. The Team Approach

4. 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 5. 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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3

Test Questions: Chapter 23. Cleft Care in Developing Countries

TEST QUESTIONS Chapter 23: Cleft Care in Developing Countries

From Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance, 3rd Edition Ann W. Kummer, Ph.D., CCC-SLP

1. 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 2. What is the primary role of the speech-language pathologist on a cleft palate surgical mission? a. To evaluate patients for VPI b. To determine which patients are appropriate for palate repair c. To work with the dental professional to develop speech appliances d. To provide speech therapy e. To counsel the family and teach others

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1

Test Questions: Chapter 23. Cleft Care in Developing Countries

3. 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 4. Which of the following statements is true? a. The prevalence of clefts does not vary with geography. b. Poverty is the only reason children in developing countries do not have access to care. c. Interpreters should be given some written "scripts" prior to the evaluations. d. The main mission of international organizations is to provide direct surgical care to affected children. e. c and d

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2

Test Questions: Comprehensive Evaluation

TEST QUESTIONS Comprehensive Evaluation

From Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance, 3rd Edition Ann W. Kummer, Ph.D., CCC-SLP

1. Match the letter of the answer with each item. Note: Not all answers in the word banks are used, and some may be used more than once. a. Hypernasality

g. Nasal grimace

b. Hyponasality

h. Palatal dorsal production

c. Cul-de-sac resonance

i. Frontal distortion

d. Mixed resonance

j. Glottal stop

e. Nasal emission

k. Pharyngeal fricative

f. Nasal rustle

l. Weak consonants

e. Associated with hypernasality and weak consonants b. Can be caused by adenoid hypertrophy c. Can be caused by enlarged tonsils

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1

Test Questions: Comprehensive Evaluation

i. Often caused by a Class III malocclusion j. Compensatory production that is often co-articulated k. Production that will cause audible nasal emission i. Can be an obligatory error f. Due to a small velopharyngeal opening a. Primarily affects vowels b. Primarily noted on nasal consonants e. Occurs on voiceless consonants but is low in intensity h. Often due to anterior crowding of the tongue tip l. Secondary to significant nasal emission c. Can be due to microstomia g. May cause phoneme-specific nasal emission k. Overflow muscle reaction to effort of trying to achieve velopharyngeal closure d. Common with apraxia of speech k. May be a substitution (not distortion) for /s/ e. When severe, is often inaudible

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2

Test Questions: Comprehensive Evaluation

3

EVALUATION 1. Match the letter of the answer with each item. Note: Not all answers in the word banks are used, and some may be used more than once. a. Oral examination

d. Nasopharyngoscopy

b. Perceptual examination

e. Aerodynamics

c. Nasometry

f. Videofluoroscopy

e. Can provide objective data regarding the approximate size of the velopharyngeal orifice d. Gives the best indication of the location of the opening c. Can provide objective data regarding phoneme-specific nasal emission f. Requires the use of barium e. Uses a hydrokinetic formula to determine orifice size c. Gives a measure of acoustic energy e. Gives a measure of nasal airway resistance f. Instrumental procedure that can give false negative (looks like there is closure when there is not) d. Best technique to determine whether there is an occult submucous cleft a. Best technique to determine whether there is an overt submucous cleft d. Allows direct visualization of the vocal folds e. Instrumental procedure that does not allow examination of connected speech a. Best technique to visualize the size of the tonsils c. Uses the SNAP test f. Is the best for evaluating the entire length of the posterior pharyngeal wall d. Is the best for evaluating for a medialized carotid artery © 2014 Cengage Learning. All Rights Reserved.

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Test Questions: Comprehensive Evaluation

TREATMENT 1. Match the letter of the answer with each item. Note: Not all answers in the word banks are used, and some may be used more than once. a. Speech therapy b. Surgery c. Blowing/sucking exercises a. Compensatory productions b. Obligatory productions b. Generalized hypernasality a. Pharyngeal fricatives a. Glottal stops a. Velopharyngeal insufficiency b. Consistent nasal emission b. Never appropriate for treatment of compensatory errors or VPI c. Hypernasality 6 months status post adenoidectomy a. Phoneme-specific nasal emission 2. 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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4

Test Questions: Comprehensive Evaluation

5

3. 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 4. Nasal emission is most audible on which of the following sounds? a. Nasal sounds b. Voiceless consonants c. Vowels d. Voiced continuents e. Voiced plosives 5. Pierre Robin sequence typically includes which of the following characteristics at birth? a. Cleft palate, micrognathia, airway obstruction b. Cleft palate, prognathia, glossoptosis c. Cleft palate, ankyloglossia, airway obstruction d. Micrognathia, glossoptosis, ankyloglossia e. Cleft lip and palate, micrognathia, glossoptosis

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Test Questions: Comprehensive Evaluation

6. 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 7. A patient evaluation finds that she has a combination of hyponasality and inconsistent nasal emission. Irregular adenoids are suspected as a cause. What is the best way to evaluate that? a. Nasometry b. Nasopharyngoscopy c. Videofluoroscopy d. Aerodynamic measures e. An Intraoral examination 8. Upon examination, the child demonstrates the use of nasal phonemes and glottal stops for all speech sounds. What is the most appropriate recommendation? a. A trial period of speech therapy b. A prosthetic device on a trial basis c. Referral to an ENT for evaluation d. Referral to a cleft palate team e. Referral to a plastic surgeon

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6

Test Questions: Comprehensive Evaluation

CASES

Adie Noid is a 7-year-old with a history of cleft palate. She had normal speech and resonance until an adenotonsillectomy at the age of 6. Her teacher says she is very “nasal” and hard to understand as a result. She has never had speech therapy before. The ENT recently evaluated Adie and recommended speech therapy. Upon evaluation it is found that Adie has mild hypernasality and nasal emission, which is particularly noted on sibilants.

1. What do you think is the probable cause of the hypernasality? a. History of cleft palate b. Adenoidectomy c. Tonsillectomy d. Mislearning after the surgery e. Use of pharyngeal fricatives 2. What is the most appropriate form of treatment? a. Surgery for repair of the palate b. Surgery for velopharyngeal insufficiency c. Surgery for velopharyngeal incompetence d. Speech therapy for articulation e. Speech therapy to increase muscle movement f. Surgery for smoothing out the remain adenoids

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7

Test Questions: Comprehensive Evaluation

8

Vela Farincks, age 6 years, has been in therapy for a speech sound disorder for 2 years with a previous speech-language pathologist. She is now on your caseload. You notice that she has a nasal rustle in connected speech. An evaluation of speech showed normal placement for all speech sounds with the exception of sibilants. You also notice that the nasal rustle occurs only during the production of sibilant sounds.

3. What would you recommend? a. Referral to an ENT for an evaluation of velopharyngeal function b. Referral to a craniofacial team for evaluation of velopharyngeal function c. Speech therapy for correction of the placement on sibilants d. Speech therapy for correction of velopharyngeal insufficiency e. Discharge from therapy, but a reevaluation in 6 months

Artie Culation, age 7 years, is seen by you for an evaluation. He has a history of bilateral complete cleft lip and palate. The nasometry scores for the SNAP Test-R were as follows: Bilabials

Lingual-Alveolars

Velars

Sibilants

Nasals

12

14

14

36

46

4. What is your diagnosis? a. Mild velopharyngeal insufficiency b. Phoneme-specific nasal emission c. Cul-de-sac resonance d. Hyponasality e. Mixed resonance

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Test Questions: Comprehensive Evaluation

9

Cliff Pilot, age 3 years, is referred to you for an evaluation of speech and resonance. An intraoral evaluation reveals a hypoplastic uvula. You hear abnormal resonance in connected speech. You evaluate speech sound production. He had the following errors in the initial position on a single word articulation test: m/b, d/n, d/t, g/k, d/g, d/f, m/v, n/s, n/sh. On the word “money,” he had an n/m substitution.

5. What is your diagnosis? a. Hypernasality b. Hyponasality c. Cul-de-sac resonance d. Mixed resonance 6. What is the probable cause? a. Velopharyngeal insufficiency b. Velopharyngeal incompetence c. Apraxia of speech d. Nasal obstruction

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Test Questions: Comprehensive Evaluation

10

A 3-year-old child has been referred to you for a speech evaluation. You perform an intraoral examination and find that there is a white line down the middle of the child’s velum. During phonation, the velum moves, but only slightly. The tonsils are large, but not touching in the midline. The child’s articulation is normal with the exception of distortions that sound like b/m and d/n substitutions. Resonance is abnormal.

7. Which of the following best describes your impressions and recommendations? a. The child has evidence of a submucous cleft and should be referred for further assessment before considering treatment. b. The child has evidence of hyponasality and should be referred to an otolaryngologist for an airway evaluation. c. The child has articulation errors only and should receive speech therapy. d. You should palpate the velum before making any decisions regarding further assessment or treatment. e. You should do a trial period of speech therapy, focusing on improving the resonance. Referral to an otolaryngologist should be made if there is no improvement resonance after a few weeks of therapy.

A child who uses pharyngeal fricatives for sibilants is evaluated. There is nasal emission on sibilants, but no audible nasal emission on any other speech sounds.

8. What is recommended in this case? a. Blowing and sucking exercises to improve velopharyngeal function b. Oral-motor exercises to improve velopharyngeal function c. Articulation therapy to change placement of sibilants d. Referral to an ENT for evaluation of velopharyngeal function and further recommendations e. Referral to a craniofacial team for assessment by a cleft palate specialist

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Test Questions: Comprehensive Evaluation

11

Peach N. Herring, age 4 years, has a history of bilateral cleft lip and palate. She demonstrates nasal emission, but only on lingual-alveolar sounds.

9. What is the probable cause? a. Velopharyngeal insufficiency b. Velopharyngeal incompetence c. Velopharyngeal mislearning d. Apraxia of speech e. A symptomatic fistula

10. You start a new job and inherit a caseload. One child on your caseload is 7 years old.

He has been in therapy for 2 years. His articulation is normal, but he has an inconsistent nasal rustle. When he is careful, he can eliminate it on the sentence level. What is the most appropriate course of action? a. Continue speech therapy, but work mostly on carryover. b. Continue speech therapy, but use blowing and sucking exercises. c. Continue speech therapy, but use oral-motor exercises. d. Refer to an ENT for evaluation and treatment. e. Refer to a craniofacial center for evaluation and treatment.

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