Cranio Test 2– Practice Test Questions – Flashcards
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Velopharyngeal Insufficiency can be attributed to:
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- An anatomical or structural defect - Irregular Adenoids
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What is the most common form of velopharyngeal dysfunction?
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-Velopharyngeal Insufficiency
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Velopharyngeal Incompetence can:
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-Occur with Dysarthria -Can be caused by a neuromuscular disorder
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Velopharyngeal Mislearning can:
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-Result in phoneme specific nasal emission -Occur due to us of ng/l substitution -Occur due to a high tongue position during speech -Occur due to production of a pharyngeal fricative for sibilants only -Occur as a result of hearing loss
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Obligatory Errors include:
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-Labial or lingual position altered due to structural abnormality -Nasalized plosives and VPI -Correct labial or lingual position but interfering structural abnormality -Class III maloclclusion and lateral lisp
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True or False: Obligatory Errors can be corrected with speech therapy
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False-- requires surgery or prosthetics
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Compensatory Errors include:
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-Pharyngeal Fricative and no VPI -Following a history of cleft palate, normal structure and physiology, but still existing nasal emission
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Mislearning includes:
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-a ng/l substitution -Includes a m/b substitution -Includes a n/s substitution
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Hypernasality is most noticeable on
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Vowels
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Hyponasality is most noticeable on:
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Nasals
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Cul-de-sac resonance is best described as
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Sound trapped in one of the cavities of the vocal tract
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What is NOT caused by significant nasal emission?
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Hypernasality
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What type of resonance disorder occurs due to abnormalities of the oral and nasal cavities during speech?
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Cul-de-sac Resonance
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What distortion can occur during production of pressure sensitive sounds?
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Nasal air emission
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Nasal emission is never audible on:
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Vowels
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What class of sounds is more often distorted by nasals?
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Voiceless fricatives
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Hyponasality most often occurs during production of which type of sound?
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Nasal consonants
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What is it called when airflow is released through the nose during production of pressure sensitive consonants?
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Nasal Emission
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Which speech characteristics are most likely to occur with a very large velopharyngeal opening?
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Hypernasality and inaudible nasal emission
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Phoneme-specific nasal emission typically occurs on:
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Sibilant Sounds
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Very large tonsils are most likely to cause:
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Cul-de-sac resonance
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A nasal rustle (sometimes called turbulence) usually occurs due to:
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A SMALL velopharyngeal gap
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Maxillary advancement may improve:
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Hyponasality
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What is an example of an obligatory distortion?
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Nasalization of vowels
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Compensatory productions usually sacrifice:
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Place of production
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Which cause of velopharyngeal dysfunction cannot be corrected or improved with surgery?
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?
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Which compensatory production for velopharyngeal insufficiency is often co-articulated with /b/?
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Nasal Fricative
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What is the most common cause of velopharyngeal dysfunction in patients with Crouzon syndrome?
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Occult submucous cleft
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Cul-de-sac resonance can be due to
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Enlarged Tonsils
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Short utterance length is usually associated with
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Nasal Air Emission
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Velopharyngeal incompetence can be due to
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Velar Paresis
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Frenulectomy is done for ______
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Ankyloglossia
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What procedure almost never causes problems with speech, but may improve both speech and resonance?
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Tonsillectomy
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What procedure is often contraindicated with a submucous cleft?
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?
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What procedure improves aesthetics but may exacerbate VPI?
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Maxillary Advancement
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What procedure can cause VPI that is usually not correctable with surgery?
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Radiation treatment
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What procedure can eliminate pharyngeal cul-de-sac resonance?
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Tonsillectomy
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What has been called potato in the mouth speech?
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Cul de sac resonance
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What resonance disorder may be due to a combination of VPI and large adenoids?
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Mixed Resonance
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What resonance disorder occurs when sound resonates in pharynx or nasal cavity and cant get out?
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Cul-de-sac resonance
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what resonance disorder is most perceptible on vowels?
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Hypernasality
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What resonance disorder is most perceptible on nasal sounds?
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Hyponasality
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What type of resonance requires velopharyngeal closure on oral sounds?
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Normal Resonance
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What resonance disorder can be caused by large touching tonsils
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Cul-de-sac resonance
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What resonance disorder can be caused by maxillary retrusion?
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Hyponasality
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What resonance disorder can be caused by a deep pharynx?
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Hypernasality
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What resonance disorder can be caused by large adenoids?
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Hyponasality
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What resonance disorder may be caused by an adenoidectomy?
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Hypernasality
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What resonance disorder may occur when the back of the tongue remains high during speech?
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Hypernasality
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What can cause nasal emission on /t/ and /s/ but not on /k/?
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Fistula
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What is the cause of consistent nasal emission on certain sounds only and can be corrected by therapy?
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Mislearning
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What can cause infants to have difficulty latching on to a nipple?
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Apraxia?
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What blocks the entry to the nasal cavity?
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Choanal atresia
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What can cause pharyngeal cul-de-sac resonance?
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Enlarged Tonsils
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What can cause hyponasality?
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Enlarged Adenoids
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What is an example of a low pressure sentence for evaluation of hypernasality?
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Why are you here?
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What is a recommended procedure to elicit speech in a child that is reticent?
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Ask either/or questions
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Which series of numbers is best to use when testing for nasal emission?
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60's
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Which series of numbers is best to use when testing for hyponasality?
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90's
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What phoneme is best to use when testing for hypernasality?
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/ɑ/
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Which phoneme best to use when testing for nasal emission?
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/s/
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If you use the nasal cul-de-sac test and you hear a difference on production of a vowel, this confirms the diagnosis of _________
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Hypernasality
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What is one group of sounds will never have nasal emission as a result of an oronasal fistula in the area of the incisive foramen?
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Velars
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What is not an effective way for assessing hypernasality, nasal emission, and velopharyngeal function?
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Manometer
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To an inexperienced listener, a pharyngeal fricative can sound similar to a _________
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Lateral Lisp
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Which of the following has a significant effect on utterance length?
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Nasal Emission
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Which of the following techniques does not use auditory detection of nasality?
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Air Paddle
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In the first year of life, what are the primary speech pathology concerns for a child with a Pierre Robin sequence?
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Feeding and prerequisites for verbal communication
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Which of the following is recommended as the best no-tech procedure for evaluation of nasal air emission?
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Straw test
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When evaluating nasal emission, the speech sample should have many of which type of phonemes?
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Voiceless consonants
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Surgery is never indicated for which of the following?
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Velopharyngeal Mislearning
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What is the appropriate recommendation for treatment of velopharyngeal mislearning?
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Speech therapy only
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What is the appropriate recommendation for treatment of compensatory productions?
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Surgery and then speech therapy
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Phoneme specific hypernasality will most likely occur in which of the following words?
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Met
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Which of the following words contains the best consonant for testing nasal emission?
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Pass
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If the child has a nasal rustle on s/z, but not on any other sounds, what is the probable cause?
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Phoneme-specific nasal emission
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When voiced plosives sound closer to their nasal cognates (m/b, n/d, and ŋ/g), what does this suggest?
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Obligatory Distortions
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What speech production can cause phoneme-specific nasal emission?
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Pharyngeal Fricative
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Which of the following misarticulations can be co-articulated with the /b/ sound?
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Velar Fricative
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Which type of resonance is common with childhood apraxia of speech?
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Hypernasality
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The extent to which the score is able to correctly identify individuals with abnormal resonance is its _____________
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Sensitivity
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The percentage value of nasal acoustic energy of the total (both nasal and oral) energy is ___________
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Nasalance Score
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The extent to which the score correctly excludes individuals with normal speech from the abnormal group is its _____________
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Specificity
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The range between the maximum and minimum nasalance is referred to as the __________
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Nasalance distance
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A visual display of the data on the computer screen is the _____________
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Nasogram
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Which of the following is NOT true about nasometry?
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It provides direct visualization of the velopharyngeal valve
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What does a high nasalance score indicate?
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Hypernasality
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What does a low nasalance score typically indicate?
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Hyponasality
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What is the advantage of using a standardized passage to gather nasometric data?
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The patient's score can be compared to normative data
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What should the nasalance score be for a prolonged /s/ when produced by a normal speaker?
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0%
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In normal speech, what is the primary determinant of the nasalance score?
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Type of the vowels in the passage
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High vowels have more nasal resonance than low vowels due to which of the following?
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Tongue position in the oral cavity
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During production of an oral passage, typical oral resonance should be in what range?
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Under 20 percentage points
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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?
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-Hyponasality -Upper Airway Obstruction
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What would you expect from a dialect, accent, or language that contains more high vowels or a higher tongue position in vowel production?
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A slightly higher average nasalance score
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What cannot be assessed through nasometry?
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Intraoral Air Pressure
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Which of the following tests allows the assessment of nasalance by type of speech sound?
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SNAP test
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Which of the following is not true about interpretation of nasalance?
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The higher the contour is on the screen, the more hyponasality to expect
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What is the most important statistic that is obtained through nasometry?
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Mean Nasalance Score
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Which of the following was the first instrument developed to measure nasal and oral acoustic energy?
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TONAR
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Where should you insert the scope when evaluating velopharyngeal function?
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Middle Meatus because it allows a view from above
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For surgical planning, what is the most important finding through nasopharyngoscopy?
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Size of the opening
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A disadvantage of nasopharyngoscopy is that it does not allow the examiner to see which of the following?
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Length of the posterior pharyngeal wall
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What is the typical diameter of a pediatric scope?
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2.2 mm
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Which of the following should not be done prior to inserting the scope?
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Put the child in a supine position
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When doing nasopharyngoscopy procedure, what is the narrowest part of the passage to the nasopharynx?
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The superior meatus
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Which of the following cannot be viewed through a nasopharyngoscopy procedure?
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Length of the posterior pharyngeal wall during speech
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Why should the morphology of the posterior pharyngeal wall be carefully examined in patients with velocardiofacial syndrome?
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The carotid arteries can be medially displaced in the pharyngeal wall
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Which of the following suggests the presence of a small velopharyngeal opening?
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Bubbling of secretions
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How should a scope be stored?
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Hanging from a wall in a cabinet
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What is used to repair a cleft lip?
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Tennison-Randall
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What is one of the oldest and most successful means to repair a cleft palate?
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Von Langenbeck procedure
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What is used to close a fistula?
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tongue flap
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What is a general term for lip repair?
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Cheiloplasty
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What is a general term for a surgery to correct VPI?
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Pharyngoplasty
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What is used for very small velopharyngeal openings?
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Pharyngeal augmentation
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What often needs to be done before a pharyngeal flap?
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Tonsilectomy
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What can be used as a primary palate repair, or as a secondary procedure?
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Furlow Z-Plasty
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What is the best procedure for a "bow tie" type of velopharyngeal gap with lateral gaps?
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Sphincter pharyngoplasty
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What is the best procedure for a large midline velopharyngeal opening?
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Pharyngeal Flap
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What uses the palatophayngeus muscles?
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Sphincter Pharyngoplasty
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What is done after facial growth has completed, to correct skeletal malocclusion?
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Le Fort I maxillary advancement
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What rarely has a negative effect on speech, and may correct hyponasality or cul-de-sac resonance?
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Tonsillectomy
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What is usually contraindicated when there is a history of cleft palate?
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Adenoidectomy
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What can improve the airway and articulation, but may cause hypernasality?
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Pharyngeal Flap
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What procedure is used for aligning the maxillary segments prior to formal surgery for unilateral and bilateral clefts?
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-Taping the lip -Dental elastics -Latham appliance -Lip adhesion
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With regard to the timing of cleft lip repair, the "rule of 10s" includes which of the following?
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10 weeks of age and 10 pounds 10 grams of hemoglobin
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What is the location of an "intentional" fistula?
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Alveolus under the lip
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Which of the following is not a major factor that determines the success of a pharyngeal flap in correction of VPI?
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Use of compensatory productions
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Why is the alveolar arch cleft left unrepaired until the age of 6 or 7?
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It does not affect speech or feeding
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Why is palate surgery more difficult than lip surgery?
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-It is technically more demanding -There is a greater risk of dehiscence -There is a greater risk of fistula formation
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Which of the following is true about VPI?
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It requires both speech therapy and surgery
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Patients with a history of cleft palate and surgical repair often demonstrate which of the following?
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-Midface Retrusion -Class III Malocclusion
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The earliest that a pharyngoplasty is usually done is at what age?
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2.5 to 3 years
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When is a cheiloplasty usually performed?
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10 to 12 weeks
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What is a common surgical procedure for correction of velopharyngeal insufficiency?
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Palatoplasty
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Which of the following is not addressed routinely by either the cheiloplasty or the palatoplasty?
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Alveolus
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What is a cant?
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Slant in occlusion
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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?
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Distraction osteogenesis
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If an alveolar cleft is left untreated, what can be the result?
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-Loss of permanent lateral incisor -Loss of the canine (cuspid) tooth
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What is the procedure to correct an alveolar cleft?
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Bone Graft
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Children with clefts may initially have a fairly normal occlusal relationship, but they usually develop which type of occlusion with growth?
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Class III
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What is the primary purpose of mandibular distraction on a young child with micrognathia?
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To improve the airway
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What is the purpose of a genioplasty?
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To advance the chin
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Which of the following may be improved with maxillary advancement surgery alone?
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Obligatory distortions and hyponasality
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Which procedure is done to lengthen bone?
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Distraction osteogenesis
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At what ages is the facial skeleton usually mature enough for secondary orthognathic surgery?
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Girls 15 years; Boys 17 years
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Which is not a method of mandibular reconstruction?
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?
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The timing of the bone graft is dependent on which of the following?
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Child's dental development
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Which of the following typically causes a cant to the maxilla?
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Hemifacial microsomia
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Which of the following is not a common problem as a result of a small maxilla?
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Hypernasality
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Orthognathic surgery of the maxilla cannot be performed until which of the following is well developed?
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Maxillary sinus
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Which of the following is a common problem associated with a retrodisplaced or a small maxilla?
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Sleep apnea and hyponasality
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What is a potential postoperative complication of maxillary advancement surgery?
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loss of teeth
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What is a potential postoperative benefit of a Le Fort I maxillary advancement?
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?
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What can be used effectively to improve hypernasality due to dysarthria?
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Palatal Lift
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What is used to occlude an open cleft or fistula?
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Palatal Obturator
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What is used for treatment of velopharyngeal insufficiency?
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Speech Bulb
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What is Appropriate for velopharyngeal incompetence?
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Palatal Lift
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What holds the velum against the pharyngeal wall for speech?
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Palatal Lift
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What is used in some centers to help with the infant feeding?
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Augmentative Device
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When is it not appropriate to use prosthetic management?
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For patients who have undergone a successful cleft repair without complications or residual effects
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With a palatal lift, which part of the appliance holds the velum in place?
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Tail
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When working directly with the prosthodontist to modify an appliance for best results, what procedure is most effective to use?
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Nasopharyngoscopy
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Which of the following is not true of reduction therapy?
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The length of the lift is gradually increased
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A feeding obturator is NOT capable of which of the following?
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Helping an infant to achieve suction
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In which situations is it most appropriate to consider the use a speech appliance?
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When surgical correction is not an option
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What is the most appropriate prosthetic choice for the patient who has had ablative surgery for oral cancer?
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Speech bulb obturator
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What is the preferred method of treatment for velopharyngeal insufficiency?
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Surgical Intervention?
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Which of the following can be corrected with speech therapy?
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Compensatory productions secondary to VPI
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What is the best way to correct phoneme-specific nasal emission on /s/?
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Changing articulation placement
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Which of the following is true about obligatory distortions?
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They commonly occur with structural anomalies in the vocal tract
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The yawn technique is used to correct which of the following?
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Substitution of ng/l
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Which of the following can be corrected with speech therapy when there is VPI?
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Placement Errors
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Which of the following is often co-articulated with an oral placement?
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Velar Fricative?
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Pushing under the child's chin may help the child to achieve appropriate placement for which group of sounds?
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Velars and /r/
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Which of the following can be treated by starting with a /t/ sound?
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Pharyngeal fricatives for /s/ and /z/
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Which of the following can be corrected by starting with the yawn technique?
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ng/l
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Which of the following will most affect the success of motor learning and motor memory for speech?
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Feedback and frequent practice
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Which of the following is appropriate for correction of compensatory errors following correction of VPI?
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Articulation placement procedures
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Which of these rules is generally not true for correction of speech sound errors?
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Begin with the sound in the final word position
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In which of the following conditions is speech therapy not appropriate?
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Obligatory Errors
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Which of the following is not a therapy technique used to treat hypernasality, nasal emission, or compensatory productions?
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Oral Motor Exercises
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Which of the following is true about obligatory distortions?
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They commonly occur with structural anomalies in the vocal tract
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Which of the following is not caused by significant nasal emission?
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Hypernasality
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Which of the following can be corrected with speech therapy?
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Phoneme specific nasal emission
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Speech therapy is effective for which of the following?
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Compensatory productions secondary to VPI
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What is the most appropriate method of therapy for children with a history of VPI?
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Articulation Therapy
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What speech sound should be inserted between the consonant and the vowel when trying to eliminate glottal stops?
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/h/
