Case Study 1:
Amira, age 4, is referred for assessment due to unintelligible speech. Her parents report she
has difficulty being understood outside of family and gets frustrated when asked to repeat
herself. Oral-motor exam is normal. She produces many sound substitutions and has diffi-
culty with clusters.
Q1. Which ax task best identify Amira's underlying speech difficulties?
A. Oral diadochokinetic rate tasks
B. Phonological process analysis from a connected speech sample
C. Maximum phonation time
D. Acoustic analysis of vowel formants
Q2. Which phono process most likely typical at 4yr?
A. Final consonant deletion
B. Gliding of /r/
C. Reduplication
D. Initial consonant deletion
Q3. Which therapy goal would be most functional to begin with?
A. Eliminating cluster reduction in /str/ words
B. Correct production of /r/ in initial position
C. Eliminating fronting of velars (/t/ for /k/)
D. Increasing vowel space area
ANSWER
Q1. B - Phonological process analysis identifies error patterns in connected speech
1
,Q2. B - Gliding of /r/ is typical until 5-6 years.
Q3. C - Fronting (/t/ for /k/) is not typical at 4 and impacts intelligibility.
A hallmark feature of ataxic dysarthria is:
A. Strained-strangled voice quality
B. Inconsistent articulatory breakdowns with excess and equal stress
C. Hypernasality with nasal emission
D. Short rushes of speech
ANSWER
B - Ataxic dysarthria hallmark: excess/equal stress, irregular breakdowns.
Which cranial nerve innervates the intrinsic muscles of the larynx (except cricothyroid)?
A. CN IX
B. CN X - Recurrent laryngeal nerve
C. CN X - Superior laryngeal nerve
D. CN XII
ANSWER
B - RLN supplies all intrinsic laryngeal muscles except cricothyroid.
Which vowel is most likely to be perceived as nasalized in velopharyngeal dysfunction?
A. /a/
B. /i/
C. /æ/
D. /ʌ/
ANSWER
B - High vowels like /i/ show greatest nasal resonance.
2
, Q7. Which of the following is not a biological function of the larynx?
A. Airway protection
B. Subglottic pressure for lifting
C. Resonance shaping of vowels
D. Cough production
ANSWER
C - Resonance is not a biological function; it's speech-specific.
A 7-year-old with difficulty repeating words, but intact comprehension and fluent spontane-
ous speech, most likely presents with:
A. Conduction aphasia
B. Broca's aphasia
C. Wernicke's aphasia
D. Transcortical sensory aphasia
ANSWER
A - Conduction aphasia = impaired repetition with intact comp + fluent speech.
Which feature best differentiates life breathing from speech breathing?
A. Inspiration is passive
B. Exhalation is longer than inhalation
C. Abdominal muscles are inactive
D. Equal ratio of inhalation to exhalation
ANSWER
B - Exhalation is much longer in speech breathing (10:90 ratio).
Which of the following is true of phonological awareness?
A. It develops after reading instruction
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Amira, age 4, is referred for assessment due to unintelligible speech. Her parents report she
has difficulty being understood outside of family and gets frustrated when asked to repeat
herself. Oral-motor exam is normal. She produces many sound substitutions and has diffi-
culty with clusters.
Q1. Which ax task best identify Amira's underlying speech difficulties?
A. Oral diadochokinetic rate tasks
B. Phonological process analysis from a connected speech sample
C. Maximum phonation time
D. Acoustic analysis of vowel formants
Q2. Which phono process most likely typical at 4yr?
A. Final consonant deletion
B. Gliding of /r/
C. Reduplication
D. Initial consonant deletion
Q3. Which therapy goal would be most functional to begin with?
A. Eliminating cluster reduction in /str/ words
B. Correct production of /r/ in initial position
C. Eliminating fronting of velars (/t/ for /k/)
D. Increasing vowel space area
ANSWER
Q1. B - Phonological process analysis identifies error patterns in connected speech
1
,Q2. B - Gliding of /r/ is typical until 5-6 years.
Q3. C - Fronting (/t/ for /k/) is not typical at 4 and impacts intelligibility.
A hallmark feature of ataxic dysarthria is:
A. Strained-strangled voice quality
B. Inconsistent articulatory breakdowns with excess and equal stress
C. Hypernasality with nasal emission
D. Short rushes of speech
ANSWER
B - Ataxic dysarthria hallmark: excess/equal stress, irregular breakdowns.
Which cranial nerve innervates the intrinsic muscles of the larynx (except cricothyroid)?
A. CN IX
B. CN X - Recurrent laryngeal nerve
C. CN X - Superior laryngeal nerve
D. CN XII
ANSWER
B - RLN supplies all intrinsic laryngeal muscles except cricothyroid.
Which vowel is most likely to be perceived as nasalized in velopharyngeal dysfunction?
A. /a/
B. /i/
C. /æ/
D. /ʌ/
ANSWER
B - High vowels like /i/ show greatest nasal resonance.
2
, Q7. Which of the following is not a biological function of the larynx?
A. Airway protection
B. Subglottic pressure for lifting
C. Resonance shaping of vowels
D. Cough production
ANSWER
C - Resonance is not a biological function; it's speech-specific.
A 7-year-old with difficulty repeating words, but intact comprehension and fluent spontane-
ous speech, most likely presents with:
A. Conduction aphasia
B. Broca's aphasia
C. Wernicke's aphasia
D. Transcortical sensory aphasia
ANSWER
A - Conduction aphasia = impaired repetition with intact comp + fluent speech.
Which feature best differentiates life breathing from speech breathing?
A. Inspiration is passive
B. Exhalation is longer than inhalation
C. Abdominal muscles are inactive
D. Equal ratio of inhalation to exhalation
ANSWER
B - Exhalation is much longer in speech breathing (10:90 ratio).
Which of the following is true of phonological awareness?
A. It develops after reading instruction
3
