Voice Final Exam

An s/z ratio >_____ suggests a lower glottal resistance with incomplete closure allowing air to escape.

1

The standard deviation for intensity during a neutral reading material is ~ ____ dB spl

10

Provide 4 characteristics of vocal nodules

1. Bilateral 2. Localized benign growths 3. Caused by misuse of abuse over a period of time 4. Patients typically have success in therapy

What are the 2 disadvantages of an Electroglottography (EGG)?

1. Poor signal quality 2. Interpretation of the waveform can change with mucous and hyperfunction

Provide 4 characteristics of polyps

1. Unilateral 2. Fluid of blood filled 3. Caused by a single traumatic event 4. Surgery may be required for removal

What is tremor frequency?

4 - 6 Hz

These lesions appear as small spears on the margins of the vocal folds and are mucus filled.

Cysts

What is mistaken for early vocal nodules?

Cysts

Of the two types of bilateral vocal fold paralysis (abductor/adductor) you would prefer for the patient to have abductor paralysis because it is non-life threatening.

False

True of False: Bilateral adductor vocal fold paralysis causes inspiratory stridor.

False

True of False: Individuals with laryngitis should be encouraged to whisper instead of speak until the edema resolves.

False

True of False: Polyps are homogeneous in appearance

False

True of False: Reinke's edema is not seen in smokers.

False

True of False: Ventricular phonation is not reversible if caused due to psychological problems and/or vocal hyperfunction.

False

True or False: Mic-mouth distance is not important for recording voice.

False

True or False: The additional amount of air you can inhale beyond the end of tidal inspiration is called inspiratory capacity

False

True or False: The superficial layer of the lamina propria is primarily made up of collagen fibers.

False

True of False: Research shows that MPT is not effected by learning and practice.

False! It can be effected by learning and practice!

True or False: The layers of the vocal folds go from more stiff (superficially) to less stiff (deep).

False! It goes from less stiff to more stiff.

True or False: For the Estimated Subglottal Pressure measurement, the patient produces / p / followed by / i / at a variable pitch and at a rate of 1.5 syllables per second.

False! It is a constant pitch-not a variable pitch.

True of False: An Electroglottography (EGG) is an invasive procedure.

False! It is non-invasive

True or False: For essential voice tremor, the larynx only moves during phonation.

False! It moves at rest-the movement increase during phonation.

Spasmodic dysphonia is also known as __________________.

Focal dystonia

A narrowband spectrogram resolves _______________ information well.

Frequency

___________ varies due to (1) syllabic and emphatic stress, (2) syntactic and semantic factors, and (3) Phonetic factors

Fundamental frequency

List the 4 suprahyoids

Geniohyoid Mylohyoid Digastric Stylohyoid

The following are perceptual signs and symptoms of a certain type of organic voice disorder: Vocal fatigue Discomfort and pain Provoked chronic throat clearing Low pitch Hoarseness Reduced pitch range

Granuloma/contact ulcer

This vascular lesion is typically unilateral caused by phonotrauma or injury Can affect full or portions of vocal fold Occurs more in women Imaging: redness and swelling, absence of mucosal wave, reduced amplitude, glottal closure varies.

Hemorrhage

This instrument was first developed in 1940 at Bell Laboratories.

High speed laryngeal imaging

This instrument was initially at 400 frames/second. Now the current high-speed images are from 2 to 4 KHz.

High speed laryngeal imaging

What is the vocal quality seen in Leukoplakia?

Hoarse and rough

What type of dysarthria is seen in Parkinson's disease?

Hypokinetic

Fundamental frequency of pitch can be represented using _______________ or _______________ units.

Hz; semitones

What are the 2 types of glottal closures you would see with sulcus vocalis?

Incomplete; spindle-shaped

The relative level of noise _______________ if the vocal folds fail to completely close the glottis.

Increases

A patient with vocal fold paralysis may not be able to increase intensity because of _______________.

Insufficient lung pressure

_____________ is the variability in the period of each successive cycle of vibration.

Jitter

Is calculated by: estimated subglottal pressure value/average airflow value.

Laryngeal resistance

Requires the accurate measurement of average airflow and estimated subglottal pressures as determined from the intra-oral air pressure signal during the /pi/ syllable.

Laryngeal resistance

These two inflammatory conditions are noted by how the edges of the vocal fold are swollen/thick and irritated. It can be caused by infections or phontotrauma.

Laryngitis and (Reinke's) edema

For this pediatric voice disorder, airway obstruction is possible as the cartilages are susceptible to collapse during the inspiratory phase.

Laryngomalacia

This organic voice disorder is premalignant and often observed in smokers.

Leukoplakia

These two organic voice disorder has reactive epithelial tissue growth on the vocal folds-thickened patches that are red (keratosis) and white (leukoplakia).

Leukoplakia and Granuloma/contact ulcer

A lower score on the Voice Related Quality of Life (VRQOL) represents a _______ voice-related QOL a. Higher b. Lower

Lower

When would you want to observe glottal closure to determine how the vocal folds approximate during the closed phase of vibration?

Maximal closure

How do you calculate the fundamental frequency range?

Maximum F0 - Minimum F0

_________________ is the duration of maximally sustained vowel.

Maximum Phonation Time

To inspect vocal fold edge, you inspect the _________ edge of each vocal fold.

Medial

Visual examination traditionally takes one of two forms: _______________ laryngoscopy and _______________ laryngoscopy.

Mirror; endoscopic

What does unilateral or bilateral damage to the superior laryngeal nerve cause?

Monopitch and paralysis of the cricothyroid muscle

What is the characteristic or classic feature of myasthenia gravis?

Muscles weaken over time After a period of rest the patient should return to their norms

A neurological condition that exhibits muscle weakness/flaccidity (specifically related to muscle of the voice).

Myasthenia gravis

On the Voice handicap Index, a 0 marked on the 5 point rating scale means what?

Never had any experience

_______________ refers to whether the vibratory patterns are: normal, hypofunctional, hyperfunctional, tremulous, and spasmodic

Overall appearance

Caused by exposure to human papilloma virus (HPV) Occurs below the vocal folds as well as surpraglottal structures Most common in children Glottal closure is affected Muscosal wave is absent in the area of lesion Decreased amplitude of vibration

Papilloma

This organic voice disorder has benign wart-like growths

Papilloma

Inappropriate adduction of the vocal folds during inspiration. Caused by: - Neurological: laryngeal dystonia - Visceral: upper airway sensitivity, asthma - GERD/LPR - Psychogenic: Conversion disorder

Paradoxical/Paroxysmal Vocal Cord Dysfunction (PVCD) or Paradoxical Vocal Fold Movement/Motion (PVFM)

This condition is due to a neurodegenerative disease of the extrapyramidal system.

Parkinson's disease

This neurodegenerative disease has the following: Decreased phonational/dynamic range Breathy/Rough/Hoarse Vocal tremor Vocal fold structure and function varies

Parkinson's disease

The 2 indirect less invasive techniques to assess subglottal air pressure are ______________ and ______________.

Pharyngeal pressure; Intraoral pressure

What happens to the vocal folds for myasthenia gravis?

Phase closure is reduced and will decline over time Vibratory amplitude is reduced over time

The ___________________muscle is the only abductor muscle for the vocal folds.

Posterior cricoarytenoid

This type of voice, also known as mutational falsetto, refers to inappropriately high pitch after puberty.

Puberphonia

_______________ is the consistency of the duration of successive cycles of vocal fold vibration.

Regularity

What condition is also known as smoker's polyps?

Reinke's edema

How is MPT measured? Time: Trials:

Seconds Longest of 3 trials

The short-term variability in the amplitude of the acoustic waveform is called _____________.

Shimmer

____________ is the variability in the amplitude of each successive cycle of vibration.

Shimmer

This condition has an unknown origin but is thought to be related to basal ganglia dysfunction.

Spasmodic dysphonia

Pulmonary function testing is done with __________________.

Spirometry

List the 4 infrahyoids

Sternohyoid Omohyoid Thyrohyoid Sternothyroid

How does the voice sound for abductor paralysis?

Strained

A __________________ is the most common clinical diagnostic technique.

Stroboscopy

This instrument has a pulsing light to simulate movement at a slower rate than actual movement.

Stroboscopy

What type of instrumentation is similar to a flip book of cartoons?

Stroboscopy

_____________ is the amount of pressure directly below the vocal folds developed by the respiratory system for voice production.

Subglottal air pressure

This pediatric voice disorder causes narrowing of tissues/space below the level of the glottis.

Subglottic stenosis

This pediatric voice disorder is rare but is one of the most common causes of chronic upper airway obstruction in infants and children.

Subglottic stenosis

What is the furrow along upper medial edge of the vocal folds? Thinning/loss of the superficial layer of vocal folds.

Sulcus vocalis

Reinke's Edema is the swelling of which layer of the vocal folds?

Superficial layer

Cricothryoid muscle is innervated by the _______________.

Superior Laryngeal Nerve

What is the best way to test vocal tremor?

Sustained vowel phonation

What speech task is the most appropriate to test for myasthenia gravis?

Sustained vowel phonation

Why is the the left recurrent laryngeal nerve more prone to traumatic or surgical injury than the right?

The left is longer than the right and the left RLN is closer to the heart.

To assess the supraglottic activity, look for _______-_______ and _______-_______ involvement of supraglottic structures.

medio-lateral; antero-posterior

What is adductor paralysis?

The vocal folds are unable to close

What is abductor paralysis?

The vocal folds are unable to open

_______________ is the only elevator extrinsic muscle from the infrahyoid group.

Thyrohyoid

The 2 direct invasive techniques to assess subglottal air pressure are ______________ and ______________.

Tracheal puncture; esophageal balloon

For this type of laryngeal visual examination, a flexible endocope is passed through the nasal cavity. It allows assessment of vocal fold function during complex vocal tasks.

Transnasal Flexible Laryngoscopy

True of False: Amplitude can be affected by fundamental frequency and intensity.

True

True of False: Complications with the heart or heart surgery can cause injury to the left recurrent laryngeal nerve.

True

True of False: Diplophonia is a consequence of irregular vocal fold or false vocal fold vibration.

True

True of False: Diplophonia of a functional nature is best addressed by reducing laryngeal hypertension.

True

True of False: For s/z ratio, the /s/ and /z/ should be of equal duration, yielding a value of 1.

True

True of False: For the s/z ratio, people with abnormal vocal folds should be expected to prolong the voiceless /s/ much longer than the voiced /z/.

True

True of False: Polypoid degeneration and Reinke's edema are the same condition.

True

True of False: Polyps are often precipitated by a single excessive vocal event.

True

True of False: The MPT of men is greater than women due to lung volume capacities.

True

True of False: The left recurrent laryngeal nerve is more prone to traumatic or surgical injury than the right.

True

True of False: The mucosal wave is assessed during normal pitch and loudness.

True

True of False: The voice of the patient with flaccid dysarthria is breathy and weak.

True

True of false: A greater intensity results in an increased mucosal wave.

True

True or False: A greater fundamental frequency results in a decreased mucosal wave.

True

True or False: In spasmodic dysphonia, laryngeal muscles spasm because too many or the wrong type of signals from the brain through the nerves to the muscles.

True

True or False: Respiratory-phonatory control is one of the crucial components of auditory perceptual evaluation of dysphonic voice.

True

True or False: The cartilages in pediatric are soft and pliable.

True

True or False: The infant larynx is positioned higher in the neck.

True

True or False: Vocal fatigue can affect phonation threshold pressure.

True

True or False: Vocal polyps have an hour-glass vocal fold pattern.

True

True or False: With a patient with functional aphonia you can expect a normal cough.

True

_______________ signals are not appropriate for most acoustic analysis because of their aperiodicity.

Type 3

Which cranial nerve innervates the larynx?

Vagus (CN X)

_______________ refers to if and how voice has changed since onset of the problem.

Variability

This vascular lesion is prominent, superficial, and lengthened blood vessel /vein Is caused by phonotrauma or injury

Vatrix

Plica Ventricularis refers to vibration of which laryngeal structures?

Ventricular folds

This types of instrumentation is high-speed but the images are of only one section of vocal folds in a single line. In addition, the analysis is not intuitive.

Videokymography

A 30-items scale which contains one total score and three subscales: functional, physical, and emotional Addresses the concept of "voice handicap" Uses a 5 point rating scale

Voice Handicap Index

What is also known as the phonetogram?

Voice Range Profile

_____________ is a method to gather comprehensive data about the entire range of fundamental frequencies and intensities that a patient can produce.

Voice Range Profile

A 10-item scale which contains 2 subscales: physical functioning and social-emotional. A 5 point scale Scores are standardized to a scale of 100.

Voice Related Quality of Life (VRQOL)

Essential voice tremor is easy to identify perceptually during ____________________.

Vowel prolongations

Can you sample connected speech and song production with a transnasal flexible laryngoscopy?

Yes

Does normative data exist for MPT?

Yes

For laryngeal resistance, the peak intraoral pressure is estimated from the /___ / portion of the syllable.

p

For the Estimated Subglottal Pressure measurement, the patient produces /___ / followed by /___ / at a constant pitch and at a rate of 1.5 syllables per second.

p; i

Contraction of the interarytenoid muscles serve to a. Draw the arytenoids together b. Decreases the distance between the cricoid and thyroid cartilages c. Tilt the thyroid cartilage superiorly d. Pull the arytenoids apart

a. Draw the arytenoids together

This indirect measurement of subglottal places a small piece of polyethylene tubing between the lips, which is attached to a differential pressure transducer. a. Estimated subglottal pressure b. Intraoral pressure c. Pharyngeal pressure d. Esophageal balloon

a. Estimated subglottal pressure

A patient with muscle tension dysphonia will often exhibit which perceptual sign? a. High pitch b. Abnormal resonance c. Breathiness

a. High pitch

How do you get the maximum phonational frequency range? a. Highest F0 - lowest f0 b. Highest intensity - lowest intensity c. Dynamic ranges from lowest to highest F0

a. Highest F0 - lowest f0

When the vocal folds fail to touch. a. Incomplete b. Complete c. Hour-glass d. Irregular e. Spindle-shaped

a. Incomplete

When vocal folds lengthen, pitch normally _______________ due to contraction of the ________________. a. Increases, cricothyroid b. Decreases, thyromuscularis c. Remains the same, thyroarytenoid d. Increase, interarytenoid

a. Increases, cricothyroid

A score between 0-30 on the Voice Handicap Index indicates a _______ level of handicap. a. Low b. Moderate c. Severe

a. Low

The free and low tech aerodynamic measures include a. MPT and s/z ratio b. Average airflow c. Subglottic pressure d. All of the above

a. MPT and s/z ratio

What part of the strobe examination confirms the presence or absence of vocal fold asymmetry? a. Phase symmetry b. Amplitude of vibration c. Phase closure d. Mucosal wave e. Periodicity/regularity

a. Phase symmetry

Of the 4 categories of drugs used in treating laryngopharyngeal reflux (LPR), which has the main action of having a pronounced and long-lasting reduction of gastric acid production? a. Proton pump inhibitors b. H2-receptor anatgonists c. Prokinetic agents d. Mucosal cytoprotectants

a. Proton pump inhibitors

Which of the following instruments measures the air capacity of the lungs? a. Spirometer b. Nasometer c. VisiPitch d. Pneumotachograph

a. Spirometer

What causes neurologic disorders of the voice? a. Stroke b. Smoking c. Reflux d. Alcohol e. Diet

a. Stroke

What is the maximum performance task used to assess the integrity of phonatory glottal closure?

s/z ratio

What is the average intensity during conversation?

~ 65 - 80 dB spl

Which of the following instruments measures and gives feedback on the presence of nasality in speech production? a. Spirometer b. Nasometer c. VisiPitch d. Pneumotachograph

b. Nasometer

This type of laryngeal visual examination is placed in the back of the mouth, has increased magnification, and the patient can be given a topical anesthesia to help desensitize gag reflex. a. Transnasal flexible laryngoscopy b. Oral rigid laryngoscopy c. Stroboscopy

b. Oral rigid laryngoscopy

This refers to the degree of out-of-phase motion of the vocal folds while in motion. a. Vertical level b. Phase asymmetry c. Glottal closure d. Phase closure

b. Phase asymmetry

What is a major factor contributing to the formation of many benign lesions of the vocal fold mucosa? a. Vocal hyperfunction b. Phonotrauma c. Vocal abuse d. Dysphonia e. Aphonia

b. Phonotrauma

What is the state of the respiratory system when alveolar pressure and atmospheric pressure are equal? a. Inspiratory reserve pressure b. Resting expiratory level c. End-expiratory level d. Expiratory reserve level e. Residual pressure

b. Resting expiratory level

Which of the following is not a congenital pediatric voice disorder? a. Laryngomalacia b. Vocal nodules c. Subglottic stenosis d. Laryngeal webs

b. Vocal nodules

Of the 4 categories of drugs used in treating laryngopharyngeal reflux (LPR), which is a type of drug that enhances gastrointestinal motility by increasing the frequency of contractions in the small intestine or making them stronger, but without disrupting their rhythm? a. Proton pump inhibitors b. H2-receptor antagonists c. Prokinetic agents d. Mucosal cytoprotectants

c. Prokinetic agents

A score >60 on the Voice Handicap Index indicates a _______ level of handicap. a. Low b. Moderate c. Severe

c. Severe

The s/z ratio a. Is the only probe necessary to measure phonatory-respiratory efficiency. b. Suggests that people with normal vocal folds should be expected to prolong the voiceless /s/ much longer than the voiced /z/. c. Tends to show quite variable results both within and across dysphonic and normal speakers. d. Has not been studied extensively over the years

c. Tends to show quite variable results both within and across dysphonic and normal speakers.

Which of the following instruments provides auditory and visual feedback so that the client can determine how close their production matches the clinician's? a. Spirometer b. Nasometer c. VisiPitch d. Pneumotachograph

c. VisiPitch

Which of the following scales is most commonly used in clinical practice to assess quality of life with regards to a voice disorder? a. Singing Voice Handicap Index b. Pediatric Voice Handicap Index c. Voice Handicap Index d. Voice Disability Coping Questionnaire (VDCQ)

c. Voice Handicap Index

Laryngoscopy a. Shows valid results even for severely dysphonic patients b. Is good at showing phonatory onset c. Works by synchronizing the flash of the stroboscopic light with the fundamental frequency of the vocal fold vibration. d. shows each open and closed phase of vocal fold vibration

c. Works by synchronizing the flash of the stroboscopic light with the fundamental frequency of the vocal fold vibration.

Vocal nodules a. Normally develop unilaterally b. Usually pedunculated c. Do not usually add any weight to the vocal folds d. Are located at the junction of anterior 1/3 and posterior 2/3 of the vocal fold

d. Are located at the junction of anterior 1/3 and posterior 2/3 of the vocal fold

Which is not a standard pulmonary function test? a. Forced vital capacity b. Forced expiratory volume in one second c. Maximum voluntary ventilation d. Esophageal balloon e. Maximum inspiratory and expiratory flow-volume loop

d. Esophageal balloon

One or both vocal folds approximate in an irregular fashion. a. Incomplete b. Complete c. Hour-glass d. Irregular e. Spindle-shaped

d. Irregular

When the diaphragm contracts for inhalation, it a. Rises b. Moves backward c. Moves laterally d. Lowers

d. Lowers

Of the 4 categories of drugs used in treating laryngopharyngeal reflux (LPR), which combats ulcers by increasing mucosal protection? a. Proton pump inhibitors b. H2-receptor antagonists c. Prokinetic agents d. Mucosal cytoprotectants

d. Mucosal cytoprotectants

The patient's voice gets progressively weaker during sustained phonation. a. Lower motor neuron disease b. Upper motor neuron disease c. Global stroke d. Myasthenia gravis e. Dysarthria

d. Myasthenia gravis

This refers to observing the amount of time the vocal folds begin to part from the midline until the lower lips of the vocal folds approximate. a. Vertical level b. Phase asymmetry c. Glottal closure d. Phase closure

d. Phase closure

Which of the following instruments records the rate of airflow during breathing? a. Spirometer b. Nasometer c. VisiPitch d. Pneumotachograph

d. Pneumotachograph

A benign lesion that is filled with fluid, tends to be unilateral, and has an active blood supply. a. Contact ulcers b. Reinker's edema c. Nodules d. Polyps e. Leukoplakia

d. Polyps

The acoustics of this voice quality is due to "increased perturbation." a. Breathy b. Harsh c. Hoarse d. Strained e. Nasal

d. Strained

The physiology of this voice quality is due to a "sudden and strong adduction of vocal folds." a. Breathy b. Harsh c. Hoarse d. Strained e. Nasal

d. Strained

Of the following, which represents the most common reason for unilateral vocal fold paralysis? a. Vertigo b. Allergic reaction to drugs c. Ganglion near skull base d. Surgical injury

d. Surgical injury

For laryngeal resistance, the peak airflow is estimated from the /___ / portion of the syllable.

i

At what age does the larynx descend in the neck for pediatrics?

2 years

The standard deviation for fundamental frequency is ~ ____ - ____ semitones for normal speakers.

2, 4

The vocal folds are comprised of how many layers?

5

During _____________ spasmodic dysphonia, the vocal fold abductors spasms when it is opening causing a breathy, weak, and hoarse voice.

Abductor

During _____________ spasmodic dysphonia, the vocal fold adductors spasm periodically causing hyperadduction which results in tightness and a strained-strangled voice.

Adductor

This type of spasmodic dysphonia has the following: Strained voice intermittent voice stoppages Hoarseness Harshness voice tremor

Adductor

Which type of Spasmodic dysphonia is most common? How common percentage-wise?

Adductor; 70%

On the Voice handicap Index, a 4 marked on the 5 point rating scale means what?

Always

Where would you expect to see vocal nodules on a patient?

Anterior 1/3 to posterior 2/3 of the vocal folds

What is a serious risk for abductor paralysis that can be life threatening?

Aspiration

For the Estimated Subglottal Pressure measurement, the patient is asked to produce a string of __________ syllables.

Bilabial

What is myasthenia gravia due to to?

Blockage of acetylcholine in the neuromuscular junction

_______________ is a biologic product and is injected directly into the affected muscles. It blocks nerve signals and reduces the number and severity of the spasms.

Botulium toxin (BTX)

How does the voice sound for myasthenia gravis?

Breathy or hoarse Reduced loudness Nasality (weakness of the velum)

How does the voice sound for adductor paralysis?

Breathy, hoarse or aphonic voice

What type of vocal quality would you see with sulcus vocalis?

Breathy/Hoarse

_______________ is the first step in the clinical/diagnostic voice evaluation.

Case History

________ are small ulcerations that develop on the medial aspect of the vocal processes of the arytenoid cartilages due to irritation.

Contact ulcers

This vascular lesion has a dilation of blood vessels Hoarseness Imaging: reduced mucosal wave, reduced amplitude, glottal closure varies

Ectasia

The signal generator of an __________ supplies a high frequency low voltage current.

Electroglottography (EGG)

This instrument uses surface electrodes over the sides of the thyroid cartilage.

Electroglottography (EGG)

For this instrument, a higher-amplitude signal means more motor units fire therefore a stronger muscle contraction occurs.

Electromyography (EMG)

This instrument is useful for recording temporal aspects of muscle actions.

Electromyography (EMG)

This instrument measures electrical activity of neural signals to muscles.

Electromyography (EMG)

The primary voice symptoms of ____________ is a regular modulation of frequency or intensity.

Essential voice tremor

In speech breathing, the inspiratory phase may be close to what percentage inspiration and what percentage expiration? a. 10% inspiration and 90% expiration b. 10% inspiration and 40% expiration c. It's 100% inspiration d. It's 100% expiration

a. 10% inspiration and 90% expiration

When adminstering the Voice Related Quality of Life (VRQOL), the questions are meant to be scored based on a _____ week period preceding assessment. a. 2 b. 1 c. 3

a. 2

In quiet breathing, the inspiratory phase may be close to what percentage inspiration and what percentage expiration? a. 40% inspiration and 60% expiration b. 10% inspiration and 90% expiration c. 60% inspiration and 40% expiration d. 50% inspiration and 50% expiration

a. 40% inspiration and 60% expiration

When it comes to differentiating patients with adductor spasmodic dysphonia from those with muscle tension dysphonia, researchers suggest that those with MTD tend to maintain hyperadduction a. Across all speech and phonation tasks b. Only when whispering c. Only on voiced phonemes d. Only on non-voiced phonemes

a. Across all speech and phonation tasks

The acoustics of this voice quality is due to an "increased aspiration noise with noise mostly in the mid or high frequencies between 3 kHz and 5 kHz." a. Breathy b. Harsh c. Hoarse d. Strained e. Nasal

a. Breathy

The physiology of this voice quality is an "incomplete glottal closure and slower adduction of vocal folds." a. Breathy b. Harsh c. Hoarse d. Strained e. Nasal

a. Breathy

Match the following in terms for how it can affect AMPLITUDE by either having an increased excursion or a decreased excursion a. Higher F0 b. Greater intensity c. Mass lesions d. Paralysis

a. Decreased excursion b. Increased excursion c. Decreased excursion d. Increased excursion

What is a primary muscle of inhalation? a. Diaphragm b. Pectoralis c. Internal intercostals d. Subclavius d. Internal oblique

a. Diaphragm

Where does the exchange of oxygen and carbon dioxide occur in the respiratory system? a. Larynx b. Alveolar sacs c. Bronci d. Pharynx e. Trachea

b. Alveolar sacs

This parameter refers to how far the vocal folds move laterally from the midline during phonation. a. Mucosal wave b. Amplitude c. Edge d. Glottal closure

b. Amplitude

Of the following, which characteristic could you expect to occur during examination of the voice affected by abductor spasmodic dysphonia? a. Tight/harsh phonation b. Breathiness/aphonia c. Diplophonia

b. Breathiness/aphonia

A glottis without evidence of any gapping during maximum vocal fold adduction. a. Incomplete b. Complete c. Hour-glass d. Irregular e. Spindle-shaped

b. Complete

What kind of glottal shape is like a pyramid, with the upper margin of the vocal folds forming the apex of the pyramid and the lower margin forms a wider base? a. Revergent b. Convergent c. Divergent d. Invergent

b. Convergent

Of the 4 categories of drugs used in treating laryngopharyngeal reflux (LPR), which works to decrease the production of stomach acid? a. Proton pump inhibitors b. H2-receptor antagonists c. Prokinetic agents d. Mucosal cytoprotectants

b. H2-receptor antagonists

The acoustics of this voice quality are due to an "increase in spectral noise in low frequency (below 2.5 kHz) and increased perturbation." a. Breathy b. Harsh c. Hoarse d. Strained e. Nasal

b. Harsh

The physiology of this voice quality is "irregular vocal fold vibration." a. Breathy b. Harsh c. Hoarse d. Strained e. Nasal

b. Harsh

How do you get the dynamic range? a. Highest F0 - lowest f0 b. Highest intensity - lowest intensity c. Dynamic ranges from lowest to highest F0

b. Highest intensity - lowest intensity

Identify which is not a vocally abusive behavior a. Screaming b. Hydrating c. Throat clearing d. Smoking

b. Hydrating

This indirect less invasive techniques to assess subglottal air pressure is done by passing a sensor around the teeth. a. Tracheal puncture b. Intraoral pressure c. Pharyngeal pressure d. Esophageal balloon

b. Intraoral pressure

What is immediately deep to the epithelium? a. Vocalis muscle b. Lamina propria c. True folds d. Extracellular matrix e. Vocal process

b. Lamina propria

A score between 31-60 on the Voice Handicap Index indicates a _______ level of handicap. a. Low b. Moderate c. Severe

b. Moderate

A patient exhibits strained/strangled voice, displayed tension around the neck, and complains of vocal fatigue. What are your initial thoughts on potential diagnosis? a. Vocal tremor b. Muscle tension dysphonia c. Abductor spasmodic dysphonia

b. Muscle tension dysphonia

What is the maximum points possible to obtain on the Voice handicap Index? a. 150 b. 100 c. 120 d. 80

c. 120

The opening of the vocal folds a. Articulation b. Phonation c. Abduction d. Adduction

c. Abduction

During inhalation alveolar pressure is a. Above atmospheric pressure b. Equal to atmospheric pressure c. Below atmospheric pressure d. Positive e. Not related to atmospheric pressure

c. Below atmospheric pressure

How do you get the voice range profile/phonteogram? a. Highest F0 - lowest f0 b. Highest intensity - lowest intensity c. Dynamic ranges from lowest to highest F0

c. Dynamic ranges from lowest to highest F0

The acoustics of this voice quality is "breathy and harsh with an increased aspiration noise and increased perturbation." a. Breathy b. Harsh c. Hoarse d. Strained e. Nasal

c. Hoarse

The presence of an anterior and posterior gap with mid-membraneous vocal fold closure. a. Incomplete b. Complete c. Hour-glass d. Irregular e. Spindle-shaped

c. Hour-glass

According to the vertical phase difference in vocal fold movement, a. Posterior to anterior closing b. Anterior to posterior opening c. Inferior edges of vocal folds contact before superior edges d. Superior edges of vocal folds contact before inferior edges

c. Inferior edges of vocal folds contact before superior edges

The "ripple-like" movement of the mucosa over the vocal fold body. a. Amplitude b. Edge c. Mucosal wave d. Regularity

c. Mucosal wave

What is the shape of the Voice Range Profile in healthy and normal speakers? a. Rectangular b. Square c. Oval/Elliptical d. Saw tooth e. Triangular

c. Oval/Elliptical

Of the following medical diagnosis, which is associated with neurogenic dysphonia? a. Vocal fold nodules b. Diabetes c. Parkinson's disease d. Anxiety

c. Parkinson's disease

This indirect less invasive techniques to assess subglottal air pressure is done by passing a tube through the nose. a. Tracheal puncture b. Intraoral pressure c. Pharyngeal pressure d. Esophageal balloon

c. Pharyngeal pressure

Muscle tension dysphonia is often characterized by: a. Vocal fatigue b. An elevated larynx c. Patient complains of neck and jaw pain d. All of the above

d. All of the above

Vocal dosage instruments via an accelerometer are programmed to analyze a. Percentage of phonation time b. Fundamental frequency c. Sound pressure level d. All of the above

d. All of the above

When observing vocal fold edge, you make judgements about: a. Smoothness b. Straightness c. Presence of mass lesions or other pathologies d. All of the above

d. All of the above

Differences between nodules and polyps include a. location of lesions b. cause of lesions c. fibronectin levels d. Blood supply e. All of the above

e. All of the above

A longer closed phase allows a. Greater frequency of vocal fold vibration b. increase in mucosal wave c. Greater buildup of lung pressure d. Greater intensity e. Both c and d

e. Both c and d

The acoustics of this voice quality is perceived as "hypernasal and the first formant frequency and bandwidth, relative amplitude of nasal resonances." a. Breathy b. Harsh c. Hoarse d. Strained e. Nasal

e. Nasal

The physiology of this voice quality is due to "excess nasal airflow: cleft palate, velopharyngeal insufficiency. a. Breathy b. Harsh c. Hoarse d. Strained e. Nasal

e. Nasal

What part of the stroboscopic examination confirms if cycles are regular, irregular, or inconsistent? a. Phase symmetry b. Amplitude of vibration c. Phase closure d. Mucosal wave e. Periodicity/regularity

e. Periodicity/regularity

What muscle abducts the glottis? a. Vocalis b. Interarytenoid c. Cricothyroid d. Cricoarytenoid e. Posterior cricoarytenoid

e. Posterior cricoarytenoid

A glottal appearance where both the anterior and posterior portions of the vocal folds are closed, but a large gap remains. a. Incomplete b. Complete c. Hour-glass d. Irregular e. Spindle-shaped

e. Spindle-shaped

What is the airtight membrane that encases the lungs? a. Epithelium b. Mucous membrane c. Alveolar Serum d. Saliva e. Visceral Pleura

e. Visceral Pleura