Voice: Quiz 1, Midterm and Anatomy Quiz Questions

A 31 yr-old male self-refers to your voice clinic with complaints of hoarse voice, significant effort to produce voice and vocal fatigue. He smokes about a pack of cigarettes a day and drinks 2-3 beers a day. On videostroboscopic examination, white plaque-like lesions are observed along his vocal folds, which do not seem to be impacting the vocal fold vibration. In addition, thickening of the posterior cricoid space and pachydermia is observed. Based on this information, what is your medical diagnosis

Leukoplakia

A 35yr old elementary school teacher comes to your clinic with a c/o inability to project her voice in her class. She indicates that it takes a lot of effort and work to project her voice and experiences vocal fatigue and sore throat with increased volume. Given her occupation, her goal is to be able to project her voice without having to push her voice. What would be the choice/s to help her achieve her goal?

decrease medial compression manipulate vocal tract

List two non-speech laryngeal fucntions of the larynx

drinking beathing coughing

List one effect of an antihistamine on the vocal folds.

dryness

List the five layers of the vocal fold

epithelium superficial lamina propria intermediate lamina propria deep lamina propria muscle/vocalis

As vocal fold elongation increases, impact stress also increases linearly.

false

Breathiness is characterized by irregularly modulated airflow.

false

Cricothyoid is a tensor and is supplied by the RLN

false

In a falsetto register, the vocal folds are stretched and there is lower than average airflow.

false

In individuals with PVFM, the usual onset of symptoms is less than 5 minutes after beginning of exercise, the recovery period is 5-10minutes and the area of constriction is in the throat.

false

Increased mucus on the true vocal folds will decrease the subglottic pressure required for phonation.

false

Intrinsic laryngeal muscles contract during the maintenance phase of phonation.

false

Intrinsic muscles of the layrynx contract during the maintenance stage of phonation

false

Resonant frequency is defined as the lowest component frequency with which a body vibrates freely.

false

The only intrinsic muscle supplied by the SLN is the cricothyroid, a muscle that aids in vocal fold shortening.

false

You can assess running speech (i.e., conversational speaking) using a rigid videostroboscopy.

false

The space between the true vocal folds in called the

glottis

_____ and ___- layers of the vocal fold form the vocal ligament.

intermediate lamina propria and deep lamina propria

The two possible non-neurological conditions leading to voice problems in individuals secondary to intubation injury is _________&_____________.

laceration of RLN and mucosa RLN & SLN Paresis arytenoid dislocation and laceration of RLN arytenoid dislocation and glottic web/scar tissue****

A 35 yr old female self-refers to your clinic with increased effort to produce her voice, something stuck in her throat sensation and constant need to clear her throat. Videostroboscopic analysis revealed increased mucus between the free edges of the vocal folds. Her subglottic pressure is likely to be increased.

true

According to the acoustic theory of vowel production, the source (vocal fold vibration) and filter (configuration of the vocal tract) are independent of each other. In other words, we can change the pitch of the vowel, without changing the vowel.

true

Thyroarytenoid is a tensor when it co-contracts with the cricothyroid muscle.

true

List two differences between asthma and PVFMD.

In PVFM, the tightness is felt in the throat where as in asthma it is felt in the chest. In PVFM, symptoms last for less then 5 minutes and in asthsma they last longer.

A 16-yr-old female singer comes to you distraught because, in auditions for roles that are important to her, she keeps "sharping" her high notes (i.e. producing a frequency that is slightly too high with some strain). Comments from the adjudicators indicate that this is the primary reason she is failing to get the roles. Her voice is otherwise good, and her larynx appears healthy based on the ENT exam. Which manipulations might you attempt to help this young lady stop sharping?

Increase subglottal pressure on high notes consider laryngeal microsurgery to shorten the vocal folds Decrease her typical subglottic pressure on high notes*****

A 45 yr old female comes to your clinic with a complaint of significant effort to produce her voice, pitch breaks at high notes, and a breathy voice quality. On visual examination, you notice bilateral vocal fold lesions depicting an hour glass glottal closure. What would you expect to see for average airflow and subglottic pressure?

Increased average airflow and increased subglottic pressure

Name the joint that aids in adduction and abduction of the voal fold

cricoid artyenoid

The structure inferior to the larynx is the ____ and superior to the larynx is the ____

trachea hyoid

Average airflow for healthy vocal folds is in the order of _______________

100-200l/sec 100-200ml/sec*** 100-350ml/sec 10-20ml/sec

A 35-yr old female comes to clinic with c/o loss of voice that started about a month ago. She has a previous experience of voice loss, but her voice returned within 6 weeks. Auditory-perceptual evaluation revealed aphonia and a strained whisper. What would you expect in terms of acoustic measures including F0, and intensity?

Acoustic measures cannot be obtained in an individual with aphonia.

A 50yr old male presents to you with c/o a strained strangled voice. His symptoms began a year ago and have gradually progressed since the onset. During the evaluation, you observe that he is able to sustain phonation and can sing and whisper without the presenting complaint of a strained strangled voice (i.e., no vocal symptoms). Based on this information, please provide the appropriate diagnosis.

Adductor Spasmodic Dysphonia

A patient is referred to you with a breathy strained voice following an intubation procedure 4 weeks ago. As you listen to her history, you begin to wonder if the client is experiencing the symptoms due to an immobile vocal fold or is she experiencing a functional dysphonia/aphonia. What is one task that you might ask the client to complete to indicate one diagnosis or the other?

Ask the client to perform any vegetative function

You are asked to consult a patient in the hospital setting for swallowing and breathing difficulties. When you probe through the history, client was admitted to the hospital following a laryngospasm where she passed out and could not breathe. She has experienced 3-4 such episodes in the past that is triggered by chemical odors, where she has difficulty catching her breath and has tried to take asthma medication to relieve the symptoms with minimal relief. Her main complaints with swallowing include a feeling of something stuck in her throat and she cannot seem to get it down. Based on the given information, what is your diagnosis?

Chemical laryngeal hypersensitivity/ Irritable larynx**** Asthma Chronic Obstructive Pulmonary Disease Laryngopharyngeal reflux

A 43 year -old female clerk is referred to you for a voice evaluation. Her primary complaints include intermittent dysphonia, an effort to produce her voice, and shortness of breath during exertion. In addition, she is constantly asked by other people "What's wrong with your voice?" On the telephone, people mistake her for a male. On further probing, she revealed constant throat clearing and wakes up hoarse every morning. The patient recently quit smoking, but used to smoke half a pack for 20 years. No other significant medical history reported. Given this information, what is your possible medical diagnosis?

Chronic Laryngitis Hypothyroidism Laryngopharyngeal reflux Reinke's edema*****

A 43-yr-old woman complains of a gradual onset, over the past 2 yrs, of her voice "catching" and "giving way." She says that she feels like she is running out of breath when she talks. However, she is able to sing fluently in her church choir. She says that she now avoids social situations and talking in public because of the problem. Although she had a bit of a cold the first time she noticed the problem, she has not had any real upper respiratory tract infections that she is aware since that time. Assuming that you do not have any other information about the patient, what is the first condition that you would want to test for?

Chronic laryngitis Essential tremor Abductory spasmodic dysphonia*** Chronic fatigue syndrome

The minimum subglottic pressure required to initiate phonation is ___________ (no unit, no credit)

3-5 cm of water

The minimum subglottic pressure required to initiate phonation is

3-5 cm of water to intitiate

What percentage of the general population is estimated to have a voice problem at any given point in time?

3-9%

A 30 year old female is referred to your clinic with bilateral vocal fold lesions. Auditory perceptual evaluation reveals a moderate breathy voice quality with mild strain and decreased pitch. Videostroboscopic evaluation revealed bilateral lesions and an hour glass glottal closure pattern. Indicate what you would expect for this client on a) F0, b) average airflow, c) minimum airflow, and d) Noise to Harmonics Ratio (type of voice).

F0- decreased Average Airflow- increased Minimum Airflow- increased Noise to Harmonics Ratio- Greater noise to harmonics ratio- Type 2 voice

A 50 year old male is referred to your clinic with a weak voice and inability to project his voice. Videostroboscopic examination reveals bilateral atrophy of the vocal folds. What trend would you expect for the following? a) Fundamental frequency (F0), b) intensity, c) subglottic pressure?

F0- increased Intensity- decreased Subglottic Pressure- decreased

A 19-yr old college student comes to your clinic with c/o high-pitched weak voice. On further probing, you understand that the client never had a change in voice after puberty. What is the first thing that comes to your mind?

Congenital sulcus Congenital web Puberphonia**** Scar

A 57 year-old female comes in to your clinic with a breathy voice following a heart surgery. On videostroboscopic analysis, the left vocal fold is immobile. Which cranial nerve, and which branch, may be impacted in this client?

Cranial: Vagus nerve. Branch: Recurrent laryngeal nerve.

A 26 year-old female comes in to your clinic with a complaint of loss of her higher pitch range. Videostroboscopic examination reveals decreased or no stretching of the vocal folds. Specify exactly the cranial nerve and the branch that might be impacted.

Cranial: Vagus nerve. Branch: Superior Laryngeal Nerve

A 23 year old soccer mom comes in to your clinic for a voice evaluation. She indicated that she was cheering for her son's team and all of a sudden her voice quality changed and fluctuated between hoarseness to no voice. She indicated a weird taste in her mouth. What is your hypothesis about her voice diagnosis and what is your immediate recommendation for this mom?

Diagnosis- Vocal Fold Hemorrhage Recommendation- Voice rest

Anatomical studies of the human vocal folds and detailed observation of mucosal behavior during phonation has led to the current "cover-body" characterization of the vocal fold. Which of the following is included in the vocal fold cover?

Epithelium and deep lamina propria Intermediate and deep lamina propria Epithelium and superficial lamina propria***** Vocalis muscle

A 55 year-old male is referred to your clinic for a voice evaluation. His wife's primary complaints include the husband's weak voice, inability to be hear him in background noise and occasional fast rate of speech, although the husband says he speaks quite loud. Acoustic measures revealed intensity at 58dBSPL and physiologic measures revealed subglottic pressure at 4.8cmH20, average airflow of 280ml/sec and a laryngeal DDK rate of 12 in 5 sec with moderately poor consistency and strength. Visual analysis reveals spindle shaped glottal closure. Given this information, what do you think is possibly going on with this client?

Myasthenia Gravis Parkinson's Disease***** Vocal Fold Atrophy Unilateral RLN Paralysis

A 26 year-old female comes in to your clinic with a compliant of loss of her higher pitch range. Videostroboscopic examination reveals decreased or no stretching of the vocal folds. Specify exactly the nerve and the branch that might be impacted.

Nerve: Vagus Branch: Superior Laryngeal Nerve

List the main factors responsible for the maintenance of phonation.

No muscles are needed for the maintenance of phonation. Subglottic pressure and air flow are needed to force the vocal folds open. The Bernoulli Effect will bring the vocal folds back together to medical compression.

Name the intrinsic muscle/s responsible for abduction of the vocal fold

PCA

The membrane that aids in the attachement of the cricoid cartilage to the 1st tracheal ring is the

cricotracheal membrane

A 57 year-old female comes in to your clinic with a breathy voice following a heart surgery. On videostroboscopic analysis, the left vocal fold is immobile. Which nerve may be impacted in this client?

Right SLN Left RLN**** Left SLN Right RLN

The two interartyenoid muscles are the ______ and ______. the most superficial muscle of the interartyenoids is the _____.

transters oblique oblique

A 77 year old male comes to your clinic with a complaint of slightly higher pitch, weak, breathy voice with an inability to project voice. It is impacting his ability to complete his teaching job as an adjunct professor. Based on this information, what is potentially the underlying voice disorder and which layer of the vocal fold is affected by this pathology?

Vocal fold atrophy, muscle/vocalis layer

You are working as an SLP in a Senior High school district. The school's music teacher refers a 15-yr old female choir singer to you with complaints of significant hoarseness, pitch breaks in higher register and increased phonatory effort when speaking and singing. You refer her to an otolaryngologist, who provides a diagnosis of mid-membranous lesions, which are probably bilateral nodules. The nodules interfere with complete vocal fold closure during phonation. Based on the physician's report, the lesions appear limited to which layer of the vocal fold?

Vocal ligament Thyroarytenoid muscle Vocal process Vocal fold mucosa*****

You are working as an SLP in a Senior High school district. The school's music teacher refers a 15-yr old female choir singer to you with complaints of significant hoarseness and increased phonatory effort when speaking and singing. You refer her to an otolaryngologist, who provides a diagnosis of mid-membranous lesions, which are probably bilateral nodules. The nodules interfere with complete vocal fold closure during phonation. Based on the physician's report, the lesions appear limited to which layer of the vocal fold.

Vocal ligament Vocal fold mucosa**** Vocalis Vocal process

In working with a patient to limit vocal fold impact stress, which of the following variables are linearly related that you are likely to manipulate?

a) Vocal fold adduction b) Subglottic pressure c) Vocal fold elongation d) a and b****** e) all of the above

A 25 year-old football player comes to your clinic with some pain in his neck and voice complaints including change in quality of his voice, specifically breathiness, vocal fatigue, and shortness of breath. He has a weird sensation of something moving in his neck when trying to speak. The problem started 3 days ago when during practice; he received a punch in his neck. Given the symptoms, what is your first impression on what could be causing his vocal impairment?

arytenoid dislocation

A 77 year old male comes to your clinic with a complaint of slightly higher pitch, weak, breathy voice with an inability to project voice. It is impacting his ability to complete his teaching job as an adjunct professor. Based on this information, what is potentially the underlying voice disorder and which layer of the vocal fold is affected by this pathology?

atrophy. muscle/vocalis

_____ and ____ are two parameters of the glottal waveform that provide information about glottal closure/glottal incompetence.

average flow and minimum flow

A 37-yr old teacher comes to your clinic with a diagnosis of bilateral true vocal fold lesions. On visual perceptual analysis, you notice that there is an hour glass glottal closure pattern with an anterior and posterior chink, no supraglottic compression and some aperiodicity (flutter) of the true vocal folds. What would you expect to find based on this information. Pick the most appropriate answer.

breathy voice, rough voice, increased airflow, decreased F0**** breathy voice, strain, decreased airflow, high F0 breathy voice, rough voice, decreased airflow, high F0 rough voice, strain, increased airflow, decreased F0

You meet a 17-yr-old male at a company party. When you tell him you are a speech-language pathologist, he tells you that you might be interested he has had 24 surgeries on his larynx, since he was 3 years old. His voice is very hoarse. He says that he has to go back in for laryngeal surgery now every 6 months to 1 yr. Otherwise he is healthy. You ask him what the name of his condition is, but he doesn't remember what it's called. What is your first guess?

congenital sulcus vocalis laryngeal cancer recurrent laryngeal papilloma*** congenital cyst

An otolarngologist examines a 47-yr-old male whose voice went south when he had a cold 1 year ago. The patient's voice never recovered. Physical examination shows that the patient's left vocal fold does not come to midline on adduction, and moves sluggishly when it moves at all. The examination also reveals a moderate-sized tissue bridge across the vocal folds at the anterior commissure. Further questioning of the patient reveals that his voice was never "entirely normal", even from childhood. What is your possible diagnosis? Pick the most appropriate answer.

left vocal fold paresis or paralysis congenital web subglottic stenosis b and c a and b*****

A 35yr old elementary school teacher comes to your clinic with a c/o inability to project her voice in her class. she indicates that it takes a lot of effort and work to project her voice and experiences vocal fatigue and sore throat with increased volume. Given her occupation, her goal is to be able to project her voice without having to push her voice. What would be the choice/s to help her achieve her goal?

manipulate vocal tract decrease medial compression

Of all layers of the vocal fold, __________layer forms the bulk of the vocal fold.

muscle/vocalis

A 45 yr old male comes to your clinic with c/o hoarse, deep voice. Problems started following a period of violent coughing during bronchitis. During videostroboscopic evaluation, you notice granuloma. To which part of the vocal fold is this lesion usually localized to?

on the vocal process

_____ is the frequency of vocal fold vibration that is most appropriate and comfortable for an individual's system

optimal frequency (fundamental frequency?)

Name the paired and unpaired cartilages of the larynx

paired- artyeniod unpaired- thyroid cricoid

Indicate the control variables in phonation and for each provide it's acoustic correlate.

pitch/frequency loudness/intensity quality/spectrum

Identify a behavioral/non-instrumental measure to obtain information on minimal flow to infer the mucosal status/ function and what is the expected norm for this measure?

s:z ratio, .99-1

List two components of voice assessment or evaluation performed by an SLP in individuals with voice disorders when access to instrumentation is limited.

self-perceptual assessment case history

List two issues that might interfere with accuracy of identification of deviance in vocal parameters during an auditory-perceptual evaluation

social norms clinician experience

_______ layer of the vocal fold is primary and the most important layer in voice production.

superficial lamina propria

Thyrovocalis originates in the ________ and inserts into the _______

thyroid notch and vocal process of the artyenoid

An eight-yr old male was referred to your clinic for a voice evaluation. Mom reported that he has a high-pitched hoarse voice and a weak voice that she has noticed since age of three following an emergent endotracheal intubation during a hospital visit. He also has dyspnea on exertion (specifically heavy physical activity). Additionally, the kid likes to use a lot of animal and vehicle noises during play and drinks about 2 cups of soda a day and 2 cups of water. On videostroboscopic evaluation, you notice a tissue bridge in the anterior aspect of the vocal folds. What is your diagnosis based on this?

vocal fold lesion sulcus subglottic stenosis acquired anterior glottic web***

You are at a broadway performance show. During the show, the lead female performer experiences a sudden break in her voice and then experiences hoarseness. The show is temporarily halted and a substitute performer comes in to complete the rest of the show. Out of curiosity and being related to the profession, you go back stage and ask the performer some questions. You find out that the client has been experiencing a cold and was on steroids. She said as soon as her voice cracked, she could taste blood. What is the first condition that comes to your mind with such a sudden onset of voice problem?

vocal fold lesion vocal fold hemorrhage*** laryngitis Laryngopharyngeal reflux