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