Praxis: Missed Practice Test Questions
52 y/o pt complains of vest. crisis event lasting 3 days with continuous vertigo & nausea. Symptoms have improved, but now reports head motion provoked vertigo--esp when he moves his head in sagittal plane. His VNG showed: normal oculomotor fx right-beating spontaneous nystagmus absent cool, warm, and ice water calorics on the left left posterior canal BPPV a. Complete loss of fx of the left vest system b. Complete loss of fx of left horizontal canal with preserved fx in anterior canal c. Loss of left horizontal canal fx, at least in the lower freq range, with preserved posterior canal fx d. Incomplete bilateral vest system loss e. Complete loss of left posterior canal fx, with preserved horizontal and anterior canal fx
c. Loss of left horizontal canal fx, at least in the lower freq range, with preserved posterior canal fx calorics = loss of left horizontal canal fx at least in the low freq range of calorics right-beating spont nystag = left vest weakness left posterior canal BPPV suggests that left posterior canal is functioning
Which of the following best identifies the appropriate tools to screen for newborn hearing loss in accordance with the Joint Committee on Infant Hearing guidelines? in the well-baby nursery; in the neonatal ICU a. ABR; OAE b. OAE, OAE & ABR c. OAE & ABR; ABR d. OAE, ABR, & ASSR; OAE & ABR e. ABR; ABR & ASSR
c. OAE & ABR; ABR JY: not choice b because in the NICU, you'd only have time to run ONE test, which would be the ABR. You wouldn't waste time trying to do additional OAEs in NICU.
The outer ear is classified as which kind of device? The middle ear? The inner ear? a. hydraulic b. mechanical c. biological d. acoustic
outer ear = acoustic middle ear = acoustic and mechanic inner ear = acoustic, mechanic, and hydraulic
What is the age range for VRA? What is the age range for CPA?
VRA = 5-27 months (6 months to 2-3 years) CPA = 2-5 years
Those with nml hearing in 1 ear and severe HL in other ear experience which of the following? a. Improvement in speech understanding when noise is closer to HL ear b. improved ability to localize when noise source closer to nml ear c. better speech understanding and localization as reverb time increases d. more difficulty understanding speech when speaker moves closer to HL ear e. improved localization when noise at 0 degress azimuth and source is closer to HL ear
a. Improvement in speech understanding when noise is closer to HL ear Speech intelligibility improves when better ear is further form noise source. When this occurs, then SNR improves in better ear. JY: Not D because textbook answer is A.
Which of the following evaluation measures is most likely to provide valid and reliable information about a typically developing 9-month-old child's hearing sensitivity at 500 to 4000 Hz? a. VRA b. Pure-tone play audiometry c. OAEs d. ABR audiometry e. BOA
a. VRA At 9 months, a typically developing infant can provide reliable responses to all octave band frequencies, and VRA is the most valid and reliable method for doing that: the infant's behavior can be reinforced and will be consistent. JY: not choice D because ABR waves can be off-norm for kids up to 18 months old
Which analysis parameter is (are) most affected when ABR is conducted using supra-aural earphones rather than inserts? a. absolute latencies b. interpeak latencies c. interaural latencies d. amplitude e. waveform morphology
a. absolute latencies Inserts cause a delay due to sound travel through the tubes; this delay lengthens absolute latencies.
A patient reports her HL in both ears has slowly worsened. She reports she can often hear better under noisy conditions than under quiet conditions. The hearing loss is most likely to be a. conductive b. SNHL c. caused by lesion of auditory nerve d. cause by cortical lesion e. due to presbycusis
a. conductive People speak more loudly in noisy conditions, which provides a higher-amp speech signal and improves SNR and the sensorineural input for individuals with CHL.
An aud fits a pt with a HA that uses WDRC. Which of the following reflects the compression parameters used with WDRC? a. Low compression threshold, low CR b. High compression threshold, high CR c. Low compression threshold, high CR d. High compression threshold, low CR e. Variable compression ratio, high compression threshold
a. low compression threshold; low CR WDRC provides gain adjustment across a wide range of input levels. It provides additional gain for *low input levels with a low compression threshold* and provides *gradual* increases in gain as input levels increase using a *low CR*.
If an audiologist does not account for the RECD (real-ear-to-coupler difference) during a HA-fitting of a 6 month old, the fitting will most likely provide a. overamplification b. underamplification c. adequate amplification d. inadequate amounts of noise suppression e. an inadequate T-coil response
a. overamplification adult's SPL to a kid-sized EAc will be too loud according to teh volume/impedance/whatchamacallit ratio
One component required in the production of sound is a hearing mechanism to receive it. The other 3 necessary components include all of the following EXCEPT a. velocity b. force c. medium d. vibration
a. velocity
Without the middle ear, if sound were to reach the inner ear, to the hearer it would be a. virtually nonexistent b. so loud it caused nerve damage c. impossible to interpret d. distorted in its frequencies
a. virtually nonexistent
Nml hearing ppl use different cues to localize sounds. Which are primarily involved in localizing an ambulance siren with a freq of 700 Hz? a. ITD & ILD b. ITD only c. spectral cues & ILD d. ILD only e. spectral cues only
b. ITD only Primary cues for location of sounds below 1500 Hz are ITD. The other cues--ILD and spectral cues--occur at HFs. Therefore, 700 Hz would be localized using ITD. JY: You would use TIME differences for LFs because you would actually be able to tell the difference, whereas HF diffs would be too hard.
According to IDEA, an audiologist's recommendations for a 6 y/o child with HL should be addressed in which of the following documents? a. Individualized Family Service Plan b. Individualized Education Program c. report card d. Behavioral Intervention Plan e. cumulative academic record
b. Individualized Education Program IEP = for pts >3 y/o IFSP = for pts <3 y/o IDEA = for pts up to 21 y/o
Mr. Jones is a 92-year-old man with moderate SNHL, dementia, reduced manual dexterity, and a history of losing personal medical devices. He has limited financial resources but would like an amplification device for everyday use. What amplification device is the most appropriate recommendation for Mr. Jones? a. FM system with receiver and transmitter b. Personal listening system with headphones c. Half-shell HAs d. RIC HAs e. Full-shell HAs
b. Personal listening system with headphones Mr. Jones could benefit from amplification and given the factors of dementia and reduced manual dexterity, the best option is a personal listening system that is easy to use and less likely to get lost.
An audiologist who has extensive training in the making of EMI inadvertently allows the impression material to go beyond the cotton block, resulting in trauma to the TM. The audiologist explains the situation to the patient and makes an appropriate referral to F/U medical care. Which of the following statements about the situation is most accurate? a. The aud may be guilty of an ethical violation. b. The aud may be subject to litigation for malpractice. c. The aud should refer the patient elsewhere for another EMI. d. The aud should use a different type of EMI material. e. The aud should receive additional training in the making of earmolds.
b. The aud may be subject to litigation for malpractice. The aud received appropriate training for the procedure and is therefore not guilty of unethical practice. However, the mistake can be construed as malpractice. JY: malpractice = "improper, illegal, or negligent professional activity or treatment"
Which of the following is a possible outcome of an audiologist using a physician's NPI for billing rather than using his/her own NPI? a. The reimbursement for services rendered will be enhanced b. The incorrect validation of the physician as the predominant provider of audiology services. c. The expansion of the scope of practice for audiologists. d. The audiologist will not be liable for malpractice. E. The audiologist will no longer be eligible to maintain his/her own NPI.
b. The incorrect validation of the physician as the predominant provider of audiology services. It is detrimental to the profession of audiology to have audiology services billed under the NPI of a physician. Doing so can skew the Medicare claims data to incorrectly indicate that physicians are the predominant providers of audiology services and, as a result, limit the role of the profession of audiology in national and regional audiology coding and reimbursement processes.
Which of the following is a reason for an audiologist to monitor and evaluate the vestibular functino of a patient who has been diagnosed with cancer and is undergoing a cisplatin-based chemotherapy regime? a. The patient reports experiencing lightheadedness upon standing up abruptly. b. The patient exhibits ataxia of gait or stance. c. The patient reports experiencing dizziness and has type B tympanograms. d. The patient reports having blurred vision and headaches. e. The patient reports having experienced hearing loss.
b. The patient exhibits ataxia of gait or stance. Cisplatin is a chemotherapeutic agent. A side effect of cisplatin is ototoxicity, which can cause HF HL followed by bilateral vestibular loss. Clinical signs and symptoms that may suggest bilateral vestibular involvement include visual instability with head movements and ataxia of gait and stance. JY: e is not correct because that's the precursor to vest. issues; questions assumes monitor/evaluation of issues should occur only AFTER symptoms show up
The CI signal-processing strategy in which brief pulses are presented to each electrode in a non-overlapping sequence is known as a. feature extraction b. continuous interleaved sampling c. fine structure d. current steering e. a filter bank
b. continuous interleaved sampling aka CIS
Which of the following is the most valid method of monitoring a 5 y/o's progress in aural rehab? a. having the child report his/her own perceptions of change b. periodically administering probes of treatment targets in naturalistic contexts c. using questionnaires to be answered by the child's parents d. having teachers report on the child's classroom performance e. administering a norm-referenced test at the end of each session
b. periodically administering probes of treatment targets in naturalistic contexts This will give an objective assessment of the child's progress and is likely to provide valid results.
Which of the following formants is (are) most useful in the recognition of vowels? a. F1 only b. F2 only c. F1 & F2 d. F1 & F3 e. F2 & F3
c. F1 & F2
Which of the following is the primary reason investigators have given for limiting a HA's OSPL90 to a lower level when it's worn by a child than when it's worn by an adult? a. loud amplified sounds may frighten a young child and result in rejection fo the HA b. the volume of the external auditory meatus in children is less than that represented by a 2-cc coupler, and consequently the SPL at the eardrum is greater c. measuring the degree of HL in preschoolers is often imprecise and may lead to improper fitting of an aid d. parents and teachers of children with hearing impairment typically talk louder than do people who interact with adults with hearing impairments e. the primary speech signal will be masked because room noise and reverberation will be amplified
b. the volume of the external auditory meatus in children is less than that represented by a 2-cc coupler, and consequently the SPL at the eardrum is greater The SPL at the eardrum is a function of the volume of the external auditory meatus: the smaller the volume, the greater the sound pressure. An OSPL90 set to a level appropriate for adults may produce an undesirably high max SPL in a child. JY: remember the smaller EAC volume means less impedance to overcome (some transmission? impedance? ratio name; can't remember) = adult's SPL is louder for kid-sized ears
Under OSHA regulations adopted in March 1983, a standard threshold shift on an annual audiogram is defined as a change in hearing threshold relative to the baseline audiogram of an average of 10 dB or more at which of the following frequencies? a. 500, 1000, 2000 Hz b. 1000, 2000, 3000 Hz c. 2000, 3000, 4000 Hz d. 500, 1000, 2000, 3000 Hz e. 500, 1000, 2000, 4000 Hz
c. 2000, 3000, 4000 Hz OSHA's definition of standard threshold shift involves 2000, 3000, 4000 Hz only. JY: note this is *OSHA's threshold shift* because these are the impt freq for speech at work. Note that this is NOT *sig changes in threshold*
Which of the following would be more appropriate acoustic modifications for an earmold when fitting a precipitously sloping HF SNHL? a. 2mm sound bore, standard tubing, no vent b. 3mm sound bore, Libby horn, narrow vent, c. 4mm sound bore, Libby horn, no vent d. 2mm sound bore, Libby horn, wide vent d. 4mm sound bore, long tubing, narrow vent
c. 2mm sound bore, Libby horn, wide vent Short sound bore = give more HF amp Libby horn (flared) = give more HF amp Wide vent = decrease LF amp (let the LFs out)
In 2002, the ANSI adopted guidelines for classroom acoustics, intended for use int he design of new classrooms and in the renovation of existing classrooms. The ANSI-recommended average noise levels and reverberation times for unoccupied classrooms (<10k cubic feet) are a. 15 dBA or less and 0.2 sec or less b. 25 dBA or less and 2.0 sec or less c. 35 dBA or less and 0.6 sec or less d. 45 dBA or less and 2.0 sec or less e. 55 dBA or less and 0.2 sec or less
c. 35 dBA or less and 0.6 sec or less
Which of the following EM mods would NOT enhance the HF response of a HA, as measure in the ear canal? a. 4mm Libby horn b. 3mm Libby horn c. bore with a narrow diameter d. shortened canal e. bell bore
c. bore with a narrow diameter Libby horns aka bell bores always help with HFs short canals help with HFs
An adult with progressive SNHL is no longer able to use a standard telephone at work. The managing audiologist should assist the patient with a. learning a manual communication system b. obtaining a job that does not require spoken communication c. obtaining reasonable accommodation for telephone communication at work d. working with vocational rehabilitation to be considered for a CI e. using an assistive listening device that alerts the client that the phone is ringing
c. obtaining reasonable accommodation for telephone communication at work The audiologist should counsel the patient about reasonable accommodations in the workplace mandated by the ADA.
Jonathon is a 2 y/o male who was recently identified as having a severe-to-profound SNHL AU after a bout with meningitis (occurred at 18 months old). Prior to contracting it, Jon had begun to develop some speech and language, but since his illness, he uses very few words expressively. In terms of receptivity, he is performing at the level of an 18-month-old. His initial responses to binaural amp have been very positive. Jon has parents and 5 y/o sister all with nml hearing. Jon's parents appear highly motivated to do what's necessary for his development. Based on the info provided, what communication methodology would be the best option for family to pursue? a. Signed Exact English b. Total communication c. oral/aural communication d. Rochester method e. simultaneous communication
c. oral/aural communication Jon had already begun to learn oral speech & language prior to the HL, and family has no known ties to Deaf culture. Jon responding well to amp and family willing to be involved with rehab, so auditory-verbal therapy is a good choice for a communication mode. JY: TC uses sign, which is not mentioned anywhere in the passage.
Click-evoked OAEs are most likely to be recorded from the ears of which of the following individuals? a. Profound HL b. severe presbycusis c. upper brainstem lesion d. OM e. has ingested large quantities of aminoglycosides
c. upper brainstem lesion Upper brainstem lesions do not always interfere with OAEs, so OAEs can be recorded from the ears of persons with upper brainstem lesions.
TDH-39 headphone on a 9-A coupler with the audiometer set at 1kHz @ 25 dB HL should produce a SPL of approx how many dB? a. 17.8 b.18.5 c. 25.0 d. 32.0 e. 35.5
d. 32.0 for 1kHz: 0 dB HL = 7 dB SPL so 25 dB HL + 7 dB SPL = 32 dB SPL
Functional gain of a HA is best defined as the difference between which of the following? a. aided vs unaided WRS b. input at HA mic vs output into HA-2 coupler c. aided vs unaided ear-canal signal levels d. aided vs unaided SF thresholds e. input at HA mic vs output into ear canal
d. aided vs unaided SF thresholds Functional gain = amt of improvement the HA brings to pt's hearing levels = dB diff b/t aided and unaided SF thresholds JY: choice a not correct because that gets into word processing, which isn't reflective of solely HA's power but also of pt's cognition
Of the following conditions that can affect children's hearing, which is the most likely cause of acquired SNHL? a. serous OM b. otosclerosis c. Waardenburg syndrome d. bacterial meningitis e. Turner syndrome
d. bacterial meningitis Bacterial meningitis can cause profound SNHL in children.
According to PL 99-457, a child under 2 years of age who has a hearing impairment must a. be fitted with binaural HAs b. have biannual hearing evaluations c. be enrolled in a center-based habilitation program d. have a written individualized family service plan e. be provided with total communication training
d. have a written individualized family service plan pt <3 y/o = IFSP pt >3 y/o = IEP IDEA = for pts up to 21 y/o
A 6 month old child born with AU bony atresia is seen for an audiological evaluation and treatment recommendation. Radiological evidence indicates the probable presence of an intact ME and cochlea. ABR responses were obtained at near-normal levels to bone-conducted signals. Of the following, the most appropriate course of action for this child at this time would be to: a. defer tx until growth of the external and ME is complete at about age 6 b. suggest that surgery be initiated on at least one ear to permit a normal air-conducted pathway c. recommend an implanted bone-anchored HA d. investigate the use of a bone-conduction HA until audiological test results can be confirmed and surgery initiated when the child is older e. counsel the parents concerning sign language and initiate a tx program based on the use of all visual cues
d. investigate the use of a bone-conduction HA until audiological test results can be confirmed and surgery initiated when the child is older JY: Not choice B because the pt is only 6 months old. So you want to get amp to brain first, and then work on AC pathway if it is determined that surgery should take place
Which of the following speech-recognition materials should the aud use in order to obtain the steepest possible PI function? a. nonsense syllables b. CID W-1 c. CID W-22 d. synthetic sentences e. NU-6
d. synthetic sentences Performance level rises most steeply with *small increases in intensity* when *speech sample is large* and provides some context, which is true of synthetic sentences, even though they do not provide as much context as natural sentences. In addition, the synthetic sentences allow the subject t pick out a word from a list, which provides addtl clues.
Which of the following is considered to be the best AI-DI for a directional microphone performing in noise? a. -5 dB b. -3 dB c. 0 dB d. 3 dB e. 5 dB
e. 5 dB AI-DI represents the ratio of mic output for front signals to sound originating from all other directions. It is weighed by the articulation index (AI). The larger the number, the better the AI-DI
Which of the following is a complete and accurate list of the signals required by federal regulations for monitoring audiometry in industry? a. 500, 1k, 2k, 4kHz b. 500, 1k, 2k, 6kHz c. 500, 1k, 2k, 3k, 8kHz d. 250, 500, 1k, 2k, 4k, 8kHz e. 500, 1k, 2k, 3k, 4k, 6kHz
e. 500, 1k, 2k, 3k, 4k, 6kHz Praxis likes "2k, 3k, 4k, 6k" so look for answers that include all those
An audiologist is asked to establish a hearing-conservation program for an industrial firm. To ensure validity in monitoring the hearing of workers in conformance with the requirements of OSHA regulations, the audiologist must do which of the following? a. Test at end of work shift to order to record observed temporary threshold shift. b. Test at all freq in octaves between 250-8000 Hz and also 3kHz and 6kHz c. Include acoustic immittance measure in the hearing-test battery d. Test only those employees whose daily noise dose exceeds maximum permissible noise levels e. Administer threshold tests in areas where ambient noise levels conform to the regulations published in the Federal Register
e. Administer threshold tests in areas where ambient noise levels conform to the regulations published in the Federal Register Test won't be valid if background nosie too high because the noise will mask signals at hearing levels needed for accurate hearing threshold measures. OSHA provides a table of max allowed octave-band SPL for audiometric test rooms.
Some individuals no longer go to the movies because their hearing loss makes it difficult for them to enjoy the experience. Which of the following domains of auditory function is being described by this behavior as defined by the International Classification of Functioning, Disability and Health fro the WHO? a. Hearing impairment b. Hearing handicap c. Body function d. Activity limitation e. Participation restriction
e. Participation restriction The individuals' hearing impairment limits their ability to participate in an activity as a result of their having trouble understanding speech. Consequently, the individuals restrict their participation in activities that require them to understand speech, such as movies. JY: activity limitation refers more to not being able to join in some activity AT ALL; participation restriction refers to being able to do the activity but having restrictions
For audiologic equipment that comes in contact with patients, disinfection and sterilization reduce the risk of cross contamination. The key consideration that calls for sterilization rather than disinfection is that the equipment a. does not have disposable parts b. is used with multiple pts c. is used with pts with known infections d. can survive the heat of sterilization in an autoclave e. comes into contact with blood or other bodily substances
e. comes into contact with blood or other bodily substances
Among children with nonsyndromic clefts of the lip and palate, which of the following types of HL is most common? a. SNHL b. congenital c. mixed d. central auditory e. conductive
e. conductive Cleft lip and palate are often associated with abnormalities of the muscles that open the Eustachian tube. ETD results in negative ME pressure, leading to OM, which in turn can cause CHL. JY: "nonsyndromic" in question wants you to think: "What type of HL will occur with clefts?"
An aud fits a young woman with binaural digital BTEs 3 weeks ago. Pt reports devices have provided suitable amp in most environments, but complains that low-level ambient noise has been distracting. In an effort to reduce the adverse noise effect, what adjustments might the aud make to the HAs? a. increasing threshold kneepoint b. decreasing threshold kneepoint c. enabling WDRC d. decreasing gain in all freq bands e. enabling explansion
e. enabling expansion Expansion reduces gain of low-level ambient sounds
VNG reveals responses to right-warm and right-cool calorics are 12% weaker than responses to left-warm and left-cool calorics. This finding should be reported as a. left unilateral weakness b. right unilateral weakness c. right directional preponderance d. left directional preponderance e. normal caloric response
e. normal caloric response Significant abnormal interaural differences = at least 15-20%
The accuracy of a hearing screening test in correctly identifying those individuals who actually have a hearing disorder is referred to as the screening test's a. reliability b. validity c. precision d. specificity e. sensitivity
e. sensitivity sensitivity = yes when yes specificity = no when no precision = consistent measurements accuracy = correct measurements validity = CORRECTLY measuring what you mean to measure (~accuracy) reliability = CONSISTENTLY measuring what you mean to measure (~precision)
The area of the ear canal where most cerumen is generated is a. at the isthmus b. at the eardrum c. the bony portion d. the middle third of the canal e. the outer third of the canal
e. the outer third of the canal lateral 1/3 of EAC = cartilaginous medial *2/3* of EAC = *BONY*