OSCE Revision

Question 1

What are the key perceptual components of voice?

Answer 1

Pitch, loudness, and quality.

Question 2

What is jitter and shimmer, and why are they clinically important?

Answer 2

Jitter: Variations in pitch; Shimmer: Variations in loudness. Both are used to detect vocal pathologies.

Question 3

List and describe three common voice disorders.

Answer 3

Vocal nodules: Bilateral growths caused by vocal overuse.
Vocal polyps: Unilateral soft lesions, often fluid-filled.
Spasmodic dysphonia: Neurological disorder causing strained voice due to spasms.

Question 4

What is the GRBAS scale used for?

Answer 4

It assesses voice quality based on Grade, Roughness, Breathiness, Asthenia, and Strain.

Question 5

What does GRBAS stand for?

Answer 5

Grade, Roughness, Breathiness, Asthenia, and Strain.

Question 6

What are common acoustic and aerodynamic measures in voice analysis?

Answer 6

Acoustic: Jitter, shimmer, HNR (Harmonics-to-Noise Ratio).
Aerodynamic: Airflow, subglottal pressure.

Question 7

What are the types of stuttering?

Answer 7

Developmental: Begins in childhood.
Acquired: Associated with neurological or psychosocial events.

Question 8

What is acquired stuttering

Answer 8

Associated with neurological or psychosocial events.

Question 9

Describe developmental stuttering

Answer 9

Occurring in childhood

Question 10

What are the risk factors for persistent stuttering?

Answer 10

Male gender, family history, longer duration of stuttering (6–12 months), late onset (closer to language development).

Question 11

What is the difference between developmental and acquired stuttering?

Answer 11

Developmental: starting in early childhood and persisting throughout the lifespan
Acquired: Due to a neurological or psychological event.

Question 12

What is persistent stuttering?

Answer 12

If child is still stuttering at seven years of age, it is less likely that the stuttering will completely go away. This is called persistent stuttering.

Question 13

What is psychogenic stuttering?

Answer 13

associated with sudden onset and some significant psychosocial trigger

Question 14

What are the three phases of swallowing?

Answer 14

Oral: Voluntary movement of food to the back of the mouth.
Pharyngeal: Involuntary phase where food passes through the throat.
Esophageal: Involuntary peristalsis moves food to the stomach.

Question 15

What is penetration?

Answer 15

Penetration: Food enters the airway but stays above the vocal folds.

Question 16

What is aspiration?

Answer 16

Aspiration: Food enters below the vocal folds and into the trachea.

Question 17

Define “the airway” in relation to swallowing

Answer 17

The airway is defined by any part of the larynx, and should be protected by the epiglottis

Question 18

How can aspiration/penetration be diagnosed?

Answer 18

It can only be seen during an instrumental assessment. We cannot confirm it completely during a bedside clinical assessment

Question 19

Clinical indicators of potential penetration include;

Answer 19

Coughing - receptors receiving information from the surfaces of the larynx, send messages to the brain that there is material going into the airway. The brain reacts and protect by coughing and attempting to eject foreign material

Throat clear - similar to coughing

Wet/gurly voice - material sitting on the vocal folds. People may not be aware of the material sitting in the airway, therefore a throat-clear or cough is not made to eject material. This may tell the speech pathologist that there is a neurological deficit and messages are not being relayed properly

Question 20

Possible indicators of aspiration might include;

Answer 20

Changes in respiratory status - increased respiratory rate, increased work of breathing, decreased oxygen saturation levels (measure via pulse oximeter).

History of frequent chest infections/aspiration pneumonia.

Question 21

Which cranial nerves are involved in swallowing?

Answer 21

CN V (Trigeminal): Chewing muscles.
CN VII (Facial): Lip strength, taste,
CN IX (Glossopharyngeal): Moves food to the pharynx.
CN X (Vagus): Controls muscles in the pharynx and larynx.
CN XII (hypoglossal nerve) muscles of the tongue

Question 22

What are the key components of the auditory system?

Answer 22

Outer ear, middle ear, inner ear, and central auditory pathways

Question 23

Describe conductive vs. sensorineural hearing loss.

Answer 23

Conductive: Problem in the outer or middle ear.
Sensorineural: Damage to the inner ear or auditory nerve.

Question 24

What is pure-tone audiometry?

Answer 24

A test that measures hearing thresholds at different frequencies.

Question 25

What is the difference between aided and unaided AAC?

Answer 25

Aided: Requires external devices (e.g., communication boards). Unaided: Relies on body language (e.g., gestures, sign language).

Question 26

What are some examples of low tech AAC

Answer 26

Chatboards, Chat books, gesture, key word sign, communication cards, visuals

Question 27

What are some examples of high tech AAC

Answer 27

speech generating devices, eye gaze devices,

Question 28

What is core vocabulary in AAC?

Answer 28

High-frequency, functional words used in daily communication.

Question 29

Describe two types of high-tech AAC systems.

Answer 29

Speech-generating devices (SGDs): Produce spoken language. Text-to-speech software: Converts written text into spoken words.

Question 30

Paraphasia

Answer 30

production of an unintended sound within a word, or of a whole word or phrase

Question 31

Perseverations

Answer 31

when someone “gets stuck” on a topic or an idea.

Question 32

Broca’s Aphasia

Answer 32

when they have trouble speaking fluently but their comprehension can be relatively preserved. Patients have difficulty producing grammatical sentences and their speech is limited mainly to short utterances of less than four words

Question 33

Wernicke’s Aphasia

Answer 33

when someone is able to speak well and use long sentences, but what they say may not make sense. They may not know that what they're saying is wrong, so may get frustrated when people don't understand them

Question 34

Anomic

Answer 34

a mild, fluent type of aphasia where individuals have word retrieval failures and cannot express the words they want to say

Question 35

Posterior

Answer 35

back

Question 36

Anterior

Answer 36

front

Question 37

L-side damage

Answer 37

likely language deficit & aphasias

Question 38

R-side damage

Answer 38

likely cognitive communication challenges including pragmatic lang

Question 39

Posterior/back brain damage/infarct likely results in this type of aphasia

Answer 39

fluent aphasia/Wernicke’s

Question 40

Anterior/front brain damage/infarct likely results in this type of aphasia

Answer 40

non-fluent aphasia/Broca’s

Question 41

What is peristalsis

Answer 41

Wave-like muscle contractions that move food through the digestive tract. Involuntary Phase

Question 42

Describe the following Swallowing Manoeuvre Chin Tuck

Answer 42

What: Chin tuck to chest Why: Narrows airway entrance for improved protection. Widens valleculae.

Question 43

Head Turn

Answer 43

What: Turn head to weaker side when swallowing Why: Aims to promote the bolus going down stronger side of pharynx

Question 44

Head Tilt

Answer 44

What: Tilt head to stronger side Why: Aims to promote bolus to stronger side of oral cavity

Question 45

Effortful swallow

Answer 45

What: Swallow with effort/purposeful squeeze Why: Reduce pharyngeal residue

Question 46

Supraglottic Swallow

Answer 46

What: Take bolus. Hold in mouth. Breath in through nose. Hold breath. Swallow. Breathe out forcefully/cough on exhalation. Why: Airway closure. Expel post swallow laryngeal residue. Increase cricopharyngeal opening.

Question 47

Lingual Strength training

Answer 47

What: Tongue strengthening exercises using just tongue postures, spoon, tongue depressor or a device. Why: Increase tongue strength for bolus control and flow.

Question 48

Thermotactile Stimulation

Answer 48

What: Provide varying temperatures and flavours on swabs, spoon or via boluses. Why: Improve sensory input (afferent) to improve initiation of pharyngeal swallow

Question 49

Apraxia

Answer 49

a neurological condition that makes it difficult or impossible to make certain movements. This happens even though your muscles are normal and you have the understanding and desire to make these movements. It's caused by damage to your brain that keeps it from forming and giving instructions to your body

Question 50

What is the difference between hypo and hyper

Answer 50

Hypo= under/reduced Hyper= over/excessive

Question 51

Hyperkinetic Dysarthria

Answer 51

Develops due to damage to basal ganglia circuitry Causes extraneous, involuntary movement of speech musculature. Prosodic disturbances are dominant.

Question 52

Hypokinetic Dysarthria

Answer 52

damage to the basal ganglia; often seen in parkinson's disease; hypertoned and rigid muscles; resting tremor that disappears with voluntary movement; accelerated movements and short rushes of speech; monopitch and loudness

Question 53

Dysarthria - Increased rate with imprecise consonants and decreased loudness.

Answer 53

Hypokinetic

Question 54

Dysarthria - Typically strained phonation with hypernasality, imprecise consonants, and variable rate (but depends on etiology).

Answer 54

Hyperkinetic

Question 55

Reduplication

Answer 55

repetition of a syllable of a word, common in very young children and not of concern until around 2 years old

Question 56

Stopping

Answer 56

stop replaces a fricative f-->p v-->b s-->t z-->d

Question 57

Fronting

Answer 57

velar sounds are replaced with alveolars k-->t g-->d

Question 58

Palatal Fronting

Answer 58

substitution of an alveolar for a palatal ship-->sip

Question 59

Deaffrication

Answer 59

substitution of a fricative for an affricate ch-->sh dg-->g

Question 60

Liquid Gliding

Answer 60

liquids are replaced by glides l-->w r-->w

Question 61

VPI

Answer 61

velopharyngeal inadequacy, the soft palate does not close to the back of the throat, most people close through lifting the soft palate

Question 62

Clefts and VPI impact to speech?

Answer 62

hypernasal resonance, nasal emission, weak pressure consonants, nasal substitutions, compensatory articulations, sibilant distortions, laryngeal.voice symptoms

Question 63

Speech of Babies with Clefts

Answer 63

delayed onset of canonical babbling smaller consonant inventories high occurrences of glottal, nasal and glides very few oral stops, alveolars, palatals and velar

Question 64

difference between receptive and expressive language disorder

Answer 64

Receptive language refers to our ability to understand and take in language, where expressing language is our ability to express ourselves.

Question 65

Difference between conductive and sensorineural hearing loss:

Answer 65

Conductive hearing loss is due to obstructions or damage in the outer/middle ear, often treatable. Sensorineural loss arises from damage to the inner ear or auditory nerve, typically permanent and often requiring hearing aids or implants.

Question 66

Strategies for Dysphagia:

Answer 66

Positioning, pacing, texture modification, and safe swallowing exercises.

Question 67

Strategies Vocal Hygiene:

Answer 67

Hydration, vocal rest, avoiding strain, and limiting irritants like smoking.

Question 68

Strategies for Hearing:

Answer 68

Amplification devices, environmental modifications, clear communication strategies.

Question 69

Stuttering strategies/interventions

Answer 69

Lidcombe (before 6yo) Behavioural offers feedback about smooth or bumpy speech Facilitate parent to provide therapy/ Camperdown (after 6, adolecent and adult) Managing stuttering through speech re-structuring Slow speech and then slowly work to improve naturalness. Self-awareness of stuttering.

Question 70

Dysarthria strategies

Answer 70

Strengthening exercises, compensatory techniques, AAC (if needed).

Question 71

Aphasia strategies

Answer 71

Simplified language, visual aids, structured communication practice. Semantic Feature Analysis Communication partner training

Question 72

What is VPI

Answer 72

Velopharyngeal Insufficiency (VPI) occurs when the soft palate doesn’t close completely, causing hypernasal speech. Velopharyngeal Dysfunction (VPD) broadly covers issues with the velopharyngeal mechanism, impacting speech resonance and intelligibility.

Question 73

Difference between articulation and phonological disorders:

Answer 73

Articulation disorders involve difficulty physically producing speech sounds. Phonological disorders involve patterned errors affecting speech sound systems, often impacting intelligibility.

Question 74

Difference between hearing aid and cochlear implant:

Answer 74

Hearing aids amplify sounds for residual hearing, suitable for mild to moderate losses. Cochlear implants bypass damaged inner ear structures, directly stimulating the auditory nerve, typically for severe to profound losses.

Question 75

What is presbycusis?:

Answer 75

Age-related hearing loss, usually from cumulative auditory cell damage. Audiogram typically shows a sloping high-frequency loss due to high-frequency hair cell degeneration.

Question 76

Hearing loss and dementia:

Answer 76

Untreated hearing loss can increase cognitive load and social isolation, potentially accelerating cognitive decline and increasing dementia risk.

Question 77

Hearing loss and speech sound development:

Answer 77

Hearing loss can delay speech sound acquisition and phonological development, especially if untreated during critical language periods.

Question 78

Explain head tilt and head turn:

Answer 78

Head tilt may be used to optimize bolus management by redirecting the bolus to the stronger side. A head turn means the Pt turns to their weaker side to direct the bolus to the stronger muscles in the oropharyngeal phases of the swallow, so that the stronger mucles can work to move the bolus more effectively.

Question 79

Explain vocal fold nodules,

Answer 79

Nodules: Callous-like growths from overuse; reduce with voice therapy. vocal hoarseness and breathiness

Question 80

Explain Vocal fold paralysis

Answer 80

Loss of nerve function, may require voice therapy or surgery. One side of the v may become paralyzed so there is air escape and changes to adduction and vibration (breathy/resp changes and hoarse)

Question 81

Muscle Tension Dysphonia:

Answer 81

Excessive muscle use, treatable with voice relaxation exercises. Often a secondary Dx caused by an underlying pathology

Question 82

Explain vocal function exercises,

Answer 82

Vocal Function Exercises: Systematic exercises to strengthen vocal folds. MPT Ahh, eee, ooo pitch glide up, pitch glide down Pitchglide wave up/down

Question 83

Explain Resonant Voice Therapy:

Answer 83

Promotes forward voice placement to reduce strain. Involves clients feeling sound moving to front /m/ sounds

Question 84

SOVT: Semi-occluded vocal tract exercises

Answer 84

Excersizes to balance airflow and subglottic pressure, improving phonation. Often using a straw eg) Buzzing on straw, feeling tingle. Diff size straws (longer = resistance, smaller circ = resistance, in water=resistance). Pitch glides through straw.

Question 85

Explain power-source-filter:

Answer 85

Speech production model: Power from lungs, Source (voice) from vocal fold vibration, Filter by articulators (throat, mouth, nose) to shape sound.

Question 86

Explain apraxia:

Answer 86

A motor planning disorder affecting speech sequencing, often resulting in inconsistent sound production errors; treated with repetitive practice for muscle coordination.

Question 87

Explain dysarthria:

Answer 87

A motor speech disorder due to muscle weakness, causing slurred or slow speech, treated with exercises to improve articulation, breath support, and pacing.

Question 88

Explain cog-comm in dementia:

Answer 88

Cognitive-communication deficits in dementia affect memory, problem-solving, and language comprehension, addressed with supportive communication strategies and memory aids.

Question 89

Difference between Broca’s aphasia and Wernicke’s aphasia:

Answer 89

Broca’s Aphasia: Non-fluent, effortful speech, comprehension relatively preserved. Wernicke’s Aphasia: Fluent but nonsensical speech, comprehension significantly impaired.