Free Speech & Language Pathologist mock test

Speech & Language Pathologist sample questions with answers

10 more original exam-style Speech & Language Pathologist questions, worked in full. They are not real or recalled exam questions, and none of them is in the mock above or on the bank page, so sit the mock first if you have not.

1. Question 1 · Screening, Assessment, Evaluation, Psychometrics & Differential Diagnosis

   A child obtains a standard score of 82 on a language test whose manual reports a standard error of measurement of 4 standard-score points at that age. Which statement best expresses the approximate 68% confidence interval around this score?

   1. AThe child's true score is exactly 82, because that is what was obtained
   2. BThe true score most likely lies between 74 and 90
   3. CThe true score most likely lies between 80 and 84
   4. DThe true score most likely lies between 78 and 86
   Show answer and explanation

   Correct answer: D. The true score most likely lies between 78 and 86

   The approximate 68% confidence interval is the obtained score plus or minus one standard error of measurement, so 82 plus or minus 4 gives 78 to 86. The 74 to 90 band uses two SEMs and corresponds to roughly 95% confidence, while 80 to 84 uses only half an SEM. Treating an obtained score as error-free ignores measurement error and can wrongly place a child on one side of a cut-off.

   Reference: McCauley RJ & Swisher L, Use and Misuse of Norm-Referenced Tests in Clinical Assessment (JSHD, 1984); Salvia J, Ysseldyke J & Witmer S, Assessment in Special and Inclusive Education, 13th ed. (2017)

2. Question 2 · Paediatric Language, Literacy & Social Communication Disorders

   A school team is planning post-school transition for a 15-year-old with severe DLD who uses an AAC system to supplement speech. Which practice best reflects current transition planning standards?

   1. ADefer transition planning until the final school year so that goals reflect the most current ability
   2. BLet the SLP and teacher select the post-school placement, informing the student once arrangements are settled
   3. CBegin transition planning in early adolescence, base measurable post-school goals on the student's own stated preferences and strengths, and support the student to lead the meeting with AAC and communication supports
   4. DRemove communication goals from the plan once the student reaches school-leaving age, as services will end
   Show answer and explanation

   Correct answer: C. Begin transition planning in early adolescence, base measurable post-school goals on the student's own stated preferences and strengths, and support the student to lead the meeting with AAC and communication supports

   Best practice, reflected in IDEA transition requirements, is that planning starts in early adolescence (by age 14-16 depending on jurisdiction), that measurable post-secondary goals are based on age-appropriate transition assessment and the student's own preferences, and that self-determination is fostered by supporting student-led participation, with AAC and communication supports provided for the meeting itself. Deferring planning, making decisions for the student, or removing communication goals all undermine self-determination and continuity of support.

   Reference: IDEA 2004 transition services requirements; ASHA Practice Portal, Transitioning Youth (accessed 2024)

3. Question 3 · Anatomy, Physiology & Neuroscience of Speech, Voice, Hearing and Swallowing

   On examination a patient has no gag response when the right posterior pharyngeal wall and tonsillar region are touched, but the gag is present when the left side is stimulated. The palate elevates symmetrically, voice quality is normal and there is no tongue weakness. Which nerve is most likely impaired?

   1. ARight vagus nerve (X)
   2. BRight facial nerve (VII)
   3. CRight trigeminal nerve (V)
   4. DRight glossopharyngeal nerve (IX)
   Show answer and explanation

   Correct answer: D. Right glossopharyngeal nerve (IX)

   The glossopharyngeal nerve carries the sensory (afferent) limb of the gag reflex from the posterior tongue, tonsillar area and upper pharynx, so a unilateral IX lesion abolishes the gag when that side is touched while the motor response remains intact. The vagus provides the efferent limb, and its lesion would cause asymmetric palatal elevation and dysphonia, which are absent here. The trigeminal nerve supplies sensation to the anterior oral cavity and face, and the facial nerve mediates facial movement and anterior taste, neither of which forms the gag afferent from the pharynx.

   Reference: Duffy JR. Motor Speech Disorders: Substrates, Differential Diagnosis, and Management, 4th ed. Elsevier, 2020

4. Question 4 · Voice, Resonance, Craniofacial & Laryngeal Disorders

   A professional singer telephones the clinic reporting abrupt, complete loss of her singing voice with a sudden 'pop' during a performance the previous night, followed by hoarseness and a sensation of fullness in the throat. What is the most appropriate action?

   1. ARecommend she complete her scheduled performances while using light articulatory contacts
   2. BBegin resonant voice therapy by telepractice the same day
   3. CArrange urgent laryngological examination with stroboscopy and advise voice rest pending assessment, because vocal fold haemorrhage must be excluded
   4. DAdvise steam inhalation and reassess in six weeks
   Show answer and explanation

   Correct answer: C. Arrange urgent laryngological examination with stroboscopy and advise voice rest pending assessment, because vocal fold haemorrhage must be excluded

   Sudden voice loss during heavy voice use in a singer is a red flag for vocal fold haemorrhage or mucosal tear, which requires urgent laryngoscopic assessment and voice rest to prevent organisation of the haematoma, scarring and permanent loss of mucosal wave. Starting behavioural therapy, delaying six weeks or continuing to perform all risk converting a treatable acute injury into permanent vocal fold scarring.

   Reference: Sataloff RT, Professional Voice: The Science and Art of Clinical Care, 4th ed. (2017); AAO-HNS Hoarseness Guideline Update (2018)

5. Question 5 · Fluency Disorders

   A postgraduate student asks how the dual diathesis-stressor framework differs from a purely emotional explanation of stuttering. Which statement best captures the framework?

   1. AA predisposing speech-motor/linguistic vulnerability and a separate emotional vulnerability each interact with their own stressors to influence the occurrence and severity of stuttering
   2. BEmotional trauma in early childhood is the necessary and sufficient cause of stuttering in genetically loaded children
   3. CStuttering is produced solely by a diathesis in the basal ganglia, and emotional factors are irrelevant to moment-to-moment fluency
   4. DAnxiety is always the primary diathesis and speech-motor factors are secondary consequences of that anxiety
   Show answer and explanation

   Correct answer: A. A predisposing speech-motor/linguistic vulnerability and a separate emotional vulnerability each interact with their own stressors to influence the occurrence and severity of stuttering

   The dual diathesis-stressor model posits two distinct predispositions, one in speech-language production and one in emotional reactivity/regulation, each of which can be triggered by relevant stressors to modulate stuttering. It does not claim emotion causes stuttering, nor does it dismiss emotional contributions; temperament research supports emotional reactivity as a moderator rather than the aetiology.

   Reference: Conture EG & Walden TA, Dual diathesis-stressor model of stuttering, in Theoretical Issues of Stuttering (2012); Guitar B, Stuttering: An Integrated Approach, 5th ed. (2019)

6. Question 6 · Hearing, Audiology & Aural Rehabilitation

   A teacher asks the speech-language pathologist to 'diagnose auditory processing disorder' in an 8-year-old who has trouble following instructions in class, based on a completed listening-behaviour questionnaire. Which statement is MOST accurate?

   1. AThe questionnaire is sufficient for diagnosis if the total score falls in the clinical range
   2. BDiagnosis requires normal peripheral hearing plus a battery of behavioural central auditory tests administered and interpreted by an audiologist, with language and attention as differential considerations
   3. CAuditory processing disorder can be confirmed by a language assessment showing below-average comprehension scores
   4. DThe presence of a developmental language disorder rules out auditory processing disorder
   Show answer and explanation

   Correct answer: B. Diagnosis requires normal peripheral hearing plus a battery of behavioural central auditory tests administered and interpreted by an audiologist, with language and attention as differential considerations

   Diagnosis of (central) auditory processing disorder rests on documented normal peripheral hearing and a multi-test battery of behavioural central auditory measures - such as dichotic listening, temporal processing and degraded-speech tests - administered by an audiologist, with electrophysiology used as needed. Questionnaires and language tests are useful for screening and for characterising functional impact, but cannot establish the diagnosis; and language, attention and cognitive disorders must be considered because their symptoms overlap heavily and can co-occur.

   Reference: American Academy of Audiology Clinical Practice Guidelines: Diagnosis, Treatment and Management of Children and Adults with Central Auditory Processing Disorder, 2010; ASHA (Central) Auditory Processing Disorders Technical Report, 2005

7. Question 7 · Professionalism, Ethics, Patient Safety, Infection Control, Scope of Practice & Evidence-Based Practice

   A 86-year-old woman with advanced dementia aspirates on all consistencies during videofluoroscopy and has had two chest infections. Her family asks whether a PEG tube would keep her safe. What should the SLP advise the team and family, based on current evidence?

   1. APEG feeding reliably prevents aspiration pneumonia and should be inserted without delay
   2. BTube feeding in advanced dementia has not been shown to prevent aspiration pneumonia, prolong survival or improve comfort, so careful hand feeding for pleasure with meticulous oral care and a documented multidisciplinary risk-feeding plan is usually preferred
   3. CThe patient should be made nil by mouth indefinitely while the family decides
   4. DThe decision belongs solely to the gastroenterologist and the SLP should not comment
   Show answer and explanation

   Correct answer: B. Tube feeding in advanced dementia has not been shown to prevent aspiration pneumonia, prolong survival or improve comfort, so careful hand feeding for pleasure with meticulous oral care and a documented multidisciplinary risk-feeding plan is usually preferred

   Systematic reviews and major geriatric society guidance show that percutaneous feeding tubes in advanced dementia do not reduce aspiration pneumonia, improve survival, healing or comfort, and add complications and restraint burden. Careful (comfort) hand feeding with rigorous oral hygiene and an agreed risk-feeding plan better serves quality of life. Prolonged nil by mouth adds distress without benefit, and the SLP has an explicit role in informing this shared decision rather than deferring entirely to another specialty.

   Reference: Sampson EL et al., Cochrane Review: Enteral tube feeding for older people with advanced dementia (2009); American Geriatrics Society Feeding Tubes in Advanced Dementia Position Statement (2014)

8. Question 8 · Dysphagia: Feeding & Swallowing Across the Lifespan

   A woman with mild Alzheimer's disease refuses a recommended gastrostomy. A junior colleague states that she cannot consent because she has dementia. Which statement about decision-making capacity is correct?

   1. AA diagnosis of dementia automatically removes capacity, so the next of kin must decide
   2. BAn unwise decision is itself sufficient evidence that a patient lacks capacity
   3. CCapacity is determined solely by her score on a cognitive screening test such as the MMSE or MoCA
   4. DCapacity is presumed and is decision-specific; she retains capacity if she can understand, retain, weigh the relevant information and communicate her decision
   Show answer and explanation

   Correct answer: D. Capacity is presumed and is decision-specific; she retains capacity if she can understand, retain, weigh the relevant information and communicate her decision

   Capacity is presumed until demonstrated otherwise and is assessed for a specific decision at a specific time using the functional criteria of understanding, retaining, using or weighing the information, and communicating a choice, with all practicable support given to help the person decide. A diagnostic label does not remove capacity, and cognitive screening scores correlate only loosely with decision-specific capacity and cannot substitute for a proper assessment. Making a decision that clinicians consider unwise is not evidence of incapacity.

   Reference: Mental Capacity Act 2005 Code of Practice (UK), 2007; Appelbaum PS. Assessment of patients' competence to consent to treatment. New England Journal of Medicine, 2007

9. Question 9 · Acquired Neurogenic Language & Cognitive-Communication Disorders

   An 76-year-old woman shows marked day-to-day fluctuation in alertness and attention, recurrent well-formed visual hallucinations of children in her room, mild rigidity and bradykinesia, and a long history of acting out her dreams. Which diagnosis should the team consider first, and what caution is clinically important?

   1. AAlzheimer's disease; avoid all cholinesterase inhibitors
   2. BDementia with Lewy bodies; severe sensitivity to antipsychotic medication
   3. CVascular dementia; avoid anticoagulation
   4. DPrimary progressive aphasia; avoid speech therapy in the early stage
   Show answer and explanation

   Correct answer: B. Dementia with Lewy bodies; severe sensitivity to antipsychotic medication

   Fluctuating cognition, recurrent visual hallucinations, spontaneous parkinsonism and REM sleep behaviour disorder are the core clinical features of dementia with Lewy bodies, and severe neuroleptic sensitivity is a well-recognised and potentially life-threatening hazard in these patients. Cholinesterase inhibitors are in fact often beneficial in DLB, anticoagulation decisions in vascular disease are individualised, and early speech-language intervention is indicated, not contraindicated, in PPA.

   Reference: McKeith IG et al. Diagnosis and management of dementia with Lewy bodies: fourth consensus report of the DLB Consortium. Neurology (2017)

10. Question 10 · Speech Sound Disorders: Articulation & Phonology

    A 5-year-old with a repaired cleft palate substitutes glottal stops for /p/, /t/ and /k/ and produces pharyngeal fricatives for /s/ and /ʃ/. Velopharyngeal closure is judged adequate on nasendoscopy during non-nasal sounds she can produce orally. Which statement about these errors is correct?

    1. AThey are obligatory errors that will only resolve after secondary palatal surgery
    2. BThey are compensatory misarticulations that are learned and are expected to respond to speech therapy targeting oral placement
    3. CThey indicate the child has developed velopharyngeal insufficiency and should not receive speech therapy
    4. DThey are developmentally typical for a 5-year-old and require monitoring only
    Show answer and explanation

    Correct answer: B. They are compensatory misarticulations that are learned and are expected to respond to speech therapy targeting oral placement

    Glottal stops and pharyngeal fricatives are classic compensatory misarticulations - learned strategies for valving airflow below the velopharyngeal port - and when closure is adequate they respond to speech therapy that establishes oral place of articulation. Obligatory errors, in contrast, are passive consequences of a structural gap and require physical management. Nasendoscopy here documented adequate closure, so surgery is not the indicated first step, and neither glottal stop substitution nor pharyngeal fricatives are developmentally typical at any age in English.

    Reference: Kummer, Cleft Palate and Craniofacial Conditions, 5th ed. (2020); Peterson-Falzone, Trost-Cardamone, Karnell & Hardin-Jones, The Clinician's Guide to Treating Cleft Palate Speech, 2nd ed. (2017)