Speech & Language Pathologist Prometric exam questions with answers

1. Question 1Anatomy, Physiology & Neuroscience of Speech, Voice, Hearing and Swallowingmedium

   A 45-year-old woman has normal vocal fold abduction and adduction after thyroidectomy but reports vocal fatigue and an inability to reach her upper pitch range when singing. Injury to which nerve, and loss of which muscle, best explains this?

   1. AInternal branch of the superior laryngeal nerve; thyroarytenoid
   2. BRecurrent laryngeal nerve; lateral cricoarytenoid
   3. CExternal branch of the superior laryngeal nerve; cricothyroid
   4. DRecurrent laryngeal nerve; posterior cricoarytenoid
   Show answer and explanation▾

   Answer: C. External branch of the superior laryngeal nerve; cricothyroid

   The cricothyroid is the only intrinsic laryngeal muscle supplied by the external branch of the superior laryngeal nerve; it tilts the thyroid cartilage to lengthen and tense the vocal folds, so injury mainly reduces pitch range and causes vocal fatigue while fold mobility looks normal. Recurrent laryngeal nerve injury affects all other intrinsic muscles and produces impaired fold movement. The internal branch is sensory to the supraglottis and does not supply the thyroarytenoid.

2. Question 2Typical Development, Linguistics, Phonetics & Multilingual Communicationeasy

   According to Brown's order of grammatical morpheme acquisition, which morpheme is typically mastered first by English-speaking children?

   1. AThird person singular -s, as in 'runs'
   2. BRegular past tense -ed, as in 'jumped'
   3. CUncontractible auxiliary, as in 'He is'
   4. DPresent progressive -ing, as in 'running'
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   Answer: D. Present progressive -ing, as in 'running'

   In Brown's sequence of 14 grammatical morphemes, the present progressive -ing is mastered first, followed by the prepositions 'in' and 'on' and the regular plural -s. Regular past tense, third person singular and auxiliary forms emerge considerably later. Tense-marking morphemes are therefore relatively late and are often vulnerable in children with language disorder.

3. Question 3Screening, Assessment, Evaluation, Psychometrics & Differential Diagnosiseasy

   Two speech-language pathologists independently score the same video-recorded conversation sample using a stuttering severity tool and obtain very similar results. Which psychometric property does this demonstrate?

   1. AInter-rater reliability
   2. BTest-retest reliability
   3. CConcurrent validity
   4. DInternal consistency
   Show answer and explanation▾

   Answer: A. Inter-rater reliability

   Agreement between different examiners scoring the same performance is inter-rater (inter-judge) reliability. Test-retest reliability compares the same person's scores on two occasions, which is not the case here because one sample was scored. Concurrent validity concerns agreement with another established measure, and internal consistency concerns how well items within a test relate to one another.

4. Question 4Speech Sound Disorders: Articulation & Phonologymedium

   A 4-year-old consistently replaces /k/ and /g/ with [t] and [d] in all word positions, for example saying 'tea' for 'key' and 'dough' for 'go'. He is beginning to be stimulable for /k/. Which minimal pair set is most appropriate for contrast therapy targeting this pattern?

   1. A'wing-ring', 'wed-red', 'wake-rake'
   2. B'bee-pea', 'bin-pin', 'bat-pat'
   3. C'sea-tea', 'sun-ton', 'sip-tip'
   4. D'tea-key', 'tape-cape', 'dough-go'
   Show answer and explanation▾

   Answer: D. 'tea-key', 'tape-cape', 'dough-go'

   The child shows velar fronting, so minimal pairs should contrast his error sound with the target in otherwise identical words, such as alveolar versus velar stops, making the meaning difference functionally clear. The other sets contrast features he is not misusing: stopping of fricatives, gliding of liquids and voicing. Choosing pairs that target the actual pattern is the basis of minimal pair (meaningful contrast) therapy.

5. Question 5Fluency Disordersmedium

   Parents of a 3-year-old boy are concerned about his speech. Which observed disfluency is most suggestive of stuttering rather than typical developmental disfluency?

   1. AInterjections such as 'um' between words
   2. BWhole-phrase repetitions, such as 'I want, I want juice'
   3. CSound prolongations with visible tension, such as 'mmmmummy'
   4. DRevisions, such as 'I saw a cat, a dog'
   Show answer and explanation▾

   Answer: C. Sound prolongations with visible tension, such as 'mmmmummy'

   Stuttering-like disfluencies include part-word and single-syllable word repetitions, prolongations and blocks, and the presence of physical tension or secondary behaviours further raises concern. Phrase repetitions, interjections and revisions are typical disfluencies seen in many young children. Assessment should also consider frequency, family history, time since onset and the child's reactions.

6. Question 6Fluency Disordershard

   A 17-year-old is referred for 'stuttering'. His speech rate is rapid and irregular, he collapses syllables (for example 'compute' for 'computer'), uses many revisions and interjections but few blocks or prolongations, and seems unaware of breakdowns until listeners ask him to repeat. Which diagnosis best fits?

   1. AChildhood apraxia of speech
   2. BCluttering
   3. CNeurogenic stuttering
   4. DDevelopmental stuttering
   Show answer and explanation▾

   Answer: B. Cluttering

   Cluttering is characterised by a rate perceived as rapid and/or irregular, with collapsing or deleting syllables, excessive typical disfluencies and often reduced awareness of the problem. Developmental stuttering features stuttering-like disfluencies such as blocks and prolongations, usually with awareness and tension. Apraxia of speech involves inconsistent errors and groping from a motor planning deficit, and neurogenic stuttering follows acquired brain injury.

7. Question 7Voice, Resonance, Craniofacial & Laryngeal Disordershard

   A 6-year-old without a history of cleft palate has audible nasal emission only on /s/ and /z/. Resonance is otherwise normal, and there is no nasal emission on other pressure consonants such as /p/, /t/ and /f/. Which is the most appropriate interpretation and management?

   1. AHypernasality from tonsillar hypertrophy; refer for tonsillectomy
   2. BVelopharyngeal insufficiency; refer for pharyngeal flap surgery
   3. CPhoneme-specific nasal emission from mislearning; treat with articulation therapy
   4. DVelopharyngeal incompetence; fit a palatal lift prosthesis
   Show answer and explanation▾

   Answer: C. Phoneme-specific nasal emission from mislearning; treat with articulation therapy

   Nasal emission limited to specific sibilants, with normal velopharyngeal function on other pressure consonants, indicates a learned posterior nasal fricative rather than a structural or neuromuscular velopharyngeal problem. It responds to articulation therapy that teaches oral airflow, for example shaping /s/ from /t/. Surgery or a prosthesis is not indicated because the mechanism can achieve closure.

8. Question 8Motor Speech Disorders: Dysarthria & Apraxiamedium

   After a cerebellar haemorrhage, a 55-year-old man has speech with excess and equal stress on syllables, irregular articulatory breakdowns and a slow, 'drunken' quality. Which dysarthria type is this?

   1. ASpastic dysarthria
   2. BHypokinetic dysarthria
   3. CAtaxic dysarthria
   4. DUnilateral upper motor neuron dysarthria
   Show answer and explanation▾

   Answer: C. Ataxic dysarthria

   Ataxic dysarthria results from cerebellar damage and is dominated by incoordination: irregular articulatory breakdowns, excess and equal stress and distorted prosody. Spastic dysarthria from bilateral upper motor neuron damage gives a strained-strangled voice, hypernasality and slow, regular rate. Hypokinetic dysarthria in Parkinson disease features reduced loudness, monopitch and short rushes of speech.

9. Question 9Paediatric Language, Literacy & Social Communication Disordersmedium

   A 5-year-old English-speaking boy with normal hearing and nonverbal ability has developmental language disorder. Which grammatical feature is regarded as the most robust clinical marker of DLD at this age?

   1. AUse of unusually formal vocabulary in everyday conversation
   2. BFrequent omission of tense markers such as third person -s and past -ed
   3. CReversal of subject and verb order in simple statements
   4. DOvergeneralisation of plural -s to irregular nouns, such as 'mouses'
   Show answer and explanation▾

   Answer: B. Frequent omission of tense markers such as third person -s and past -ed

   Extended optional infinitive use, meaning omission of finite tense and agreement marking such as third person -s, past -ed and BE/DO forms, is a well-established clinical marker of DLD in English-speaking children. Overgeneralisations like 'mouses' are a normal developmental stage. Subject-verb reversal in statements is not a typical DLD error, and formal vocabulary suggests other profiles.

10. Question 10Acquired Neurogenic Language & Cognitive-Communication Disordersmedium

    A 66-year-old man has fluent speech with good auditory comprehension but markedly impaired repetition and frequent phonemic paraphasias, which he repeatedly tries to self-correct ('a tep, a pet, a step'). Which aphasia type best fits?

    1. AWernicke aphasia
    2. BConduction aphasia
    3. CAnomic aphasia
    4. DTranscortical sensory aphasia
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    Answer: B. Conduction aphasia

    Conduction aphasia combines fluent output and relatively preserved comprehension with disproportionately impaired repetition and phonemic paraphasias, with repeated self-correction attempts (conduite d'approche). Wernicke aphasia also has fluent paraphasic speech but comprehension is poor and self-monitoring limited. Transcortical sensory and anomic aphasias both preserve repetition.

11. Question 11Dysphagia: Feeding & Swallowing Across the Lifespanhard

    On videofluoroscopy, a thin liquid bolus passes below the true vocal folds and the patient makes no cough or other attempt to eject it. Which Penetration-Aspiration Scale score should be assigned?

    1. A6
    2. B5
    3. C7
    4. D8
    Show answer and explanation▾

    Answer: D. 8

    On the Penetration-Aspiration Scale, a score of 8 means material passes below the vocal folds with no effort to eject it, which is silent aspiration. A score of 6 means aspirated material is ejected into the larynx or out of the airway, and 7 means it remains below the folds despite an effort to eject. A score of 5 describes penetration that contacts the vocal folds without passing below them.

12. Question 12Dysphagia: Feeding & Swallowing Across the Lifespanhard

    On videofluoroscopy, a 72-year-old man after a brainstem stroke has reduced anterior hyolaryngeal excursion, reduced upper oesophageal sphincter opening and residue in the pyriform sinuses after the swallow. Which rehabilitative exercise most directly targets this impairment?

    1. AShaker (head-lift) exercise
    2. BEffortful swallow
    3. CMasako (tongue-hold) manoeuvre
    4. DSupraglottic swallow
    Show answer and explanation▾

    Answer: A. Shaker (head-lift) exercise

    The Shaker exercise strengthens the suprahyoid muscles and has been shown to increase anterior laryngeal excursion and the diameter and duration of upper oesophageal sphincter opening, reducing pyriform sinus residue. The effortful swallow mainly increases tongue base retraction and is used for vallecular residue. The Masako manoeuvre targets posterior pharyngeal wall movement, and the supraglottic swallow is an airway protection technique.

13. Question 13Hearing, Audiology & Aural Rehabilitationeasy

    A 4-year-old with recent speech regression and inattentiveness has a flat (type B) tympanogram with a normal ear canal volume in both ears. Which finding is most likely?

    1. AMiddle ear effusion
    2. BNormal middle ear function
    3. CTympanic membrane perforation
    4. DOssicular discontinuity
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    Answer: A. Middle ear effusion

    A flat type B tympanogram with a normal ear canal volume indicates an immobile tympanic membrane, most often from middle ear effusion. A type B trace with a large ear canal volume suggests a perforation or patent grommet. Ossicular discontinuity typically produces a hypercompliant (type Ad) trace, and normal function gives a type A trace.

14. Question 14Augmentative & Alternative Communication, Assistive Technology and Instrumentationmedium

    To build symbol understanding in a 4-year-old who is new to a speech-generating device, the speech-language pathologist coaches parents to touch symbols on the child's device as they talk during play, without requiring the child to imitate. Which strategy is this?

    1. APhysical prompting through a prompt hierarchy
    2. BAided language modelling (aided language stimulation)
    3. CPartner-assisted auditory scanning
    4. DPhase I of the Picture Exchange Communication System
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    Answer: B. Aided language modelling (aided language stimulation)

    Aided language modelling means communication partners use the child's own AAC system while speaking, providing input in the same mode the child is expected to use, without demanding a response. Partner-assisted scanning is an access method in which the partner presents options for the user to select. PECS phase I teaches physical exchange of a single picture for a desired item and relies on a prompter rather than modelling.

15. Question 15Professionalism, Ethics, Patient Safety, Infection Control, Scope of Practice & Evidence-Based Practiceeasy

    When appraising evidence for an intervention, which source generally provides the highest level of evidence?

    1. AA systematic review and meta-analysis of randomised controlled trials
    2. BA single well-designed randomised controlled trial
    3. CConsensus opinion from an expert committee
    4. DA large prospective cohort study
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    Answer: A. A systematic review and meta-analysis of randomised controlled trials

    In standard evidence hierarchies, systematic reviews and meta-analyses of well-conducted randomised controlled trials sit at the top because they combine multiple trials and reduce the influence of chance and single-study bias. A single RCT is strong but ranks below a systematic review of several. Cohort studies and expert opinion rank lower because of confounding and bias.

Last reviewed September 2026. Questions are original and written to the published exam blueprint; they are not taken from any real paper.