Speech & Language Pathologist Prometric exam questions

The Speech & Language Pathologist exam in every GCC country

From each regulator's own exam pages; anything a regulator does not publish says so. Assessment mode also depends on your licence title, so confirm your route on your eligibility notice.

12 worked Speech & Language Pathologist practice questions

Original exam-style questions from the bank, spread across the blueprint domains. They are not real or recalled exam questions. Try each one, then open the answer for the rationale and reference. None of them appear in the free mock exam, so reading them will not spoil it.

1. Question 1 · Professionalism, Ethics, Patient Safety, Infection Control, Scope of Practice & Evidence-Based Practice

   Under the Spaulding classification, how should a flexible nasendoscope used for FEES be categorised and reprocessed between patients?

   1. ANon-critical item requiring cleaning with a detergent wipe only
   2. BNon-critical item requiring low-level disinfection with an alcohol wipe
   3. CSemicritical item requiring thorough cleaning followed by high-level disinfection or sterilisation
   4. DCritical item that must be autoclaved after every use
   Show answer and explanation

   Correct answer: C. Semicritical item requiring thorough cleaning followed by high-level disinfection or sterilisation

   Spaulding classifies devices by the tissue they contact: the nasendoscope touches intact mucous membranes without entering sterile tissue, making it semicritical and requiring meticulous cleaning followed by high-level disinfection (or sterilisation where compatible). Detergent or alcohol wipes provide only low-level disinfection appropriate for non-critical items that touch intact skin. Critical items, which enter sterile tissue or the vascular system, require sterilisation, and most flexible endoscopes are heat-sensitive and cannot be routinely autoclaved.

   Reference: CDC Guideline for Disinfection and Sterilization in Healthcare Facilities (2008, updated); Spaulding EH classification

2. Question 2 · Dysphagia: Feeding & Swallowing Across the Lifespan

   Why is the Masako (tongue-hold) manoeuvre taught as a dry, non-bolus exercise rather than being practised with food or liquid?

   1. AHolding the tongue between the teeth prevents the patient from tasting the bolus, which abolishes the swallow reflex
   2. BIt transiently reduces airway protection and increases pharyngeal residue, so practising it with a bolus increases aspiration risk
   3. CThe manoeuvre is only effective when the mouth is completely dry because saliva blocks pharyngeal wall movement
   4. DAny bolus would be forced into the nasopharynx because the manoeuvre opens the velopharyngeal port
   Show answer and explanation

   Correct answer: B. It transiently reduces airway protection and increases pharyngeal residue, so practising it with a bolus increases aspiration risk

   Anchoring the tongue anteriorly deliberately reduces tongue base retraction so the posterior pharyngeal wall must move further forward, but this also delays laryngeal vestibule closure and increases pharyngeal residue during the exercise swallow. For that reason it is prescribed as a saliva-only exercise and is not used as a compensatory strategy during meals. Taste and saliva are not the reason for the restriction, and the manoeuvre does not open the velopharyngeal port.

   Reference: Fujiu M, Logemann JA. Effect of a tongue-holding maneuver on posterior pharyngeal wall movement during deglutition. American Journal of Speech-Language Pathology, 1996; Doeltgen SH et al. Biomechanical effects of the tongue-hold swallow. Dysphagia, 2017

3. Question 3 · Acquired Neurogenic Language & Cognitive-Communication Disorders

   Over repeated Coma Recovery Scale-Revised assessments, a patient with severe anoxic brain injury shows inconsistent but clearly reproducible visual pursuit of a mirror, occasional localisation to noxious stimulus, and on two of six trials follows a simple command. There is no functional communication and no functional object use. How should this patient be classified?

   1. AComa
   2. BUnresponsive wakefulness syndrome (vegetative state)
   3. CEmergence from minimally conscious state
   4. DMinimally conscious state
   Show answer and explanation

   Correct answer: D. Minimally conscious state

   Reproducible visual pursuit, localisation and inconsistent command following are behavioural evidence of awareness, which defines the minimally conscious state. Coma involves no eye opening and no arousal; unresponsive wakefulness syndrome shows arousal with only reflexive responses and no reproducible purposeful behaviour. Emergence from MCS requires reliable functional communication or functional object use, neither of which is present. Repeated CRS-R assessment is essential because responses fluctuate.

   Reference: Giacino JT et al. The JFK Coma Recovery Scale-Revised. Arch Phys Med Rehabil (2004); Giacino JT et al. Practice guideline update: disorders of consciousness. Neurology/AAN-ACRM-NIDILRR (2018)

4. Question 4 · Speech Sound Disorders: Articulation & Phonology

   When using acoustic feedback to treat a residual /r/ distortion in an adolescent, which spectral change best indicates that the client has achieved an acceptable American English /r/?

   1. AA rise in the fundamental frequency
   2. BA marked lowering of the third formant so that it approaches the second formant
   3. CA rise in the second formant towards the first formant
   4. DAn increase in high-frequency noise energy above 4 kHz
   Show answer and explanation

   Correct answer: B. A marked lowering of the third formant so that it approaches the second formant

   The acoustic hallmark of a correct rhotic is a substantially lowered third formant that moves close to the second formant; this occurs with either a bunched or a retroflex tongue configuration, both of which are acceptable. Fundamental frequency reflects vocal fold vibration rate and is unrelated to rhotic accuracy. A rising second formant approaching the first characterises back vowels, and high-frequency noise energy above 4 kHz is the signature of sibilant fricatives, not /r/.

   Reference: Hagiwara, UCLA Working Papers in Phonetics / Kent & Read, Acoustic Analysis of Speech, 2nd ed. (2002); McAllister Byun & Hitchcock, American Journal of Speech-Language Pathology (2012)

5. Question 5 · Typical Development, Linguistics, Phonetics & Multilingual Communication

   A school team asks which kindergarten measure is the strongest single predictor of later word-level decoding skill. Which is the best answer?

   1. AReceptive vocabulary size
   2. BPhoneme segmentation and manipulation ability
   3. CNon-word repetition length only
   4. DSpeed of colour naming
   Show answer and explanation

   Correct answer: B. Phoneme segmentation and manipulation ability

   Phoneme-level awareness, particularly segmentation and manipulation, together with letter knowledge and rapid automatised naming, is consistently the strongest early predictor of subsequent decoding accuracy. Receptive vocabulary predicts reading comprehension more strongly than decoding. Non-word repetition indexes phonological memory and contributes only modestly, and colour naming is a weaker rapid-naming variant than letter or digit naming.

   Reference: National Early Literacy Panel, Developing Early Literacy (2008); Gillon GT, Phonological Awareness: From Research to Practice, 2nd ed. (2018)

6. Question 6 · Motor Speech Disorders: Dysarthria & Apraxia

   Which pattern of error consistency and oral mechanism findings best differentiates dysarthria from apraxia of speech in an adult with a new neurological diagnosis?

   1. ADysarthria shows relatively consistent errors across repeated attempts with abnormal strength, tone or range on oral examination; apraxia of speech shows variable errors with a normal oral examination
   2. BDysarthria shows highly variable errors with prominent groping; apraxia of speech shows consistent errors with weakness
   3. CBoth disorders show identical error consistency, so only imaging can differentiate them
   4. DDysarthria improves markedly on automatic speech tasks whereas apraxia of speech does not
   Show answer and explanation

   Correct answer: A. Dysarthria shows relatively consistent errors across repeated attempts with abnormal strength, tone or range on oral examination; apraxia of speech shows variable errors with a normal oral examination

   Dysarthria arises from neuromuscular execution impairment, so errors are largely consistent distortions and the oral mechanism examination shows weakness, altered tone, reduced range or incoordination, whereas apraxia of speech is a planning and programming disorder with variable errors, groping and a normal oral mechanism. Groping variability belongs to apraxia not dysarthria, the two are distinguished clinically rather than only by imaging, and it is apraxia of speech, not dysarthria, that improves on automatic and overlearned utterances.

   Reference: Duffy JR. Motor Speech Disorders, 4th ed. Elsevier, 2020; ASHA Practice Portal: Acquired Apraxia of Speech

7. Question 7 · Augmentative & Alternative Communication, Assistive Technology and Instrumentation

   A 34-year-old Emirati woman with bulbar ALS wishes to bank a personalised voice. She speaks Arabic at home and English at work, and her articulation is already mildly imprecise. Which is the most important clinical consideration?

   1. ARecording should be delayed until her speech deteriorates further so the banked voice sounds familiar to the family
   2. BRecording should begin promptly, and the language(s) supported by the banking service must be verified before starting
   3. COnly an English voice should be banked because synthetic voice engines cannot render Arabic
   4. DVoice banking is contraindicated once any articulatory imprecision is present
   Show answer and explanation

   Correct answer: B. Recording should begin promptly, and the language(s) supported by the banking service must be verified before starting

   Voice quality of the banked voice depends on recording while speech is still relatively intelligible, so banking should start as early as possible after diagnosis; mild imprecision is not a contraindication, though further delay will degrade the result. Equally important in multilingual GCC populations is checking which languages and dialects the banking service supports, since many synthetic-voice services have limited Arabic coverage, and the person may need voices for more than one language. Banking a deteriorated voice or a single language by default would not meet her communication needs.

   Reference: Costello JM, Perspectives (ASHA), 2016; ASHA Practice Portal, Amyotrophic Lateral Sclerosis; ALS Association voice banking guidance

8. Question 8 · Screening, Assessment, Evaluation, Psychometrics & Differential Diagnosis

   Two hundred children are screened in a community where the true prevalence of language disorder is 10%. The screening tool has a sensitivity of 90% and a specificity of 80%. What is the approximate positive predictive value of a positive screen in this population?

   1. AAbout 90%
   2. BAbout 80%
   3. CAbout 33%
   4. DAbout 99%
   Show answer and explanation

   Correct answer: C. About 33%

   With 20 true cases and 180 non-cases, 90% sensitivity yields 18 true positives and 80% specificity yields 36 false positives, so positive predictive value is 18 divided by 54, roughly 33%. The 90% and 80% figures simply restate sensitivity and specificity, which are properties of the test rather than of a positive result. The 99% figure approximates the negative predictive value, not the positive one, and this contrast illustrates how low prevalence depresses PPV.

   Reference: Dollaghan CA, The Handbook for Evidence-Based Practice in Communication Disorders (2007); Straus SE et al., Evidence-Based Medicine: How to Practice and Teach EBM, 5th ed. (2019)

9. Question 9 · Paediatric Language, Literacy & Social Communication Disorders

   A 6-year-old girl with a confirmed 22q11.2 deletion presents with severe expressive and receptive language impairment. Using current international terminology, how should her language difficulty be described?

   1. ADevelopmental language disorder, severe subtype
   2. BLanguage disorder associated with a biomedical condition
   3. CSpecific language impairment with a genetic modifier
   4. DGlobal developmental delay rather than a language disorder
   Show answer and explanation

   Correct answer: B. Language disorder associated with a biomedical condition

   CATALISE distinguishes DLD, which excludes differentiating biomedical conditions, from 'language disorder associated with X', used when a known condition such as a genetic syndrome, sensorineural hearing loss, acquired brain injury or ASD is present. A 22q11.2 deletion is a differentiating condition, so DLD and the older term specific language impairment are both incorrect. Global developmental delay is a separate construct requiring impairment across multiple developmental domains and does not replace the language diagnosis.

   Reference: Bishop DVM et al., CATALISE Phase 2 consensus, Journal of Child Psychology and Psychiatry (2017)

10. Question 10 · Anatomy, Physiology & Neuroscience of Speech, Voice, Hearing and Swallowing

    A 58-year-old man has sudden vertigo, ipsilateral facial sensory loss with contralateral body sensory loss, hoarseness, and severe dysphagia with absent pharyngeal contraction on one side and failure of upper oesophageal sphincter opening. Which lesion best accounts for the severity of his dysphagia?

    1. ALateral medullary infarct involving the nucleus ambiguus and adjacent swallowing CPG
    2. BUnilateral lesion of the left precentral gyrus swallowing cortex
    3. CMidbrain lesion of the periaqueductal grey
    4. DBilateral cerebellar hemispheric infarction
    Show answer and explanation

    Correct answer: A. Lateral medullary infarct involving the nucleus ambiguus and adjacent swallowing CPG

    The picture is lateral medullary (Wallenberg) syndrome, in which damage to the nucleus ambiguus and the neighbouring central pattern generator causes disproportionately severe pharyngeal dysphagia with unilateral pharyngeal paresis, cricopharyngeal dysfunction and a high risk of aspiration. Unilateral cortical lesions usually produce milder, more transient dysphagia because of bilateral cortical representation, the periaqueductal grey has no swallowing motor role, and cerebellar lesions cause incoordination rather than absent pharyngeal contraction with UES failure.

    Reference: Jean A. Brain stem control of swallowing. Physiological Reviews, 2001; Duffy JR, Motor Speech Disorders, 4th ed, 2020

11. Question 11 · Voice, Resonance, Craniofacial & Laryngeal Disorders

    A 47-year-old woman has a severely dysphonic, markedly aperiodic voice. The analysis software cannot reliably extract jitter or shimmer from her sustained vowel. Which acoustic measure is most appropriate for quantifying her dysphonia severity, including in connected speech?

    1. AShimmer expressed in decibels
    2. BSmoothed cepstral peak prominence (CPPS)
    3. CVoice range profile area
    4. DMean fundamental frequency
    Show answer and explanation

    Correct answer: B. Smoothed cepstral peak prominence (CPPS)

    Cepstral peak prominence does not require cycle-by-cycle period extraction, so it remains valid in severely aperiodic voices and can be computed on connected speech; it is currently the single acoustic measure most strongly correlated with perceived dysphonia severity. Jitter and shimmer both depend on reliable fundamental period tracking and become invalid here, mean F0 reflects pitch rather than severity, and the voice range profile maps frequency-intensity limits rather than dysphonia severity.

    Reference: Patel RR et al., Recommended Protocols for Instrumental Assessment of Voice, American Journal of Speech-Language Pathology (2018)

12. Question 12 · Typical Development, Linguistics, Phonetics & Multilingual Communication

    Which of the following sentence types typically emerges LATEST in the syntactic development of English-speaking children?

    1. ACoordination with "and" ("I ran and I fell")
    2. BA centre-embedded object relative clause ("The boy that the girl pushed is crying")
    3. CA simple wh-question with subject-auxiliary inversion ("What is he doing?")
    4. DAn infinitival complement with the same subject ("I want to go")
    Show answer and explanation

    Correct answer: B. A centre-embedded object relative clause ("The boy that the girl pushed is crying")

    Centre-embedded object relative clauses place heavy demands on working memory and thematic role assignment and are among the last structures mastered, often not fully comprehended until 7-9 years. Conjoining with "and" and same-subject infinitival complements appear around 2;6-3;6, and inverted wh-questions are generally established by 3-4 years. The distinguishing feature is the embedded, non-canonical word order rather than mere sentence length.

    Reference: Paul R, Norbury C & Gosse C, Language Disorders from Infancy through Adolescence, 5th ed. (2018); Owens RE, Language Development: An Introduction, 10th ed. (2020)

Speech & Language Pathologist reference books and guidelines

Every question in this bank names the textbook or guideline its answer rests on. These are the sources our Speech & Language Pathologist questions cite most often - the reading list to revise from alongside the bank.

Where your regulator publishes a reading list, use the editions it names. Exam questions are not taken from any one book.