Articulation Disorders — MCQs

10 questions

Joseph Wolpe developed the following behaviour management technique -

Facial paralysis is tested by:

Match the following: A) Glossopharyngeal nerve B) Spinal accessory nerve C) Facial nerve D) Mandibular nerve 1) Shrugging of shoulder 2) Touch sensation from the posterior one-third of the tongue 3) Chewing 4) Taste from the anterior two-thirds of the tongue

Best therapy suited to teach daily life skills to a child with intellectual disability:

A 7-year-old girl presents with difficulties in writing and spelling, while her overall intelligence is normal. What is the most likely diagnosis?

A singer presents with difficulty singing at a high pitch. On examination, bowing of the vocal cord is observed on the right side. Which of the following muscles has likely been compromised?

Behavioural problems caused by senility, drug damage, brain injury or disease, and the toxic effects of poisons are classified as __________ disorders

Best therapy suited to teach daily life skill to a mentally challenged child:

Residual auditory defect is a common complication in meningitis caused by

Q10

A first-grade teacher is concerned about a 6-year-old girl in her class who has not spoken a single word since school started. The little girl participates appropriately in the class activities and uses gestures, drawings, nods, and shakes her head to communicate. The parents report that the little girl talks only at home and only in the presence of her closest relatives. Which of the following is the most appropriate diagnosis?

Articulation Disorders Indian Medical PG Practice Questions and MCQs

Question 1: Joseph Wolpe developed the following behaviour management technique -

A. Flooding
B. Aversion therapy
C. Desensitization (Correct Answer)
D. Modeling

Explanation: ***Desensitization*** - **Joseph Wolpe** is credited with developing **systematic desensitization** in the 1950s, a behavior therapy technique used to treat phobias and anxiety disorders. - This technique involves **gradually exposing** an individual to a feared object or situation in a **hierarchical manner** while teaching them **relaxation techniques** (such as progressive muscle relaxation) to overcome anxiety responses. - Based on the principle of **reciprocal inhibition** - the idea that relaxation and anxiety are incompatible responses. *Flooding* - **Flooding** is an exposure-based behavioral technique where the patient is exposed to the **most feared stimulus immediately** at full intensity, rather than gradually. - While also an exposure therapy, it differs from Wolpe's systematic desensitization as it involves **intense, prolonged exposure** without gradual progression. - Associated with **Thomas Stampfl** and is also called **implosion therapy** when done imaginally. *Aversion therapy* - **Aversion therapy** is a behavioral technique that pairs an **undesirable behavior with an unpleasant stimulus** to reduce that behavior. - Used historically for conditions like alcoholism and smoking cessation, but not developed by Wolpe. - Based on **classical conditioning** principles but uses punishment rather than gradual exposure and relaxation. *Modeling* - **Modeling** (observational learning or vicarious learning) is a behavior management technique where an individual learns by observing others. - Extensively studied by **Albert Bandura** through his social learning theory and famous Bobo doll experiments. - Often used to teach new behaviors or reduce fears by observing a fearless peer or model, but this is not Wolpe's primary contribution.

Question 2: Facial paralysis is tested by:

A. Whistling (Correct Answer)
B. Chewing
C. Protruding the tongue
D. Swallowing

Explanation: Facial paralysis is tested by: ***Whistling*** - Whistling requires the coordinated action of several facial muscles, including the **orbicularis oris** and **buccinator**, which are innervated by the **facial nerve (cranial nerve VII)** [1]. - Inability to whistle or an asymmetrical attempt strongly suggests a deficit in **facial nerve function**, indicative of facial paralysis [1]. *Chewing* - Chewing is primarily controlled by the **muscles of mastication**, such as the masseter and temporalis, which are innervated by the **trigeminal nerve (cranial nerve V)**, not the facial nerve. - While facial muscles play a minor role in holding food, their primary involvement in chewing is limited compared to the trigeminal nerve. *Protruding the tongue* - Protruding the tongue is governed by the **hypoglossal nerve (cranial nerve XII)**, which innervates the intrinsic and extrinsic muscles of the tongue [1]. - This action does not test the function of the facial nerve. *Swallowing* - Swallowing (deglutition) is a complex process involving multiple cranial nerves, including the **trigeminal (V)**, **facial (VII)**, **glossopharyngeal (IX)**, **vagus (X)**, and **hypoglossal (XII)** nerves. - While the facial nerve assists in lip closure and maintaining oral pressure, it's not the primary nerve tested for this function, and difficulties here are often more indicative of issues with nerves IX, X, or XII.

Question 3: Match the following: A) Glossopharyngeal nerve B) Spinal accessory nerve C) Facial nerve D) Mandibular nerve 1) Shrugging of shoulder 2) Touch sensation from the posterior one-third of the tongue 3) Chewing 4) Taste from the anterior two-thirds of the tongue

A. A-3 , B-1 , C-4 , D-2
B. A-2 , B-3 , C-4 , D-1
C. A-4 , B-1 , C-2 , D-3
D. A-2 , B-1 , C-4 , D-3 (Correct Answer)

Explanation: ***A-2 , B-1 , C-4 , D-3*** - **A) Glossopharyngeal nerve (CN IX)** is responsible for **general sensation and taste from the posterior one-third of the tongue** [1]. (2). - **B) Spinal Accessory nerve (CN XI)** innervates the **sternocleidomastoid** and **trapezius muscles**, which are involved in shrugging the shoulders (1). - **C) Facial nerve (CN VII)** carries **taste sensation from the anterior two-thirds of the tongue** [1] (4) via the chorda tympani. - **D) Mandibular nerve (V3)**, a branch of the trigeminal nerve, innervates the muscles of mastication, enabling **chewing** (3). *A-3 , B-1 , C-4 , D-2* - This option incorrectly associates the **glossopharyngeal nerve** with chewing, which is a function of the mandibular nerve (V3). - It also incorrectly associates the **mandibular nerve** with touch sensation from the posterior one-third of the tongue, which is a function of the glossopharyngeal nerve [1]. *A-2 , B-3 , C-4 , D-1* - This option incorrectly links the **spinal accessory nerve** with chewing; this nerve primarily controls shoulder and neck movements. - It also incorrectly assigns shrugging of the shoulder to the **mandibular nerve** instead of the spinal accessory nerve. *A-4 , B-1 , C-2 , D-3* - This choice incorrectly attributes **taste from the anterior two-thirds of the tongue** to the glossopharyngeal nerve, which supplies the posterior one-third [1]. - It also incorrectly links **touch sensation from the posterior one-third of the tongue** to the facial nerve, which is involved in taste from the anterior two-thirds [1].

Question 4: Best therapy suited to teach daily life skills to a child with intellectual disability:

A. Applied Behavior Analysis (ABA) (Correct Answer)
B. Cognitive Behavioral Therapy (CBT)
C. Social skills training
D. Self-instructional training

Explanation: **Applied Behavior Analysis (ABA)** - **ABA** is a highly structured, evidence-based therapy that focuses on teaching specific skills by breaking them down into smaller steps and using **positive reinforcement**. - It is particularly effective for children with intellectual disabilities in acquiring **adaptive daily living skills**, communication, and social behaviors. *Cognitive Behavioral Therapy (CBT)* - **CBT** primarily targets changing negative thought patterns and behaviors, requiring a level of abstract reasoning that may be challenging for children with significant intellectual disabilities. - While it can be adapted, its core methods rely on cognitive processes that might not be the most direct approach for teaching basic daily life skills to a mentally challenged child. *Social skills training* - **Social skills training** focuses specifically on improving social interactions and communication within social contexts. - While important for overall development, it is a subcomponent of broader skill development and may not directly address all aspects of **daily living skills** in a comprehensive manner. *Self-instructional training* - **Self-instructional training** involves teaching individuals to guide themselves through tasks using internal speech or self-talk, which relies on a child's ability to internalize and follow complex verbal instructions. - This approach might be too cognitively demanding for a child with significant developmental delays when the primary goal is mastering basic, functional daily life skills.

Question 5: A 7-year-old girl presents with difficulties in writing and spelling, while her overall intelligence is normal. What is the most likely diagnosis?

A. Dyslexia
B. Intellectual disability
C. Dysphonia
D. Specific learning disorder affecting writing (Correct Answer)

Explanation: ***Specific learning disorder affecting writing*** - This diagnosis aligns with documented difficulties in **writing and spelling** despite **normal overall intelligence**. - Formerly known as **dysgraphia**, it specifically impacts the motor and cognitive aspects of written expression. *Dyslexia* - Primarily affects **reading abilities**, with challenges in **decoding and phonological processing**. - While it can co-occur with writing difficulties, the primary presentation here emphasizes writing and spelling. *Intellectual disability* - Characterized by significant limitations in both **intellectual functioning** and **adaptive behavior**. - The descriptor "normal overall intelligence" directly rules out intellectual disability. *Dysphonia* - Refers to a **disorder of the voice**, affecting its quality, pitch, or loudness. - This condition is related to speech production and has no direct involvement with difficulties in writing or spelling.

Question 6: A singer presents with difficulty singing at a high pitch. On examination, bowing of the vocal cord is observed on the right side. Which of the following muscles has likely been compromised?

A. Posterior cricoarytenoid
B. Lateral cricoarytenoid
C. Cricothyroid (Correct Answer)
D. Thyroarytenoid

Explanation: ***Cricothyroid*** - The **cricothyroid muscle** is primarily responsible for **tensioning and elongating the vocal cords**, which is crucial for increasing vocal pitch. - Damage to this muscle or its innervation (superior laryngeal nerve) results in an inability to reach higher pitches and can cause **vocal cord bowing** due to reduced tension. *Posterior cricoarytenoid* - This muscle is the **primary abductor** of the vocal cords, meaning it opens the vocal cords for breathing. - Compromise would lead to difficulty breathing or a paralyzed vocal cord in the adducted position, not bowing with difficulty singing high notes. *Lateral cricoarytenoid* - The **lateral cricoarytenoid muscle** is a **vocal cord adductor** and rotator, bringing the vocal cords together to regulate voice intensity. - Dysfunction typically results in a weak and breathy voice, or difficulty bringing the cords together, not specifically difficulty with high pitch. *Thyroarytenoid* - The **thyroarytenoid muscle** (which includes the vocalis muscle) acts to **relax and shorten the vocal cords**, lowering pitch and modulating vocal cord tension. - Dysfunction would primarily lead to difficulty with lower pitches or a hoarse voice, as it prevents proper relaxation of the vocal cords.

Question 7: Behavioural problems caused by senility, drug damage, brain injury or disease, and the toxic effects of poisons are classified as __________ disorders

A. Psychosomatic
B. Substance use
C. Organic (Correct Answer)
D. Psychotic

Explanation: ***Organic*** - **Organic disorders** are characterized by behavioral or psychological symptoms that are directly attributable to a **physiological dysfunction** or structural change in the brain. - This category includes conditions arising from **senility**, drug-induced damage, brain injury, disease (e.g., **dementia**), or exposure to **neurotoxins**. *Psychosomatic* - **Psychosomatic disorders** involve physical symptoms that are caused or aggravated by **psychological factors**, like stress. - The primary cause is not a direct physiological injury or disease of the brain itself. *Substance use* - **Substance use disorders** describe maladaptive patterns of substance use leading to clinically significant impairment or distress. - While drug damage is mentioned in the question, this category focuses specifically on the **addiction** and related behaviors, not the broad range of organic causes. *Psychotic* - **Psychotic disorders** are characterized by a significant loss of contact with reality, often involving **hallucinations** or **delusions**. - While some organic conditions can cause psychotic symptoms, the term "psychotic disorders" refers to a specific symptom cluster rather than the underlying physical cause.

Question 8: Best therapy suited to teach daily life skill to a mentally challenged child:

A. Contingency management (Correct Answer)
B. Cognitive reconstruction
C. Self instruction
D. CBT (Cognitive behavior therapy)

Explanation: ***Contingency management*** - This therapy involves consistently **rewarding desired behaviors** and withholding rewards for undesirable ones, which is highly effective for teaching new skills to individuals with intellectual disabilities. - It uses principles of **operant conditioning** to shape behavior through positive reinforcement, making it suitable for acquiring daily living skills. *Cognitive reconstruction* - This technique focuses on identifying and changing **maladaptive thought patterns**, which typically requires a higher level of cognitive function. - It is generally not the primary or most effective approach for teaching concrete daily life skills to individuals with significant **cognitive limitations**. *Self instruction* - This involves teaching individuals to guide their own behavior using **internal verbal cues** or self-talk. - While beneficial for some, it often requires a certain degree of **abstract thinking** and memory, making it less suitable as a standalone method for those with profound cognitive challenges in acquiring basic skills. *CBT (Cognitive behavior therapy)* - CBT integrates cognitive and behavioral strategies to address emotional and behavioral problems by modifying **thoughts, feelings, and behaviors**. - While beneficial for a range of psychological issues, its emphasis on **cognitive restructuring** makes it less directly applicable or the most effective first-line therapy for teaching concrete, functional daily living skills to mentally challenged children.

Question 9: Residual auditory defect is a common complication in meningitis caused by

A. Staphylococcus
B. Meningococcus
C. Escherichia coli
D. Haemophilus influenzae (Correct Answer)

Explanation: ***Haemophilus influenzae*** - *Haemophilus influenzae* type b (Hib) meningitis has the **highest rate of sensorineural hearing loss** among bacterial meningitis causes, affecting **5-35% of survivors**. - Direct damage to the **cochlea and auditory nerve** occurs from intense inflammation, bacterial toxins, and cell wall components (lipopolysaccharide). - The inflammatory response leads to **labyrinthitis, cochlear obliteration**, and subsequent permanent auditory impairment. - Even though Hib meningitis is now rare due to vaccination, when it occurs, **residual hearing loss remains its most common neurological sequela**. *Staphylococcus* - **Staphylococcal meningitis** is typically associated with **neurosurgical procedures, trauma, or CSF shunt infections**, not community-acquired disease. - More commonly leads to complications like **abscess formation, ventriculitis**, or **subdural empyema** rather than isolated hearing loss. - While severe meningitis of any cause can cause auditory defects, *Staphylococcus* is not primarily recognized for this specific sequela. *Meningococcus* - **Meningococcal meningitis** (*Neisseria meningitidis*) can cause hearing loss, but at a **lower rate (5-10%)** compared to H. influenzae. - Though currently more prevalent than Hib meningitis (due to vaccination programs), the **frequency of hearing loss as a complication** is lower when comparing case-to-case outcomes. - Often associated with more dramatic systemic complications like **fulminant septicemia** and **Waterhouse-Friderichsen syndrome** rather than isolated auditory defects. *Escherichia coli* - **E. coli meningitis** primarily affects **neonates and infants**, acquired during birth from maternal gastrointestinal flora. - Main complications include **hydrocephalus, cerebral abscess, developmental delays**, and **ventriculitis**. - While neurological sequelae are common (up to 50%), **residual auditory defects are not the predominant or most characteristic long-term complication** compared to H. influenzae.

Question 10: A first-grade teacher is concerned about a 6-year-old girl in her class who has not spoken a single word since school started. The little girl participates appropriately in the class activities and uses gestures, drawings, nods, and shakes her head to communicate. The parents report that the little girl talks only at home and only in the presence of her closest relatives. Which of the following is the most appropriate diagnosis?

A. Autism
B. Selective mutism (Correct Answer)
C. Expressive language disorder
D. School phobia

Explanation: ***Selective mutism*** - This condition is characterized by a **consistent failure to speak in specific social situations** (e.g., school) despite speaking in other situations (e.g., at home with close family). - The child's **appropriate participation in class activities** and use of alternative communication methods (gestures, drawings) are typical features. *Autism* - Children with autism spectrum disorder often exhibit **deficits in social-emotional reciprocity** and may have **restricted, repetitive patterns of behavior or interests**. - While they may have communication challenges, the selective nature of the mutism and otherwise appropriate social engagement in the classroom argue against autism. *Expressive language disorder* - This disorder involves difficulty **producing spoken language**, regardless of the setting. - The fact that the child speaks normally at home suggests her expressive language abilities are intact, making this diagnosis unlikely. *School phobia* - School phobia, now often referred to as **school refusal**, is characterized by symptoms of anxiety or panic when attending or anticipating school. - While the child might be anxious, her ability to participate in class activities and communicate nonverbally suggests the primary issue is not an avoidance of school itself but a selective inability to speak.

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