ETS Domain: Assessment

Praxis 5331 Resonance & Cleft Palate Questions

Resonance and cleft items test your ability to identify hypernasality vs hyponasality, understand VPI, know cleft repair timing, and recognize compensatory articulations. Expect 3-6 items.

Why this topic matters

VPI vs mislearned articulation is a common differential — one needs surgery, the other therapy.
Cleft team roles/timing is tested for scope-of-practice reasons.

High-yield concepts

Hypernasality: too much nasal resonance on non-nasal sounds (VPI).
Hyponasality: too little nasal resonance on nasal sounds (obstruction).
VPI = Velopharyngeal Insufficiency — structural gap; requires surgical/prosthetic management.
Cleft lip repair ~3 months; cleft palate repair ~9-12 months.
Compensatory articulations: glottal stops, pharyngeal fricatives — learned, target with therapy.
Nasometry: objective measure of nasalance; Nasometer II.

Sample practice questions

Try answering before revealing the rationale — mark misses to retry later.

Q1.A 6-year-old post-cleft palate repair produces glottal stops for /p/, /t/, and /k/. The MOST appropriate action is:

A.Refer for pharyngoplasty
B.Provide speech therapy targeting oral articulation placement
C.Wait 12 months for spontaneous resolution
D.Refer for hearing evaluation only

Show answer & rationale

Correct: B. Glottal stops are compensatory articulations that are learned behaviors, not structural. They respond to speech therapy with oral placement cues. Structural intervention is reserved for confirmed VPI.

Q2.A patient produces excessive nasal air emission and hypernasality on all non-nasal sounds. Nasometry confirms elevated nasalance. The MOST likely cause is:

A.Adenoid hypertrophy
B.Velopharyngeal insufficiency
C.Deviated septum
D.Vocal fold nodules

Show answer & rationale

Correct: B. Hypernasality with elevated nasalance and nasal air emission is characteristic of VPI — the velopharyngeal port does not close adequately during non-nasal sounds.

Q3.Standard cleft palate surgical repair typically occurs at approximately:

A.1 month
B.3 months
C.9-12 months
D.3 years

Show answer & rationale

Correct: C. Cleft palate repair is typically performed at 9-12 months to balance surgical safety with speech development. Cleft lip repair is earlier (~3 months).

Common wrong-answer traps

Recommending surgery for compensatory articulations — those need therapy.
Confusing hyper- and hyponasality patterns.
Assuming all resonance issues are structural — mislearning is common.

Study moves this week

Distinguish hyper vs hyponasality with 5 examples.
Memorize typical cleft repair timing.
Learn 3 common compensatory articulations.

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FAQ

Are SLPs on the cleft team?

Yes — SLPs assess resonance and articulation and often participate in the multidisciplinary cleft/craniofacial team.

Do all children with cleft palate have VPI?

No — many achieve adequate velopharyngeal closure post-repair. VPI is diagnosed via clinical evaluation, nasometry, and/or nasendoscopy.

What is nasometry?

An objective acoustic measure of nasalance (ratio of nasal to total acoustic energy) used to quantify hypernasality.

Praxis 5331 Resonance & Cleft Palate Questions

Why this topic matters

High-yield concepts

Sample practice questions

Common wrong-answer traps

Study moves this week

Want 400+ scenario questions with rationales?

FAQ

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