ETS Domain: Treatment

Praxis 5331 Voice Disorders Questions

Voice items test your ability to link vocal behavior and lifestyle to pathology, then choose the correct assessment and evidence-based therapy. Expect 6-10 items, several involving stroboscopy findings or medical vs behavioral treatment decisions.

Why this topic matters

Voice cases require knowing when to refer to ENT vs treat directly — an ethical/scope-of-practice issue ETS values.
LSVT LOUD is one of the most heavily tested treatments, spanning voice AND neurogenic caseloads.

High-yield concepts

Vocal nodules: bilateral, mid-membranous, from phonotrauma; behavioral therapy first.
Vocal polyps: often unilateral, may need surgical + behavioral.
Unilateral vocal fold paralysis: breathy, weak cough; medialization vs voice therapy.
Spasmodic dysphonia (adductor most common): Botox is first-line.
Muscle tension dysphonia: no lesion; resonant voice / vocal function exercises.
LSVT LOUD: high effort, high phonatory output; Parkinson's evidence base.
Stroboscopy: visualizes mucosal wave; gold-standard for structural voice dx.

Sample practice questions

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

Q1.A 42-year-old teacher presents with 3 months of hoarseness, worse at end of day. Stroboscopy shows bilateral, symmetrical mid-membranous lesions. The MOST likely diagnosis is:

A.Unilateral polyp
B.Vocal fold nodules
C.Reinke's edema
D.Adductor spasmodic dysphonia

Show answer & rationale

Correct: B. Bilateral, symmetrical, mid-membranous lesions in a heavy voice user are the classic presentation of vocal fold nodules. Polyps are typically unilateral; SD has no lesion; Reinke's is diffuse edema.

Q2.First-line treatment for adductor spasmodic dysphonia is:

A.Voice rest
B.Botulinum toxin injection
C.LSVT LOUD
D.Resonant voice therapy

Show answer & rationale

Correct: B. Botox to the thyroarytenoid is the first-line evidence-based treatment for adductor spasmodic dysphonia. Behavioral therapy alone is not effective for SD.

Q3.LSVT LOUD is MOST strongly indicated for:

A.Vocal fold nodules
B.Hypokinetic dysarthria in Parkinson's disease
C.Spastic dysarthria
D.Muscle tension dysphonia

Show answer & rationale

Correct: B. LSVT LOUD has its strongest evidence in hypokinetic dysarthria associated with Parkinson's disease. It targets reduced loudness with high-effort phonation.

Common wrong-answer traps

Treating a lesion behaviorally without ENT referral — always confirm laryngeal exam has occurred.
Choosing voice rest as first-line for nodules (behavioral therapy is first).
Applying LSVT LOUD to non-Parkinson's voice cases.

Study moves this week

Build a table: pathology → hallmark stroboscopy finding → first-line management.
Memorize the LSVT LOUD dose (16 sessions, 4×/week × 4 weeks).
Distinguish MTD (no lesion) from nodules (bilateral lesion) with 5 practice cases.

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FAQ

Does every voice patient need ENT referral before therapy?

Yes — SLPs cannot treat voice disorders without a laryngeal exam. It is a scope-of-practice/ethical standard tested on the Praxis.

Is LSVT LOUD only for Parkinson's?

It has the strongest evidence there but is applied to other hypokinetic presentations. Praxis answers usually anchor it to Parkinson's.

What's the difference between MTD and nodules?

MTD has no lesion — dysphonia is from excess muscle tension. Nodules are visible bilateral mid-membranous lesions from phonotrauma.

Praxis 5331 Voice Disorders 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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