Study Guide PRAXIS Audiology ST Questions with Complete Verified Solutions 2024/2025, Study Guides, Projects, Research of Health sciences

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Study Guide PRAXIS Audiology ST Questions

with Complete Verified Solutions 2024/

what is the CPT code for comprehensive (air, bone, speech) 92557 What does sensitivity measure? Specificity? Sensitivity measures the probability of actual positives specificity measures the probability of actual negatives. What is the formula for sensitivity? Sensitivity= TP/(TP+FN) What is the formula for specificity? Specificity = TN/(TN+FP) What is the formula for positive predictive value? PPV = TP/ (TP+FP) What is the formula for negative predictive value? NPV = TN/(FN+TN) What does ASSR use instead of latency and amplitude? amplitudes and phases What types of stimuli to measure ASSR ASSR is evoked using repeated sound stimuli presented at a high repetition rate What methods does ASSR use to detect and define hearing thresholds? ASSR uses an objective, statistics-based mathematical detection algorithm to detect and define hearing thresholds. What are the pros of using ASSR when compared to ABR? ASSR can be used binaurally, while evaluating broad bands or four frequencies (500 Hz, 1,000 Hz, 2, Hz, and 4,000 Hz) simultaneously. It can estimate and differentiate hearing within the severe-to-profound hearing loss ranges.

What is the most sensitive measure of CN VIII dysfunction? ABR Where is ABR measure derived from (big picture) ABRs are peripheral measures of neural function/ periphery recordings between the cochlea and the inferior colliculus. Where is wave I from (ABR) Distal (peripheral portion) of the cochlear nerve Where is wave II from (ABR) Proximal (more central) part of the cochlear nerve Where is wave III from (ABR) cochlear nucleus Where is wave IV from (ABR) SOC Where is wave V from (ABR) Nuclei of the lateral lemniscus Where is wave VI from (ABR) inferior colliculus What is the optimal stim rate for ABR? 11 - 21 In ABR, increasing the rate will do what to the amplitude and latencies? Increasing the stimulus rate will decrease amplitude, increase absolute latencies, and prolong I-V wave interpeak latencies In ABR, decreasing the rate will do what? decreasing rate decreases latency and improves morphology. What is a typical ABR filter for adults? Children? decreasing rate decreases latency and improves morphology. <50 are preferred. Nystagmus seen in post canal BPPV upbeat torsional towards the affected ear Nystagmus seen in anterior canal BPPV anterior canal nystagmus: downbeat torsional toward the affected ear what does cVEMP test? cVEMP: tests the function of the saccule and inferior branch of the 8th nerve what does oVEMP test? oVEMP: tests the function of the utricle and superior branch of the 8th nerve What are the most common pediatric vestibular disorders?

Most common disorders reported to cause dizziness in children are otitis media, migraine headache, benign paroxysmal vertigo of childhood (BPVC), trauma, and vestibular neuritis. DPOAE performs best at what frequencies? TEOAE performs best at what frequencies? DPOAEs: perform better at >4000 Hz TEOAEs: perform better at 500-1500 Hz Where does DPOAE originate? Where does TEOAE originate? DPOAEs have two sites of origin and TOAEs have a single site. What types of medications are ototoxic? Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), including aspirin, ibuprofen, and naproxen aminoglycoside antibiotics cancer (cisplatin/carboplatin) medications Water pills and loop diuretics Quinine-based medications What are concerns related to patients treated with gentamiacin? For patients on gentamicin (antibiotics/aminoglycosides), this is ototoxic and can lead to vestibular issues. They should be tested for vestibular function if they exhibit ataxia of gait or stance. What are the modes of stimulation in a CI? What is the default phase? Modes of stimulation: monopolar, bipolar, and common ground. Monopolar is the default.This is where the current flows from one electrode in the cochlea to a ground electrode outside the cochlea. Biphasic pulse is also default. What is pulse width? Pulse width is the duration of each biphasic pulse. It is changed (increased) to meet C level (increase intensity). Can be changed by amplitude or length.

Current steering vs. continuous interleaved sampling Current steering: virtual electrodes are created by simultaneous stimulation of adjacent physical electrodes Continuous Interleaved Sampling: strategy that minimizes channel interaction by presenting pulses to each electrode in a non overlapping sequence. doubling in sound source does what increases 3 dB doubling the distance from a sound decreases by 6dB TWA TWA: the average noise level exposed to an 8 hour period Max permissible exposure limit for OSHA 90 dBA for 8hours exchange rate of 5dB Max permissible exposure limit for OSHA Max permissible exposure limit for NIOSH NIOSH= 85 for 8 hours w/ 3 dB exchange rate What frequencies should be tested annually for all exposed >85 dBA TWA Test frequencies: .5, 1, 2, 3, 4, & 6 kHz When should an employee have a baseline hearing test? (OSHA) within 6 months of hire 14 hours of no noise exposure before test When should an employee have a baseline hearing test? (NIOSH) Baseline audiometry: prior to start date or within 30 days - noise free for 12 hours- NIOSH How do you calculate a threshold shift? change from 2, 3, and 4, divided by 3. Equal or greater than 10 is sig. 15 dB at two of the frequencies What should you do if there is a significant threshold shift? (occupational aud) If STS is present: notify employee within 21 days, retest within 30 to confirm, refit and counsel on HP, schedule with an audiologist as needed. Technical HIPAA safeguards

antivirus software, two factor authentication, data encryption, de-identification of data, firewalls, mobile device management, remote wire capability. Physical HIPAA safeguards surveillance cameras and locked doors. What are the chronological steps in the listening hierarchy? Describe them Detection: awareness/response to sound: VRA/CPA Discrimination: distinguish importance of sounds/ differences among sounds Identification: ability to label the speech stimuli heard Comprehension: understand the meaning of speech, ie. following directions What is the most realistic way to measure speechreading? Most realistic measures of speech reading are in auditory-visual stimuli. Variation in speech reading scores can be due to what? Variation in patient scores can be due to authorial vocabulary or syntax. What are recommendations for patients with hyperacusis? These patients should avoid wearing ear plugs and have exposure to average level environmental sounds in order to desensitize them. They should avoid loud sounds. Non genetic causes of pediatric HL (5) TORCH (toxoplasmosis, other agents, rubella, cytomegalovirus, herpes), alcohol toxins head trauma noise Non genetic/syndromic pediatric HL cases that are progressive could be due to? ototoxicity, meningitis, TORCH, Mondini, hyperbilirubinemia Syndromic HL causes Dominant (4) What types of HL do they present with?

Waardenburg (SNHL) Branchio-oto-Renal (CHL,SNHL or mixed Stickler (CHL,SNHL or mixed) Treacher-Collins (CHL or mixed) Syndromic HL causes Recessive (4) What types of HL do they present with? Usher (SNHL and Vision) Pendred (SNHL mondini or EVA and goiter) Jervell & Lange-Nielsen (SNHL, sudden death) Alport syndrome - X linked (SNHL & renal) Non syndromic causes of hearing loss? (genetic) Connexin 26 ANSD Behavioral testing for pediatrics: Birth-6 months: 6 months- 2 ½ years: 2 ½ years- 5 years: 5 years + standard CI for children: 12 to 18 months w/ exception of meningitis Birth-6 months: BOA, OAEs, ABR 6 months- 2 ½ years: VRA (minimal response levels)

2 ½ years- 5 years: CPA CI for children: 12 to 18 months w/ exception of meningitis, <30% open set WRS best aided Part C of IDEA serves what age? What does it entail? Part C services start from birth to 2 years old, that requires services, specifically an Individual Family Service Plan. Part B of IDEA serves what age? What does it entail? children 3-21 who need services. IEP What is a 504 plan? 504 provides services for a lifetime and creates accommodations rather than goals. Sunshine Act: requires the reporting of gifts and payments made to the practice Anti Kickback statute: any item or service for which payment may be made Stark Law: prohibits physicians from referring patients for health services paid for by Medicare to any entity in which they have a "financial relationship". False Claims Act: medicare/medicaid fraud. Quid pro quo: gifts in exchange for services or favors. Violations of professional ethical standards can result in Violations are felonies and are subject to fine, imprisonment, and exclusion from health care. Medicare part B Medicare part B covers medically necessary services and preventative services. What must a medicare audiogram report contain? Medicare audiogram reports must contain: referral source, reason for referral, and medical history. Basic research method Basic: application does not apply, done in a controlled laboratory Applied research method Applied: done with a specific question, find answers to practical problems Experimental research method Experimental: treatments given to subject, cause and effect questions Non experimental research method Non-experimental: participants are observed naturally

Retrospective study look into the past of patients who have already had a disease Normative study looking at a societal standards independent variable dependent variable independent variable: variable that is manipulated or controlled by researcher dependent variable: effect of the independent variable To verify directional microphones To verify directional microphones: perform real-ear front-to-back ratio measurements. Vents effect what frequencies? Damping effects what frequencies? Horns effect what frequencies? venting: low to mid 20-1,500Hz damping: midrage 1,000-4000Hz Horn effect: highs: 3-10,000Hz Low frequency sounds are localized using what? High frequencies are localized using? TIME INTENSITY What is AI-DI AI-DI is the ratio between the output of signals in front rather than all other directions- the bigger the number, the better the AI-DI. What is frequency, what is the formula? Frequency is the number of cycles per second (cycles/time) reported in Hz f=1/t What is period, what is the formula?

Period is the time required for one cycle (time/cycles) reported in seconds or milliseconds. t=1/f What is phase? Phase is a particular stage in the cycle of motion using angles as the unit of measurement. One full rotation of a cycle is from 0º to 360 º. Stages of digital sound processing (3) First stage: Analog to digital is where an analog signal is captured. Then sampling is occurred by measuring and storing the values of an analogue signal. Second stage: Digitization- the quantized samples are converted to binary digits. d=2^n (d is number of digitized values and n is the number of bits. Each binary number is mapped to a unique range of voltage. Third stage: Digital to analogue conversion. Total amplification by the middle ear 33 dB Tensor tympani attaches to? Stapedius muscle attaches to? Tensor tympani: attaches to the long process of the malleus Stapedius muscle: attaches to the stapedius muscle Utricle senses what type of movement? Saccule senses what type of movement? Utricle: senses linear acceleration (horizontal) Saccule: senses head position relative to gravity Duration of common causes of vertigo Seconds Minutes Hours Days

Seconds: Benign paroxysmal positional vertigo (BPPV) or orthostatic hypotension (low blood pressure: light-headedness from standing up). Minutes: vertebrobasilar insufficiency or migraine attacks (with or without headaches) Hours: Meniere's syndrome or migraine attacks Days: vestibular neuritis/labyrinthitis, acute toxic or traumatic labyrinth injury, labyrinthine infarction The hearing of a 47-year-old patient who has worked in an office in a large factory for the last twenty years has been declining for the last five years. The noise measurements on the factory floor were 94 dB LAeq94 decibels equivalent sound level. The patient walked around the factory floor four times a day, and each walk took six minutes. Which of the following is closest to the NIOSH noise dose associated with the worker's exposure to the factory noise? An exposure to a maximum sound level of 94 dB LAeq94 decibels equivalent sound level would reach a 100 percent noise dose in an hour using NIOSH criteria. As described in the scenario, the patient will have been exposed to the sound for only 24 minutes during the day, which makes option (B), or 40 percent, the best answer. A 78-year-old male presents to a clinic with significant symptoms of imbalance and a recent fall with injury. Upon further questioning, the patient reports a "swirling" feeling when he rolls over in bed to the right and left side. He is now avoiding movements in bed. Supine head-roll testing reveals the following findings. Head roll to the right: 52 degrees/second right-beating nystagmus, which had a crescendo- decrescendo pattern and strong symptom response Head roll to the left: 34 degrees/second left-beating nystagmus, which had a crescendo- decrescendo pattern and less intense symptom response The audiologist concludes that the patient has horizontal canal benign paroxysmal positional vertigo. Which of the following treatment maneuvers is most likely to be recommended? Geotropic Gufoni maneuver for right horizontal canal BPPV of canalithiasis type B.Geotropic Gufoni maneuver for left horizontal canal BPPV of canalithiasis type C.Apogeotropic Gufoni maneuver for right horizontal canal BPPV of cupulolithiasis type D.Apogeotropic Gufoni maneuver for left horizontal canal BPPV of cupulolithiasis type Option (A) is correct. The geotropic nystagmus pattern (right-beating with head right and left-beating with head left). The geotropic pattern of nystagmus suggests canalithiasis type horizontal canal BPPV. The

supine head roll side with the stronger nystagmus response represents the side involved with the horizontal canal BPPV, which is on the right side in this example. Which of the following lists examples of technical safeguard options outlined by the Health Insurance Portability and Accountability Act? A.De-identification of data, firewalls, mobile device management B.Data encryption, multifactor authentication, malware C.Remote wipe capability, surveillance cameras, password renewal cycles D.Locked doors, de-identification of data, two-factor authentication Option (A) is correct. Under HIPAA guidelines common technical safeguard options can include but are not limited to antivirus software, multifactor or two-factor authentication, data encryption, de-identification of data, firewalls, mobile device management (MDM), and remote wipe capability. Surveillance cameras and locked doors are considered physical safeguards. When conducting real-ear measurements, which of the following is most appropriate for verifying accurate probe-tube placement in the ear canal? A.Performing REUG and monitoring gain at 6 kHz6 kilohertz B.Using the intertragal notch for probe-tube insertion depth at 10-15 mm10 to 15 millimeters C.Performing REAG and monitoring gain at 6 kHz6 kilohertz D.Arranging the probe module on the ear with the reference microphone facing inward Option (A) is correct. Proper probe-tube placement is crucial to appropriate amplification settings. Measuring unaided gain at 6 kHz6 kilohertz will determine if the probe tube is close enough to the eardrum. Which of the following lists the most appropriate set of acoustic modifications for an earmold when fitting a patient with a precipitously sloping high-frequency sensorineural hearing loss? A.Standard tubing, 2 mm2 millimeter sound bore, no vent B.Libby horn, 3 mm3 millimeter sound bore, narrow vent C.Libby horn, 4 mm4 millimeter sound bore, no vent

D.Libby horn, 2 mm2 millimeter sound bore, wide vent Option (D) is correct. Acoustic modification should emphasize high-frequency amplification and de- emphasize low-frequency amplification. A flared horn (Libby), a short sound bore, and a wide vent is the best combination to achieve that goal. Which of the following types of speech recognition materials is most useful to rule out a lesion affecting the VIIIth nerve? A.Closed-set monosyllabic and bisyllabic words that vary in stress pattern B.Closed-set sentences approximating natural syntax, administered in varying intensity levels as in an ongoing message C.Open-set, monosyllabic, phonetically balanced word lists that are representative of the patient's language D.Open-set, monosyllabic, phonetically balanced word lists, administered at several intensity levels Option (D) is correct. Speech understanding may be affected in a patient with a suspected retrocochlear lesion. Administering a performance-intensity function and then calculating rollover would be an appropriate step before referring the patient for more objective tests to rule out a retrocochlear lesion. Which of the following tests would yield the most important information in the audiological evaluation of an adult with an average unmasked air-conduction threshold of 90 dB90 decibels HL in one ear and normal sensitivity in the other ear? A.Tympanometry B.Reflex decay test C.The Stenger test D.Acoustic reflex testing Option (C) is correct. A large difference in sensitivity in the ears of an adult is easily verified by the Stenger test. An audiologist owns a private practice and is in partnership with a sibling, who is an ear, nose, and throat (ENT) specialist. The audiologist receives direct referrals from the ENT specialist for hearing-aid dispensing. Which of the following laws are the professionals violating?

A.Anti-kickback law B.Stark law C.False Claims Act D.Medicare Part B Option (B) is correct. The Stark law is a set of United States federal laws that prohibit physician self- referral, specifically a referral by a physician of a Medicare or Medicaid patient, to an entity providing designated health services (DHS) if the physician (or an immediate family member) has a financial relationship with that entity. Stimulus Right contra NR Ipsi obtained Stimulus Left contra obtained ipsi NR A.VIIItheighth-nerve pathology on the right side B.VIIItheighth-nerve pathology on the left side C.VIIthseventh-nerve pathology on the right side D.VIIthseventh-nerve pathology on the left side Option (D) is correct. The acoustic reflex relies on the VIIthseventh nerve to carry the stimulus to the stapedial muscle. The absence of any reflex in the left ear suggests that there is a VIIthseventh-nerve pathology preventing measurable reflex contraction on the left side. Which of the following abnormal eye movements (fast-phase of the nystagmus) corresponds with right anterior canal benign paroxysmal positional vertigo (BPPV)? A.Rightward torsional and down-beating vertical nystagmus B.Leftward torsional and down-beating vertical nystagmus

C.Rightward torsional and up-beating vertical nystagmus D.Leftward torsional and up-beating vertical nystagmus Option (A) is correct. Anterior canal BPPV corresponds with a torsional nystagmus that beats toward the involved ear (in this case, the right ear) and a vertical down-beating nystagmus. Which of the following is the primary reason for limiting a hearing aid's OSPL 90 to a lower level when it is worn by a child than when it is worn by an adult? A.Loud amplified sounds may frighten a young child and result in rejection of the hearing aid. B.The volume of the external auditory meatus in children is less than that represented by a 2-cc coupler, and consequently the SPL at the eardrum is greater. C.Parents and teachers of children with hearing impairments typically talk louder than do people who interact with adults with hearing impairments. D.The primary speech signal will be masked because room noise and reverberation will be amplified. Option (B) is correct. The sound pressure level (SPL) at the eardrum is a function of the volume of the external auditory meatus: the smaller the volume, the greater the sound pressure. An OSPL 90 set to a level appropriate for adults may produce an undesirably high maximum SPL in a child. A 55-year-old sound engineer who works at a local television news company visits an audiologist. He recently obtained receivers in the ears (RITEs) from another audiologist, but he still experiences listening difficulty. His recent audiogram is within normal limits, from 250 Hz250 hertz to 750 Hz750 hertz, progressively sloping to severe impairment at 8 kHz8 kilohertz in both ears. To address his reported listening difficulties, the audiologist reviews his hearing-aid settings and creates a new multichannel expansion program. Also completed was on-ear speech mapping at increasing input levels (50 dB50 decibels SPL to 80 dB80 decibels SPL). Which of the following responses to this adjustment would the patient be most likely to report? A.Reporting that the internal noise from his hearing aids has increased B.Reporting that high-frequency speech sounds are much clearer C.Reporting that there is no difference between soft and loud speech sounds D.Reporting increased difficulty hearing low-level, high-frequency speech sounds

Option (D) is correct. Low-level environmental noise or internal noise generated by the hearing instrument should be less audible when expansion is activated. A patient who has a severe hearing loss takes a consonant recognition test. An analysis of the consonant-confusion error patterns is performed. Results will most likely indicate that the feature recognized most accurately was Option (C) is correct. It is most likely that a person with a severe hearing loss will most accurately recognize voicing. Which of the following is most appropriate to use to determine information about a patient's individual situation and communicative needs? A.Hearing Aid Selection Profile (HASP) B.Communication Profile for the Hearing Impaired (CPHI) C.Hearing Handicap Inventory for Adults (HHIA) D.Client Oriented Scale of Improvement (COSI) Option (D) is correct. The COSI is a self-reported assessment questionnaire. One of the greatest advantages of the COSI has been to promote a greater focus on the patient's individual needs when designing a rehabilitation program. The other self-report inventories are too lengthy or may have questions that do not apply to the patient's specific lifestyle. Which of the following speech-recognition materials should the audiologist use to obtain the steepest possible performance-intensity function? A.Nonsense Syllable Test (NST) B.Central Institute for the Deaf, Test W-22 (CID W-22) C.Synthetic Sentence Identification (SSI) Test D.Northwestern University Auditory Test No. 6 (NU-6) Option (C) is correct. Performance level rises most steeply with small increases in intensity when the speech sample is large and provides some context; this is true of synthetic sentences, even though they do not provide as much context as natural sentences. In addition, the SSI allows the subject to pick out a word from a list, which provides additional clues. Individuals with normal hearing use multiple cues to localize sounds. Which of the following are primarily involved in localizing a siren with a frequency of 700 Hz700 hertz?

A.Interaural time and intensity differences B.Interaural time differences only C.Spectral cues and interaural intensity differences D.Interaural intensity differences only Option (B) is correct. The primary cues used for localization of sounds below 1500 hertz are interaural time differences. The other cues, interaural intensity differences and spectral cues, occur at high frequencies. Therefore, a signal with energy centered at 700 Hz would be localized using interaural time differences. Explain the anti kickback law and describe some examples The federal Anti-Kickback Statute (AKS) s a criminal statute that prohibits the exchange (or offer to exchange), of anything of value, in an effort to induce (or reward) the referral of business reimbursable by federal health care programs. Examples of prohibited kickbacks include receiving financial incentives for referrals, free or very low rent for office space, or excessive compensation for medical directorships. Other kickbacks include waving copayments, either routinely or on a selective case-by-case basis. The Centers for Medicare and Medicaid Services (CMS) claims that kickbacks have led to overutilization and increased costs of healthcare services, corruption of medical decision making, steering patients away from valid services or therapies and unfair, non-competitive service delivery. Possible penalties for violating the AKS include: fines of up to $25,000, up to five years in jail, and exclusion from Medicare and Medicaid care program business. Explain the stark laws and give some examples (Stark Laws)are a set of United States federal civil laws that prohibit physician self-referral, specifically a referral by a physician of a Medicare or Medicaid patient to an entity providing designated health services (DHS) if the physician (or his/her immediate family member) has a financial relationship with that entity. Although the financial penalties may be even greater than with the AKS, these are non-criminal charges. Penalties for violations of Stark Law include denial of payment for the DHS provided, refund of monies received by physicians and facilities for amounts collected, payment of civil penalties of up to $15,000 for each service that a person "knows or should know" was provided in violation of the law, and three times the amount of improper payment the entity received from the Medicare program, exclusion from the Medicare program and/or state healthcare programs including Medicaid and payment of civil penalties for attempting to circumvent the law of up to $100,000 for each circumvention scheme. Explain the false claims act and give some examples The False Claim Act is a federal law that makes it a crime for any person or organization to knowingly make a false record or file a false claim regarding any federal health care program, which includes any

plan or program that provides health benefits, whether directly, through insurance or otherwise, which is funded directly, in whole or in part, by the United States Government or any state healthcare system. Knowingly includes having actual knowledge that a claim is false or acting with "reckless disregard" as to whether a claim is false. In addition to the federal law, the state has adopted similar laws under the Michigan Medicaid False Claims Act (MMFCA). The MMFCA is designed to prevent fraud, kickbacks and conspiracies in connection with the Medicaid program. Examples of false claims include billing for services not provided, billing for the same service more than once or making false statements to obtain payment for services. HASP (Hearing aid selection profile) The purpose of the HASP is to include patients' self-perceptions in many areas related to core beliefs and attitudes that might impact the successful selection and fitting of amplification. he HASP is a 40-item self-report measure, to be given prior to the selection and fitting of hearing aids. It contains eight subscales, each consisting of five items. Three of the eight subscales address issues directly related to hearing aids (motivation, expectations and general communication needs) and 5 subscales contain items that assess a patient's perceptions and attitudes about issues not directly related to the use of hearing aids: cosmetics, attitude toward cost, attitude toward technology, physical functioning and lifestyle. CPHI communication profile for the hearing impaired The goal of the CPHI (Erdman & Demorest, 1990) is to identify up to five specific areas of listening difficulty and the degree of benefit obtained compared to that expected for the population in similar situations. The CPHI is a 145-item questionnaire addressing four areas: communication performance, communication environments, communication strategies, and personal adjustment. It has been normed on 827 patients at the Walter Reed Army Medical Center. HHIA/E The HHIA was designed to both quantify handicap and also assess benefit by measuring change in perceived handicap after the fitting of hearing aids. The 25-item HHIA has 2 subscales (emotional consequences and social and situational effects) that have been normed on 28 adults. Like the HHIA, the HHIE has 25 items with the same subscales used for the HHIA. The goal of the HHIE is to measure the perceived effects of hearing loss. Both the HHIE and the HHIA allow the patient to answer "yes", "no", or

"sometimes" to all 25 items on the questionnaire. The HHIA and the HHIE both have 10-item screening versions. COSI The Client Orient Scale of Improvement (COSI) was developed by the National Acoustic Laboratories (NAL) (Dillon, James, & Ginis, 1997). The COSI is an open-ended scale in which the patient targets up to five listening situations for improvement with amplification. The patient is able to choose up to 5 listening situation from a list of 16. The goal of the COSI is for the patient to target up to five specific listening situations and report the degree of benefit obtained compared to that expected for the population in similar listening situations.