Dysphagia Midterm
An HNC patient shows sore mouth and ulcers. She is only able to take liquids but not solids. What is the WHO grade for oral mucositis:
3
In general, thicker bolus viscosities will -Create less effort and movement in the swallow and tend to make it faster -Create less effort and movement in the swallow and tend to slow it down -Create more effort and movement in the swallow and tend to slow it down -Create more effort and movement in the swallow and tend to make it faster
Create more effort and movement in the swallow and tend to slow it down
The relaxation of this muscle opens the pharyngoesophageal segment during the esophageal phase of swallowing. Criocopharyngeus Palatopharyngeus Salpingopharyngeus Pharyngeal constrictors
Criocopharyngeus
True/False Swallowing is a process that happens in three distinct stages
False because the stages are overlapped and not distinct
True/False Pulsion diverticula form as a result of high extraluminal pressures against the esophageal wall:
False its intraluminal
True/False A vertical mouth opening of less than 45 mm is considered as trismus:
False... 35mm
Which statement is correct? -Feeding disorder refers to changes in dietary selections, and problems with the oral transport of the bolus -Eating disorder refers to impairment of the food transport outside the alimentary canal -Patients with eating disorders usually complain of swallowing problems -Feeding disorder may be used interchangeably with swallowing disorders for infants or children
Feeding disorder may be used interchangeably with swallowing disorders for infants or children
Comparing the feeding behavior in patients with Alzheimer and frontotemporal dementia which statement is CORRECT Patients with Alzheimer have better appetite Eating habits is less deviated in patients with frontotemporal dementia Swallowing problems is highly frequent in both groups Food preferences are increased in patients with frontotemporal dementia
Food preferences are increased in patients with frontotemporal dementia
What brain region is responsible for intent, initiation, coordination, organization, and timely execution of movement?
Frontal Lobe
This tool documents the type and amount of oral diet intake in patients with dysphagia:
Functional oral intake scale (FOIS)
Which statement is CORRECT regarding Gastroesophageal Reflux Disease? a 12-hour esophageal pH probe is standard practice for diagnosing GERD. GERD, with or without esophagitis, may cause esophageal dysmotility All events of gastroesophageal refluxes are pathologic. Patients with GERD have less frequent episodes of transient LES relaxations
GERD, with or without esophagitis, may cause esophageal dysmotility
Which muscle elevates the hyoid bone during swallowing? Omohyoid Thyrohyoid Geniohyoid Sternothyroid
Geniohyoid
A schatzki's ring is always noted in the presence of a ____.
Hiatal hernia
Which of the following is an appropriate treatment for Osteonecrosis? Physical Therapy Muscle relaxants Mandibular stretching exercises Hyperbaric oxygen therapy
Hyperbaric oxygen therapy
Which of the following interventions could help with both mucosal and muscle changes from radiation therapy for head and neck cancer?
Ice Chips
Which intervention may be beneficial for both mucosal and muscle changes following radiation therapy? Analgesics Pharyngocise Ice chips Medication
Ice chips
Passy Muir Valve in patients with tracheostomy can _________________________. Improve speech Increase upper airway secretions Restore olfaction (smell) Decrease ability to cough and clear secretions A and C
Improve speech and Restore olfaction (smell)
Dysphagia in Brainstem Stroke include all of the following EXCEPT Absent or delayed pharyngeal response Reduced hyolaryngeal excursion Reduced pharyngeal constriction Increased PES opening Generalized incoordination
Increased PES opening
What is the most common respiratory pattern during swallowing? Inhale-brief exhale- swallow apnea- finish exhale Brief exhale-inhale-swallowing apnea- finish exhale Swallowing apnea- brief exhale -inhale- finish exhale Brief exhale- swallowing apnea-Inhale- finish exhale
Inhale-brief exhale- swallow apnea- finish exhale
How do different medications may affect swallowing? Interfering with cognition and/or motor function. Causing xerostomia. Affecting GI functions. All of the above.
Interfering with cognition and/or motor function. Causing xerostomia. Affecting GI functions.
All statements regarding the Schatzki's rings are correct EXCEPT: Most common type of bandlike constriction of the esophagus This lesion is typically symmetric and located at the esophagogastric junction It is always noted in the presence of a hiatal hernia. It is a congenital disease.
It is a congenital disease.
Trismus may result from fibrosis of which group of muscles? Hyolaryngeal depressors Hyolaryngeal elevators Jaw depressors Jaw elevators
Jaw depressors
Which muscle lowers the mandible
Lateral pterygoid
Which of these treatments has been specifically used for dysphagia rehabilitation in patients with Parkinson s Disease? Transcutaneous Electrical Stimulation Lee Silverman Voice Treatment (LSVT) Bolus modification Oromotor exercises
Lee Silverman Voice Treatment (LSVT)
Which clinical population has the lowest prevalence rates for dysphagia?
Long term TBI patients
Which of the following is among the psychosocial consequence of dysphagia Aspiration Pneumonia Dehydration Loss of quality of life Malnourishment
Loss of quality of life
What is the possible cause of aspiration in patients with tracheotomy? Low subglottic air pressure Poor laryngeal elevation Increasing airway sensitivity Over active laryngeal closure reflex
Low subglottic air pressure
This tool is specifically designed to evaluate the effect of dysphagia on QOL in patients with HNC:
MD Anderson Dysphagia inventory (MDADI)
What behavioral strategy may improve structural movement restrictions in patients with HNC? Salivary stimulants Hyperbaric oxygen therapy Glossectomy spoons Mendelsohn Maneuver
Mendelsohn Maneuver
Please read the case scenario and answer the following four questions. David is 78 years old. He started to notice that he coughs more frequently during his mealtimes. Also, he sometimes has to swallow multiple times to clear his throat. He was referred to an SLP for a complete swallowing evaluation. The SLP noticed that there is a delayed pharyngeal response along with reduced hyoid elevation during swallowing. What is (are) the symptoms? (multiple answers may apply) Delayed pharyngeal response Reduced hyoid elevation Multiple swallows per bolus Coughing
Multiple swallows per bolus Coughing
Swallowing function worsen towards the end of the meal in patients with Polyneuropathy Myasthenia Gravis Polymyositis Scleroderma
Myasthenia Gravis
Which of these cancers may have no early dysphagia symptoms:
Nasal and hypopharyngeal
In order to fully understand the underlying cause of the problem, David should be referred to a(n)_________ . ENT Psychologist Gastroenterologist Neurologist
Neurologist
"Based on the existing evidence, feeding tubes in advanced dementia " Prevent aspiration pneumonia Prolong survival Reduce pressure sores or infections None of the above
None of the above
All statements regarding the neural control of swallowing are correct except Swallowing motor functions are bilaterally represented in the hemispheres One hemisphere is dominant for swallowing control and this is related to handedness If the dominant hemisphere is impaired a contralateral back up may be available No single location has been shown to be 'responsible' for swallow function Bilateral damage results in the greatest functional impairment
One hemisphere is dominant for swallowing control and this is related to handedness
All of these muscles are innervated by the trigeminal nerve except: Orbicularis oris Masseter Temporalis Medial pterygoid
Orbicularis oris
All statements are correct regarding Osteophytes EXCEPT _______________________. Bony changes in the cervical spine that may push on the posterior pharyngeal wall or esophagus, creating obstructive dysphagia. Osteophytes are secondary to a syndrome known as diffuse idiopathic skeletal hyperostosis. Osteophytes are more common in older adults and most are asymptomatic. Osteophytes larger than 2 mm are often associated with aspiration. Osteophytes typically at the C3 and C6 levels are most commonly symptomatic.
Osteophytes larger than 2 mm are often associated with aspiration.
Which of the following is considered a dysphagia symptom?
Pain when swallowing
Which muscle raises back of the tongue to keep the bolus in the mouth during chewing? Palatopharyngeus Digastric Buccinator Palatoglossus
Palatoglossus
All the following muscles are active during chewing EXCEPT Temporalis Masseter Medial pterygoid Palatopharyngeus
Palatopharyngeus
What brain region is responsible for recognizing and interpreting sensory functions related to swallowing?
Parietal lobe
A patient demonstrates repetitive tongue pumping along with velar and lingual tremors. What neurological problem best accounts for this patient's deficits?
Parkinson's
A patient demonstrates repetitive tongue pumping, velar tremor, and impaired laryngeal elevation. What neurological problem best accounts for this patient's deficits? Alzheimer's Myasthenia Gravis Brainstem Stroke Parkinson's
Parkinson's
Which group of patients usually have good stamina for dysphagia treatment? Patients in acute care Patients in rehab Patients in Skilled Nursing Facility Patients in Home Healthcare
Patients in rehab
A patient reports difficulty swallowing solids but no issues with liquids. However, he states that this problem has gotten progressively worse and is now accompanied by heartburn. Based on differential diagnosis, what is the likely cause of suspected esophageal dysphagia?
Peptic stricture
Strengthening exercises before _____ may benefit QOL and swallowing function in patients with HNC:
Radiation therapy
Which health professional performs the videofluoroscopy?
Radiologist
A patient with ALS demonstrates early swallowing problems. Which intervention would be most appropriate? Recommending double swallow Changing to soft diet Encouraging washing foods down with liquids to help move bolus Inserting PEG tube
Recommending double swallow
A patient underwent hemilaryngectomy. What deficit may she experience?
Reduced airway protection
A patient has undergone a glossectomy that involves the removal of > 50% of his tongue. What deficit may he experience?
Reduced tongue driving force
Aging can make the following changes on swallowing EXCEPT Reducing hyolaryngeal excursion Reducing pharyngeal constriction Increasing pharyngeal pressures Reducing PES opening and decreasing open time
Reducing pharyngeal constriction
A self-administered questionnaire for evaluating the LPR Reflux Finding Score Reflux Symptom Index Sydney Swallow Questionnaire Ambulatory acid (pH) probe test
Reflux Symptom Index
All the following are advantages of tracheostomy tubes over endotracheal tubes EXCEPT ______________________. The possibility for swallowing and speaking Less trauma to the vocal folds Patient comfort Requiring a surgical procedure to place the tube
Requiring a surgical procedure to place the tube
Which of the following sings might be the result of reduced tongue strength?
Residue in the oral cavity
Which statement is correct regarding the swallowing function during radiotherapy:
Saliva becomes ropey and thick
A narrow band of tissue comprised of mucosa and submucosa at the gastroesophageal junction is referred to as a ___.
Schatzki's Ring
Which statement is correct regarding the esophageal stage of swallowing? Primary peristalsis initiated by bolus distention of esophagus at any location Secondary peristalsis often assists in primary transport of solid food boluses Tertiary contractions are often orderly and peristaltic The Secondary peristalsis is the highest and therefore the strongest.
Secondary peristalsis often assists in primary transport of solid food boluses
A comprehensive definition of dysphagia should encompass.... -Signs, symptoms, and consequences -Signs, medical history, and quality of life -Sign, symptoms, and level of impairment -Patient chief complains and related consequences
Signs, symptoms, and consequences
The Physiologic reserve is: The difference between maximum pressure and sub maximum swallowing pressures The sum of maximum pressure and sub maximum swallowing pressures The sum of maximum pressure and sub maximum swallowing pressures divided by tidal respiratory capacity The difference between maximum pressure and sub maximum swallowing pressures divided by tidal respiratory capacity
The difference between maximum pressure and sub maximum swallowing pressures
All the following radiographic features of esophageal benign strictures are correct EXCEPT The length of narrowed esophageal segment is 1 cm or longer. The stricture is usually smooth. The narrowed lumen is symmetric. The narrowed lumen deviates from the normal path of esophagus.
The narrowed lumen deviates from the normal path of esophagus.
All the following statements regarding the neurological control of swallowing are correct EXCEPT -Multimodal sensory impulses are sent to the nucleus tractus solitarius (NTS), which initiates the pharyngeal swallow Higher control centers may be involved in continuing, modifying, and monitoring swallowing and also responding to input variability -The oral preparatory stage of swallowing is highly involuntary. -Motor function of swallowing is mediated by the nucleus ambigus (NA) via multiple cranial nerves
The oral preparatory stage of swallowing is highly involuntary
Most stroke patients recover functional swallowing ability within 1 to 6 ____:
months
Trismus refers to reduced :
mouth opening
Contraction of which muscle elevates the hyoid
mylohyoid
Based on the TNM system, the "T4" in T4N2M1" suggests that:
The tumor is large
All the following options may reduce mucositis EXCEPT Antacid solutions Artificial saliva Viscous lidocaine Therabite
Therabite
The oral stage of swallowing involves Mastication of food in preparation for transfer Transport of food from the pharynx to the esophagus Transfer of food from the mouth to the oropharynx Movement of food through the esophagus into the gastric cardia
Transfer of food from the mouth to the oropharynx
This cranial nerve plays a prominent role during pharyngeal swallowing. Trigeminal (V) Abducens (VI) Facial (VIII) Vagus (XII)
Vagus (XII)
The pharyngeal stage starts when a bolus arrives at ___ and ends when ____.
Valleculae, PES closes again
Swallow-generated pressures are most sensitive to changes in _____________. Volume Viscosity Taste Temperature
Viscosity
All of the following options may relieve xerostomia EXPECT:
Zinc sulfate supplements
To swallow while a tracheotomy tube is in place, one must:
occlude the stoma and deflate the cuff
Mendelsohn Maneuver
poor swallowing coordination
Late regurgitation of undigested food is a feature seen in patients with:
achalasia, zenker's diverticulum, esophageal diverticulum
What is sarcopenia:
age-related loss of muscle mass, strength, and function
Thyroplasty may help to improve:
airway protection
Deflating the cuff of a tracheotomy tube will prevent aspiration of secretions. prevent the air from leaking into the upper airway. restrict voice and limits swallow by anchoring the larynx. allow pulmonary air to flow to the upper airway
allow pulmonary air to flow to the upper airway
What is the laryngeal vestibule closure pattern during sequential straw swallows:
an opening of the laryngeal vestibule after each swallow, continued vestibule closure after each swallow, interchangeable vestibule opening and closing during the swallow sequence
Long-term use of ___ may cause tardive dyskinesia:
antipsychotics
Osteophytes (bony projections that happen because of aging) at the C3 level can cause:
aspiration, disrupt epiglottic inversion
Inflating the cuff of a tracheotomy tube will:
prevent air from entering the upper airway
Mandibulectomy
removal of a piece of the jawbone
Laryngectomy
removal of the entire larynx
Maxillectomy
removing all or part of the hard palate
Mandibulotomy
splitting the mandible to gain access to a tumor
Which level(s) of CNS is (are) responsible for refinement of motor functions? Subcortical Brainstem Cerebellum Peripheral nerves a and c
subcortical and cerebellum
Which esophageal peristaltic wave is abnormal during swallowing:
tertiary
The oral stage involves
transfer of food from the mouth to the oropharynx
True/False An acid level of <4.0 is abnormal and indicative of GERD:
true
True/False: Nucleus Tractus Solitarius (NTS) receives the sensory information in the medulla:
true
True/False Patients with total laryngectormy do not frequently have a risk of airway compromise during swallowing:
true because we completely separate the airway
SLPs should______ diagnose and treat esophageal dysphagia. understand how esophageal deficits and treatments impact oropharyngeal swallow functions. ignore signs and symptoms related to esophageal dysphagia because it is out of their scope of practice. consider strengthening the esophageal muscles as part of dysphagia rehabilitation.
understand how esophageal deficits and treatments impact oropharyngeal swallow functions.
Head-turn
unilateral pharyngeal weakness
thyroplasty
unilateral vocal cord paralysis
All the statements regarding TBI is correct except: a. Pneumonia is common in early posttraumatic course b. Recovery of swallowing function is generally poor c. Communication functions can impact assessment and treatment d. Treatment is multifactorial
b. Recovery of swallowing function is generally poor
Treatment in the early stage of a LMN disease would most typically include:
behavioral compensations (changing diet to posture to certain maneuvers)
This muscle holds food in contact with the molars during chewing:
buccinator
Treatment for osteophytes can include all the following except: a. Avoiding solid foods b. Surgery c. Chin-down maneuver d. Strengthening the swallowing muscles
d. Strengthening the swallowing muscles
Swallowing deficits after hemispheric stroke may include all EXCEPT:
decreased pharyngeal transit duration
Chin-down
delayed phayrngeal swallow
A common problem for a patient with a total laryngectomy is:
difficulty swallowing solids
Sialorrhea means:
drooling
What is the best term to describe David's problem? Feeding disorder Anorexia Dysphagia Bulimia nervosa
dysphagia
All the following are parts of clinical examination except:
identifying patients who are at risk of dysphagia
Dysphagia treatment in HNC should focus on:
improving bolus transport, improving airway protection, relieving impact factors
Dysphagia in brainstem lesions is characterized by
incoordination between swallowing stages, muscular weakness, and incomplete swallow
Which of the following characteristics are seen in patients with COPD
ineffective cough reflex, increased GERD, swallow decompensation, physical fatigue
Which one is NOT considered as clinical symptoms of dysphagia? -Food sticking -Reduction in tongue strength -Coughing and choking during and/or after a meal -Pain on swallowing
-Reduction in tongue strength
MDADI
A patient-report questionnaire to describe the effect of dysphagia on QOL
The highest prevalence of dysphagia is in the ______ phase of stroke. -Acute -Subacute -Long term -Rehabilitative
Acute
All the followings are mechanisms of the pharyngoesophageal segment opening EXCEPT Mechanical traction Brainstem disinhibition Bolus driving forces Aerodynamic traction
Aerodynamic traction
Patients with HNC may regain the ability to taste Following the surgical insertion of a flap After radiation therapy has ended During the early stages of radiation therapy If they receive anesthetics during the course of cancer treatment
After radiation therapy has ended
Dysphagia in brainstem is characterized by: Incoordination between stages and between swallowing and respiration Muscular weakness incomplete swallow All of the above
All of the above
The coordination of swallowing gestures based on different bolus characteristics is called Bolus accommodation Swallowing reflex physiologic reserve Sarcopenia
Bolus accommodation
The Pharyngeal Stage begins when the PES opens Bolus arrives at valleculae Epiglottis inverts Hyoid bursts
Bolus arrives at valleculae
With an endotracheal tube, a patient can _____.
Breathe
A 65 year-old patient complains that his ability to swallow solid foods has been getting worse over the last couple of months. He has no complain about the heartburn. Based on the differential diagnostic decision tree, what is the potential cause of his dysphagia? Rings or webs Peptic stricture Carcinoma Achalasia
Carcinoma
Swallow apnea occurs when the bolus:
Collects at the vallecular level
Which of the following is a sign of dysphagia
Delay in oral bolus propulsion
What are the signs? (multiple answers may apply) Coughing Delayed pharyngeal response Multiple swallows per bolus Reduced hyoid elevation
Delayed pharyngeal response Reduced hyoid elevation
Which of the following signs is likely observed in stroke patients with dysphagia Increased self-feeding cues Decreased pharyngeal transit duration Lingual tremor Delayed triggering of pharyngeal swallow
Delayed triggering of pharyngeal swallow
What is the most common oropharyngeal swallowing problem in treated HNC patients:
Dry mouth
All statements regarding Iatrogenic dysphagia are correct EXCEPT ____________________________. Dysphagia after anterior cervical fusion worsens over time. Patients who undergo esophagectomy may be at risk for oropharyngeal dysphagia. Surgical procedures that involve the base of the skull and brainstem potentially can affect the peripheral cranial nerves important for swallowing. Patients with burn injuries may be vulnerable to swallowing disorders as a result of respiratory complications and direct injury to the tissue and structures in the mouth and pharynx.
Dysphagia after anterior cervical fusion worsens over time.
All of the following characteristics are likely seen in malignant conditions of the esophagus EXCEPT:
Dysphagia initially occurs for liquids
Dysphagia therapy for patients with HNC are most effective when they begin Early, before RT and/or chemotherapy onset In combination with RT and/or chemotherapy Later, after the patient has recovered from RT and/or chemotherapy side effects As soon as the patients report they are ready
Early, before RT and/or chemotherapy onset
What is the advantage of a tracheotomy tube compared to an endotracheal tube?
Easy suctioning of the lungs, less trauma to vocal folds, patient comfort
A(n) _____ tube is temporarily placed through the mouth to improve respiratory distress:
Endotracheal
All statements are correct regarding endotracheal tubes EXCEPT ________________. These tubes are inserted through the mouth, through the vocal folds, and into the trachea to aid the patient with respiratory distress. They are designed to be connected to a respirator to help the patient breathe. At the end of the tube is a cuff that is inflated to prevent oral secretions from entering the lungs by sealing the tracheal lumen and to keep air from escaping from the lings past the tube. Endotracheal tubes are usually placed permanently to support the patient's respiratory competence.
Endotracheal tubes are usually placed permanently to support the patient's respiratory competence.
Which statement is CORRECT regarding the differences between GERD and LPR? In LPR, most events happen during nighttime. GERD require higher medication doses for symptom control Esophageal motility and acid clearance mechanisms are usually normal in LPR. All of the above
Esophageal motility and acid clearance mechanisms are usually normal in LPR.
What is the consequence of medication sticking in the esophagus? GERD Esophagitis Laryngeal spasm Achalasia
Esophagitis
SSQ
a patient-report survey of swallowing difficulty with different foods/liquids
MASA-C
a standard clinical assessment tool for dysphagia in patients with HNC
FOIS
a tool to document the type and amount of oral diet intake
Dysgeusia refers to __________ and usually is a(n)__________ side effect of radiotherapy. a) Reduced acuity of tastes_ late b) Reduced acuity of smells_ immediate c) Reduced acuity of tastes_ immediate d) Reduced acuity of smells_ late
a) Reduced acuity of tastes_ late
The traditional 50% rule in head and surgery indicates that a) Removal of less than 50% of a structure will not result in a significant swallowing problem b) Removal of more than 50% of a structure will not result in a significant swallowing problem c) At least 50% of patients experience dysphagia immediately post-surgery d) At least 50% of patients experience dysphagia at least one year post-surgery
a) Removal of less than 50% of a structure will not result in a significant swallowing problem
Which of these side effects can appear later after radiotherapy a) Skin redness and or irritation b) Dental carries c) Fatigue d) Dry cough / sore throat (mucositis)
b) Dental carries
All of the following side effects after radiotherapy are due to changes in the mucosal tissue EXCEPT a) Xerostomia b) Neuropathy c) Mucositis d) Edema
b) Neuropathy
Dilation is appropriate form of esophageal dysphagia treatment for all the following disorders EXCEPT: a. Achalasia b. Diffuse esophageal spasm c. Rings and webs d. Benign strictures
b. Diffuse esophageal spasm
What is the effect of partial pharyngeal resection on swallowing? a) Difficulty holding and preparing a bolus for swallowing b) Reduced tongue driving force c) Difficulty clearing materials from the pharynx d) Retrograde movement of materials into the nasopharynx
c) Difficulty clearing materials from the pharynx
All of the following can be immediate side effect of surgery to head and neck except a) Swelling in mouth/throat impairing respiration b) Impaired speech/voice c) Mucosal fibrosis and atrophy d) Difficulty chewing/swallowing
c) Mucosal fibrosis and atrophy
A patient with ALS demonstrates early swallowing problems (stage 2). All interventions would be appropriate except: a. Avoiding distractions b. Training choking first aid c. Permanent tube placement d. Training chin tuck
c. Permanent tube placement
T4N2M0 means a) Tumor is small, has not invaded neighboring lymph nodes, and has not spread to other body organ systems." b) Tumor is large, has invaded neighboring lymph nodes, and has metastasized to other body organ systems." c) Tumor is small, has invaded neighboring lymph nodes, but has not spread to other body organ systems." d) Tumor is large, has invaded neighboring lymph nodes, but has not spread to other body organ systems."
d) Tumor is large, has invaded neighboring lymph nodes, but has not spread to other body organ systems."
Which symptom specifically relates to cancer at the glottal level? a) white or red patch on gums b) pain on swallow c) lump or thickening of cheek d) hoarseness stridor
d) hoarseness stridor
All of these symptoms can be related expilicitly to the HNC EXCEPT: a. Sore throats that do not heal b. Thickening or lump in the neck c. Dysphagia d. Nagging cough or hoarseness e. Indigestion
e. Indigestion
Which of the following is a passive movement subsequent to bolus driving force during pharyngeal swallow:
epiglottic inversion
Unlike GERD, LPR may include:
episodes during the day without nighttime occurrences
Tracheostomy
establishing a hole in the anterior neck (stoma) into the trachea to establish an airway
Saliva production regulates all the following actions EXCEPT:
facilitating velopharyngeal closure
True/False Compared with Alzheimer's dz, patients with frontotemporal dementia have less deviated eating habits
false
True/False: The cricopharyngeal muscle contracts during the pharyngeal stage of the swallow:
false because it relaxes
All the following are medial consequences of dysphagia except:
family stress