Dysphagia Midterm Review

Approximately how long after a stroke does the nutritional status begin to improve?

1 month

The effect of a successful Botox injection into the lower esophageal sphincter lasts on average for __________.

1 to 4 years

The majority of acute stroke patients recover functional swallowing within ___________.

1 to 6 months

Patients with laryngopharyngeal reflux differ from those with classic GERD in which of the following ways?

1.Higher doses of medication are needed for longer periods 2. Esophageal motility and acid clearance mechanisms are normal 3.Most events occur during the day without nighttime episodes

Asymptomatic Schatzki's rings are detected in approximately ___% of the population.

10%

Patients with sensory deficits may demonstrate a variety of dysphagia characteristics such as:

1. Hypopharynx residue 2. Retention of a portion of a bolus in the mouth 3. Oropharynx residue

Clinical examination of swallowing includes:

1. Medical history 2. Physical evaluation 3. Test swallows, if appropriate

Which of the following is a common intrinsic structural abnormality that narrows the esophagus?

1. Mucosal rings 2. Malignant tumors 3. Benign structures

Several things are the same for the fluoroscopic and the endoscopic swallowing evaluations. They both:

1. Provide dynamic imaging of the swallowing mechanism and performance 2.Use multiple bolus volumes and textures 3.Have the potential to evaluate the impact of compensatory maneuvers on swallowing safety and efficiency

Most TBI patients will regain some functional swallowing ability within:

3 to 6 months

As many as ________ of patients with scleroderma have swallowing-related complaints.

90%

In most studies of esophageal acidification, a pH of ____ or less is considered abnormal.

4.0

The characteristics of spastic dysarthria are believed to be the direct result of spasticity in the _______ system governing speech production.

Corticobulbar

If the clinician notes aspiration of saliva, what might a corresponding patient symptom be?

Coughing when not eating

Asking the patient to bite down while palpating the response of the masseter muscles provides information about the integrity of the motor function of which cranial nerve?

Cranial Nerve V

Damage to this nerve can prevent the lips from maintain the bolus in the mouth

Cranial Nerve VII (Facial)

Damage to this nerve can reduce sensation to the posterior 1/3 of the tongue, the velum, and the upper pharynx

Cranial nerve IX (Glossopharyngeal)

This nerve innervates the masseter and other muscles involved in chewing

Cranial nerve V (Trigeminal)

This nerve controls the muscles involved in the esophageal phase of swallowing

Cranial nerve X (Vagus)

Damage to this nerve can affect the tongue's ability to propel the bolus back

Cranial nerve XII (Hypoglossal)

This sphincter muscle relaxes during the swallow.

Cricopharyngeus

Contracts at rest to form UES

Cricopharyngeus muscle

The purpose of a videofluoroscopic swallow study is to:

Examine swallow pathophysiology and trial compensatory strategies as indicated

Coughing and choking during or after a meal, food sticking, regurgitation, odynophagia, drooling, unexplained weight loss, and nutritional deficiencies tell us that the patient might be ___________?

Experiencing dysphagia

One advantage of FEES in comparison to videofluoroscopy is:

FEES is a portable examination and can be done at the patient's bedside

Which nerve flattens the cheeks?

Facial Nerve

Which nerve innervates the stylohyoid and elevates the hyoid bone and tongue base?

Facial Nerve

Which nerve closes, opens, protrudes, inverts, and twists lips?

Facial nerve

Which nerve innervates the buccinator muscle?

Facial nerve

A patient's report of symptoms is a highly reliable diagnostic indicator of the underlying dysfunction.

False

An instrumental examination should always precede a clinical examination.

False

Compensatory maneuvers should not be introduced during a standardized fluoroscopic swallowing examination

False

Excessive pooled secretions (saliva) in the larynx can be visualized with both fluoroscopy and endoscopy.

False

For patients with dementia, feeding tubes are effective in reducing rates of aspiration pneumonia and improving nutritional status.

False

It is the role of the speech-language pathologist to diagnose and treat dysphagia of esophageal origin.

False

Oral cavity and esophageal structure and function are part of the typical endoscopic swallow evaluation.

False

Patients realize that repeated bouts of pneumonia and weight loss are consequences of their dysphagia.

False

Polyneuropathy literally means "pathology to the brainstem."

False

Respiration does not cease during swallowing.

False

Scleroderma is an inflammation of striated muscle tissue.

False

Swallowing disorder and feeding disorder are both the same.

False

The duration of the pharyngeal muscle contraction is affected by bolus size, with larger boluses requiring extended periods of contraction.

False

The esophagus has two sphincters, the upper esophageal sphincter (UES) and the pharyngoesophageal segment (PES).

False

Unilateral strokes produce the most severe dysphagias.

False

Webs and rings typically produce dysphagia for liquids only.

False

When you are assessing the patient's level of alertness you are assessing their feeding method

False

___________ is an impairment in the process of food transport outside the alimentary system.

Feeding disorder

Where is the swallowing function represented in the human cortex?

Frontal lobe

Which lobe is responsible for the multiple aspects of motor control, ranging from intent and initiation of movement to coordinating a movement in time and space to executing the movement in an organized and timely fashion?

Frontal lobe

Which muscle has an origin at the mental spine of the mandible and an insertion at the hyoid bone?

Geniohyoid

When patients complain that food or fluids "get stuck," the medical term for this feeling is ________?

Globus

Use of anesthesia during FEES

Has been found to result in higher Penetration-Aspiration scale scores

Information (memories) relating to smell may be stored in the:

Hippocampus

Connected by muscles to the floor of the mouth and the larynx, it moves superiorly and anteriorly during the pharyngeal phase

Hyoid bone

Which nerve innervates the styloglossus muscle to bring the tongue up and back?

Hypoglossal

During test swallows in a clinical exam, the safest item to start with is:

Ice chips

Generally, the shape of the tongue is controlled by

Intrinsic tongue muscles

One reason to consider use of a standardized protocol for videofluoroscopic swallow studies is:

It allows for cross-examination comparisons to enable clinicians to monitor treatment outcomes

Which is NOT a strength of endoscopy?

It can visualize the entire swallowing mechanism from the lips to the esophagus.

Which of the following is NOT a strength of the fluoroscopic swallowing study?

It truly reflects a patient's functional eating abilities.

Stasis refers to:

Lack of movement; stoppage of flow

Penetration occurs when food or liquid enters this

Laryngeal Vestibule

Initially during the swallow study, the patient is seated and viewed from the ________ perspective.

Lateral

When a patient complains of excessive drooling, what might the clinician note in a clinical exam?

Lip or tongue weakness

Which mechanism is NOT responsible for preventing the bolus from entering the airway?

Mastication through the use of buccinator muscle (responsible options = approximation of true and false vocal folds, closure of laryngeal aditus and tongue base movement over rising larynx, and cessation of active respiration)

Which standardized test was developed to clinically assess a patient's functional eating skills in a natural environment?

McGill Ingestive Skills Assessment

What type of intervention may include a change in medication negatively affecting mental status and swallow or the placement of a nasogastric tube?

Medical

According to Yorkston, Miller, and Strand, delay in the swallow reflex in a Parkinson's patient means what type of disability?

Moderate

The most common x-ray technique that assesses the oral, pharyngeal, and cervical esophageal phases of swallowing is called:

Modified Barium Swallow Study

Research indicates that duration of radiation exposure is longer for:

More severely impaired patients

This is a disease process in which the neurotransmitter substance between motor nerves and muscles is depleted with use.

Myasthenia Gravis

______ is the surgical relaxation of a muscle or group of muscles.

Myotomy

What does the palatoglossus do?

Narrows fauces and elevates posterior tongue

Majority of patients with oropharyngeal dysphagia have swallowing impairment as a result of:

Neurological disease

What is the leading cause of dysphagia?

Neurological disorders like stroke, MS, and Parkinson's disease

Weaknesses/potential hazards regarding endoscopy include:

Nosebleeds

Instrumental studies of swallowing provide what kind of results?

Objective

Which muscle is NOT in the suprahyoid muscle group?

Omohyoid

Videofluoroscopy is the examination of choice when:

One wishes to determine extent and duration of hyolaryngeal excursion

Swallowing behaviors are usually divided into four stages. Which stage entails the transfer of material from the mouth to the oropharynx?

Oral Stage

What stage of swallowing would be of particular interest to a dentist?

Oral phase

Swallowing behaviors are divided into four stages. Which stage is where the food is masticated prior to transfer?

Oral preparatory stage

What is the most common type of dysphagia seen in patients with dementia?

Oral stage dysphagia

Odynophagia refers to:

Painful swallowing

Which muscle is responsible for shutting off the nasopharynx during the second stage of swallowing?

Palatopharyngeus

Damage to the motor tracts leaving the primary motor strip in the posterior frontal lobe (upper motor neurons) results in:

Paresis or paralysis of the corresponding body area

Suspected esophageal dysphagia for solid foods only, that is progressive in nature, and accompanied with heartburn would likely be diagnosed as:

Peptic stricture

Swallowing behaviors are usually divided into four stages. Which stage is happening when the material is transported away from the oropharynx, around an occluded laryngeal vestibule, and through a relaxed cricopharyngeus muscle into the upper esophagus?

Pharyngeal Stage

_______ are lateral protrusions on the pharyngeal wall seen at the level of the thyrohyoid membrane.

Pharyngeal pouches

The glossopharyngeal nerve is important during which stage of swallowing?

Pharyngeal stage

What type of sickness is commonly noted in acute stroke patients?

Pneumonia

Suspected esophageal dysphagia for both solids and liquids, that is progressive nature, and accompanied with heartburn would likely be diagnosed as:

Progressive systemic sclerosis

These spaces are created where the inferior constrictor attaches to the thyroid cartilage

Pyriform sinuses

Damage to the sensory tracts arriving in the primary sensory strip of the anterior parietal lobe results in loss of __________.

Recognition of sensory stimuli in the corresponding body area

_________ is a level of health care that is not acute, but is more oriented toward rehabilitation.

Rehabilitation

When comparing accuracy of videofluoroscopy to FEES, research indicates:

Residue tends to be perceived as being greater (larger amount) on FEES compared to videofluoroscopy

The esophagus may be narrowed by a band of tissue composed of mucosa and submucosa. This type of lesion is called a ______ when located at the esophagogastric junction and a _________ when located elsewhere in the esophagus or hypopharynx.

Ring, web

One aspect of swallowing that can be observed on FEES but not on videofluoroscopy is:

Secretions within the pharynx and possible aspiration of secretions

Most patients with dysphagia resulting from a neurologic disorder also have:

Sensorimotor deficits

Drooling is sometimes called ________?

Sialorrhea

Observed drooling, choking, respiratory congestion after eating, and fatigue in eating are ___ of dysphagia.

Signs

What type of setting does a patient go if they haven't responded to attempts at rehabilitation, are not candidates for rehabilitation after their acute hospitalization, are too ill to be at home, or have chronic medical conditions that require monitoring in a structured environment?

Skilled Nursing Facility

What is an example of swallowing deviation in a mild stage dementia?

Slow or delayed pharyngeal response

Patients who are admitted to this type of setting are usually not ready for a strenuous rehabilitation program. They may require additional medical monitoring but not the type of costly care of an acute admission associated with intensive care.

Subacute Care Setting

The first of the muscles to contract in the pharyngeal phase to propel the bolus down though the pharynx

Superior Pharyngeal constrictor

What type of intervention might include mobilization of a weak vocal fold or the placement of a gastrostomy tube?

Surgical

Globus sensation, heartburn, and loss of pleasure associated with eating are all _____ of dysphagia?

Symptoms

The gastroenterologist who participates on the swallowing disorders team usually has a special interest in ______?

The esophagus

Patients with LPR and GERD are similar in which of the following ways?

The pharyngeal esophageal segment and LES often are normal

Brainstem stroke often results in severe dysphagia because

They can impair overall swallow coordination as well as cause muscle weakness and sensory deficits

__________ is a plastic tube placed through a surgical incision in the neck below the level of the vocal folds to help the patient breathe

Tracheostomy tube

What typically results in diffuse neurologic deficits that affect several aspects of behavioral control?

Traumatic brain injury

A potential complication of patients with oropharyngeal dysphagia is aspiration pneumonia.

True

ASHA provides a statement of guidelines for speech-language pathologists (SLPs) who perform the modified barium swallow.

True

Both the fluoroscopic and endoscopic examinations are intended to provide an objective assessment of the anatomy and physiology of the upper aerodigestive mechanisms used in swallowing.

True

Cerebellar damage results in unsteadiness (ataxia), intention tremor, and hypotonia.

True

Clinicians must decide how much of the standard protocol to complete for any given patient.

True

Disorders specific to the region of the PES include cricopharyngeal bars, lateral pharyngeal pouches, and Zenker's diverticulum.

True

During a fluoroscopic study, general categories of viscosity or textures include thin liquid, thickened liquid, paste or pudding, and masticated material.

True

During the endoscopic swallowing study, a period of whiteout occurs at the point of maximal pharyngeal constriction.

True

External compression of the esophagus, such as from an enlarged heart, could narrow the lumen of the esophagus and result in dysphagia.

True

Fluoroscopy is considered to provide the more comprehensive perspective, including structures from the lips to the stomach when compared to the endoscopy.

True

For TBI patients, the severity of the initial injury is a strong predictor of the presence of swallowing deficits and the time to recovery of functional swallowing ability.

True

In persons older than 65 years, some demonstrable changes in swallowing performance are attributable to age alone. These changes may interact to decompensate swallowing. Some of these changes may appear as early as age 45 years.

True

Oculopharyngeal muscular dystrophy is a slowly progressive disorder characterized by dysphagia, dysarthria, ptosis, and face and trunk weakness.

True

Polymyositis is an inflammation of striated muscle

True

The clinical examination of swallowing fails to detect all patients who aspirate and patients who do not aspirate.

True

The most common mistake in the treatment of esophageal dysmotility is to assume that the patient has a primary disorder of esophageal motility.

True

The prevalence of dysphagia is highest in those with neurologic disease.

True

The process of aging alone does not create dysphagia but may contribute to it.

True

Aspiration occurs when food or liquid passes this structure

True Vocal folds

What position should the patient be in for an instrumental examination to get accurate results?

Upright position

What position is best for swallowing

Upright posture

For a patient with ALS, what intervention would the clinician do if solid foods were too difficult to eat?

Use chin-tuck position

The spaces between the tongue and the epiglottis

Valleculae

As the bolus enters the pharynx, it is divided by _________ to help deflect it away from the airway.

Valleculae spaces

Retracts and elevates to close off the nasal cavity during swallowing

Velum

When does the pharyngeal stage end?

When the PES closes

When does the pharyngeal phase begin?

When the bolus arrives at the level of the valleculae

If the comprehensive clinical examination fails to thoroughly address the clinical questions posed by the patient and/or problem, is the instrumental examination needed?

Yes, definitely needed

Signs of dysphagia are:

objective measurements or observations of behaviors that people elicit during a physical examination.

Physical examination of a patient with dysphagia may begin with?

asking the patient to describe the symptoms they are having.

Fasciculations are:

small, involuntary muscle contractions consistent with lower motor neuron damage.

The biggest limitation of the endoscopic swallowing study is:

the relatively limited scope of view

Cervical auscultation involves:

using a stethoscope to listen to sounds associated with swallowing.

Which strategy is not a common compensatory maneuver?

yawn -sigh

Therapeutic interventions for patients with degenerative diseases often focus on:

diet modifications and compensatory strategies

A good screening test for dysphagia will have:

high sensitivity and high specificity

Structures of the larynx from superior to inferior placement are:

hyoid, thyroid cartilage, cricoid cartilage

Normal laryngeal elevation ranges from ______.

2 to 4 cm

ASHA estimates that __________ Americans show some degree of dysphagia.

6 to 10 million

Patients with ALS will show:

A mixture of spastic and flaccid weakness

Patients with physical limitations from weakness, fatigue, disease, or other reasons may require special positioning for their examination. What does the clinician use?

A positioning chair

The care of patients in whom dysphagia is suspected usually begins with _________?

A process of identification in an attempt to determine if dysphagia is present

The brainstem is also believed to be home to _____?

A swallowing center

Hypertrophy refers to:

Abnormal enlargement of a structure

Where is the nasopharynx?

Above the oropharynx

______ is a condition in which a nonrelaxing or incompletely relaxing LES prevents the passage of swallowed material into the stomach.

Achalasia

When is the greatest risk for dysphagia when the patient has had a stroke?

Acute (0-1 month)

_______ is short-term health care offered in a hospital or emergency department for an illness with severe of rapidly developing symptoms.

Acute Care Setting

Patients whose dysphagia is related to the head and neck may see:

An SLP, a dentist, and a neurologist

In some patients, the activity of the superior pharyngeal constrictor muscle can be observed after_____.

An active gag reflex or a falsetto voice

What is the key element in the fluoroscopic swallow study?

Barium Sulfate

Retracts to meet the posterior pharyngeal wall during the pharyngeal phase

Base of tongue

Dysphagia intervention with a patient with dementia should involve?

Basic principles of quality of life, dignity, and comfort

What type of intervention includes engaging the patient in some change in swallowing behavior, such as changing the patient's posture or eating rate?

Behavioral

Contraction of these muscles prevents the bolus from falling into the lateral sulci

Buccal Musculature

The extrinsic muscles (except palatoglossus) of the tongue depend on which two cranial nerves for motor function?

CN V and CN XII

During the cranial nerve assessment, which nerve is being assessed when you ask the patient to pucker and smile?

CN VII (Facial)

Clinical observations of the tongue range of motion, tongue strength and fasciculations (atrophy) is for what cranial nerve?

CN XII

Research indicates that, when interpreting videofluoroscopic swallow studies, clinicians:

Can achieve good reliability for Penetration-Aspiration scale scores, but only with training to criteria

The _______ is a funnel-shaped opening, as in the space in the posterior nasal cavity behind the septum.

Choana

What may occur over time, increasing the utility of the intact nondominant hemisphere to control swallowing motor functions?

Cortical plasticity

__________ is defined as the removal of a tube, as in a tracheostomy.

Decannulation

Reducing pulse rate during a videofluoroscopic swallow study:

Decreases amount of radiation exposures

Water tests, measures of oxygen saturation levels, cervical auscultation, and the Evans Blue dye test are all tests to _____?

Detect aspiration

What type of intervention might include modifications of texture, taste, or volume?

Dietary

Suspected esophageal dysphagia for both solids and liquids, that is intermittent and often accompanied with chest pain would likely be diagnosed as:

Diffuse Spasm

Xerostomia refers to:

Dry mouth

Parkinson's disease, amyotrophic lateral sclerosis and multiple sclerosis are progressive neurological diseases which frequently result in ______?

Dysphagia

What is "an impairment of emotional, cognitive, sensory, and/or motor acts involved with transfer of food from the mouth to stomach"?

Dysphagia

If the patient has a medical condition that has a high risk for dysphagia, is an instrumental examination needed?

Examination May be indicated

If the patient's condition in too medically compromised or the patient is too uncooperative to complete the procedure, what is the recommendation for an instrumental examination?

Examination Not indicated

Anorexia and bulimia nervosa are _____?

Eating disorders

Appropriate movement of the hyolaryngeal complex is responsible for movement of what structure during swallowing?

Epiglottis

Inverts during the pharyngeal phase to provide a level of laryngeal protection

Epiglottis

Swallowing behaviors are divided into four stages. Which stage is happening when the material is transported through the esophagus into the gastric cardia?

Esophageal stage

________ refers to the inflammation of the lining of the esophagus.

Esophagitis

When patients report dysphagia for liquids and solids without choking episodes, they may have a more _________-focused cause.

Espohageal

What is the test where suctioning is required every 15 minutes for an hour?

Evans blue dye test