Dysphagia Quiz 1
A healthy older adult chewing a mixed consistency allows the thin liquid to enter the pharynx filling the pyriform sinuses while chewing the solid part of the bolus. Is it the laryngeal anatomy, physiology, or both responsible for splitting the bolus in two until it reaches the pyriforms? A. Anatomy B. Physiology C. Both
A. Anatomy
Nasal regurgitation (escape of the bolus through the nasal passageway) can occur if the seal is incomplete. In order to create a seal and prevent leakage, the soft palate should move in a(n) ___________ and ____________ direction through contraction of the _____________ and ____________ muscles. A. elevated/posterior; palatoglossus/palatopharyngeus B. elevated/posterior; levator veli palatini/musculus uvulae C. depressed/anterior; palatoglossus/palatopharyngeus D. depressed/anterior; levator veli palatini/musculus uvulae
B
Strokes resulting in dysphagia can occur in many areas of the brain, but strokes occurring in the ____________________ are often the most devastating because this area is responsible for the spatial and temporal organization of the entire sequence of neuronal excitations and inhibitions that characterize a swallow. A. Frontal lobe B. Brainstem C. Primary sensory cortex D. Occipital lobe E. Cerebellum F. Primary motor cortex
B.
The thyrohyoid, sternohyoid, sternothyroid, and omohyoid are innervated by the ________________ plexus. A. Sacral B. Cervical C. Brachial D. Pharyngeal E. Peripheral
B.
Indicate whether the following sensations are general or special: Pressure Taste Smell Vibration Touch Hearing
General Special Special General General Special
Match the following functions to the nerve responsible for motor and/or sensory innervation: 1. General sensory from the ant 2/3 of the tongue, hard palate, and soft palates 2. General and special sensation from the post 1/3 of the tongue 3. Motor for all muscles of the face 4. Special sensory (taste) from the ant 2/3 of the tongue 5. Motor for all muscles of the jaw except geniohyoid 6. Motor for stylopharyngeus 7. Motor for all intrinsic laryngeal muscles 8. Motor for all intrinsic and extrinsic muscles of the tongue except palatoglossus 9. General sensory for the larynx and esophagus
1. CN V 2. CN IX 3. CN VII 4. CN VII 5. CN V 6. CN IX 7. CN X 8. CN XII 9. CN X
What factors are required for opening of the UES? (check all that apply): A. Laryngeal elevation B. Sensory innervation from CN V and CN IX C. Motor innervation from pharyngeal plexus D. Hyoid anterior movement E. Belching F. Bolus size G. All of the above H. None of the above
A and C
During VFSS, a young healthy patient is given 5mL boluses of thin liquids as well as cup sips of thin liquids (~20mL). What differences, if any, would you expect to see between these two bolus volumes? (choose all that apply) A. Increased duration of laryngeal closure with larger volumes B. Increased duration of laryngeal closure with smaller volumes C. Bolus located at a more superior position in the pharynx at the time of laryngeal closure with larger volume D. Bolus located at a more inferior position in the pharynx at the time of laryngeal closure with larger volume E. No difference between boluses
A and D
Eating and swallowing are complex behaviors that include both volitional and reflexive activities to achieve crucial biological features which include: (choose all that apply) A.bolus passage/efficiency B. heightened gag reflex C. quality of life D. bolus safety
A and D
When the pharynx is contracted, it aids in safety during the swallow by contributing to: (check all that apply): A. laryngeal elevation B. arytenoid adduction C. no residue left to be aspirated after swallow D. epiglottic inversion
A and D
The muscles of the soft palate primarily elevate and depress and their function impacts (choose all that apply): A. Swallowing B. Respiration C. Resonance
A, B, and C
A patient suffered a stroke in the pons of the brainstem. Which muscles responsible for motor function would be affected? (check all that apply): A. Mylohyoid B. Tensor veli palatini C. Levator veli palatini D. Obicularis oris E. Stylopharyngeus
A, B, and D
Indicate all of the events that are critical for laryngeal vestibule closure: A. Pharyngeal constriction B. Vocal fold adduction C. Laryngeal elevation D. Epiglottic inversion E. Weight of bolus F. Arytenoid approximation G. Tongue base retraction
A, C, D, F, G
In this video neuromuscular electrical stimulation (NMES) was applied to the anterior neck. Which muscles are likely being stimulated to induce the movement seen in this video? (choose all that apply): A. Sternohyoid B. Mylohyoid C. Anterior belly of the digastric D. Omohyoid E. Sternothyroid F. Geniohyoid
A, D, E
There is evidence of significant variability of hyoid and laryngeal displacement in both the anterior and superior planes of movement. Clinicians should recognize and consider this potential when making management decisions about oral feeding and compensatory strategies. Subjective decisions on videofluoroscopy should be made with caution. A. True B. False
A. True
While reading the patient's chart you notice that an infection has caused localized edema (swelling), putting pressure on the maxillary branch of the trigeminal nerve. What might you notice on this patient's oral motor exam? A. Sensory perception diminished/absent on soft and hard palate and tongue B. Change in airflow for sound production C. Restricted lateral and upward movement of the jaw D. A and C E. All of the above
A. Sensory perception diminished/absent on soft and hard palate and tongue
A patient that suffers a stroke affecting the corticobulbar pathway may still be able to swallow. A. True B. False
A. True
All extrinsic and intrinsic lingual muscles are paired: A. True B. False
A. True
Central control of both breathing and swallowing occurs in the brainstem and cerebral cortex. A. True B. False
A. True
Sensory input to the swallowing tract has three primary functions: 1) to assist in initiating the swallow, 2) to modify the threshold for a pharyngeal swallow, and 3) to alter the level of muscle recruitment during swallowing. A. True B. False
A. True
Swallowing can be initiated voluntarily via cortical pathways or can be triggered reflexively by the appropriate combination of stimuli arising from oral and pharyngeal sensory receptive fields. A. True B. False
A. True
The UES opens during belching. A. True B. False
A. True
The soft palate in the elevated/ posterior position helps to prevent nasal regurgitation during swallow, as well as builds positive pressure to encourage downward movement of bolus. A. True B. False
A. True
There is a period of apnea that occurs during the swallow, not only due to closure of the airway but also by elevation of the soft palate. A. True B. False
A. True
During FEES, a patient could not feel the scope. Then with further assessment with VFSS was found to have virtually no laryngeal movement. Which of the following is likely impaired and related to the pathologies? A. stylopharyngeus and sensation in nasopharynx related to CNIX B. thyrohyoid and sensation in laryngeal vestibule related to C1 and iSLN C. palatopharyngeus and sensation in posterior oral cavity related to pharyngeal plexus D. salpingopharyngeus and sensation in nasopharynx related with the CNIX
A. stylopharyngeus and sensation in nasopharynx related to CNIX
During a cardiac procedure, the surgeon injured the recurrent laryngeal nerve. What impairments are you most likely to see when you assess this patient at bedside? (Choose all that apply): A. Inability to significantly change pitch B. Breathy vocal quality C. Diminished vocal intensity D. Lingual deviation E. Incomplete bilabial seal
B and C
Different bolus volumes may impact normal pharyngeal and UES functions differently. Some bolus modifications might make movements easier, and others more challenging. With increasing bolus volumes, what pharyngeal and/or UES outcomes might you expect? (check all that apply) A. Nasopharyngeal regurgitation B. Increasing UES opening durations C. Decreasing duration of pharyngeal pressures D. Decreasing UES opening durations E. Increasing durations of pharyngeal pressures
B and E
During a swallow, longitudinal pharyngeal muscles are responsible for shortening the pharynx, while the constrictor muscles primarily elevate. A. True B. False
B. False
During swallowing, contraction of the sternothyroid muscle aids in UES opening. A. True B. False
B. False
Regardless of bolus size, closure of the laryngeal vestibule occurs superiorly to inferiorly. A. True B. False
B. False
A patient with reduced superior pharyngeal constriction also has difficulty with mastication. How can this be? (check all that apply): A. Superior constrictor muscles attach to the mandible responsible for mastication B. Superior constrictor muscles attach to bilateral buccinators involved in mastication C. Reduced pharyngeal constriction due to reduced lingual range of motion and bolus propulsion D. Pharyngeal plexus is not carrying information about the position of the bolus E. Reduced pharyngeal constriction is associated with reduced mastication
B. Superior constrictor muscles attach to bilateral buccinators involved in mastication
During the oral propulsive stage, the tongue tip rises via contraction of _____________ muscle(s) to touch the alveolar ridge of the hard palate. Also the posterior tongue drops to open the back of the oral cavity through contraction of the _____________. (Choose the best answer) A.Superior longitudinal and genioglossus; Styloglossus B. Inferior longitudinal; Styloglossus C. Superior longitudinal and genioglossus; Hyoglossus D. Inferior longitudinal; Hyoglossus
C
What factors are involved in modulating the opening of the UES prior to the swallow? (check all that apply): A. Laryngeal elevation B. Motor innervation from pharyngeal plexus C. Sensory innervation from CN V and CN IX D. Bolus size E. Belching F. Hyoid anterior movement G. All of the above H. None of the above
C and D
You go to the dentist and receive oral anesthesia for dental work which affects the tongue, soft palate, and floor of the mouth. This may result in: (check all that apply): A. Facilitation of swallowing modulation B. Decreased time to evoke repeated swallows C. Increased time to evoke repeated swallows D. Disruption of swallowing modulation E. Elimination of the swallow completely
C and D
Your patient suffered a devastating unilateral cortical stroke but you notice on VFSS that some swallowing function is preserved. Why is this? (check all that apply) A. The central pattern generator was damaged B. Damage occurred in the dominant swallowing hemisphere C. Swallowing musculature is bilaterally controlled D. Nerve deafferentation E. Both hemispheres play a role in the control of swallowing.
C and E
A healthy young person was talking and laughing while eating. The bolus entered the airway by draining down the posterior aspect of the upright epiglottis. When the bolus reached the vocal folds it elicited a cough and was eventually ejected. We might surmise that the following structure(s) are responsible for the bolus entering the airway: A. Pharynx (constriction and shortening) B. Arytenoids (adduction) C. Tongue (posterior lingual propulsion) D. All of the above
C.
The fundamental rhythmic pattern of mastication is controlled by the _________________________ and supplemented by the motor cortex. A. Insula B. Primary sensorimotor cortex C. Central pattern generator D. Cerebellum E. Thalamus
C.
Posterior lingual propulsion is the rapid forceful movement of the tongue that propels the bolus into the pharynx. This movement aids in __________. A. Bolus efficiency B. Airway protection C. Both
C. Both
This structure, which plays a role in both breathing and swallowing functions, has been shown to be responsible for the highest pressure generation on the bolus tail in order to ensure complete pharyngeal clearance and is also critical for airway maintenance as it forms the ventral wall of the respiratory pharynx . A. Velum B. Epiglottis C. Tongue D. Hyoid E. More than one above
C. Tongue
If the neck was cut midsagittally, __(a)__, __(b)__, and __(c)__ laryngeal cartilages would remain intact while __(d)__, __(e)__, and __(f)__ would be split in half. A. (a) thyroid, (b) cricoid, (c) arytenoids; (d) cuneiforms, (e) corniculates, (f) epiglottis B. (a) epiglottis, (b) thyroid, (c) cricoid; (d) arytenoids, (e) cuneiforms, (f) corniculates C. (a) cricoid, (b) cuneiforms, (c) corniculates; (d) thyroid, (e) arytenoids, (f) epiglottis D. (a) arytenoids, (b) cuneiforms, (c) corniculates; (d) thyroid, (e) cricoid, (f) epiglottis E. (a) arytenoids, (b) epiglottis, (c) thyroid; (d) corniculates, (e) cuneiforms, (f) cricoid
D. (a) arytenoids, (b) cuneiforms, (c) corniculates; (d) thyroid, (e) cricoid, (f) epiglottis
What factors contribute to bolus movement through the pharynx? A. Pharyngeal shortening B. Contraction of the pharyngeal constrictors C. Gravity D. Tongue base retraction E. UES opening F. All of the above
F. All of the above