D1 Part 4

Front 1

the clinician begins to examine a patient from

Back 1

history taking, chart review, patient descriptions, and bedside eval

Front 2

the videofluoroscopy should be completed on any patient whose disordered deglutition

Back 2

is not clearly limited to the oral cavity or who may be aspirating

Front 3

the clinician uses info from the videofluoroscopy study to (3 things)

Back 3

1. define anatomic or neuromuscular dysfunction 2. determine the recommendation as to whether or not the person should eat by mouth and the conditions under which to eat and what consistencies of food 3. plan direct or indirect treatment appropriate for the specific swallowing disorders

Front 4

normal mastication requires

Back 4

an intact mandible and maxilla and intact buccal and lingual musculature

Front 5

when food falls from teh mouth anteriorly, it is an indication of

Back 5

reduced lip closure

Front 6

if a patient has reduced ability to shape the tongue around the liquid or paste, what will happen

Back 6

material will immediately spread throughout the oral cavity

Front 7

if the soft palate cannot or does not bulge anteriorly to contact the back fo the tongue,

Back 7

food can be lost into the pharynx prematurely

Front 8

inability to hold a bolus is an indication of

Back 8

reduced tongue coordination.

Front 9

premature loss of liquid or paste into the valleculae is an indication of

Back 9

reduced anterior soft palate positioning and/or poor tongue control

Front 10

if a patient has ______________, he or she will have difficulty in pulling food back together into a cohesive bolus

Back 10

reduced range or coordination of tongue movement

Front 11

food falling into the anterior sulcus is an indication of

Back 11

reduced labial and facial muscle tone

Front 12

material falling into the lateral sulcus ans the patient chews is an indication of

Back 12

reduced musce tension or tone in the buccal musculature

Front 13

an abnormal hold position is an indication of

Back 13

reduced tongue control or tongue thrust

Front 14

oral transit terminates when

Back 14

the pharyngeal swallow is triggered

Front 15

the swallow is triggered from sensory input to cranial nerve

Back 15

IX (glossopharyngeal)

Front 16

delayed oral onset of swallow is an indication of

Back 16

apraxia of swallow or reduced oral sensation

Front 17

when the bolus is held in the mouth with no lingual movment it could indicate

Back 17

1. severe swallow apraxia, 2. reduced oral sensation 3. lack of recognition of the bolus as something to be swallowed (oral tactile agnosia)

Front 18

for patients with delayed oral onset of swallow, the clinician can increase sensory stim by increasing

Back 18

the pressure of the spoon on the tongue as the bolus is presented, using a cold bolus, a larger bolus, a stronger tasting bolus, or a textured bolus, which may cause the oral swallow to begin

Front 19

searching tongue movements are an indication of

Back 19

apraxia of swallow - good range of motion but inability to organize the front-to-back linguagl and bolus movement.

Front 20

refrain from giving any _______ to __________ to the swallow apraxic

Back 20

commands to swallow

Front 21

tongue that moves forward to start the swallow is an indication of

Back 21

tongue thrust

Front 22

usually, a tongue thrust is preceded by an abnormal hold position of the bolus against the

Back 22

central incisors

Front 23

residue in the anterior sulcus in an indication of

Back 23

reduced labial tension and tone

Front 24

residue on the floor of the mouth is an indication of

Back 24

reduced tongue shaping or failure of the peripheral seal of the tongue to the anterior and lateral alveolus

Front 25

food that tends to lodge in a depression in the tongue's surface is an indication of

Back 25

scar tissue in the tongue

Front 26

the greater the lingual struggle to swallow, the _____ the effect of the scar tissue on the swallow, and the ____ the amount of food that collects in the depression created by the scar tissue

Back 26

worse, greater

Front 27

residue of food on the tongue is an indication of

Back 27

reduced tongue range of movement or strength

Front 28

if tongue range of mevemnt is very poor , food may

Back 28

sit on the tongue surface or hard palate and remain there - usually occurs with thicker consistencies

Front 29

if residue increases on the tongue as food becomes more viscous, it is an indication of

Back 29

reduced tongue strength

Front 30

if the sequential squeezing action of the tongue in the oral stage is disturbed (tongue moves in somewhat random, nonproductive motions) it is an indication of

Back 30

lingual discoordination

Front 31

incomplete tongue-palate contact is an indication of

Back 31

reduced tongue elevation

Front 32

residue of food on the hard palate is an indication of

Back 32

reduced tongue elevation or strength

Front 33

if increased amounts of food collect on the palate as more viscous food is presented, it is an indication

Back 33

of reduced tongue strength

Front 34

reduced anterior-posterior tongue movement (interrupted or broken into multiple small tongue movements with normal range of motion) is an indication of

Back 34

reduced lingual coordination

Front 35

repetitive lingual rocking-rolling actions is an indication of

Back 35

parkinson's disease

Front 36

patients with PD show a typical tongue mevement pattern characterized by a repetitive ____ and ____ movement of the central portion of the tongue. the posterior tongue fails to _____ at the appropriate time

Back 36

upward and backward, lower - often lasts 10 seconds or more before a swallow

Front 37

uncontrolled bolus/premature loss of liquid or pudding consistency into the pharynx is an indicaton of

Back 37

reduced tongue control; reduced linguavelar seal

Front 38

an uncontrolled bolus and premature loss indicate reduced lingual control and may result in aspiration _______ the swallow

Back 38

before the swallow

Front 39

piecemeal deglutition indicates that

Back 39

rather than swallowing the bolus in a single cohesive mass, the patient swallows only one portion or piece of the bolus at a time

Front 40

piecemeal deglutition may indicate a ________ of swallowing

Back 40

fear

Front 41

oral transit time should lasat no longer than

Back 41

1 to 1.5 seconds

Front 42

most patients with delay in triggering the phayngeal swallow complain of difficulty swallowing

Back 42

liquids

Front 43

during the pharyngeal swallow delay, the bolus may land in the (3)

Back 43

pyriform sinuses, valleculae, or the open airway

Front 44

the critical symptom of delay is the location of the bolus head. the bolus head must be differentiated from

Back 44

premature bolus loss

Front 45

premature bolus loss is ____ a delay in triggering the pharyngeal swallow

Back 45

not

Front 46

during a delay, there is increased risk of aspiration as the pharyngeal swallow is activated because the pyriform sinuses are___

Back 46

significantly shortened as the pharynx and larynx elevate. the contents are at high risk for being dumped into the airway

Front 47

in patients with a delayed pharyngeal swallow, a chin-down posture may be ________

Back 47

less helpful. because the posture neither changes the degree of pharyngeal shortening that occurs during swallow nor prevenets the contens of the sinuses from entering the airway

Front 48

in teh pharyngeal swallow, _____________ are the first events

Back 48

elevation of the larynx and hyoid

Front 49

in normal young adult subjects, pharyngeal delay is

Back 49

minimal (0 to .2 sec)

Front 50

in normal subjects over 60, pharyngeal delay is

Back 50

.4 to .5 sec

Front 51

a delay of more than ___ seconds or an even shorter delay during which aspiration occurs is considered ____ delay in adults regardless of age

Back 51

2 seconds, abnormal

Front 52

in an infant, and abnormal delay is defined as more than ___ second between the last tongue pump and the onset of the pharyngeal swallow

Back 52

1 second

Front 53

normal pharyngeal transit time is a maximum of ____

Back 53

1 second

Front 54

pharygeal transit time _________ as volume increases

Back 54

increases

Front 55

nasal penetration during a swallow is an indication of

Back 55

reduced velopharyngeal closure.

Front 56

pseudoepiglottis is

Back 56

a fold of mucosa at the base of the tongue

Front 57

a bony outgrowth from cervical vertebrae is an indication of

Back 57

cervical osteophytes

Front 58

cervical osteophytes can interfere with the swallow by

Back 58

narrowing the pharynx or directing the bolus toward the ariway entrance

Front 59

residue on one side of the pharynx in pyriform sinus is an indication of

Back 59

unilateral pharyngeal wall weakness

Front 60

coating on the pharyngeal walls after teh swallow is an indication of

Back 60

reduced pharyngeal contraction bilaterally

Front 61

older normal individuals exhibit a ____ ____ in residue on the pharynx as compared with younger adults

Back 61

slight increase

Front 62

it is _____ to watch for the patient's reaction to any residue left in the pharynx after the swallow

Back 62

important - does patient have awareness of residue?

Front 63

vallecular residue after the swallow is an indication of

Back 63

reduced tongue base posterior movement

Front 64

if the residue in the valleculae is a large amount -

Back 64

the patient may be at risk of aspirating some or all o fthe residue during respiration after the swallow

Front 65

coating in a depression on the pharyngeal wall is an indication of

Back 65

scar tissue; pharyngeal pouch

Front 66

if laryngeal elevation during the swallow is mildly impaired ___

Back 66

some residual material will remeain on top of the larynx after the swallow.

Front 67

the patient is at risk for aspiration of the food sittin gon top of the airway after the swallow, when ....

Back 67

he or she opens the larynx to inhale following deglutition

Front 68

as the larynx elevates, the arytenoid cartilage is brought to a level where it is ______ to the ____ of the _______ and can tilt forward to contact the _____ of the _____ and close the _______

Back 68

closer to the base of teh epiglottis and can tilt forward to caontact the thickening base of the epiglottis and close the entrance to the airway

Front 69

moderately reduced laryngeal elevation can result in an inability of the ________ to tilt __________ enough to make good contact with the epiglottic base

Back 69

arytenoid, anteriorly - leaving the entrance to the airway slight ly open, allowing penetration of the bolus INTO the airway

Front 70

some patients _____________ for reduced laryngeal elevation by tilting the arytenoid more anteriorly than normal to close the airway entrance

Back 70

can compensate

Front 71

laryngeal penetration and aspiration after the swallow is an indication of

Back 71

reduced closure of the airway entrance (arytenoid to base of epiglottis and false vocal folds)

Front 72

the bolus may enter the airway to the level of (list 3)

Back 72

1. level of the middle of the arytenoid cartilage 2. level of the surface of the false vocal folds 3. level of true vocal folds

Front 73

penetration can occur if (list 3)

Back 73

1. larynxt lifts inadequately and leaves the airway entrance slightly open 2. arytenoid cartilage fails to tilt forward adequately to close off the airway 3. larynx lifts too slowly during the swallow.

Front 74

if the larynx lifts too slowly but eventually lifts to its full range of motion, all of the penetrated material will

Back 74

usually be cleared from teh ariway entrance

Front 75

penetration is a problem only when

Back 75

the larynx fails to lift adequately during the course of the swallow, and the penetrated material remains in the larynx after the swallow, and is then aspirated as the individual inhales following the swallow

Front 76

penetration may also occur if the bolus _______the airway entrance ____ the pharyngeal swallow triggers

Back 76

falls into, before

Front 77

aspiration during the swallow is an indication of

Back 77

reduced laryngeal closure

Front 78

if the larynx does not close adequately from bottom to top ________ the swallow, material will enter the airway _________ the swallow.

Back 78

during during - this is the only etiology for aspiration during the swallow

Front 79

significant residue in both pyriform sinuses is an indication of

Back 79

reduced anterior laryngeal motion; cricopharyngeal dysfunction; stricture

Front 80

if the pharyngeal swallow has not triggered, a _______ disorder cannot be diagnosed

Back 80

cricopharyngeal

Front 81

if residue in the pyriform sinuses is combined with residue in other parts of the pharynx (valleculae, pharyngeal walls) it is symptom of

Back 81

generalized dysfunction in pharyngeal pressure generation during the swallow - includes reduced posterior movement of the tongue base and reduced pharyngeal wall movement.

Front 82

normally pharyngeal transit time is

Back 82

less than 1 second

Front 83

if there is any question about the patient's esophageal function, an esophageal study should be performed _________ the modified barium swallow is completed

Back 83

AFTER - patient's ability to swallow without aspiration is established and they can do the barium swallow safely

Front 84

the esophageal stage of deglutition ___ be modified by therapy

Back 84

cannot

Front 85

backflow of material out of the esophagus into the pharynx requires the ___________

Back 85

UES to open

Front 86

the tracheoesophageal fistula is usually located at the level of the

Back 86

1st to 3rd thoracic vertebrae. patients shoulders should be turned diagonallyto improve visualization of this part of the esophagus and trachea b/c sholders shadow it

Front 87

aenker's diverticulum

Back 87

occurs in teh area of the cricopharyngeal reagion - it is a side pocket that forms when the muscle herniates

Front 88

gastroesophageal reflux disease (GERD)

Back 88

backflow of food and stomach acid from the stomach to the esophagus

Front 89

during the oral prep phase in the posterior-anterior view, the clinician can examine (3)

Back 89

1. the ability of the tongue to lateralize material 2. the pattern of jaw motion in crushing the food during mastication 3. shape of the tongue in holding the bolus prior to initiation of swallow

Front 90

unable to align teeth is an indication of

Back 90

reduced mandibular movement

Front 91

inability to lateralize material with the tongeu is an indication of

Back 91

reduced tongue lateralization

Front 92

inability to mash materials is an indication of

Back 92

reduced tongue elevation to the hard palate

Front 93

material falls to the floor of the mouth is an indication of

Back 93

reduced tongue control - particularly in the seal of the lateral margins of the gongue to the lateral alveolus

Front 94

bolus spread across mouth is an indication of

Back 94

reduced lingual shaping and fine tongue control. inability to elevate one or both sides of the tongue or to form a central groove to contain food

Front 95

unilateral vallecular residue is an indication of

Back 95

unilateral dysfunction in posterior movement of the tongue base

Front 96

residue in one pyriform sinus is an indication of

Back 96

unilateral dysfunction of the pharynx

Front 97

reduced vocal fold adduction may be a cause of

Back 97

aspiration during the swallow

Front 98

unequal height of the VF is seen in

Back 98

laryngectomized patients. . airway closure is incomplete

Front 99

test

Back 99

the flashcard

Front 100

to see

Back 100

what happens