Dysphagia Quiz 1

Front 1

List and describe the 5 categories of dysphagia.

Back 1

1. Constricta- narrowing of he pharynx/esophagus
2. Lusoria- esophageal compression by the right subclavian artery
3. Oropharyngeal: difficulty propelling from the mouth to the esophagus (common)
4. Paralytica: paralysis of the muscles of the mouth, pharynx, or esophagus
5. Spastica: dysphagia from spasm of pharynx/esophagus

Front 2

Dysphagia is not a medical diagnosis, but rather it is...

Back 2

a symptom of an underlying disease and is described by its clinical characteristics.

Front 3

Define dysphagia.

Back 3

an impairment of emotional, cognitive, sensory, and/or motor acts involved with transferring a substance from the mouth to stomach, resulting in failure to maintain hydration and nutrition, and posing a choking and aspiration risk

Front 4

What are some symptoms of dysphagia?

Back 4

choking, coughing, food sticking, regurgitation, odynophagia (painful swallow), drooling, unexplained weight loss, nutritional deficits

Front 5

What are the 2 hallmarks of dysphagia?

Back 5

1. delay in propelling the bolus as it moves from mouth to stomach and/or
2. misdirection of a bolus

Front 6

Bolus entering the airway and/or lungs or material that enters the mouth, pharynx, or espohagus during swallowing but fails to reach the stomach

Back 6

misdirection of a bolus

Front 7

T/F: Not all patients with swallowing show obvious delay in bolus flow/midirection

Back 7

T

Front 8

T/F: Only when swallowing changes result in changes in eating habits associated with medical complications (undernourishment, aspiration penumonia) is a person truly classified as having dysphagia.

Back 8

T

Front 9

The result of weakness/incoordination of the hand/arm used to move food from the plate to the mouth

Back 9

feeding disorder

Front 10

____% of people who have had an acute stroke could have dysphagia and ____% of that group could have silent aspiration

Back 10

50
20

Front 11

T/F: Dysphagia is more common after consecutive hospital admissions.

Back 11

T

Front 12

T/F: Once patients enter the hospital setting, their chances of returning to eating foods increases.

Back 12

F

Front 13

What are the medical consequences of dysphagia?

Back 13

aspiration pneumonia
dehydration
undernutrtion
immune system compromised
infection, sepsis, death

Front 14

What are the psychosocial consequences of dysphagia?

Back 14

limits the extend of socialization, leading to lifestyle change
fear of choking = social isolation & depression
even subtle diet changes can lead to feelings of discontent

Front 15

What are the steps involved in a clinical eval?

Back 15

1. review of the medical & psychosocial history
2. physical eval that includes mental status screening
3. evaluation of the musculature of the head & neck
4. trial swallows of liquid, semisolid, & solids
5. instrumental assessment (if further testing needed)

Front 16

What are the steps in clinical management of dysphagia?

Back 16

1. Identification (is dysphagia present?)
2. simple screen (wathing pt eat/drink)
3. instrumental assessment (barium x-ray, direct visualization, etc.)

Front 17

What are some instrumental assessments for dysphagia?

Back 17

modified barium swallow (videoflouroscopy/esophagram) - most common
pressure measurements

Front 18

What are treatment goals for dysphagia?

Back 18

Make sure the pt can eat & drink enough food to be nourished and hydrated and prevent aspiration pneumonia

Front 19

What are behavioral interventions for swallowing?

Back 19

encouraging pt to change swallowing behavior

Front 20

What is a compensatory intervention for swallowing?

Back 20

postural changes, change in eating rate

Front 21

What is a rehab intervention for swallowing?

Back 21

teaching a new way to swallow
strengthening the muscles

Front 22

What is a medical intervention for swallowing?

Back 22

change in medication that affects mental status
placement of NG tube

Front 23

What does the otolaryngologist focus mainly on?

Back 23

upper digestive tract

Front 24

What does the gastroenterologist focus on?

Back 24

esophagus
manage GERD
place PEG tube

Front 25

What does the radiologist focus on?

Back 25

GI tract
modified barium swallow w/ SLP

Front 26

What does the neurologist focus on?

Back 26

identification & management

Front 27

What does the nurse focus on?

Back 27

24- hour monitoring of the swallowing problem
administering tube feedings
maintaining good oral hygiene

Front 28

How long is a stay in an acute care setting? What is the prevalence of dysphagia?

Back 28

2-5 days
13%

Front 29

Introduced in the NICU to minimize the potential for emotional and neurodevelopmental disorders

Back 29

integrated developmental care

Front 30

What do NICU interventions focus on?

Back 30

improving systems of delivering respiratory support (result in higher survival rate)

Front 31

Allows infants to sleep for 3 hours after which they are awakened for all care

Back 31

cluster care

Front 32

How long is a typical stay in a subacute setting?

Back 32

5 to 28 days; after this they are discharged to home, rehab, or SNF

Front 33

How long is a rehab setting stay? What is the goal of therapy here?

Back 33

1 month
goal: return pt to dietary level near normal
ensure that special maneuvers are upheld i.e. chin tuck etc

Front 34

What is the dysphagia prevalence in a SNF? Most of the therapy here is focused on....?

Back 34

60%
preventing aspiration pneumonia (intervention, dietary monitoring)

Front 35

A statement executed by the patient/family member detailing their desires and wishes about medical care in a life-threatening situation

Back 35

advanced directive

Front 36

What is the focus of therapy in a home health setting?

Back 36

making sure the patient is using the feeding strategies/ has improved to a point where dietary level can change

Front 37

What separates the oral cavity from the nasal cavity?

Back 37

bony palate & velum

Front 38

The ______________ & _____________ ______________ seal & open communication between the nasal & oral cavities during swallwowing and respiration.

Back 38

velum; posterior nasopharynx

Front 39

This is protected during pharyngeal swallow by occlusive muscular constriction of the laryngeal vestibule and downward displacement of the epiglottis.

Back 39

respiratory system

Front 40

Inferior margin of the laryngeal ventricle; attached to the thyroid cartilage

Back 40

true VF

Front 41

separate the ventricle and the vestibule

Back 41

false VF

Front 42

During this stage, food is masticated in preparation for transfer

Back 42

oral preparatory stage

Front 43

What CNs are involved in the oral prep statge?

Back 43

CN 5, CN 7, CN 12

Front 44

Which branch of CN 5 innervates the muscles for chewing behaviors?

Back 44

mandibular branch

Front 45

What are the muscles for chewing behaviors?

Back 45

1) masseter- close jaw
2) temporalis- moves jaw up, down, forward, back
3) pterygoid- bilaterally elevate mandible when shifting jaw side to side

Front 46

This CN innervates lower facial muscles attached to the maxilae and mandibule.

Back 46

facial nerve CN 7

Front 47

What does the facial nerve include?

Back 47

buccinators- compress lips & flatten cheeks when moving food across teeth

Front 48

Which CN innervates the tongue, which contains 4 separate intrinsic muscles?

Back 48

hypglossal CN 12

Front 49

This stage of the swallow involves transfer of material from the mouth to the oropharynx (into the upper esophagus)

Back 49

oral/pharyngeal stage

Front 50

The __________ bone serves as a fulcrum that gives a mechanical advantage for pharyngeal musculature associated with swallowing behaviors of the posterior tongue, pharynx, and larynx

Back 50

hyoid

Front 51

During this stage of the swallow, material is transported through the esophagus intro the gastric cardia

Back 51

esophageal stage

Front 52

A tube that connects the pharynx to the stomach

Back 52

esophagus

Front 53

Food/liquid in the mouth stimulates...?

Back 53

taste, temp, pressure receptors

Front 54

Produced by the activation of the submandibular, submaxillary, and tongue and hyoid bone during bolus prep

Back 54

saliva

Front 55

How many times per hour do people swallow?

Back 55

18-400

Front 56

What is the primary sensory receptors?

Back 56

dorsum of the tongue (responsible for perception of salt, sweet, sour, bitter), activated by saliva

Front 57

Responsible for taste sensation anterior 2/3 of tongue

Back 57

CN 7

Front 58

List the steps once the bolus has been prepared.

Back 58

1. Tongue tip elevated to occlue the oral cavity @ alveolar ridge, bolus held against hard palate
2. Tongue tip & dorsum deliver bolus to pharynx
3. With the first movement of the tongue, respiration ceases, VF adduct
4. Tongue base applies pressure to tail of bolus wall
5. Tongue propels bolus posteriorly, palatopharyngeal folds are pulled medially to form a slit so bolus can pass through
6. Leator veli palatini elvates velum to seal nasopharyngeal opening

Front 59

What 3 things maintain the positive pressure on the bolus as it moves towards zones of negative pressure?

Back 59

tongue contact with velum, posterior pharyngeal wall, sealing nasopharynx

Front 60

How are respiration and swallowing linked?

Back 60

by their anatomy & relations in the medulla of the brainstem

Front 61

Respiration is ___________ by swallowing

Back 61

respiration

Front 62

This stage begins when bolus arrives at the level of the valeculae

Back 62

pharyngeal stage

Front 63

Which 5 mechanisms are active in preventing the bolus from entering the upper airway?

Back 63

1. cessation of respiration
2. approximation of T/F VF
3. closure of laryngeal aditus
4. defelction of bolus material by tongue base rising over larynx
5. division of bolus through valleculae

Front 64

What is the ordered pattern of function that depends on coordinated activities in three distinct zones?

Back 64

esophageal stage

Front 65

Altering ________________, __________, ________________, & ___________________ may affect the biomechanics of the normal swallow

Back 65

volume, texture, taste, delivery method

Front 66

What is a normal amount of liquid taken per swallow?

Back 66

10 to 25 mL

Front 67

As the bolus size increases, the ___________ stays open longer

Back 67

PES

Front 68

As the bolus becomes ________________, more tongue pressure is needed to transition the bolus

Back 68

thicker

Front 69

T/F: effects of sweet, sour, salty, bitter did not affect swallwoing pressures

Back 69

T

Front 70

What does successful straw drinking require?

Back 70

adequate lip strength
intraoral pressures to draw fluid into the oral cavity from the cup

Front 71

T/F: There are no significant differences observed when comparing younger and older cohorts on their ability to generate maximum tongue pressures on nonswallowing tasks

Back 71

F

Front 72

Dentures may affect _________-stage mechanics

Back 72

oral

Front 73

Movement of the esophagus decrease/increases with age? There is an increase of _________________ actions.

Back 73

decreases
nonperistaltic

Front 74

What is a pharyngeal swallow initated by?

Back 74

sensory impulses transmitted as a result of stimulation of recepters on face, tonsils, soft palate, tongue base, etc

Front 75

Sensory impulses reach the medulla through CN ...?

Back 75

7, 9, 10

Front 76

Mastication depends primarily on CN _____ while muscles of the lips and cheeks depend on CN ____

Back 76

5
7

Front 77

What are the 3 levels of the nervous system organization for swallowing?

Back 77

1. peripheral level linked to bolus characeristics
2. subcortical level that organizes and executes patterns of efferent activity
3. descending cortical portion that responds to any needed changes to modify feeding behavior

Front 78

How many disciples are involved in a TEAM approach?

Back 78

3.5 PER PATIENT

Front 79

This is sometimes referred to as a clinical examination because it is not just done at the bedside. It can be modified for an uncooperative patient. It gives a ____________ prospective compared to a dysphagia screening.

Back 79

bedside exam
broad

Front 80

Includes tests that are conducted outside the clinical environment like radiographic studies

Back 80

insrumental eval

Front 81

What are the 3 main components of a clinical evaluation?

Back 81

1. medical history
2. physical inspection of the swallowing musculature
3. observation of swallowing competence with test swallows

Front 82

What are the 5 reasons for performing a clinical eval?

Back 82

1. define the potential cause
2. establish a hypothesis that defines the disorder
3. develop a list of questions that may require further study
4. establish a tx plan
5. establish the readiness of the pt

Front 83

If a patient is not cooperative or does not perform, what do we rely on as clinicians?

Back 83

medical history/observation of swallow

Front 84

A valid screening tool will have high levels of...?

Back 84

sensitivity
specificity

Front 85

Why is early detection of dysphagia important?

Back 85

if undetected, it can lead to increase in morbidity, risk of death, and length of hospital stay

Front 86

What is a common point within diagnosis?

Back 86

ask the patient to describe the problem

Front 87

Investigation should be tailored to the _______________ since most abnormalities occur there. If the pt reports these things in addition to heartburn, dysphagia may be present

Back 87

esophagus
prior dilatation, pain, weight loss

Front 88

Lump int he throat relieved by swallowing/talking, not cause for dysphagia; thought to be hysterical

Back 88

globus hystericus

Front 89

Medical term for the feeling of food or fluid getting stuck.

Back 89

globus sensation

Front 90

Patients with globus sensation have more difficulty swallowing __________ than _________.

Back 90

solids than liquids

Front 91

If a patient is choking on liquids/solids, it suggests a __________________ cause. If a patient is not choking but has dysphagia, it suggests a ________________ cause.

Back 91

pharyngeal
esophageal

Front 92

Described as pain/fullness in the chest associated with reflux

Back 92

GERD (heartburn)

Front 93

If there is excessive chewing of solid food to avoid the sticking sensation, it can indicate....?

Back 93

esophageal disease

Front 94

If there is liquid that comes back through the nose, it can indicate...?

Back 94

pharyngeal disease

Front 95

What are the clincal signs of dysphagia?

Back 95

-drooling from lip, tongue weakness, poor dentition, loss of strength, ROM in tongue, jaw, velum
-poor strength/coordination that results in choking on liquids/lack of bolus flow
-cognitive deficits: failure to chew, talk while swallowing, inattention to feeding