Last Quiz - Lectures And Readings

Front 1

Three types of injury

Back 1

coup
contra coup
twisting of brainstem

Hint 1

4-26

Front 2

Three types of brain damage

Back 2

diffues (microscopic damage throught brain)
hypoxic-ischemic (swelling causes hypoperfusion)
focal

Hint 2

4-26

Front 3

Two common late secondary complications:

Back 3

hydrocephalus
chronic subdural hematoma

Hint 3

4-26

Front 4

Three stages of medical tx

Back 4

acute (saving pt. life)
subacute (after stabilized)
chronic (two categories)

Hint 4

4-26

Front 5

Two categories of chronic tx

Back 5

community-based rehabe
tx of long-term consequences (like pain, depression, behavior)

Hint 5

4-26

Front 6

Most common swallow disorder in TBI

Back 6

delay in triggering of the pharygneal swallow

Hint 6

4-26

Front 7

Always check for a _ _

Back 7

bite reflex

Hint 7

4-26

Front 8

Reduced closure of the larynx and reduced cp opening are likely NOT due to neurologic damage but ARE likely due to:

Back 8

changes in laryngeal motion (usually caused by physical damage to the neck)

Hint 8

4-26

Front 9

Characteristics that make oral intake more difficult in TBI

Back 9

impulsiveness
Tendency to put too much food in mouth
cognitive difficulties
reduced sensation

Hint 9

4-26

Front 10

Is there a relationship b/t length of coma and swallowing problems?

Back 10

Yes.
Swallowing probs worse with longer comas

Hint 10

4-26

Front 11

Tx for TBI
Cognitively impaired

Back 11

compensatory strategies (postural and sensory)
Resistance and ROM
Maneuvers are TOO DIFFICULT
Changing diet

Hint 11

4-26

Front 12

What if TBI pt has reached max. gains in treatment, but still cannot eat b/c they are aspirating or have inefficient swallowing?

Back 12

Do periodic evals - ethicially cannot continue to work with them

Hint 12

4-26

Front 13

Do back injuries, like ruptured disks, spinal stenosis, or pinched nerves lead to dysphagia?

Back 13

No

Hint 13

4-26

Front 14

SCI is

Back 14

damage to the spinal cord that resultsi n a loss of function

Hint 14

4-26

Front 15

What is the leading cause of SCI?

Back 15

Motor vehicle accidents

Hint 15

4-26

Front 16

# of:
cervical vertabre
thoracic
lumbar
sacral

Back 16

7
12
5
5

Hint 16

4-26

Front 17

Effects of SCI depend on the _ of injury and the _ of the injury.

Back 17

type
level

Hint 17

4-26

Front 18

Two types of SCI injury

Back 18

complete
incomplete

Hint 18

4-26

Front 19

Complete SCI injury is

Back 19

no function below the level of the injury on both sides

Hint 19

4-26

Front 20

Incomplete SCI is

Back 20

some function below the primary level of injury

Hint 20

4-26

Front 21

Injury at C1 or C2

Back 21

no sensory awareness of swallowing difficulty (Silent aspiration)

Hint 21

4-26

Front 22

Injury at C4, C5, C6 (what happened to C3?)

Back 22

poor laryngeal movt and reduced cricopharyngeal opening

Hint 22

4-26

Front 23

Swallowing probs in cercial injury may be exacerbated by:

Back 23

trach w/inflated cuff
cervical brace
mechanical vent

Hint 23

4-26

Front 24

Always perform a _ physiologic assessment if pt complains of swallowing difficulty

Back 24

in-depth

Hint 24

4-26

Front 25

What is most likely NOT possible in pt with SCI

Back 25

postural changes

Hint 25

4-26

Front 26

What is MOST helpful in SCI tx?

Back 26

sensory enhancement
swallow maneuvers

Hint 26

4-26

Front 27

****Name the four types of cervical bracing

Back 27

soft collar
philadelphia collar
Sterno-Occipital Mandibular Immobilzation Device
halo

Hint 27

4-26

Front 28

Swallowing worsens w/what two braces?

Back 28

SOMI
Halo

Hint 28

4-26

Front 29

More swallowing difficulty with

Back 29

chin pulled back
chin/head retracted to neck
pt's head is extended

Hint 29

4-26

Front 30

Two types of cervical fusion

Back 30

anterior
posterior

Hint 30

4-26

Front 31

Swallowing probs as a result of Anterior Cervical Fusion (incision in front of neck)

Back 31

Swelling in post pharyngeal w
red. laryn. elevation and anter movt (+ red. CP opening and red. airway closure)
may see oral stage probs and delay in trigger

Hint 31

4-26

Front 32

Tx for Anterior Cervical Fusion

Back 32

Significant recovery in 3 months
swallow maneuvers are most helpful

Hint 32

4-26

Front 33

Brainstem problems? Try...

Back 33

TTS
Suck-swallow

Hint 33

4-26

Front 34

Extent of damage in tumors from cranial nerves depends on (2)

Back 34

size of tumor
difficulty of resection

Hint 34

4-26

Front 35

If CN IX (glossopharyngeal) is damaged, expect

Back 35

a delay in triggering pharyngeal swallow

Hint 35

4-26

Front 36

CN damage? Try...

Back 36

(often unilateral)
postural strategies
aggressive ROM and resistance

Hint 36

4-26

Front 37

Three levels of neural control:

Back 37

CNS
Autonamic System
Enteric Nervous System (ENS)

Hint 37

5-1

Front 38

LES seperates _ from _

Back 38

esophagus from stomach

Hint 38

5-1

Front 39

Pressure gradiate is higher/lower in the stomach than in the thoracic cavity

Back 39

higher

Hint 39

5-1

Front 40

Dx testing used for esophagus

Back 40

upper GI/Barium swallow
Endoscopy
24 hour ambulatar pH testing
Esophageal Manometry

Hint 40

5-1

Front 41

Upper GI looks for

Back 41

structural probs
function

Hint 41

5-1

Front 42

Endoscopic allows us to see

Back 42

stomach
EGJ (esopheogastric junction)

Hint 42

5-1

Front 43

Manometry shows us

Back 43

pharynx
UES
Esophageal body
LES
peristalsis

Hint 43

5-1

Front 44

name the structural causes of dysphagia due to esophageal problems (7)

Back 44

Schatzki's ring
Eosinophilic esophagitis
peptic sticture
hiatal hernia
esophagial diverticula
esophageal cervical web
cricopharygneal bar

Hint 44

5-1

Front 45

What is Schatzki's ring?

Back 45

it's at the EGJ, a thin lip of tissue b/t esophageous and stomach, "washer-like"

Hint 45

5-1

Front 46

What is the most common cause of dysphagia complaint re: esoph.

Back 46

eosinophilic esophagitis (4 of 1,000)

Hint 46

5-1

Front 47

What is eosinophilic esophagitis?

Back 47

looks like the trachea
a lot of schatzki's rings
leads to food impaction
squamous cells and esoinophilic cells

Hint 47

5-1

Front 48

What is a peptic stricture?

Back 48

a narrowing, see ulceration and bleeding, an hourglass appearance

Hint 48

5-1

Front 49

What is a Hiatal Hernia?

Back 49

predisposes the person to reflux
usually doesn't need surgery

Hint 49

5-1

Front 50

Does a Hiatal Hernia cause dysphagia?

Back 50

No

Hint 50

5-1

Front 51

What is another name for "esophageal diverticula?"

Back 51

Zenker's diverticulum

Hint 51

5-1

Front 52

What is a esophageal cervical web?

Back 52

like a shatzki's ring, but right below the CP muscle
Not often caused by other diseases

Hint 52

5-1

Front 53

What is a cricophargyneal bar?

Back 53

it's thicker than a e.c. web, creates a funnel effect,a posterior shelf

Hint 53

5-1

Front 54

Motility is a _ problem

Back 54

function

Hint 54

5-1

Front 55

Two motility probs

Back 55

Achalasia
Diffuse Esophageal Spasm

Hint 55

5-1

Front 56

What is achalasia?

Back 56

Failure of LES to relax
No peristalsis
a neuropathy of the ENETRIC nervous system

Hint 56

5-1

Front 57

What is a Diffuse Esophageal Spasm?

Back 57

"a corkscrew esophagus"
smooth muscle is affected

Hint 57

5-1

Front 58

5 Iatrogenic Disorders

Back 58

1. pill
2. radiation
3. neoplastic-esphogeal cancer
4. infections
5. congential development

Hint 58

5-1

Front 59

what does odynaphagia mean?

Back 59

pain w/swallowing, indicates ulcer

Hint 59

5-1

Front 60

What is ptosis?

Back 60

drooping eyelids

Hint 60

5-1

Front 61

Another name for Schatzki's Ring

Back 61

Steakhouse syndrome

Hint 61

5-1

Front 62

Schatzki's Ring and _ _ often coexist

Back 62

hiatal hernia

Hint 62

5-1

Front 63

What is Boyce's sign?

Back 63

focal neck swelling that gurgles on palpation; usually on left side (mentioned with Zenker's

Hint 63

5-1

Front 64

What is the physiologic hierarchy?****

Back 64

respiration
swallowing
speech

Hint 64

5-3

Front 65

Three aspects of respiration

Back 65

ventilation
external respiration
internal respiartion

Hint 65

5-3

Front 66

ventilation is

Back 66

movt of air back forth b/t outside atmosphere and inner spaces of the lungs

Hint 66

5-3

Front 67

external respiration is

Back 67

exchange of gases b/t walls of the lung spaces and the transporting blood

Hint 67

5-3

Front 68

internal respiration is

Back 68

gases are exhanged bt blood cells and the body

Hint 68

5-3

Front 69

two subdivisions of the respiratory system

Back 69

conducting zone (brings air in and out)
respiratory zone (where gas exchange occurs)

Hint 69

5-3

Front 70

What is the Law of LaPlace?****

Back 70

P=2T/r

Hint 70

5-3

Front 71

P=2T/r
P stands for

Back 71

collapsing pressur on alveolus

Hint 71

5-3

Front 72

P=2T/r
T stands for

Back 72

surface tension

Hint 72

5-3

Front 73

P=2T/r
r stands for

Back 73

radius of alveous

Hint 73

5-3

Front 74

Large alveolus = _ collapsing pressure

Back 74

low

Hint 74

5-3

Front 75

Small alveolus = _ collapsing pressure

Back 75

high

Hint 75

5-3

Front 76

_ alveolus are not ideal because they collapse often

Back 76

small

Hint 76

5-3

Front 77

What is surfactant?

Back 77

A misture of phopholipids that line the alveoli and reduce their surface tension

Hint 77

5-3

Front 78

Without _, Law of _ predicts that _ alveolus will collpase

Back 78

surfactant
LaPlace
small

Hint 78

5-3

Front 79

What is atelectasis?

Back 79

When small alveoli collapse

Hint 79

5-3

Front 80

What is the space between the two pleura?

Back 80

pleural cavity OR intrapleural space

Hint 80

5-3

Front 81

What is another name for when the lungs collapse?

Back 81

Pneumothorax

Hint 81

5-3

Front 82

When elastiance goes _, compliance goes _

Back 82

up
down

Hint 82

5-3

Front 83

_ is the boundary between the upper and lower airway

Back 83

larynx

Hint 83

5-3

Front 84

What is the focal point of breathing?

Back 84

should breathe diaphragmatically (NOT clavicular or abdominal breathing)

Hint 84

5-3

Front 85

What is the most common pattern of respiration and swallowing?

Back 85

inhale
start to exhale
stop exhale (swallow + airway closure)
return to exhalation (thought to be protective: prevents residual food in airway)

Hint 85

5-3

Front 86

Focal point of breathing****

Back 86

diaphragmatically

Hint 86

5-3

Front 87

What does COPD stand for?

Back 87

Chronic Obstructive Pulmonary Disease

Hint 87

5-3

Front 88

Two types of COPD

Back 88

emphysema
chronic bronchitis

Hint 88

5-3

Front 89

Compare and contrast aspiration pneumonia and pneumonitis

Back 89

asp pneumonia is an acute inflammation caused by INFECTION and is a reaction to bacteria and bacterial byproducts (SLP issue)

Pneumonitis is lung INJURY caused by acidic and particulate gastric contents (reflux, etc. a GI issue)

Hint 89

5-3

Front 90

Bronchospasm is caused by

Back 90

asthma

Hint 90

5-3

Front 91

Atelectasis is

Back 91

collapse of expanded lung

Hint 91

5-3

Front 92

dyspnea is

Back 92

an unpleasant awareness/perception of shortness of breath

Hint 92

5-3

Front 93

hemoptysis is

Back 93

coughing up blood tinged mucous

Hint 93

5-3

Front 94

hypoxemia is

Back 94

deficit in oxygenization of blood

Hint 94

5-3

Front 95

rhonchi is

Back 95

whistle or snoring sound upon ascultation

Hint 95

5-3

Front 96

Name a the Parkinson's drug Logemann AND Nicole mentioned during lectures.

Back 96

Halodol

Hint 96

5-3

Front 97

What is another name for having no teeth?

Back 97

edentulous

Hint 97

lab

Front 98

Two risk factors for head and neck cancer

Back 98

smoking
alcohol

Hint 98

5-8

Front 99

What is "the dump" according to Logemann?

Back 99

When it is YOUR fault the pt isn't swallowing yet, when in all actuality it is the doctor's fault, because drs do everything wrong, right? They obviously have no idea what they're doing - they just follow people around for a few years...

Hint 99

5-8

Front 100

What does exsanguinate mean?

Back 100

to bleed to death

Hint 100

5-8

Front 101

What does radiation cause? (5)

Back 101

decreased blood flow
increased stiffness
xerostomia
fistula
fibrosis

Hint 101

5-8

Front 102

Chemo causes?

Back 102

mucositis (sores in mouth)
a lot of weight loss

Hint 102

5-8

Front 103

Dysphagia types resulting from radiation and chemo:

Back 103

dec oral tongue motion
dec BOT motion
dec ph wall motion
dec laryngeal elev

Hint 103

5-8

Front 104

what is anastomosis?

Back 104

reattachment

Hint 104

5-8

Front 105

What is a simple resection?

Back 105

part or all of one structure

Hint 105

5-10

Front 106

What is a composite resection?

Back 106

part or all of more than one structure (often occurs in the mouth)

Hint 106

5-10

Front 107

Two most common spots for composite resection?

Back 107

anterior floor of mouth
lateral (bot or tonsil)

Hint 107

5-10

Front 108

_ composite resection has the worst functional problems:

Back 108

lateral
(results in loss of food and nasality)

Hint 108

5-10

Front 109

What does IMRT stand for and what is it?

Back 109

Image Modified Radiation Therapy; I have no idea what it is...!? But the trusty internet tells me it's actually Intensity-Modulated Radiation Therapy. hmmm.

Hint 109

5-10

Front 110

Two types of a partial laryngectomy

Back 110

supraglottic
hemi

Hint 110

5-10

Front 111

Two types of laryngeal surgery

Back 111

partial laryngectomy
total laryngectomy

Hint 111

5-10

Front 112

If the pt has a supraglottic (horizontal) laryngectomy, what can you expect to be removed?

Back 112

epiglottis, fvf, areypiglottic folds

Hint 112

5-10

Front 113

What treatment does a pt with a supraglottic/horizontal laryngectomy require?

Back 113

since top 2/3 of larynx + hyoid are removed expect: laryngeal elevation problem and a need for airway protection

Super-supraglottic maneuver

Hint 113

5-10

Front 114

What to do with a hemilarygnectomy?

Back 114

head rotation
chin down
head rotation + chin down
adduction exercises

This is because airway closure is a big prob;

Hint 114

5-10

Front 115

What should you expect with a person who has had a total laryngectomy?

Back 115

no hyoid or larynx, no CP region

1. tight closure
2. pseudoepiglottis

Hint 115

5-10

Front 116

Can total laryngectomees aspirate?

Back 116

No, not phsically possible

Hint 116

5-10

Front 117

Stroke occurs most often in what population?

Back 117

African Americans, equal among gender

Hint 117

5-10

Front 118

2 areas of stroke

Back 118

hemorrhage (bursting of vessel;s lower recovery)
blockage (infarct; faster recovery)

Hint 118

5-10

Front 119

If a pt presents with a medullary stroke, what should you expect and how would you treat?

Back 119

expect no swallow at first, once they have a swallow, do TTS
dec laryngeal elev (mendelsohn, falsetto, gargle, yawn)
unilateral vf paralysis (head rotation)

Hint 119

5-10

Front 120

Most common probl in stroke pt

Back 120

delay in trigger

Hint 120

5-10

Front 121

R or L cortical lesion worse? why?

Back 121

r, because alertness and focus decrease

Hint 121

5-15

Front 122

Two types of ALS

Back 122

bublar
spinal

Hint 122

5-15

Front 123

Bublar/spinal rapildy deteriates?

Back 123

bulbar - takes 3 1/2 years

Hint 123

5-15

Front 124

How long does spinal ALS take

Back 124

10-15 years

Hint 124

5-15

Front 125

No exercises will help what populations

Back 125

postpolio
Motor neuron disease (ALS)

Hint 125

5-15

Front 126

Exercies to do with medullary stroke

Back 126

TTS for delay or absent swallow
head rot to affected side
adduction exercises
Mendelsohn, Shaker

Front 127

Pontine stroke results in

Back 127

hypertonicity
absent/delyaed pharyngeal swallow
unilateral pharyngeal wall paresis
reduced laryngeal elevation/cp opening

Front 128

What do to for pontine stroke

Back 128

TTS for delay/absent swallow
head rotation (try both sides)
Mendelsohn, Shaker

Front 129

In bulbar als, what do you expect to see and how to treat?

Back 129

tongue later and dec strength
change their diet
use compensation which won't work after a year
don't over work them

Hint 129

5-15

Front 130

In spinal als, what do you expect to see and how do you treat?

Back 130

mostly pharyngeal wall problems
use postural techniques

Front 131

What do you see in postpolio?

Back 131

unilater ph w (turn head)
dec airway closure
dec laryngeal elevation

Front 132

In parkinson's, what do you see?

Back 132

tongue pumping
dec airway closure
dec bot motion

Front 133

MS causes

Back 133

delayed ph sw (TTS)
dec bot motion
airway closure prob
exercies help

Front 134

Guillan Barre see

Back 134

dec ROM
Everything is weak

Front 135

Mysthenia Graves

Back 135

hypernasality
fatigue of muscle w/use