Paediatric Dysphagia 06/17

Front 1

When does the nutritive suck rhythm develop?

Back 1

35-36 wks

Hint 1

Either 28-33 wks or 35-36

Front 2

Describe 4 differences between nutritive (N) and non nutritive suck (NNS)

Back 2

N: for nutrition NNS: state regulation/exploration

N: initially continuous bursts then shorter suck bursts

NNS: short suck bursts w/ brief pauses eg. Maggie in Simpsons

N: 1 Suck /sec NNS: 2 sucks/sec

N: suck/swallow 1:1 NNS: suck/swallow 8:1

Front 3

Which reflex is debated to have dvpd at term?

Back 3

Cough - new research suggests neonates have apnoeac event to protect airway

Hint 3

Has major role in airway protection

Front 4

What does penetration mean ;)

Back 4

When food/drink gets to the level of vocal folds

Front 5

What does aspiration mean?

Back 5

When food/drink enters the airway, below level of vocal folds

Front 6

At what age does World Health Organisation recommend weaning?

Back 6

6 months

Front 7

Name 2 treatments for reflux

Back 7

Anti reflux meds & Nissen fundoplication

Front 8

In the International Dysphagia Diet Standardisation Innitiative (IDDSI) what are the 5 levels of drink thickness?

Back 8

Thin, Slightly Thick, Mildly Thick, Moderately Thick, Extremely Thick

Front 9

What does a Moderately Thick drink equate to on the modified food scale?

Back 9

Liquidised

Front 10

What does an extremely thick drink equate to on modified food scale?

Back 10

Pureed

Front 11

Which cranial nerve innervates the intrinsic and extrinsic tongue muscles

Back 11

Hypoglossal (12)

Front 12

Which cranial nerve responsible for taste and touch of posterior 1/3 tongue

Back 12

Glossopharyngeal (9)

Front 13

What are 4 key principles of ethics?

Back 13

Beneficience- acting in the best interest

Non-maleficience- avoiding deliberate harm

Autonomy-respect for clients wishes & ability to make decisions for themselves.

Justice- fair distribution of resources

(Beauchamp & Childress, 2001)

Front 14

Name 5 types of consent

Back 14

Implied

Expressed

Restricted

Unaltered

Refused

Front 15

True or False- intervention without consent is considered to be assault?

Back 15

True

Front 16

Which statement is not from BMA guidance on consent.

A) make a free choice (no pressure)B) understand, in broad terms, what consequence would be of not receiving proposed treatment.C) retain the informatiom for at least 45 minutes.

Back 16

C

Person also needs to:

Understand what the medical treatment is, it's purpose and why being proposed.

Understand main benefits, risks and alternatives

Retain information long enough to make an effective decision (thus have to ask repeatedly if have any short term memory diffs)

Front 17

What is Gillick (Fraser) Competence

Back 17

A child under age 16 can give consent if have sufficient understanding and intelligence to make their own decision on the matter. (Example of requesting contraceptive pill).

Front 18

What's the age of legal consent?

Back 18

16 yrs

Front 19

At what age can you refuse treatment without needing parents' consent?

Back 19

18 yrs +

Front 20

Describe Mendelsohn Manouevre + what it's for

Back 20

Compensatory Technique. Swallow and palate your larynx. When your larynx is elevated, hold it in position for several secs.

Works on poor laryngeal elevation, keeping the cricophartngeal sphincter open for longer,

Front 21

Back 21

Front 22

Back 22

Front 23

Back 23

Front 24

Back 24

Front 25

Back 25

Front 26

What's the respiratory rate of a pre-term infant

Back 26

40-60 breaths per min

Front 27

What's the respiratory rate of full term infant?

Back 27

30-40 breaths/min

Front 28

What's respiratory rate of an infant 1-4 yrs?

Back 28

25-30 breaths /min

Front 29

What's the respiratory rate of adult?

Back 29

12-16 breaths /min

Front 30

How is O2 saturation measured?

Back 30

Quant of O2 in blood ready for exchange at tissue level. %

Front 31

Which of these O2 sats indicate hypoxia?

< 90, 92-95, < 95

Back 31

< 90

Pre-term infants: 92-95, term infants > 95, infants with cardio often < 95

Front 32

Name the 12 Limiting Factors

Back 32

1. Exaggerated jaw movement (high tone) eg. Open mouth, gross jaw gradation

2. Jaw thrust (high tone) eg. Forceful & sudden jaw drop

3. Jaw retraction (high tone)

4.Exaggerated tongue protrusion (low tone)

5. Tongue thrust (high tone)

6. Tongue retraction (pulled: high tone, falls into pharynx: low tone),

7. Tonic bite reflex (high tone)

8. Jaw clenching (high tone)

9. Jaw anchoring (low tone)

10. Lip retraction (high tone)

11. Lip pursing (high tone)

12. Low tone lips

Front 33

What's blue dye test and name disadv and advantages

Back 33

Used with trachee patients, where they swallow blue dye and then SLT suctions trachee to see if blue dye has entered airway.

Disadv: only shows gross aspiration so cld get "false negative" eg. trace, subjective, doesn't tell you when / why aspiration occured, pts have died from blue dye poisoning

Adv: simple, available, low cost, indicates gross aspiration

Front 34

What's Oximetry and advs and disadvs?

Back 34

Monitors o2 saturation of capillary blood flow. Normal sats = 99-100%.

Advs: portable, non-invasive, info on swallow breath co-ord, monitors 1 aspect of response to feeding, can show readiness for ax eg. If desat when handled then bad sign

Disadv: research not correlated desats to aspiration, affected by movement, affected by skin pigmentation, need to use over period time.

Front 35

What is Scintintigraphy and what can it measure?

Back 35

Assesses movement of a radoinuclide bolus through oral, pharyngeal and oesophageal stages of the swallow.

Quantifies bolus residue if pharynx and amount aspirated. Also records GOR.

Can use with vffs and to see lungs ability to clear penetrated material over time.

Disadv: lower spec images of anatomy, can't be used diagnostically without other tool.