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OMC IV, Module I > 6. Swallow > Flashcards

6. Swallow Flashcards

1
Q

Swallowing:
! The act of swallowing (deglutition) is an intricate action involving the integration of a complex series of sensory and motor responses.
! The act of swallowing must occur in a ____ and coordinated fashion in order to propel the food bolus into the esophagus and stomach without penetration into the larynx (voice box) and airway (lungs).

A

sequential

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2
Q

Phases of swallowing

! ____ Preparatory
! ____ Phase
! ____ Phase
! ____ Phase

A

oral
oral
pharyngeal
esophageal

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3
Q

Oral Preparatory/ Oral Phase:
! Adequate labial seal to prevent ____ leakage
! Mastication as necessary
! ____ movement for bolus formation and control during A-P transfer
! ____ seal to prevent nasal regurgitation

A

anterior
lingual
velar

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4
Q

Oral phase: labial seal

! Obicularis Oris and Zygomaticus- both lip muscles.
◦ Form seal for ____ oral cavity.

! Buccinator (cheek muscle)
◦ holds ____ in contact with the teeth

! All three innervated by the ____

A

anterior
food
facial nerve (VII)

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5
Q

Oral Phase:
! Food is moistened by saliva from the salivary glands
◦ 3 large salivary glands on each side: parotid, submandibular, and sublingual
◦ Innervated by ____ nerve

A

glossopharyngeal

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6
Q

Oral Phase: Mandible
! Muscles involved in chewing are all innervated by the ____.

! Temporalis- elevated, ____, and assists in closing the mandible.
! Masseter- elevated and ____ the mandible
! Lateral Pterygoid- ____, opens and protrudes the mandible (as well as ____ movement)

A

trigeminal nerve (V)

retracts
closes
depresses
lateral

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7
Q

Oral Phase: Tongue

! ____ to posterior rolling action of the midline tongue
! Tongue elevation progressing sequentially more ____ to push the bolus backward
! Sides and tip of tongue remain anchored against ____
! Central groove is formed in the tongue-acting as a chute or ramp for food to pass through as it moves ____.

A

anterior
posteriorly
alveolar ridge
posteriorly

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8
Q

Oral phase: Tongue

! Intrinsic muscles of the tongue (superior ____, inferior longitudinal, transverse, and ____) form trough
◦ Innervated by ____
! The tongue then elevated to the roof of the mouth by the extrinsic tongue muscles (____, styloglossus, and ____)
◦ Innervated by ____
! Sensation to tongue innervated by
◦ Anterior 2/3- ____
◦ Posterior 1/3- ____

A 
longitudinal
vertical
hypoglossal (XII)
genioglossues
hyoglossus
hypoglossal (XII)
trigeminal (V)
glossopharyngeal (IX)
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9
Q

Oral phase: velar seal

! Palate elevates to make contact with the posterior pharyngeal wall
◦ Tensor Veli Palati and Levator Veli Palati muscles form a “sling,” lifting the soft palate up and backwards, ____ off the entrance to the nasal cavity.
◦ Palatoglossus and Palatopharyngeus muscles ____ off the opening to the oropharnx
So that we don’t have stuff coming out of our nose
◦ All muscles are innervated by the pharyngeal plexus via the ____ nerve, with the exception of the tensor veli palatini (innervated by the ____ nerve,).

A

closing
closes
vagus
trigeminal

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10
Q

Oral Phase deficits
! Problems of weakness of the lips, tongue and cheeks due to ____, or degenerative neurological conditions can cause problems keeping food in the mouth.
! Such neurologic disorders prevent an individual from organizing the food into a well-formed bolus and moving it ____ in the mouth.
! If there is specific unilateral cheek (buccal) weakness, food can enter a pocket in one cheek making eating unsafe.

! Problems with xerostomia (dry mouth) such as after ____ therapy can result in difficulty breaking down solids and difficulty swallowing them smoothly through the hypopharynx.

! If someone has had oral cancer and has had part of the lips, tongue, cheek or palate removed, similar problems can occur with containing, ____ and transporting food through the mouth.

A

stroke
posteriorly
radiation
masticating

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11
Q

Pharyngeal Phase:

! Sensory receptors in the ____ trigger pharyngeal swallow
! Elevation and anterior movement of the ____
! ____ of the larynx
! Tongue base retraction
! Progressive contraction of the ____
! Opening of the ____ sphincter

A 
oropharynx
hyoid and larynx
closure
pharyngeal constrictors
circopharyngeal
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12
Q

Pharyngeal Phase: hyolaryngeal elevation

! Hyoid bone and larynx elevate and move ____ (anterior belly of the diagastric, mylohyoid, geniohyoid, and thyrohyoid)
! This elevation contributes to ____ of airway and forward movement contributes to opening of the ____
! Innervated by ____

A

anteriorly
closure
upper esophageal sphincter
vagus (X)

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13
Q

Pharyngeal Phase: closure of the larynx

! Intrinsic muscles (except ____) of the larynx close the vocal folds
◦ ____, lateral cricoarytenoid, ____, and thyroarytenoid
◦ Innervated by ____

A

PCA
interarytenoid
cricothyroid
vagus (X)

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14
Q

Pharyngeal Phase: tongue base retraction

! Tongue base assumes a ramp shape directing the bolus into the pharynx
! Tongue base ____ and pharyngeal wall ____ to make complete contact
• This is the ____ push to the back of our throat
! Innervated by ____ nerve

A

retracts
contracts
major
hypoglossal (XII)

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15
Q

Pharyngeal Phase: Pharyngeal Contraction

! Pharyngeal constrictor muscles (superior, middle, and inferior) help move the bolus towards the esophagus via ____ action
! ____ and ____ nerves innervate pharyngeal constrictors

A

stripping
glossopharyngeal (IX)
vagus (X)

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16
Q

Pharyngeal Phase: Cricopharyngeal opening

! Segment that separates the ____ from the esophagus
! At the end of the pharyngeal stage, it ____ to allow the bolus to enter the esophagus
! Innervated by the ____
! Rare to problems with cricopharyngeal opening- treated with botox or myotomy

A

phayrnx
relaxes
vagus (X)

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17
Q

Pharyngeal Phase deficits

! Categorized by timing or weakness
! Problems with timing usually occur in patients with neurological deficits. In such persons, the swallow reflex does not trigger effectively enough for the larynx to be protected beneath the epiglottis. This may result in penetration or ____ of food or liquids.
! When the food passes through the ____(aspiration) the patient may cough in an attempt to expel the dangerous food particles from the airway.

A

aspiration

vocal folds

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18
Q

Pharyngeal Phase deficits:
! Problems with weakness usually result in residuals and possible ____ aspiration
◦ If one side of pharynx is weak, foods tends of cling to that pharyngeal wall and collect in the ____ sinus on that side.

! Poor airway closure
◦ ____ during the swallow

A

overflow
pyriform
aspiration

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19
Q

Esophageal Phase:
! ____ wave pushes bolus through the esophagus
! Lower Esophageal sphincter ____ to allow bolus to enter the stomach.

A

peristaltic

opens

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20
Q

Esophageal Deficits:

! Retrograde flow
! Zenker’s Diverticulum-side pocket forms when
pharyngeal or esophageal muscle ____
! GERD
! ____ Fistula
◦ Usual to see but they do happen, sometimes
after an AEG

A

herniates

tracheoesophageal

21
Q

Signs and Symptoms of Dysphagia

! ____ before, during, after swallow
! Frequent coughing at ____ of meal
! ____/wet vocal quality
! Increase of ____

! Pneumonia
! ____
! Dehydration

A 
coughing
end
gurgly
secretions
malnutrition
22
Q 
Evaluation of Swallowing:
! \_\_\_\_/ Bedside Evaluation
! \_\_\_\_ Endoscopic Evaluation of Swallowing
(FEES)
! Modified \_\_\_\_(MBS)
A

clinical
fiberoptic
barium swallow

23
Q 
Clinical Evaluation
! Medical history/chart review
! Oral Motor evaluation
! Evaluate the swallow subjectively using varied food and liquid consistencies via
◦ \_\_\_\_ auscultation
◦ Visual exam
◦ \_\_\_\_ of the swallow
◦ Quality of respiration and phonation
A

cervical

palpation

24
Q 
Blue Dye Evaluation
! Deflate cuff
! Attempt \_\_\_\_
! PMSV as appropriate
! Attempt various consistencies
! \_\_\_\_ patient after trials to assess for immediate or delayed aspiration of food and liquid trials
A

cuff

suction

25
Q

FEES

! Passage of \_\_\_\_ flexible endoscope
! Endoscope placement is below the soft palate, superior to the epiglottis, parallel to posterior pharyngeal wall.
! Direct visualization 
◦ \_\_\_\_ port
◦ \_\_\_\_/hypopharynx 
◦ \_\_\_\_ structures
A

transnasal
velopharyngeal
oropharynx
laryngeal

26
Q 
FEES
! Assess secretion management
! Administration of food/liquid 
◦ \_\_\_\_ Spillage
◦ Aspiration before/after swallow
◦ Status of pharyngeal constriction
! Utilize \_\_\_\_/strategies/maneuvers during the examination
! Biofeedback
A

premature

positions

27
Q

Limitations:
! Does not allow for full analysis of ____ phase
! View of ____ is obliterated during the swallow (“white-out”)
• in a normal swallow, the epiglottis ____ & on the camera you see a “white out”

A

oral
larynx
inverts

28
Q

Abnormal FEES

“You can already see pooling of these secretions on the patient’s right side. So you’d infer there’s some sort of weakness here because you usually have pooling towards the patient’s weakness.”
• So you can see their not really initiating the swallow, it’s sort of spilling back there
• They haven’t aspirated yet - it’s just to the point they have penetrated
◦ ____: spilling into the vestibule to the true vocal folds (the V)
◦ ____: spilling past the true vocal folds (V)
‣ She has the mouse cursor on the true vocal cords

A

penetration

aspiration

29
Q

MBS
! Defines the abnormalities in anatomy and physiology causing the patient’s symptoms.
! Identify and evaluate treatment strategies that may immediately enable the patient to swallow safely.
! Evaluate ____ stages of the swallow.
! Radiologist and Speech Pathologist ____.

• Modified Barium Swallow allows you to look at:
◦ their anatomy, physiology, anything that is causing their symptoms. ◦ all stages of the swallowing
‣ including their ____ phase.
• Done in conjunction with a radiologist under fluoroscopy.

A

all
present
esophageal

30
Q

MBS A-P view

  • AP-position view is done to check ____ as the patient swallow the bolus.
  • & they’ll do a whole ____ follow through as well.
A

symmetry

esophageal

31
Q

Indications for 

FEES or MBS

INDICATIONS FOR FEES:
! Need to assess status of ____
! Pt. unable to be transported to Radiology
! Need exam that ____
! Post-intubation/ post- surgery
! Assess ____ or swallow status over a meal

INDICATIONS FOR MBS:
! Pt will not/does not accept \_\_\_\_
Oral stage needs to be examined
\_\_\_\_ complaints
Esophageal stage problem or reflux suspected
\_\_\_\_ during the swallow (verification)
A

secretions
day
fatigue

endoscopy
globus
aspiration

32
Q 
Dysphagia Management
! Direct vs. Indirect Therapy
! Compensatory Strategies 
◦ \_\_\_\_ Techniques
◦ Swallow Maneuvers
! Food Consistency/ Diet Changes
 ! \_\_\_\_ Prosthestics

• First we have to decide, can we feed them or not?
• Do we do direct vs. indirect therapy?
◦ ____ therapy: secretion management, swallowing management/ exercises, motor exercises
◦ ____ therapy: puree/food trials

A

postural
intraoral

indirect
direct

33
Q

Direct v. Indirect Therapy

! ____ and/or liquid

! ____ Programs
trials following

! ____ Management specified directions

A

food
exercise
saliva

34
Q 
Postural Techniques
! Chin \_\_\_\_ Posture 
! Chin \_\_\_\_ Posture
! Head \_\_\_\_
! Head \_\_\_\_
A

down
up
rotation
tilt

35
Q

Chin Down Posture
! Pushes anterior pharyngeal wall ____
! Tongue base and epiglottis pushed closer to
____
! ____ space between epiglottic base and arytenoid cartilage
! Useful for patients with ____ in triggering pharyngeal swallow, reduced tongue base retraction, and/or reduced airway entrance closure.

A

posteriorly
PPW
narrows
delays

36
Q

Chin Up Posture
! Allows ____ to assist in propelling bolus from oral cavity into the pharynx
! Useful for patients with reduced ____ control

A

gravity

tongue

37
Q

Head Rotation

! Closes the damaged/weak side of the pharynx so bolus flows through the more ____ (stronger) side
! Pushes damaged/weak side toward ____, improving VF adduction
! Useful for patients with unilateral ____ weakness or unilateral ____ paresis/paralysis

A

normal
midline
pharyngeal
VF

38
Q

Head Tilt
! Bolus moves down stronger side with better ____

! Useful for patients with ____ oral impairment

A

control

unilateral

39
Q 
Swallow Maneuvers
! \_\_\_\_ Swallow
! Super-supraglottic Swallow 
! \_\_\_\_ Swallow
! Mendelsohn Maneuver
A

supraglottic

effortful

40
Q

Supraglottic Swallow
! Closes the true ____ before and during the swallow
! Useful for patients with reduced or late vocal fold ____ or delayed ____ swallow

A

vocal folds
closure
pharyngeal

41
Q

Super-supraglottic Swallow
! Effortful breath hold tilts arytenoid ____, closing airway entrance before and during swallow.
! Useful for patients with reduced closure of ____ entrance

A

forward

airway

42
Q

Effortful Swallow
! Effort increases ____ tongue base movement
! Useful for patients with decreased ____ movement of the tongue base

A

posterior

posterior

43
Q

Mendelsohn Maneuver

! Increases the extent and duration of ____ elevation and width of ____ opening
! Useful for patients with reduced ____ movement or discoordinated swallow

A

laryngeal
cricopharyngeal
laryngeal

44
Q 
Diet Changes
! Should be last compensatory strategy
! Food Consistencies:
◦ \_\_\_\_ liquids
◦ \_\_\_\_ liquids (nectar, honey) = pudding-thick liquid 
◦ \_\_\_\_
◦ Soft
A

thin
thickened
pureed

45
Q

Intraoral Prosthetics
! Palatal Lift: lifts soft palate into ____ (closed) position.
! Palatal Obturator: used with significant ____ of the soft palate.
! Palatal Reshaping Prosthesis: recontours the ____ to interact with the remaining tongue.

A

elevated
resection
hard palate

46
Q

Post-TORS FEES
! Continue primary nutrition via ____ tube with facilitative feeds of puree and nectar with compensatory strategy of head turn to the ____, chin down and ____ swallow
! Prior to initiation of chemoradiation, feeding tube ____ and patient eating a ____ diet

A

feeding
R
effortful

removed
regular

47
Q

Post-chemoradiation

• You can see how ____ his secretions are
• His epiglottis is smaller now - you can see it hanging over a little bit. don’t know why they don’t just take out the entire epiglottis because it’s
not really useful after all this.
• His airways still moves ____ - things are a little swollen in there.
• The more the patient swallows, the more they can ____ a lot of that out.
• Radiation can cause ____ and tightening, so once we deem they are
safe to swallow we want them to do as much as possible to get those muscles moving. The more they swallow, the better.

A

thick
well
clean
fibrosis

48
Q

Post-chemoradiation FEES
! Pt currently on ____ diet, following FEES recommendations included increasing diet to puree and thin liquids/ nutritional shakes
! ____ swallowing exercises and artificial saliva products
! Secretion management recommendations
! Resumed ____ diet within 6 weeks

A

liquid
aggressive
regular

OMC IV, Module I (6 decks)

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