Chapter 13. Neurogenic Dysphagia Flashcards
Question 13-1: Which of the following can be causes of Mechanical dysphagia? A. Esophageal stricture B. Gastroesophageal reflux C. Aortic aneurysm D. Macroglossia E. All of the above
Answer 13-1: E.
All of the listed conditions can be causes of
mechanical dysphagia. Mechanical dysphagia
is due to structural abnormalities within and
adjacent to the mouth, pbarynx. and
esopbagus. The interruption of function is on a
mechanical basis. In addition to the listed
causes, GERD and hiatal hernia can also
produce mechanical dysphagia. (p166)
Question 13-2: Which of the following is most prominent in patients with myotonic dystrophy? A. Aspiration B. Spastic dysphonia C. Neuromuscular dysphagia D. Mechanical dysphagia
Answer 13-2: C.
Neuromuscular dysph3gia is due to weakness
of oropharyngeal and esophageal muscles by
the neuromuscular disease. Neuromuscular
dysphagia is the most common of these
disorders in patients with myotonic dystropby,
present in up to 56% of patients. Aspiration is
also seen in patients with myotonic dystrophy,
but with lesser incidence. being present in up
to 33% of patients. The other disorders are not
expected in this disorder. (p166-167)
Question 13-3:
A 64-year–old man presents with diplopia,
Wlilateral ptosis, and dysphagia. Which of the following is the most likely diagnosis?
A. Myotonic dystrophy
B. Myasthenia gravis
C. Brainstem infarction
D. Paraneoplastic syndrome
Answer 13-3: B.
Myasthenia gravis commonly presents with
diplopia and ptosis, and the ocular motor
findings cannot be ascribed to a single nerve
defect. Dysphagia is present in up to 30% of
patients early in the course, and develops in
almost all patients with generalized
myasthenia at some time in their disease. The
dysphagia of myasthenia can be at the oral,
pharyngeal, or even esophageal leveL (p 169)
Question 13-4: A 54-year-old female presents with dysphagia associated with hemiataxia and a small pupil on the same side. Which is the most likely diagnosis? A. Brainstem tumor B. Multiple sclerosis' C. Diabetic cranial neuropathy D. Stroke
answer 13-4: D.
The patient has features of the lateral
medullary syndrome, a stroke syndrome. MS
would not be expected to produce this
extensive a focal deficit involving the
brainstem. Brainstem tumor would also be
expected to produce more extensive
symptoms. with the distribution differing
depending on whether the tumor was intraaxial
or extra-axial. (p 169)
Question 13-5:
Which of the following statements regarding stroke and dysphagia is true?
A. Dysphagia following stroke indicates a brainstem localization of the lesion
B. Aspiration is Wlcommon in patients with stroke
C. Dysphagia to the point of requiring tube feeding rarely shows subsequent improvement
D. Dysphagia can be the sole manifestation of stroke
Aaswer 13-5: D.
Dysphagia can be the sole manifestation of
stroke. although this is uncommon. Lesion is
often in the medulla. Dysphagia often
develops with bilateral strokes of the cerebral
hemispheres. so dysphagia does not
necessarily localize the lesion to the
brainstem. Aspiration is common in patients
with stroke, and many patients require tube
feedings. Luckily, most patients improve, so
that most patients are not left with long-term
tube feedings. (p 170)
Question 13-6:
Which of the following statements is true regarding dysphagia in mUltiple sclerosis?
A. Dysphagia is uncommon in MS because this is a disease of myelin rather than neurons
B. Dysphagia is common in patients with brainstem dysfunction from MS
C. Dysphagia in MS usually develops early in the course of the disease
D. Dysphagia in MS is usually due to dysfunction of the esophageal phase
Answer 13-6: B.
Dysphagia is common in MS, seen in up to
34% of patients, with double this incidence in
patients with severe disability from MS.
Prominence ofbrainstem lesions predisposes
to development of dysphagia. About half of
patients with objective abnormalities on
swallowing may not be aware of their deficit.
Dysphagia is more prominent with advanced
disease rather than early in the course.
Dysphagia with MS is usually due to
dysfunction in the oral and pharyngeal phases
rather than the esophageal phase. (p 170-171)
Question 13-7:
A 60-year-old female presents with slowly
progressive dysphagia and dysarthria with no other signs of weakness or ataxia. Reflexes are brisk and the plantar responses are upgoing. Which is the most likely diagnosis?
A. ALS
B. Brainstem tumor
C. Multiple sclerosis
D. Central pontine myelinolysis
Answer 13-7: A.
ALS presents with dysphagia in about 25% of
patients. With advancing disease, the majority
of patients develop dysphagia. Brainstern
tumor is uncommon in this age, unless
metastatic, and there would usually be other
signs of brains tern dysfunction at the pontine
and medullary level. MS is uncommon to
begin at this age, and usually does not present
with a slow progression. CPM is an acute
process typically in the setting of electrolyte
abnormalities. (p 171-172)
Questions 13-8 through 13-10: The following questions present a clinical manifestation of dysphagia. For each,select the localization of the dysfunction from the following list. A. Oropharyngeal dysfunction B. Esophageal dysfunction C. Mechanical obstruction D. Zencer's diverticulum Question 13-8: Difficulty with solids but not liquids
Answer 13-8: C.
Mechanical obstruction can be associated with
difficulty allowing passage of solids while
liquids can pass through the restricted
opening. This is the reverse of most cases of
dysphagia due to neurologic causes, Where
patients have more difficulty with liquids than
solids. (p 173)
Questions 13-8 through 13-10: The following questions present a clinical manifestation of dysphagia. For each,select the localization of the dysfunction from the following list. A. Oropharyngeal dysfunction B. Esophageal dysfunction C. Mechanical obstruction D. Zencer's diverticulum
Question 13-9:
Difficulty initiating swallowing.
Answer 13-9: A.
Oropharyngeal dysfunction results in
difficulty initiating swallowing. The other
major clue to this localization is repetitive
swallowing attempts. (p 173)
Questions 13-8 through 13-10: The following questions present a clinical manifestation of dysphagia. For each,select the localization of the dysfunction from the following list. A. Oropharyngeal dysfunction B. Esophageal dysfunction C. Mechanical obstruction D. Zencer's diverticulum Question 13-10: Retrosternal "hanging up" sensation.
Answer 13-10: B.
Esophageal dysfunction, which can have
neurologic causes, can give a sensation of
food hanging up. Documentation is best by
videofluoroscopy. (p173-174)
