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Dysphagia Test 1 > Chapter 2 > Flashcards

Chapter 2 Flashcards

1
Q

What are the structures of the oral phase?

A 
Lips
Teeth 
Maxilla (hard palate)
Velum (soft palate) – shared with oropharynx 
Uvula
Mandible
Floor of mouth
Tongue (all but base)
Faucial arches - anterior & posterior
Palatine tonsils
Sulci - anterior & lateral
Salivary glands
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2
Q

What are the three salivary glands?

A

parotid, submandibular, sublingual

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3
Q

Where does the oral tongue end?

A

at the circumvallate papillae

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4
Q

What are the intrinsic muscles of the tongue (oral)?

A

superior longitudinal, inferior longitudinal, transverse, vertical (alter shape)

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5
Q

What are the extrinsic muscles of the tongue (oral)?

A

genioglossus, hyoglossus, styloglossus, palatoglossus (protrude/retract, elevate/depress)

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6
Q

What are the structures of the pharyngeal phase?

A 
Pterygoid plates on sphenoid bone- (nasopharynx)
Velum (oropharynx)
Tongue base
Mandible
Hyoid bone
Pharynx! (pharyngeal walls)
Epiglottis
Thyroid cartilage
Cricoid cartilage
Vallecula (plural is valleculae) 
Pyriform sinuses
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7
Q

What are the muscles of the roof of the mouth (Oral)?

A

Palatoglossus and Palatopharyngeus

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8
Q

What does the palatoglossus do and where is it located?

A

in anterior faucial arch and it pulls the velum down and forward against the back of tongue

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9
Q

What does the palatopharyngeus do and where is it located?

A

in posterior faucial arch and it helps elevate & retract velum (VP closure)

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10
Q

What are the muscles in pharyngeal/laryngeal phase?

A

Suprahyoids/submental
Infrahyoid
Contrictors
Cricopharyngeus (CP)

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11
Q

What are the muscles within the suprahyoids (pharyngeal)?

A

mylohyoids
geniohyoids
digastrics (anterior belly)

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12
Q

What is the muscle within the infrahyoid (pharyngeal)?

A

thyrohyoid

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13
Q

What are the muscles within the constrictors (pharyngeal)?

A

Superior, Middle, Inferior

Posterior & lateral walls

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14
Q

The CP inferior constrictor fibers attach to

A

cricoid lamina

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15
Q

What is the CP’s job?

A

to prevent air from entering esophagus, reduces backflow

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16
Q

The CP is __ at rest (when awake) and __ when activated

A

tonic (tight)

loose/long

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17
Q

The CP divides the

A

pharynx and esophagus

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18
Q

What are the structures of the larynx?

A 
Hyoid Bone
Epiglottis
Valleculae
Laryngeal vestibule
Aryepiglottic folds > lateral vestibule walls
Thyroid cartilage
Arytenoid cartilages
False vocal folds
True vocal folds
Ventricles – lateral
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19
Q

What are the Laryngeal muscles?

A 
PCA (posterior cricoarytenoid) 
LCA (lateral cricoarytenoid) 
Interarytenoid
TA (thyroarytenoid)
Laryngeal strap muscles
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20
Q

What does the PCA attach and what is its purpose?

A

attaches the cricoid lamina to arytenoid

and it abducts arytenoids/vocal folds for respiration at the end of swallow

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21
Q

What does the LCA attach and what is its purpose?

A

attaches cricoid cartilages to arytenoid

and it adducts arytenoids/vocal folds

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22
Q

What do the Interarytenoid attach and what is its purpose?

A

it attaches 2 arytenoids

and adducts arytenoids/vocal folds

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23
Q

What does the TA attach and what is its purpose?

A

attaches thyroid cartilage to arytenoid

and it tilts arytenoids anteriorly during swallow to assist with airway closure

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24
Q

What are the laryngeal strap muscles?

A

Thyrohyoid
Sternothyroid
Sternohyoid

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25
Q

Laryngeal Strap muscles

What does the thyrohyoid attach and what is its purpose?

A

it attaches thyroid cartilage to hyoid bone

and it elevates and lowers larynx

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26
Q

Laryngeal Strap muscles

What does the sternothyroid attach and what is its purpose?

A

it attaches the sternum to the thyroid cartilage

and it suspends larynx & trachea in neck

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27
Q

Laryngeal Strap muscles

What does the sternohyoid attach and what is its purpose?

A

it attaches the sternum to the hyoid

and it lowers and stabilizes hyoid

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28
Q

What are the structures of esophageal phase?

A

UES
Esophagus
LES

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29
Q

What are other names for the UES?

A

CP (cricopharyngeus)

PE or PES segment (pharyngoesophageal sphincter)

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30
Q

The UES can also be part of the

A

Pharyngeal phase structures

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31
Q

How long is the esophagus?

A

~25 cm or 9 in

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32
Q

What are the muscles of the esophageal phase?

A

UES
LES
2 layers of muscle in esophagus

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33
Q

What is the purpose of the UES?

A

keeps air out of lungs, keeps contents swallowed from coming back up

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34
Q

What is the purpose of the LES?

A

keeps contents in stomach

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35
Q

What are the 2 layers of muscle in esophagus?

A

inner circular and outer longitudinal which are both striated and smooth muscle

36
Q

What is the purpose of the inner circular and outer longitudinal muscles?

A

help with peristaltic contractions to move food down

37
Q

What is the first line of defense against aspiration?

A

epiglottis

38
Q

What is the second line of defense against aspiration?

A

Vocal folds

39
Q

What are the stages of dysphagia?

A

oral, pharyngeal and esophageal

40
Q

Describe the what is involved in the oral stage?

A

labial muscle, labial movement, sensory receptors, buccal muscle and nose breathing

41
Q

Describe the oral stage steps

A

mastication
bolus formation
tipper or dipper
bolus transport from oral cavity to the pharynx

42
Q

The dysphagia population are known to be __

A

dippers

43
Q

What happens in the mastication step in the oral stage?

A

rotary lateral movement of jaw and tongue

44
Q

What happens in the bolus formation step in the oral stage?

A

the tongue mixes bolus with saliva

45
Q

When the bolus is transported from oral cavity to pharynx in the oral stage, what propels the movement of the bolus?

A

the tongue’s posterior movement

46
Q

What are the steps of the pharyngeal phase?

A
  1. the velum elevates and retracts for VP closure, bolus transport with tongue base retraction and pharyngeal wall contraction
  2. epiglottis inverts, hyolaryngeal elevation and protraction
  3. closure of larynx
  4. CP opening
  5. Transport by pharyngeal constrictors
  6. CP closure, larynx resets
47
Q

What are the steps of the esophageal phase?

A
  1. transit time is measure from UES through LES
  2. Bolus flow through the esophagus via peristaltic contractions of striated and smooth muscle along the esophageal wall
  3. Relaxation of LES allows bolus to flow into stomach
48
Q

What are some characteristics of a normal swallow in a young person?

A
  • Higher hyoid and larynx, less elevation
  • lower velum, shorter pharynx
  • uvula in epiglottis, pocketing valleculae
  • pharyngeal swallow is triggered at anterior faucial arch
  • the bolus flow is uninterrupted, no pauses
49
Q

Why do young children have move protection?

A

because their structures are very compressed and leaves little room for things to go wrong

50
Q

What are some characteristics of a normal swallow in an older person?

A
  • ossification of cartilages and hyoid bone
  • pharyngeal swallow triggered when bolus head reaches middle of tongue base
  • they can normally have delayed pharyngeal swallow and spillage
  • 70+ larynx lower
  • arthritis in C vertebrae impinge on pharyngeal wall
  • primarily ‘dippers’
  • delay, residue, penetration are normal
  • reduced hyolaryngeal excursion, plateaus at CP opening
  • reduced CP opening flexibility
51
Q

What are some characteristics of the swallow of a patient with neurologic issues?

A
  • pharyngeal swallow triggered when bolus head reaches the middle of the tongue base or when it falls into pyriforms
  • delays
  • they often aspirate
52
Q

What is never normal in any swallow?

A

aspiration

53
Q

Sensory for Trigeminal (V)

A

sensation anterior 2/3 of tongue

54
Q

Sensory for Facial (VII)

A

taste anterior 2/3 of tongue

55
Q

Sensory for Hypoglossal (XII)

A

Sensation, mucous membranes of pharynx, palate, posterior tongue and tonsils

56
Q

Sensory for Vagus (X)

*Most important

A

Mucous membrane of pharynx, larynx, bronchi, lungs, esophagus, stomach

57
Q

Sensory for Glossopharyngeal (IX)

A

Taste and sensation of posterior 1/3 of tongue

58
Q

Motor for Trigeminal (V)

A

mastication

59
Q

Motor for Facial (VII)

A

lips, face, salivary glands

60
Q

Motor for Hypoglossal (XII)

A

tongue

61
Q

Motor for Glossopharyngeal (IX)

A

pharynx, gag reflex

62
Q

Motor for Vagus (X)

A

trachea, larynx, pharynx, cough reflex

63
Q

Motor for Accessory (XI)

A

Uvula, palate, pharyngeal constrictors (because of location)

64
Q

What is the Apneic Period?

A

it happens during pharyngeal stage
it increases as bolus increases
mostly during exhalation (at end or near end)

65
Q

How long does the apneic period last?

A

~1 second

66
Q

Why is it safer for the apneic period to be on exhalation instead of inspiration?

A

because the airway is better protected

The VFs close for protection

67
Q

What is dysphnea?

A

problems with breathing

68
Q

Is it necessary to have an apneic period?

A

yes, there are problems when there is no apneic period

69
Q

As viscosity of the bolus increases then volume __ and pressure __ which leads to __ muscle activity pharyngeally

A

decreases, increases, increased

70
Q

Is it ok to have multiple swallows?

A

yes, it is actually a therapy technique

71
Q

What cranial nerves provide sensory information during the pharyngeal swallow?

A 
IX (glossopharyngeal)
X (vagus)
XI (accessory)
XII (hypoglossal)
VII (facial)
V (trigeminal)
72
Q

What cranial nerves provide motor information during the pharyngeal swallow?

A

XI (accessory)

X (vagus)

73
Q

What two structures should make complete contact at the tail of the bolus to create pressure during pharyngeal phase?

A

tongue base and pharygeal walls

74
Q

What two structures move simultaneously during pharyngeal phase?

A

VP closure and hylolaryngeal upward and forward movement

75
Q

___ opens and the __ closes simultaneously

A

UES; airway

76
Q

Can the UES be under voluntary control?

A

yes, patients can be taught to voluntarily protect their airway or to open the UES sphincter voluntarily

77
Q

Is there a way to voluntarily initiate or modify the pharyngeal wall constriction?

A

No

78
Q

Patients with esophageal phases disorders should be referred to __

A

gastroentrologist

79
Q

What are the functions of the valves?

A

directing food, applying pressure and to propel it along

80
Q

What are the names of the valves?

A

lips, oral tongue, vp sphincter, tongue base and pharyngeal wall, larynx (epiglottis, arytenoids, false vfs, vfs), UES, LES

81
Q

Describe the oral tongue

A

it is for speech and used in the oral stage and is under voluntary control and ends and circumvallate papillae

82
Q

Describe tongue base

A

involuntary control, starts at circumvallate papillae and extends to hyoid bone

83
Q

The UES is a __ valve

A

muscoskeletal

84
Q

The LES is a __ spincter

A

muscular

85
Q

What do dysphagic patients do in reference to breathing that increases their risk of aspiration?

A

they often interrupt inhalation to swallow

86
Q

What happens when you are drinking from a cup?

A

early airway closure and some pre elevation of larynx as cup is approaching lips

Dysphagia Test 1 (5 decks)

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