Chapter 3 - Swallowing disorders arising from neurological and other conditions

Question 1

SWALLOWING

Answer 1

A complex activity that requires the simultaneous interaction between the sensory and motor neurologic system

Question 2

ETIOLOGY

Answer 2

• neurological disorders like stroke
• organ removal as a result of cancer
• degenerative disorders like PD
• altered level of consciousness
• GERD

Question 3

EVENTS IN A NORMAL SWALLOW

Answer 3

• bolus preparation
• airway protection
• bolus propulsion

Question 4

STAGES OF SWALLOWING

Answer 4

• oral preparatory stage
• oral stage
• pharyngeal stage
• esophageal stage

Question 5

MOTOR HOMUNCULUS

Answer 5

It refers to the primary motor cortex, that lies superior to the Broca’s area, establishing a relationship to the motor commands of speech and swallowing
Pg 56 for diagram

Question 6

PENETRATION

Answer 6

The entry of bolus contents into the larynx to a level that does not extend beyond the true VFs

Question 7

ASPIRATION

Answer 7

Entry of bolus content into the airway below the true VFs. It can occur before, during or after the swallow.
Result - Prandial aspiration

Question 8

CLASSIFICATION OF PRANDIAL ASPIRATION

Answer 8

refer to the table at Pg 58

Question 9

ASPIRATION PNEUMONIA

Answer 9

the entrance of food or liquids into the bronchi of lungs resulting in infection
3 types - anaerobic pneumonia, Lung abscess, empyema

Question 10

CHEMICAL PNEUMONITIS

Answer 10

a condition referring to chemical injury caused by inhalation of sterile gastric contents from the stomach or esophagus

Question 11

BACTERIAL INFECTION

Answer 11

occurs as a result of an increased volume of oropharyngeal secretions coupled with impaired defense mechanisms
Result - aspiration pneumonia

Question 12

SILENT ASPIRATION

Answer 12

aspiration occurring without elicitation of cough reflex

Question 13

ANAEROBIC PNEUMONIA

Answer 13

type of AP that results in low grade fever

Question 14

LUNG ABSCESS

Answer 14

accumulation of pus that has been contained by a surrounding inflammatory process within the lungs

Question 15

EMPYEMA

Answer 15

the accumulation of pus in the pleural space
if not treated - results in rupturing of pleural walls

Question 16

GERD

Answer 16

gastro esophageal reflux disease
test to detect - prolonged esophageal pH monitoring
retrograde movement of gastric contents from the stomach through the LES and into the esophagus
complaint of heart burn

Question 17

LPR

Answer 17

laryngopharyngeal reflux - when the refluxate reaches the larynx

Question 18

ALS

Answer 18

amyotrophic lateral sclerosis
progressive disease involving the degeneration of the UMN and LMN
lower age < higher age group
males > females
progression is rapid
bulbar involvement results in worst prognosis

Question 19

STROKE

Answer 19

brainstem stroke&raquo_space; cortical stroke

Question 20

PSEUDO BULBAR PALSY

Answer 20

weakness of muscles innervated by the medulla because of interruption of corticobulbar fibers

Question 21

BDST

Answer 21

burke dysphagia screening test - screening test to identify stroke patients at risk for developing pneumonia and upper airway obstruction

Question 22

PD

Answer 22

parkinson’s disease - progressive degenerative neuromuscular disorder charcterized by loss of dopamine

Question 23

DUCHENNE DYSTROPHY

Answer 23

childhood form of muscular dystrophy
deficits in oral preparatory as oral phases
pharyngeal impairment includes weakness of pterygoid and superior constrictor muscles

Question 24

ODYNOPHAGIA

Answer 24

pain in swallowing

Question 25

ACHALASIA

Answer 25

failure of movement of bolus into the stomach looks like a "bird's beak" complaint - feeling of food getting stuck in the throat even after repeated swallow

Question 26

CURLING

Answer 26

alteration in esophageal motility frequently seen in elderly individuals caused by scarring in the esophagus following surgery or bleeding

Question 27

DES

Answer 27

diffuse esophageal spasm intermittent dysphagia, chest pain and repetitive contractions of the esophagus (tertiary contraction) appearance looks like a rosary bead or corkscrew

Question 28

DIVERTICULA

Answer 28

esophageal diverticula are outpouchings of one or more layers of the esophageal wall. complaint of the food coming back - reflux back to larynx

Question 29

WEBS/RINGS

Answer 29

schatzki ring - intermittent dysphagia for solids

Question 30

GLOBUS

Answer 30

Sensation of lump in the throat

Question 31

Zenker diverticulum

Answer 31

formed by the protrusion of the posterior hypopharyngeal mucosa between fibers of the inferior constrictor and CPMs.

Question 32

LPRD

Answer 32

laryngopharyngeal reflux disease inflammatory disease of the larynx , originating form the stomach symptoms - hoarseness, vocal process granulomas, coughing complaints - hoarseness, throat clearing, excess phlegm in the throat worst case scenario - excessive coughing, occasional choking of foods, globus

Question 33

GERD vs LPRD

Answer 33

refer to the table on pg 80

Question 34

BARRETT ESOPHAGUS

Answer 34

compensatory change in the esophageal mucosa from squamous to specialized intestinal epithelium can progress to esophageal cancer treatment - medication for GERD and diet modification

Question 35

BACTERIAL INFECTION OF OROPHARYNX

Answer 35

tonsillitis, pharyngitis, abscesses inflammation of primary mucosa or lymph symptoms - odynophagia

Question 36

Eosinophilic Esophagitis

Answer 36

An inflammation that builds up in a type of white blood cells in the esophagus. symptoms - vomiting, chest or abdominal pain, regurgitation of foods and liquids, discomfort in swallowing

Question 37

CHAGAS DISEASE

Answer 37

parasitic infectious disease that leads to achalasia cause - parasite called Trypanosoma cruzi Ask patients their travel history

Question 38

LYME DISEASE

Answer 38

bacterial infection caused by a bite from an infected tick. Progresses to paralysis, joint problems, chewing fatigue complaints - swallowing fatigue, difficulty chewing, food not going down

Question 39

XEROSTOMIA

Answer 39

permanent injury to salivary glands

Question 40

SJOGREN SYNDROME

Answer 40

dryness in the eyes, salivary and lacrimal glands and mouth prominent features - xerostomia, oral pain, glossodynia, dysgeusia

Question 41

CROHN DISEASE

Answer 41

presence of lesions throughout the digestive tract

Question 42

EPIDERMOLYSIS BULLOSA

Answer 42

rare disorder characterized by blistering of the mucosal lining, often elicited by minimal trauma

Question 43

CTE OR DEMENTIA PUGILISTICA

Answer 43

chronic traumatic encephalopathy identified as a condition following multiple mild or severe head injuries or concussions