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Linares > chapter 4: disorders of deglutition > Flashcards

chapter 4: disorders of deglutition Flashcards

1
Q

in dysphagia, the anatomic and/or neuromuscular dysfunctions are the actual _____ leading to the _____ for which treatment is designed.

A

disorder, symptoms

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2
Q

________ and _________ are symptoms, not the disorder

A

aspiration, penetration

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3
Q

a radiographic study (MBS) should be completed on any patient who is suspected of having _________ or who may be __________.

A

pharyngeal dysphagia, aspirating/penetration/coughing

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4
Q

An MBS should provide three types of information

A

a. anatomic/neuromuscular dysfunction or cause
b. whether oral eating is recommended (and bolus consistency)
c. plan treatment/ therapy
(d. trial treatments)

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5
Q

a patients description of his/her swallowing problem can be ______

A

erroneous

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6
Q

OTT stands for

A

oral transit time

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7
Q

OTT begins from the initiation of the ________ and ends when the bolus head reaches _________

A

posterior propulsion, faucal pillars/ base of tongue

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8
Q

The OTT time is approximately

A

1 second

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9
Q

when does the pharyngeal DELAY time (PDT) begins?

A

the bolus head reaches the base of the tongue and ends when the swallow is triggered

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10
Q

the pharyngeal TRANSIT time (PTT) is the time

A

from the time the trigger occurs until the bolus tail passes the UES

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11
Q

the PTT takes

A

less than 1 second

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12
Q

it is critical to know whether aspiration occurs …

A

before, during or after the pharyngeal swallow

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13
Q

normal mastication requires

A
  • intact mandible
  • intact maxilla
  • intact buccal musculature
  • intact lingua musculature
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14
Q

the purpose of the oral preparation for the swallow is to break down food, mix it with saliva, and form it …

A

into a cohesive bolus

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15
Q

what are the disorders in oral preparation of the swallow

A

a. cannot hold food in the mouth anteriorly-reduced lip closure
b. cannot hold a bolus reduced tongue shaping/coordination
c. cannot form a bolus reduced range of tongue motion or coordination
d. material falls into anterior sulcus reduced labial tension/tone
e. material falls into lateral sulcus reduced buccal tension/tone
f. abnormal hold position-reduced tongue control/tongue thrust

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16
Q

if food falls from the mouth, check if the patient is a ________ _________, check for reduced _____ closure.

A

mouth breather, lip

could be the result of a stroke or lack of sensory information from cranial nerve VII

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17
Q

inability to hold a bolus of liquid or paste can be the result of the inability to _____________ around the material.

A

shape the tongue

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18
Q

during the oral prep phase the ____ _______ contacts the back of the tongue to prevent premature spillage

A

Soft palate

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19
Q

premature spillage is normal during _______ but not while holding a liquid or pudding bolus.

A

mastication

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20
Q

premature spillage can result in

A

coughing/aspiration/penetration

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21
Q

inability to hold bolus shape is due to reduced ________, while premature spillage is due to ______ or ________.

A

tongue movement, weak velar position, poor buccal control

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22
Q

reduced tongue motion/coordination will prevent the formation of the _____ resulting in food spread throughout the oral cavity just prior to the swallow.

A

bolus

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23
Q

food falling into the anterior cavity is the result of reduced _____ and _______ tone

A

labial and facial

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24
Q

the dominate muscle of the cheeks is the ________ innervated by the ______ branch of the ____ cranial nerve.

A

buccinatior, buccal, VII

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25
Q

normally the bolus is held between the tongue and the hard palate (tippers) or on the _____ of the mouth (dippers)

A

floor

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26
Q

an abnormal position would be if the bolus was held immediately behind the front _____ possible resulting in a _______________

A

teeth, tongue thrust

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27
Q

the oral phase is the ________ of the bolus through the oral cavity

A

propulsion

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28
Q

the oral phase ends when the __________ is triggered

A

normal swallow

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29
Q

the pharyngeal swallow is predominately triggered via sensory information from the ___________

A

glossopharyngeal nerve (IX)

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30
Q

the oral phase transit time is typically around

A

1 second

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31
Q

when a bolus is held in the mouth with no lingual movement, 3 possible causes are:

A

a. swallow apraxia
b. reduced sensation in mouth
c. tactile/oral agnosia

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32
Q

the text gives ___ ways to increase sensory stimulation.

A

5

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33
Q

true or false: patients may not react to liquid or pureed material in the mouth but may react to a cookie

true or false: allowing the patient to feed himself may increase oral activity

A

true

true

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34
Q

apraxia of swallow is often accompanied by

A

oral apraxia (the reverse is not true)

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35
Q

true or false: refraining from giving an commands to eat/swallow may be helpful in a patient presenting with apraxia of swallow.

A

true

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36
Q

at times , a __________ may cause the tongue to thrust forward toward the ______ incisors

A

neurological disorder, central

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37
Q

a tongue thrust may be preceded by an abnormal ___________

A

bolus position

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38
Q

labial buccal rension is generated by this major lip muscle

A

orbicularis oris

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39
Q

buccal muscles may provide __________ or _________ in the lateral walls of the oral cavity to help with the backward movement of the bolus.

A

resistance or pressure

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40
Q

food collecting in the anterior or lateral floor of the mouth is the result of

a. ______
b. ______

A

a. reduced ability to shape and coordinate the tongue around the bolus
b. reduced contact between the tongue and the alveolar ridge

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41
Q

during a swallow scar tissue cannot move in this direction

A

up ( it cannot bulge upward)

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42
Q

any residue left on the tongue surface indicates reduced tongue ______

A

movement

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43
Q

if the residue increases as food becomes more viscous it is an indication of reduced tongue _______

A

strength

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44
Q

inability to propel the bolus _________ is likely the result of lingual discoordination

A

posteriorly

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45
Q

when the tongue cannot elevate to touch the palate the bolus may be _______

A

spread

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46
Q

residue on the hard palate indicates reduced tongue ________

A

elevation

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47
Q

greater residue from more viscous food indicates reduced tongue ______

A

strength

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48
Q

if the front to back action of the tongue is broken into multiple small tongue movements it is a sympton of ______________.

A

reduced lingual coordination

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49
Q

in parkinsons patients the posterior tongue fails to lower at the appropriate time so the bolus only reaches the ____________ before it rolls forward again.

A

back of the hard palate

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50
Q

this incomplete posterior propulsion behavior may last up to ___ seconds before a swallow is initiated

A

10

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51
Q

when liwuid or pudding is placed in the mouth the soft palate contacts the ___________- sealing the bolus in the mouth posteriorly to prevent spillage

A

back of the tongue

52
Q

the soft palate does not contact the back of the tongue on foods requiring _________

A

chewing

53
Q

premature spillage may fall into the ________, the _______________, or the __________

A

vallecule, pyriform sinuses, larynx

54
Q

premature spillage indicates reduced lingual _______ or possibly ______ incompetency

A

control, velar

55
Q

premature spillage into the pharynx does not _________ the oharyngeal swallow.

A

trigger

56
Q

a patient who requires two three or more repeated swallows to empty the oral cavity is called __________

A

piecemeal deglutition

57
Q

during a MBS the small amount of food given should be cleared from the oral cavity in a _____________-

A

single swallow

58
Q

the normal oral transit time is ___, increasing _____ seconds in individuals over the age of 60

A

1 seconds, 1/4

59
Q

the glossopharyngeal nerve monitors _________, and _______ from the ____________ one third of the tongue

A

sensation, taste, posterior

60
Q

it is motor to the ________ muscle whch raises the pharynx during swallowing and speech.

A

stylopharyngeous

61
Q

the glossopharyngeal nerve receives motor impulses from its nucleus in the nucleus ambiguous area. this nucleus receives its motor impulses from both hemispheres. therefore the glossopharyngeal nerve is said to be ________ innervated. damage to one hemisphere will have little to no effect on the glossopharyngeal function

A

bilaterally

62
Q

draw the glossopharyngeal motor innervation

A
63
Q

delayed phayngeal swallow occurs when the head of the bolus enters the ______ and the pharyngeal swallow has NOT been triggered.

A

pharynx

64
Q

a delay in triggering the pharyngeal swallow increases the risk of

A

penetration/ aspiration, (the longer the delay the greater the chances of this occuring)

65
Q

a delay in the pharyngeal swallow may cause the bolus to land in the

A

a. valleculaw
b. pyriform sinuses
c. airway

66
Q

the critical aspect of delay is the ________________

A

location of the bolus

67
Q

the ________ must be differentiated from the premature bolus loss

A

bolus

68
Q

premature bolus loss does not ________ the pharyngeal swallow

A

trigger

69
Q

if the bolus lands into the ______________ the bolus is at a high risk of being dumped into the _____ when the pharyngeal swallow is triggered

A

pyriform sinus, airway

70
Q

the chin down posture changes only the ____________ dimensions which occurs ___ the level level of the pyriform sinuses.

A

anterior posterior pharyngeal, above

71
Q

the chin down posture neither changes the degree of ______ shortening nor prevents contents in the ____________ from emptying into the airway.

A

pharyngeal elevation, pyriform sinuses (is for airway protection)

72
Q

material in the pyriform sinuses is not a _____- disorder

A

cricopharengeal (UES)

73
Q

the pharyngeal delay is measured from the time when the __ passes the point where the lower edge of the mandible crosses the tongue base to the point in time when the larynx and hyoid begin to ______

A

bolus, elevate

74
Q

the pharyngeal swallow actually begins with ________-of the larynx and hyoid AND IS FOLLOWED BY THE REST OF THE SWALLOW

A

elevation

75
Q

in normal young adults the pharyngeal delay is _______ seconds

A

0-0.2

76
Q

in adults over 60 the delay may be ___________ seconds

A

up to 0.5

77
Q

a delay of _ seconds is abnormal at any age especially if aspiration occurs

A

2

78
Q

in infants and young children, the bolus may collect in the _____- before the pharyngeal swallow is triggered.

A

vallecula

79
Q

in infants an abnormal delay is defined as more than ___ second between the last _____________- and the onset of the pharyngeal swallow.

A

1, tongue pump

80
Q

the pharyngeal stage ends when the bolus passes through the _______

A

UES

81
Q

normal pharyngeal transit time is a maximum of _________

A

1 second

82
Q

nasal regurgitation occurs when ____________________

A

the velopharyngeal port closure is inadequate and backflow occurs

83
Q

when a liquid or pudding is put in the mouth the soft palate makes complete contact with the ___________ and during the swallow the soft palate makes complete contact with the _________________

A

posterior tongue, posterior pharyngeal wall

84
Q

this latter contact only lasts a __________ second and occurs only as the bolus passes through the _____________

A

fraction of a, velopharyngeal port

85
Q

when a bolus cannot pass through the pharynx into the esophagus, material will move back upward, which is called _________

A

regurgitation/backflow

86
Q

a pseudoepiglottis is a ____________ located at the vase of the tongue after a total laryngectomy

A

flap of tissue

87
Q

upon swallowing the pseudo epiglottis is pulled ____________ narrowing the ___________ so that the patient can barely move food past this point.

A

towards the larynx, pharynx

88
Q

bony projectiles into the pharynx from the vertebrae are called __________

A

osteophytes (spurs)

89
Q

these growths may cause patients to think that there is _____________

A

something there

90
Q

a weak pharyngeal wall may result in food _____________ as well as food collecting in the __________ on the same side.

A

clinging to the wall, pyriform sinus

91
Q

little to no residue is left in the _________ in normal individuals after a swallow. only when there is apparent density of material on the walls is it considered a symptom of reduced __________

A

pharynx, pharyngeal contraction

92
Q

these patients may ____ swallow if they are aware of the residue.

A

dry

93
Q

when residue remains on the wall, the patient is at risk for _________ upon inhalation

A

aspiration

94
Q

in a normal swallow, 2/3 of the distance between the tongue base and posterior pharyngeal wall is closed by posterior movement of the ______ while the remaining 1/3 of the distance is closed by the anterior movement of the _________

A

tongue, pharynx

95
Q

clearing of residue in the valleculae is largely the result of ___________

A

tongue base movement

96
Q

large amounts of residue in the valleculae may put the patient at risk for _________ upon a subsequent inhalation

A

aspiration

97
Q

careful examination of a lateral radiograph may show slight residue in a depression along the pharyngeal wall. this could be due to _______________ or _____________ possibly resulting from a previous ___________

A

pharyngeal pouches, scare crease, fistula

98
Q

in a normal swallow the larynx tucks itself under the ______________ to protect the _________

A

tongue base, airway

99
Q

the larynx typically moves _____ upward during the swallow

A

2 cm

100
Q

if the larynx does not reach this elevation, residue may remain _________ of the larynx putting the patient at risk for __________ following deglutition

A

on top, aspiration

101
Q

during a normal swallow, the _________ tilt forward to contact the base of the epiglottis closing off the airway

A

arytenoids

102
Q

if the larynx does not elevate adequately this art-epiglottic contact will not occur leaving the entrance to the airway slightly ____ allowing ________ of the bolus into the airway

A

open, penetration

103
Q

subsequently the penetrated residue will usually be _____________ after the swallow

A

penetrated

104
Q

some patients can compensate for reduced laryngeal elevation by __________ the arytenoids more ____________ than normal

A

tilting, anteriorly

105
Q

penetration and or aspiration can occur _____ or _______ the swallow

A

before, after

106
Q

penetration can occur if the larynx lifts ______ leaving the airway entrance slightly ____

A

inadequately, open

107
Q

penetration can occur if the arytenoids fail to ___________ closing off the _________

A

tilt anteriorly, airway/laryngeal entrance

108
Q

In a normal swallow the ray tenpins fully tilt to contact the ______

A

The epiglottis base

108
Q

penetration can occur if the larynx lifts ______ during the swallow

A

during

109
Q

Penetration can occur if the bonus falls into the airway entrance before the__________

A

Swallow is initiated

110
Q

Any penetration material that is not cleared from the airway entrance by the swallow may be __________when the patient subsequently inhales

A

Aspirated

111
Q

The longer the pharyngeal delay the lower the ______ may either _________ the airway entrance or even pass the vocal folds causing __________. Especially if the patient is a _______________.

A

Bolus, penetrate, aspiration, silent aspirator

112
Q

During a normal swallow the three levels of protection for the airway are

A

A. True vocal folds
B. False vocal folds, arytenoids to epiglottis base
C. Epiglottis and army epiglottis folds

113
Q

The only etiology for aspiration during the swallow is_________

A

All three valves are not working

114
Q

In a normal swallow little to no residue is left in the pyro form sinuses. If residue remains the three main causes are:

A

A. Little laryngeal movement
B. Cricopharyngeal dysfunction
C. UES stricture (too narrow)

115
Q

If the pharyngeal swallow has not triggered a crick pharyngeal disorder cannot be _______

A

Diagnosed

116
Q

_____________ hyolaryngeal movement triggers the opening of the cricopharyngealsphincter

A

Anterior and vertical

117
Q

If residue is left in the pyro form sinus, valleculae and pharyngeal walls, it is probably the result of generalized dysfunction in _________________ resulting from reduced posterior movement of the tongue, reduced anterior movement of the pharyngeal wall and reduced elevation of the larynx.

A

Pharyngeal pressure

118
Q

Normal pharyngeal transit time is ______ second regardless of age or food.

A

Less than 1

119
Q

Esophageal disorders can _____ as pharyngeal phase disorders because they can cause __________ of the material out of the esophagus into the pharynx causing _________

A

Mask, back flow/reflux, aspiration

120
Q

Back flow into the pharynx may be caused by:

A

Achalasia, reflux, tumor, etc

121
Q

Reflux may cause _______ of the arytenoids as well as a ____________ sensation.

A

Redness, burning

122
Q

A fistula between the _______________________ may cause back flow

A

Trachea and esophagus

123
Q

A diverticulum is a side pocket(hernia) in the pharynx that takes the shape of a _______which traps residue that could possibly fall into the airway if the diverticulum is in the pharynx causing ___________. A diverticulum in the upper esophagus is called a __________ diverticulum.

A

Pocket, aspiration, zenkers

124
Q

The correct use of the term reflux is when food or stomach acid from the stomach enters the _________ because of failure of the _____ to keep food in the stomach.

A

Esophagus, LES

Linares (6 decks)

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