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CSD > Dysphagia > Flashcards

Dysphagia Flashcards

1
Q

What is Swallowing Apraxia?

A

a repetitive rocking motion without posterior movement into the pharynx

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2
Q

What is Stasis?

A

Residue

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3
Q

What is Premature Spillage indicative of?

A

Reduced lingual control and possibly soft palate posterior seal against tongue

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4
Q

What is the Piecemeal Swallow?

A

small, numerous divisions of bolus to swallow; can be caused by feat of swallowing

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5
Q

When is the Piecemeal Swallow Normal?

A

When there is a large bolus that requires multiple swallows

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6
Q

Why is slow oral transit a red flag?

A

Can be indicative of swallowing apraxia, spillage of food into sulci, and/or weak lingual motion

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7
Q

List the 3 Oral Prep disorders

A
  1. Lack of strong anterior hold of bolus (lip closure, tongue strength/coordination)
  2. Reduced labial or buccal tone
  3. Abnormal bolus hold position
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8
Q

List the 5 Oral Stage disorders

A
  1. Lingual Propulsion
  2. Stasis (residue)
  3. Premature Spillage
  4. Piecemeal Swallow
  5. Slow Oral Transit
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9
Q

What is the 1 bolus transition problem/disorder?

A

Delayed Pharyngeal Swallow

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10
Q

An Abnormal Hold position that is too far anterior and tongue thrust-like is common with which three diagnoses?

A

Cerebral palsy, stroke, head injury

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11
Q

When should the hyoid bone move anteriorly? Where is the bolus?

A

When the bolus head passes the ramus of the mandible

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12
Q

True or False: In normal, young adults transition is delayed if the bolus reaches the VALLECULAE prior to hyoid motion.

A

True

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13
Q

True or False: In people over 60, it may be normal for the bolus to reach valleculae before the hyoid moves

A

True

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14
Q

True or False: In older adults, the bolus should not sit in the valleculae because this should trigger the swallow

A

True

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15
Q

What causes Nasal Regurgitation?

A

Reduced Velopharyngeal closure; bolus enters nasal cavity due to soft palate weakness/dysfunction due to lack of closure to nasal cavity

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16
Q

What are bony growths from vertebrae called?

A

Osteophytes

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17
Q

What can Osteophytes do?

A

They can narrow the pharynx and/or redirect bolus flow into airway.

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18
Q

What is the treatment for an Osteophyte?

A

cut into the bone growth, but can grow back

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19
Q

What causes food to cling to the pharyngeal wall and pyriforms?

A

Pharyngeal weakness and poor pharyngeal stripping wave

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20
Q

True or False: Pharyngeal Weakness is only unilateral.

A

False; can be unilateral or bilateral

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21
Q

True or False: Pharyngeal Weakness is best visualized in A-P view.

A

True! This view is best to decide on residual location or weakness

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22
Q

True or False: If residue is in valleculae, determine if weak tongue base or weak epiglottis closure is related as a cause or if BOTH are.

A

True

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23
Q

What is the Masako Maneuver?

A

Placing the tongue between the teeth and swallowing (ONLY A DRY SWALLOW)

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24
Q

True or False: A bolus should be used in the Masako Maneuver

A

FALSE! Only a dry swallow can be used

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25
Q

What is the purpose of the Masako Manuever?

A

To improve strength of the tongue base

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26
Q

True or False: Premature Spillage is leakage of the bolus into the pharynx WITH swallowing initiation

A

False! Swalllowing is not initiated in Premature Spillage. That’s why its PREMATURE

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27
Q

Example: a patient reports that they cannot feel the bolus hit the back of their mouth (faucial pillars) due to a sensory issue. This may be causing what disorder to occur?

A

Premature Spillage.

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28
Q

What is the purpose of the dry swallow?

A

This helps patients clear residue in the pharynx and sometimes the oral cavity without the presence of a bolus

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29
Q

True or False: The superior pharyngeal contracture is at the area of the pyriform sinuses?

A

False! The inferior pharyngeal contracture is at the area of the pyriform sinuses

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30
Q

If the bolus is found at one side, the patient should use compensatory strategies. Which one should be used? Describe the strategy.

A

The patient should turn their head towards the weaker side to swallow their food, as this makes the stronger side wider, along with head rotation

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31
Q

Residue in the Valleculae is indicative of what?

A

Weak tongue base/Reduced tongue base movement against the posterior pharyngeal wall and/or epiglottic insufficiency.

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32
Q

What is the Pharyngeal Pouch?

A

a collection of contrast in depression of the pharyngeal wall.

33
Q

What can a Pharyngeal Pouch cause?

A

Aspiration due to pooled residue in pouch can fail to be cleared in swallow

34
Q

What are 3 things that can cause reduced laryngeal elevation?

A
  1. Residue found at the top of the airway
  2. Epiglottic dysfunction
  3. UES opening dysfunction
35
Q

What is the difference between Penetration and Aspiration?

A

Penetration - bolus/residue does NOT pass the TVF’s
Aspiration - bolus/residue DOES pass the TVF’s

36
Q

True or False: If bolus is on top of TVFs and is coughed out, it is not considered Penetration.

A

False! It is considered Penetration since the bolus came in contact with TVFs

37
Q

True or False: If bolus passes TVFs and is coughed out, it is considered Penetration.

A

False! This is considered Aspiration since it passed the TVFs

38
Q

What is Silent Aspiration?

A

Aspiration without cough response

39
Q

What causes Zenker’s Diverticulum?

A

It develops when the muscle between the throat and esophagus, known as the cricopharyngeus muscle, over-tightens, causing the throat above it to pouch out.

40
Q

True or False: Zenker’s Diverticulum can cause aspiration

A

True! Residue can enter a weakened area and spill out into pharynx which can cause it to be aspirated

41
Q

What are the 4 Cervical-Esophageal Disorders we discussed in class?

A

Esophageal-Pharyngeal Backflow
GERD (gastro-esophageal reflux disease)
Zenker’s Diverticulum
Tracheo-esophageal Fistula

42
Q

If aspiration occurs without oral-pharyngeal signs, what is likely the cause?

A

Esophageal disorders causing backflow into pharynx and can cause aspiration.

43
Q

What are the 4 components of the Clinical Bedside Exam?

A
  1. Pt Case History
  2. Oral Motor Speech Praxis
  3. Voice
  4. Trial Swallows
44
Q

What non-swallowing related disorder is commonly seen in patients who aspirate post-stroke?

A

Dysphonia

45
Q

True or False: During VFSE, using larger volumes can detect aspiration easier

A

True

46
Q

What is the 4-finger method used during Trial Swallows?

A

Place 4 fingers horizontally on larynx and swallow to note if it rises

47
Q

True or False: the Trial Swallows can include compensatory procedures

A

True!

48
Q

What compensatory strategy would work best to prevent premature spillage?

A

Chin Down Swallow as this allows more time to prepare bolus in oral stage

49
Q

True or False: Chin Down swallow strategy is best for patients with oral prep and transit disorders and pharyngeal disorders.

A

False! Chin Up is best for those patients as this helps move the bolus back and drop down in the pharynx due to gravity

50
Q

Why is the VFSE done in lateral view?

A

This view is best for viewing majority of the structures, viewing passage of bolus, analizing majority of biomechanical aspects of swallow, and for noting alterations of physiology

51
Q

Why is A&P view beneficial?

A

This is best when looking at the flow via pyriforms and for scanning the esophagus.

52
Q

Which 5 Cranial Nerves impact swallowing function?

A

V Trigeminal
VII Facial
IX Glossopharyngeal
X Vagus
XII Hypoglossal

53
Q

Which 2 Cranial Nerves contribute to facial sensation?

A

Trigeminal and Facial (V and VII)

54
Q

Which 2 Cranial Nerves contribute to taste sensation?

A

Facial and Glossopharyngeal (VII and IX)

55
Q

What is the most important Cranial Nerve for the swallowing function and sensation?

A

Vagus (X)

56
Q

How can damage to Cranial Nerve VII affect swallowing?

A

Damage causes issues with the ORAL PHASE OF SWALLOW including :
- Excessive secretions and loss of taste
-

57
Q

How can damage to Cranial Nerve IX affect swallowing?

A

Damage causes issues with the ORAL AND PHARYNGEAL STAGES OF SWALLOW including:
- Reduced pharyngeal sensation
- Reduced gag reflex
- Reduced pharyngeal elevation
- Excess salivation
Disorders can include:
- delayed pharyngeal swallow
- premature spillage

58
Q

How can damage to Cranial Nerve X affect swallowing?

A

Damage to this nerve is EXTENSIVE and causes issues with the PHARYNGEAL STAGE OF SWALLOW including:
- weakness/loss of sensation of soft palate, pharynx, larynx
Disorders include:
- nasal regurgitation
- delayed pharyngeal swallow
- penetration/aspiration
- premature spillage

59
Q

How can damage to Cranial Nerve XII affect swallowing?

A

Damage can cause ORAL PHASE DYSFUNCTION including:
- Weak tongue base/movement/strength
Therefore causing:
- poor bolus formation
- chewing difficulty
Disorders include:
- premature spillage
- delayed pharyngeal swallow

60
Q

What does the FEES stand for?

A

Fiberoptic Endoscopic Evaluation of Swallowing

61
Q

What equipment is needed for the FEES?

A
  • Flexible nasopharyngolaryngoscope
  • Portable light source
  • Camera
  • Videomonitor and recorder
  • Video printer
62
Q

The FEES allows us to observe two things…

A
  1. Laryngeal Function
  2. Secretions
63
Q

During the FEES, there are two exercises that are done to ensure intact laryngeal function. What are they?

A
  1. Sustained and repeated /a/ to note TVF closure
  2. Holding the breath for several seconds
64
Q

True or False: During the FEES, it is important to note excess secretions in valleculae/pyriforms and larynx.

A

True!

65
Q

True or False: Secretions in the laryngeal vestibule are especially correlated with aspiration of food and liquid

A

True!

66
Q

True or False: In the FEES, consistencies used are typically mixed with food coloring.

A

True!

67
Q

True or False: When determining the right consistency for the patient during FEES, the factors are the same as for the clinical and VFS exam.

A

True!

68
Q

True or False: Feeding principles are much different between the FEES and VFSS.

A

False! Feeding principles are the same

69
Q

True or False: During the FEES exam, one can observe aspiration before AND after the swallow.

A

True!

70
Q

True or False: During the FEES, if the pt has reacted to the nasoscope or to aspiration/residue without attempts to clear, you can test sensation.

A

False! Only test sensation if the patient has NOT reacted

71
Q

True or False: Before administering the FEES, test pharyngeal sensation.

A

False! One should test pharyngeal sensation AFTER/at the end of the FEES

72
Q

How do you test pharyngeal sensation at the end of the FEES/during the FEESST?

A

Touch the tip of the endoscope to posterior pharyngeal wall, epiglottis, and the lateral walls

73
Q

What are the benefits/strengths of administering the VFSE as compared to the FEES?

A
  • Can see all stages of swallow, from Oral to right before esophageal
  • Can see symmetry of swallow in AP view
74
Q

What are the benefits/strengths of administering the FEES as compared to the VFSE?

A
  • Can note Discoloration
  • Can identify residue easier
  • Clear view of vocal folds
  • Provides better information on residue location from this exam, except for oral cavities
    -Can evaluate many swallows from FEES without worry of radiation exposure
    -Can test sensory of swallowing structures
75
Q

What are the disadvantages/weaknesses of administering the VFSE as compared to the FEES?

A
  • RADIATION EXPOSURE
  • The picture is not as clear
  • It is more difficult to note residue and identify specific structures
76
Q

What are the disadvantages/weaknesses of administering the FEES as compared to the VFSE?

A
  • CAN ONLY VIEW THE PHARYNGEAL PHASE OF SWALLOW
    -Anesthetia
    -Cannot see actual swallow during fees
77
Q

Which instrumental examination utilizes high frequency sound waves through a small transducer placed on the skin?

A

Ultrasound

78
Q

During which instrumental examination is tongue movement and efficiency best viewed?

A

ULTRASOUND

79
Q

What is Manometry?

A

a test that senses the pressure and constriction of muscles in the esophagus as you swallow

CSD (6 decks)

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