dysphagia and nutrition

Question 1

dysphagia

Answer 1

difficulty swallowing

Question 2

odynophagia

Answer 2

painful swallowing

Question 3

achalasia

Answer 3

aperistalsis and incomplete LES relaxation

Question 4

globus pharyngeus

Answer 4

sensation of lump lodged in throat

-swallowing unaffected

Question 5

modified barium swallow

Answer 5

To determine cause for and evaluate the
severity of tracheal aspiration
Performed by a speech pathologist and
radiologist
Barium suspensions of varying thickness
during fluoroscopy
Thin liquid, thick liquid, nectar, paste and
solid—mimic different food consistencies
videotaped

Question 6

bedside swallow assessment

Answer 6

• Cognitive assessment
• Alert, coherent
• Posture
• Upright: gravity is our friend
• Respiratory Status
• Breath through nose
• Speech and Vocal Status
• Clear vs slurred speech
• Normal voice vs dysphonia
• Cough to clear and retest
• Oral mechanism exam

Question 7

what are the components of oral trials during bedside swallow assessment

Answer 7

Start with water (thin liquid)
Observe the swallowing
Palpate the thyroid notch for rise and fall
Have the patient speak
Voice quality?
Coughing?
Other signs of aspiration
Advance to crackers or graham crackers, repeat
Check for food retained in the oropharynx

Question 8

what are the muscles of mastication

Answer 8

• temporal muscle
• lateral pterygoid
• medial pterygoid
• massester muscle

Question 9

what are the sensory and motor innervation in swallowing?

Answer 9

-CN V-3 mandibular branches

Question 10

esophagogram (barium swallow)

Answer 10

• Designed to evaluate pharyngeal
and esophageal mucosa
• Video capture fluoroscopy to
study functional dynamics of the
pharynx and esophagus
• Air contrast (double contrast)make
mucosal surface more distinct

Question 11

neuromuscular involvement

Answer 11

Sensorimotor control of
swallowing involves:
• Afferent sensory fibers in CNs
• Cerebral and midbrain fibers
synapse with brainstem
swallowing centers
• Paired swallowing centers in
the brain stem
• Efferent motor fibers in CNs
• Muscle & end organs

Question 12

how many muscles control swallowing

Answer 12

26 pairs

Question 13

what nerve controls muscles of mastication

Answer 13

CN V

Question 14

what nerve controls Lips, buccal musculature, orbicularis and buccinators:

Answer 14

CN VII

Question 15

xerostomia

Answer 15

dry mouth

Question 16

dysosmia

Answer 16

difficulty with sense of small

Question 17

dysgeusia

Answer 17

difficulty with sense of tast

Question 18

which area of spine should you pay attention to for oral/esophageal lesions

Answer 18

-cervical and thoracic

Question 19

what should you include in PE?

Answer 19

1) ABD (masses)
2) HEENT(look at teeth)
3) neck: thyroid, masses
4) neuro: proximal vs distal weakness
5) hair and skin
6) muscle mass: symmetry, bulk or atropy (esp temple region)

Question 20

what labs should you order for dysphagia?

Answer 20

• CBC
• CMP
• TSH
• swallow study (barium, modified barium, bedside)

Question 21

what are dysphagia diets?

Answer 21

1) pureed
2) mechanically altered (moist soft textured)
3) dysphagia advanced (excludes hard, dry, sticky,crunchy)