Dysphagia Exam I Flashcards
1
Q
Complications of Dysphagia
A
Pneumonia, Dehydration, malnutrition, depression, weight loss
2
Q
CN V
A
five, trigeminal
3
Q
CN VII
A
Seven, Facial
4
Q
CN IX
A
Nine, Glossopharyngeal
5
Q
CN X
A
Ten, Vagus
6
Q
CN XI
A
Eleven, accessory
7
Q
CN XII
A
Twelve, Hypoglossal
8
Q
Dysphagia Screening
A
Pass/Fail, admin’d by nurses, assess risk
9
Q
Role of saliva
A
lubricates and dilutes bolus for swallow.
10
Q
What is saliva made of
A
an enzyme for digestion and mucus for lubrication
11
Q
Salivary glands, viscous, serous, or mixed
A
Parotid: viscous only
Submandibular: mixed more serous
Sublingual: mixed more viscous
12
Q
Tongue sensory innervation:
2 types and 2 zones
A
Types:
General: anterior 2/3 = CNV posterior= CNIX
Special: Taste
Anterior: VII Posterior=CNIX
13
Q
Tongue motor innervation
A
CNX= pharyngeal branch of vagus -> palatal glossus CNXII = extrinisic and intrinsic muscles.
14
Q
3 extrinsic muscles of the tongue and what they do.
A
- Hyoglossus: depresses sides of tongue
- Styloglossus: elevates the sides of tongue
- Genioglossus: protrudes tongue out
15
Q
What do intrinsic muscles of the tongue do generally for the bolus?
A
hold the bolus
16
Q
4 intrinisc muscles of the tongue and how they move
A
Super Longitudinal: elevates apex of the tongue
Inferior Longitudinal: depresses apex
Transverse: lateralizes (Left and right)
Vertical: Flattens
17
Q
Parts of the hard palate (4)
A
Maxillae: anterior 2/3 of palate
Palatine
Superficial layer of keratinize (waterproof)
Rugae - Ridges that help move the bolus back
18
Q
What are the 4 muscles of the velum and what do they do
A
Tensor Veli Palatini: pulls laterally and downward
Levator veli palatini: elevates and retracts
Palatoglossus: connects palate with tongue to close off the back of the oral cavity
Muscularis Uvulae: shortens and elevates
19
Q
Motor Innervation for soft palate
A
CNV + CNX
20
Q
Sensory innervation for soft palate
A
CNV + CNIX
21
Q
3 constricter muscles of the pharynx in order
A
Superior pharyngeal constrictor
Middle pharyngeal Constrictor
Inferior pharyngeal constrictor
22
Q
Innervation of the pharynx
A
pharyngeal plexus which is the pharyngeal branch of CNX and CNIX
23
Q
Stylopharyngeus innervation
A
CNIX - motor
24
Q
Palatopharyngeal innervation
A
Pharyngeal branch of CNX
25
Cricopharyngeus (CP) inntervation
Pharyngeal branch of CNX
26
What does the cricopharyngeus do during the swallow?
relaxes to allow passage of the bolus. It is chronically conctracted. The primary muscle of the UES. It's part of the inferior pharyngeal constrictor. Prevents food from coming back up.
27
What causes epiglottic inversion?
hyolaryngeal excursion and lifting.
28
Where are the valleculae?
Behind the tongue and above the epiglottis
29
What are the 4 suprahyoid muscles and their innervation
Anterior belly of the digastric: CNVII
Mylohyoid: CNV
Hypoglossal: CNXII
Stylohyoid: CNVII
30
What does the anterior belly of the digastric do?
Opens jaw and allows hyoid to move up (CNVII)
31
What is the movement caused by the mylohyoid
upward movement of the hyoid (CNV)
32
What is the movement caused by the hypoglossal muscle?
Upward forward movement of the hyoid (CNXII)
33
What is the movement caused by the stylohyoid?
posterior upward hyoid movement (hyolaryngeal excursion/elevation) CNVII
34
What direction does the larynx move during swallow?
Up and forward
35
Which branch of CNX is important for laryngeal closure
The recurrent laryngeal nerve
36
What are the five intrinisic laryngeal muscles
Thyroaretnoids: Tense and lengthen the vocal folds
Posterior chricoarytnoids: abduct the cords
Lateral cricoarytnoids: adduct arytnoids
Transverse and oblique artnoids: adduct
Vocalas: opens the posterior portion of the vocal folds
37
Sensory information to the larynx:
CN 10- via recurrent laryngeal nerve (Sensation below the vocal folds)
38
What do the aryepiglottic folds form?
The lateral walls of the laryngeal vestibule
39
what direction do the Arytenoid Cartilages go? What do the assist with?
Tilt anteriorly during the swallow. Assist in airway closure.
40
What structures of the larynx act as a line of defense for epiglottic closure?
Aryepiglottic folds and the arytenoids
41
Muscles conncting to a superior structure ____
| Muscles connecting to an inferior structure _____
ELEVATE
| LOWER
42
Which muscles assist in elevation of the larynx:
Omohyoid
Sternohyoid
Sternocleidomastoid
43
How long is the average esophagus (cm)
21cm-27cm
44
At which vertebre does the esophegas connect to the pharynx and to the stomach
Pharynx=C6
| Stomach=T12
45
What is the position of the esophagus at rest?
Collapsed at rest
46
What muscles are within the UES/PES
Cricopharyngeus, thyropharyngeus, and parts of the cervical esophegus
47
What does the UES do during swallow and what is UES innervation?
Relaxes during swallow
| CNX does motor+sensory innervation
48
Describe: Bolus Acceptance/recognition
ability to strip bolus from utensil
49
Describe: Sensory recognition of bolus
the receptors provide information about bolus volume and taste. Understanding what your bolus is
50
Describe: Labial Seal
lips closed and nasal closure. Prevents spilling of bolus, anterior oral containment. Tongue containment.
51
Describe: Oral manipulation
Using the tongue to shape and move the bolus
52
Describe: Mastication
Rotary movement of the tongue. Vallecular aggagation
53
Is the soft palate down during chewing?
NO
54
What are the cranial nerves involved in chewing?
CNV: Muscles of mastication. Elevate the mandible to close the mouth, side to side movement of mandible.
CNXII: Intrinisic+extrinisic muslces of the tongue: Move bolus to surface of teeth for chewing and assist with bolus formation. Oral containment
CNVII: Facial muscles and lips. Compress cheeks against teeth. Oral containment
CNV and CNVII: Suprahyoid. Stabalize floor of mouth to assist with chewing and tongue movement. Depress mandible for open mouth.
55
Describe oral transport
Brisk and coordinated movement of tongue without delay. Same muscles as above minus mastication.
description for reference:
•CN XII (hypoglossal): Intrinisic muscles of the tongue à press tongue against palate to move bolus posteriorly, maintain cohesive shape of bolus between tongue & palate
•CN XII (hypoglossal) and X (vagus): extrinsic muscles of the tongue: position tongue against palate to move bolus posteriorly
•CN V (trigeminal), VII (facial): suprahyoid muscles à stabilize floor of mouth to maximize efficiency of tongue movement
56
How long does oral transport take?
1-1.5 seconds.
57
Describe: pharyngeal swallow onset
a motor response. The soft palate elevates and retracts, the larynx elevates, anterior hyoid movement, epiglottic inversion, laryngeal vestibular closure, pharyngeal stripping wave, contraction, PES opening, tongue base retraction.
58
What cranial nerves are involved with pharyngeal swallow onset
CNIX and X
59
Describe soft palate elevation
The soft palate elevates and retracts, pushes bolus back to the nasopharynx. Velopharyngeal closure and hyolaryngeal movement occur simultaneously.
60
What is the primary generator of positive pressure against to bolus tail and a mechanism of airway protection?
Base of tongue retraction
61
Describe laryngeal elevation
Shortening and contracting of the thyrohyoid. Intrinsic muscles of the larynx cause the downward, inward, and forward rotation of the arytenoid cartilages to the epiglottic base. True vocal folds close and approixmate the ventricular folds.
62
Describe: Anterior hyoid excursion
Sometimes called hyolaryngeal complex. The hyoid moves up and forward.
63
Describe: Pharyngeal stripping wave
The stripping action of the pharynx achieved by sequential progressive contraction of the superior, middle, and inferior pharyngeal constrictor muscles.
64
Describe: Laryngeal Vestibule closure
Laryngeal elevation, anterior hyoid excursion, epiglottic inversion, tongue base retraction, vocal fold closure.
65
Define: Penetration
bolus dips into the laryngeal vestibule but moves back out. Always above the vocal folds.
66
What is a normal response to penetration?
A dry swallow
67
Define Aspiration
Below vocal folds. Silent aspiration = no audible cough response.
68
Define: Residue
Material left in oral cavity, pharynx, esophegues, or laryngeal vestibule post-swallow.
69
List the steps in the oropharyngeal phase (14)
Strip bolus from utensil, bolus in mouth, labial seal, form bolus, mastication, lingual transport, swallow initation, velopharyngeal closure, hyolaryngeal elevation, tongue base retraction, pharyngeal constriction, epiglottic inversion, laryngeal vestibule closure, PES opening.
70
Define aspiration pneumonia
Pulmonary infection caused by aspiration. No specific amount of aspiration causes aspiration pneumonia.
71
What are causes of lip spillage
weakness, stroke, bells palsy, cleft lip
72
What does lack of bolus cohesion indicate
poor oral cohesion, tongue weakness.
73
What does decreased mastication look like
reduced opening (trismas), reduced awareness of bolus sensation
74
What is a reason for and symptom of Oral Residue
Material is left in the oral cavity. Caused by loss of sensation. Indicated by piecemeal swallow (swallowing little chunks at a time)
75
What is lingual pumping, cause, and result
Definition: repetitive or disorganized movement
Result: faliure to finish whole bolus
Cause: cog-impariment, CP, parkinsons
76
What is the time length classified as prolongued oral transport?
Greater than 1.5 seconds.
77
What causes nasopharyngeal regurgiation.
Can happen as it passes the velpharyngeal port or could come back up. Caused by structure, strength, and coordination.
78
What are the areas residue can collect?
Base of Tongue, Valleculae, pyriform sinuses, post pharyngeal wall. Diffuse means it's in 3 or more areas.
79
What would bedside indicators of aspiration be?
throat clearing, wet voice, coughing.
80
What would cause aspiration/penetration BEFORE the swallow?
reduced oral control, early loss of bolus, delay of swallow
81
What would cause aspiration/penetration AFTER the swallow?
overflow of residue, problem with UES
82
What would cause aspiration/penetration DURING the swallow?
Incomplete vestibular closure, decreased hyolaryngeal movement, glottic closure trouble, reduced PES
83
What are the names of the 3 mentioned esophegeal deficits?
Cricopharyngeal prominence, cervical esophegus web, Zenkers (herneation in the cervical esophegus)
84
What are the goals of a swallow screen
Pass/Fail, ID who needs a rx for an SLP consult
85
What are the steps of an inital clinical swallow eval?
Not instrumental. 1. ID the presence or absence of dysphagia. 2. Determine need for instrumental assessment (be sure to outline the specific questions you want to have answered by the assessment.3. Determine dx or oral dysphagia.
86
What is normal oxygenation
92-100 SPo2
87
What is normal respritory rate
15-30 for adults
