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Clin 2 > Dysphagia Quiz > Flashcards

Dysphagia Quiz Flashcards

1
Q

Name disorders that can possibly lead to dysphagia

A

– Acute neurological diseases: Stroke, closed head injury
– Chronic neurological diseases: Amyotrophic lateral sclerosis, Parkinson’s, MS, myasthenia gravis, Alzheimer’s, Huntington’s, Neuropathy (T1DM)
– Muscle disorders: Myositis, myopathies, scleroderma
– GI diseases: GERD, hiatal hernia, achalasia, gastroparesis
– Malignancy: Head and neck cancers, stomatitis, mucositis, esophagitis associated with chemotherapy, and radiation therapy
– Others: Inflammation 2° to infection, post intubation, aspiration, esophageal varices, drug side effects, aging

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2
Q

What does FEES mean?

A

Fiberoptic endoscopic evaluation of swallowing

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3
Q

What is the dysphagia severity scale level 0?

A

Normal swallowing mechanism

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4
Q

What is the dysphagia severity scale level 1?

A

Minimal dysphagia; slight deviance from normal swallow. No change of diet is required

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5
Q

What is the dysphagia severity scale level 2?

A

Mild dysphagia; oropharyngeal dysphagia present, which can be managed by specific swallow suggestions. May need slight modifications in consistency of diet

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6
Q

What is the dysphagia severity scale level 3?

A

Mild-moderate dysphagia: potential for aspiration exists but is diminished by specific swallow techniques and a modified diet. Time for eating is significantly increased; thus, supplemental nutrition may be indicated

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7
Q

What is the dysphagia severity scale level 4?

A

Moderate dysphagia: significant potential for aspiration exists. Trace aspiration of one or more consistencies. Patient may eat certain consistencies by using specific techniques to minimize potential for aspiration and/or to facilitate swallowing. Supervision at mealtimes is required. May require supplemental nutrition orally or via feeding tube.

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8
Q

What is the dysphagia severity scale level 5?

A

Moderately severe dysphagia: Aspiration of 5-10% on one or + consistencies, with potential for aspiration on all consistencies. Cough reflex is absent and nonprotective. Alternative mode of feeding is required to maintain nutritional needs. NPO if pulmonary status is compromised

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9
Q

What is the dysphagia severity scale level 6?

A

Severe dysphagia: more than 10% aspiration for all consistencies. NPO.

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10
Q

What proportion of people with neurological disorders develop dysphagia?

A

1/17

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11
Q

What proportion of patients in long term care have dysphagia?

A

7-40%

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12
Q

What proportion of people who have a stroke develop dysphagia? Aphagia?

A

Dysphagia: 44%
Aphagia: 30% (no swallowing)

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13
Q

What are the 3 parts of the pharynx and where are they located?

A
  1. Nasopharynx - between top an hard palate
  2. Oropharynx - between hard palate and epiglottis
  3. Hypopharynx (or laryngopharynx) - under epiglottis
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14
Q

Where is the larynx?

A

Between pharynx and the trachea. Houses vocal folds.

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15
Q

What are the two arches inside the oral cavity and what lies between them?

A
  1. Palatoglossal arch (or anterior faucial pillars)
  2. Palatopharyngeal arch (or posterior faucial pillars)
    Between: Palatine tonsils
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16
Q

What are named the 2 ducts under the tongue?

A

Ducts of the submandibular gland

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17
Q

What are named the pieces of tissues that 1. keep tongue down, 2. keeps lips with gingivae?

A
  1. Lingual frenulum

2. inferior/superior labial frenulum

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18
Q

What is called the area between the lips, teeth and cheeks?

A

Vestibule

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19
Q

Name 2 types of tonsils

A

Palatine and lingual

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20
Q

What is the line in the middle of the palate?

A

Palatine raphe

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21
Q

How many times per day do we swallow?

A

> 1000 times/d

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22
Q

Swallowing requires the coordination of (x) muscles and (y) cranial nerves

A 
x = 25
y = 5-6
23
Q

In which part of the brain are the cranial nerves?

A

Cerebellum

24
Q

Name the 6 cranial nerves involved in swallowing

A 
V. Trigeminal 
VII. Facial
IX. Glossopharyngeal
X. Vagus
XI:  Spinal accessory 
XII: hypoglossal
25
Q

What is the motor function of the trigeminal nerve and in which stage of swallowing is it involved?

A

Motor function: Mastication

Involved in oral preparatory and transit phases

26
Q

What is the motor function of the facial nerve and in which stage of swallowing is it involved?

A

Motor function: All muscles of the facial expressions and corneal reflex
Involved in oral preparatory and transit phase

27
Q

What is the motor function of the Glossopharyngeal nerve and in which stage of swallowing is it involved?

A

Motor function: Swallowing, gag reflex

Involved in pharyngeal, esophageal phases

28
Q

What is the motor function of the vagus nerve and in which stage of swallowing is it involved?

A

Motor function: GI activity, cough reflex

Involved in pharyngeal and esophageal phases

29
Q

What is the motor function of the Spinal accesory nerve and in which stage of swallowing is it involved?

A

Motor function: Innervates muscles that control soft palate; constricts pharynx
Involved in pharyngeal phase

30
Q

What is the motor function of the hypoglossal nerve and in which stage of swallowing is it involved?

A

Motor function: Tongue control

Involved in all phases

31
Q

Which 3 cranial nerves are also sensory?

A

Trigeminal
glossopharyngeal
Vagus

32
Q

Where is the soft palate in the oral preparatory phase?

A

Against the base of the tongue

33
Q

Name considerations for the oral preparatory phase.

A
  • Sight
  • Hand-mouth coordination (get food to the mouth)
  • Autonomy in eating; is help present if needed?
  • Lip seal, tongue control (can you open/close mouth? Move tongue side to side)
  • Dentition issues
  • Drooling
  • Positioning
  • Cognition
  • Neurological conditions, diseases, aging
34
Q

What are the 3 sets of salivary glands?

A
  1. Parotid (and accessory parotid gland)
  2. Sublingual gland
  3. Submandibular gland
35
Q

Name 3 proteins in saliva

A

Enzymes (amylase)
Mucus
Lysozyme

36
Q

Name 3 electrolytes in saliva

A

NaCl
bicarbonate
potassium

37
Q

Name 6 functions of saliva

A
  1. Moistening/lubrication
  2. Initial CHO digestion
  3. Enhances taste
  4. Buffer
  5. Antibacterial protection, oral hygiene
  6. Assisting speech
38
Q

What does the larynx do during the pharyngeal phase of swallowing?

A

It moves upwards to prevent any food or liquid passing into the trachea

39
Q

What closes during the pharyngeal phase of swallowing?

A

Aryepiglottic folds
False vocal folds
True vocal cords

40
Q

Which muscle elevates the hyoid bone?

A

Suprahyoid muscle

41
Q

What is the other name for the UES? what is it made up of?

A

Cricopharyngeal sphincter

Made up of many cricopharyngeal muscles

42
Q

What are the 4 layers of tissue in the esophagus?

A

Mucosa
Submucosa
Muscle
Adventitia

43
Q

What is the UES referred to as?

A

The pharyngoesophageal junction

Main barrier in preventing laryngopharyngeal reflux

44
Q

What do you start with in trying out textures?

A

Thickest –> thinnest safely tolerated

45
Q

What is the unit for viscosity?

A

Centipoise or millipascal/s

46
Q

cP for thin liquid

A

1-50 cP

47
Q

cP for nectar liquid

A

51-350 cP

48
Q

cP for honey liquid

A

351-1750 cP

49
Q

cP for pudding liquid

A

> 1750 cP

50
Q 
Viscosity of...
Water
Milk
Honey
Chocolate
Ketchup
Mustard
Sour cream
Peanut butter
A 
Water: 1
Milk: 3
Honey: 10,000
Chocolate: 25,000
Ketchup: 50,000
Mustard: 70,000
Sour cream: 100,000
Peanut Butter: 250,000
51
Q

Which is better to use in dysphagia? Consistency or viscosity?

A

Consistency

52
Q

What is the name of the consistometer used in Ste Anne Hospital?

A

Bostwick consistometer

53
Q

What is the distance travelled by nectar, honey and pudding liquids in a Bostwick consistometer in 30 s?

A

Nectar: 13-15 cm
Honey: 7-9 cm
Pudding: 3-5 cm

Clin 2 (3 decks)

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