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Dysphagia > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Most neurogenic disorders have an effect on…

A

Sensory Feedback

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2
Q

It is important to determine the etiology to determine the appropriate

A

treatment plan

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3
Q

When might a clinical bedside assessment not completely identify dysphagia

A

In cases on silent aspiration

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4
Q

A clinical bedside assessment is approximately sensitive to __ to __% of identification of dysphagia

A

40-80%

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5
Q

Provides objective or quantitative data on all phases of swallowing
Known as the “gold standard”

A

Videofluoroscopic Swallow Study (VFSS)

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6
Q

This is a 2D assessment
Requires exposure to radiation
Not always available

A

Videofluoroscopic Swallow Study (VFSS)

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7
Q 
can identify the presence of aspiration
Provides distinct information
Can be performed at bedside
Avoids radiation risk
Able to see smaller instances of aspiration
A

Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

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8
Q

Cortical impairments can be determined by

A

Lobe function

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9
Q

Cortical impairments may also be implied dependent on

A

Hemisphere

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10
Q

Diseases of cortical impact include

A

CVA, dementia, TBI

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11
Q

For CVA, Sensory deficits, especially in the pharynx lead to

A

dysphagia

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12
Q

CVA commonly results

A

oropharyngeal dysphagia

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13
Q

Locations of CVA —

A
  1. Medulla
  2. Pontine
    — Cerebellum & cortex
    — Depends on severity and location
  3. Subcortical
  4. Cortical
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14
Q

What might a CVA in the lower brainstem (medulla) exhibit in the oral phase?

A

normal oral processing but significantly impaired triggering of pharyngeal swallow

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15
Q

In relation to dysphagia, What might be absent with a CVA in the lower brainstem (medulla)?

A

Absent pharyngeal swallow

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16
Q

Allows for viewing of before or after the swallow

A

Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

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17
Q

In relation to dysphagia, what might be reduced in a lower brainstem (medulla) CVA?

A

Reduced laryngeal elevation and anterior motion with reduced CP opening

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18
Q

What swallowing difficulties might be present in a lower brainstem (medulla) CVA?

A

Difficulty with oral processing or pharyngeal swallow

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19
Q

Lower brainstem (medulla) CVAs generally result in significant oropharyngeal dysphagia because of the location of what?

A

Central pattern generator

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20
Q

Reduced laryngeal elevation and anterior motion with reduced CP opening may cause…

A

A lot of residue in pharynx or bolus can’t get through pharyngeous

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21
Q

A lower brainstem (medulla) CVA may cause _____ ______ weakness.

A

unilateral pharyngeal weakness

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22
Q

A higher brainstem (pontine) CVA may cause severe…

A

hypertonicity.

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23
Q

What 5 things might a person with a higher brainstem (pontine) CVA exhibit in relation to dysphagia?

A
  1. Delay in triggering the pharyngeal swallow
  2. Absent pharyngeal swallow
  3. Unilateral spastic pharyngeal wall paresis/paralysis
  4. Reduced laryngeal elevation
  5. CP dysfunction
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24
Q

Subcortical involves the _____ and _____ pathways

A

motor and sensory pathways

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25
Q

This location CVA is usually not as significant of an impairment as other patients

A

Subcortical

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26
Q

In relation to dysphagia, A person with a subcortical CVA may exhibit…(4 things)

A
  1. Mild delay in oral transit
  2. Mild delay in triggering the pharyngeal swallow
  3. Could have 3-5 second delay in pharyngeal swallow
  4. Mild-moderate impairment of timing of neural controls
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27
Q

Anterior left cortical CVA can result in… including…

A

Mild to severe apraxia

including delay in initiation or oral swallow with no tongue motion

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28
Q

In an anterior left cortical CVA, Pharyngeal swallow may present _____ _____. Explain.

A

motorically normal. Could be that once food makes it to the mandibular line the rest of the swallow is normal

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29
Q

An anterior left cortical CVA may result in…. and have delays in…. in relation to dysphagia.

A

Mild-severe searching motions

Delays in noticing something is in the mouth and in tongue movement.

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30
Q

In relation to dysphagia, a right hemisphere cortical CVA can result in these delays.

A

Mild oral transit delay and longer pharyngeal delays (Neglect or hemiparesis)

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31
Q

Describe silent aspiration and when you should be more alert to it

A

Bolus into lungs but nothing to notify that it happened
sensory impairment that they cannot feel it is going into their airway
If they have sensory impairments you should be more alert

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32
Q

What tools are important in finding out if there is silent aspiration

A

VFSS and FEES are important here

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33
Q

What typically follows the clinical bedside assessment with CVA populations?

A

Instrumental assessment

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34
Q

Additional risk factors of aspiration in patients with CVA

A
  1. Site of lesion
  2. Co-morbidities
  3. Age
  4. Pulmonary health (How do their lungs sound? History of pneumonia?)
  5. Head/Neck cancer
  6. Dementia
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35
Q

Instrumental assessment is performed based on…(3 things)

A

history, risk factors, and clinical bedside swallow evaluation results

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36
Q

For CVA timing of evaluation is typically ____ at a hospital they must be seen _____

A

within the first week

within 24 hours

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37
Q

What patients change rapidly and often?

A

CVA

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38
Q

the leading cause of oropharyngeal dysphagia and esophageal dysphagia

A

CVA

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39
Q

__% of CVA patients experience ________ after 2 weeks

A

50% ; dysphagia

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40
Q

CVA is a primary risk factor for _____

A

aspiration pneumonia

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41
Q

There is silent aspiration in __/__ of CVA patients

A

2/3

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42
Q

Progressive motor system disease caused by failed dopamine production

A

Parkinson’s disease

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43
Q

slowed rate of movement

A

Hypokinesia

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44
Q

What stages of swallowing does dysphagia present in for parkinson’s disease?

A

All stages! oral, pharyngeal and esophageal

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45
Q

How can parkinson’s effect the oral stage of swallowing? (3)

A
  1. slow oral swallow initiation
  2. tremor may impact tongue and lips
  3. May not have all the sensory needed to move or create the bolus
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46
Q

How can parkinson’s effect the pharyngeal stage of swallowing? (4)

A
  1. Delay in swallow initiation
  2. Reduced pharyngeal contraction
  3. Reduced tongue base movement
  4. Aspiration typically after the swallow
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47
Q

How can Parkinson’s effect the esophageal stage of swallowing?

A

CP dysfunction

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48
Q

Progressive disorder, impact on cells within brain and spinal cord

A

ALS - Amyotrophic lateral sclerosis

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49
Q

ALS may exhibit decreased _____. Also may have ____. Characterized by ________

A
  1. decreased tongue mobility
  2. Weight loss
  3. Characterized by reduced velar movement and reduced pharyngeal contraction
50
Q

A person with this may not exhibit dysphagia for a number of years

A

ALS

51
Q

In ALS, Dysphagia begins with patient

A

avoiding solid consistency items

52
Q

In ALS there is decreased _____ _____ with _______ present

A

decreased oral control ; fasciculations

53
Q

What might be seen when ALS becomes more global for swallowing

A
  1. Decreased laryngeal elevation
  2. Residue, penetration, aspiration
  3. May include globus
54
Q

20-70% of people with ___ have dysphagia

A

TBI

55
Q

What scales are used for TBI?

A

Ranchos Los Amigos Scale

Glasgow Coma Scale

56
Q

3 causes of TBI include:

A
  1. Targeted intervention (Radiation)
  2. Trauma
  3. Vascular or metabolic disorder
57
Q

3 comorbidities of TBI

A

— Cognitive deficits
— Impulsivity
— Reduced sensation

58
Q

4 ways the oral stage is affected by TBIs

A

— Reduced lip closure
— Reduced lingual range of motion (ROM)
— Reduced bolus control
— Abnormal oral reflexes (Primitive reflexes may return)

59
Q

6 ways the pharyngeal stage is affected by TBIs

A 
—	Delay in triggering of pharyngeal swallow
—	Absent pharyngeal swallow
—	Reduced laryngeal elevation
—	Reduced airway closure
—	Reduced tongue base motion
—	Pharyngeal wall weakness
60
Q

Progressive disease

Developing plaques in nerves results in decreased transfer of information and loss of function

A

Multiple sclerosis

61
Q

In MS, Increased number of _______, increases likelihood of _________

A

plaques; dysphagia

62
Q

If MS affects the hypoglossal nerve, how does that affect swallowing?

A

decreased lingual control, decreased mastication, decreased transit

63
Q

If MS affects trigeminal nerve, how does that affect swallowing?

A

decreased tongue base movement, decreased pharyngeal wall movement, and decreased laryngeal function

64
Q

If MS affects the glossopharyngeal nerve, how does that affect swallowing?

A

difficulty initiating swallow

65
Q

Non-progressive neurological motor and processing disorder

Follows injury to fetal or infant brain

A

Cerebral Palsy

66
Q

For cerebral palsy, Dysphagia may be due to…

A

sensory or motor deficits

67
Q

What are the 3 different ways or categories of dysphagia in patients with cerebral palsy?

A

— 1: moderate-severe oral dysfunction
— 2: oral dysfunction with delay in trigger of pharyngeal swallow
— 3: oral and pharyngeal with neuromuscular abnormalities

68
Q

What are different ways oral involvement can be affected in cerebral palsy? (3)

A

Inappropriate oral reflexes

Inability to hold material in a cohesive bolus

Disorganized lingual movements

69
Q

Characterized by overall decline in function, including cognitive deficits

A

Dementia

70
Q

How can dementia affect the motor programming for the oral phase? (4)

A

Agnosia for food

Decreased oral acceptance

Feeding and swallowing apraxia (Know what they have to do but can’t do it)

Reduced lateral motion for chewing

71
Q

What ways can dementia impact the pharyngeal stage? (4)

A

Poor vocal fold mobility

Weak cough

Prolonged swallow gestures

1/3 of patients aspirate

72
Q

Muscles become full of inflammatory cells

A

Inflammatory myositis

73
Q

explain pharyngeal dysphagia caused by inflammatory myositis (5)

A

Pharyngeal weakness with prolonged PTT

Pyriform pooling

Decreased hyolaryngeal elevation

Reduced UES opening

Aspiration

74
Q

Autoimmune neuromuscular disorder with poor muscular control and easy fatigue

A

Myasthenia Gravis

75
Q

What is unique cause dysphasia in relation to Myasthenia Gravis

A

Dysphagia symptoms worsen with use and improve with rest

76
Q

How does Myasthenia Gravis affect the oral stage?

A

poor oral control, decreased velar function, decreased mastication, oral residue

77
Q

How does Myasthenia Gravis affect the pharyngeal stage?

A

slow pharyngeal transit, reduced pharyngeal contraction, penetration/aspiration

78
Q

— Disorder involving involuntary, repetitive, tic-like movements with slow onset as a result of long-term or high dose antipsychtropics

A

— Tardive Dyskinesia

79
Q

How does tardive dyskinesia affect the oral stage?

A

— Uncontrolled tongue movements
— Lip smacking, puckering, pursing
— Difficulty with oral opening
— Difficulty with bolus formation and transfer

80
Q

How does tardive dyskinesia affect the pharyngeal stage?

A

— Respiratory irregularity

— Potential for aspiration

81
Q

When does esophogeal phase begin?

A

When bolus passes ues

82
Q

What is esophageal dysphagia?

A

Abnormal swallowing during the esophageal phase

83
Q

_____ and _____ are responsible for movement of the bolus through the esophagus

A

gravity and peristalsis

84
Q

may be present in 60% of dysphagia

A

esophageal dysphagia

85
Q

Esophageal dysphagia is commonly due to

A

Gastroesphageal Reflux Disease (GERD)

86
Q

Define esophagitis

A

Chronic inflammation of esophagus due to reflux

87
Q

Dysphagia in esophagitis is due to ________ ______ ______ due to what 3 symptoms?

A

diminished esophageal motility

inflammation, irritation, and swelling

88
Q

Esophagitis may resolve after…

A

pharmacological intervention

89
Q

Esophagitis may lead to these two things happening..

A

esophageal stricture (narrowing of the lumen aka opening)

hiatal hernia (portion of stomach comes up through diaphragm)

90
Q

List 7 causes of espohagitis

A 
—	GERD
—	Medication
—	Infection
—	Radiation
—	Chemotherapy
—	Allergies
—	Caustic injury
91
Q

This may lead to trachealization, trachealization is..

A

— Eosinophillic Esophagitis

Hardening of esophagus

92
Q

What are esophageal rings? What can benefit them?

A

— Narrowing that occurs at the gastroesophageal junction
— Can block the esophagus
— Benefits from esophageal dilatation

93
Q

What are 5 esophageal dysmotilities?

A

Ineffective esophageal motility (IEM)

Hypertensive LES (HTLES)
—	
Distal esophageal spasm (DES)
—	
Nutcracker Esophagus
—	
Achalasia
94
Q

What is achalasia?

A

Absence of contractions, rely on gravity

95
Q

What is nutcracker esophagus?

A

Esophagus moves more than normal

96
Q

Laryngopharyngeal Reflux (LPR) is when

A

Acid from stomach comes up to the level of the larynx

97
Q

— Excessive backflow of stomach contents into the laryngopharynx causing breakdown of mucosal structures

A

Laryngopharyngeal Reflux (LPR)

98
Q

Compare and contrast GERD and LPR

A 
GERD	
—	Primarily nighttime in supine position
—	Episodes may be prolonged
—	More obese patients
—	Result of LES dysfunction
—	Not tight enough to keep acid from passing through
—	Result of esophageal dysmotility
—
LPR
—	Daytime reflux
—	Brief episodes
—	Not related to body mass
—	Appears unrelated to LES dysfunction
—	May be related to UES dysfunction
99
Q

T/F: the esophagus can handle intermittent exposure to stomach acids

A

True

100
Q

____ _____ clears the majority of esophageal bolus while____ _____ is a result of repeat swallows to clear

A

Primary peristalsis; secondary peristalsis

101
Q

Two layers of protection include…

A

esophageal lining and epithelium

102
Q

poorly protected, highly sensitive

A

Larynx

103
Q

6 LPR symptoms

A 
—	Throat clearing
—	Chronic cough
—	Globus
—	Dysphonia
—	More edema at level of vocal folds 
—	Postnasal drip
104
Q

What is nissen fundoplication?

A

put in structures to tighten LES

105
Q

— Dysphagia can result in head and neck CA patients related to:

A

Tumor growth

changes in tissue due to radiation or chemotherapy can increase dysphagia risk

Surgical procedures

TMN

106
Q

What functional deficits may result from oral cancer?

A

— Unable to form cohesive bolus
— Unable to transfer bolus
— Decrease trigger for pharyngeal swallow
— Decreased pressure
— Reduced mastication
— Anterior loss of the bolus
— May not be able to accept a large bolus through oral opening
— Reduced sensation and taste
— Decreased epiglottic inversion/hyoid elevation
— Decreased protection of the airway

107
Q

A swallow requires _____ and ______ function

A

smooth and coordinated

108
Q

What is a simple resection vs a composite resection?

A

simple is 1 structure and composite is more than 1 structure

109
Q

Effects are dependent on..

A

— Location
— Age
— Size
— Severity

110
Q

Best treatment for swallowing is

A

Swallowing itself

111
Q

— The “mainstay” for small oral and small laryngeal CA

A

Surgical intervention

112
Q

Typical locations for oral cavity cancer are…

A

— anterior floor of mouth or lower alveolar ridge
— tongue
— lateral floor of mouth or lateral alveolar ridge
— tonsil
— tongue base
— hard palate
— soft palate

113
Q

Ability to open/close the mouth after surgery oral sphincter surgery depends on

A

the size of the resection, the nerves involved, and what structural support remains in place

114
Q

— What muscles are on the floor of the mouth?

A

— Genioglossus
— Mylohyoid & Geniohyoid
— Stylohyoid

115
Q

Surgery in the anterior floor of the mouth could cause

A

Decreased hyoid elevation and decreased tongue mobility

116
Q

— Swallowing efficiency is dependent on

A

ability of tongue base to contact the posterior pharyngeal wall

117
Q

3 types of glossectomy are

A

total, partial and hemiglossectomy

118
Q

Removal of a portion of the mandible can cause

A

malocclusion or inability to close the jaw at all

119
Q

Removal of a portion of the mandible can impact

A

masseter and pterygoid

120
Q

What is oronasal fistula

A

a hole up to the nasal cavity

121
Q

What is the role of the pharynx?

A

— To assist in Closure and generate Pressures

— Job of pharyngeal constriction is to move the bolus downward

122
Q

What are the 3 areas of cancer of the larynx?

A

superglottic (above vocal folds), glottis (between vocal folds), and subglottic (below vocal folds)

Dysphagia (6 decks)

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