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Dysphagia > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Why does it make sense for SLPs to treat swallowing disorders?

A

Because the same systems that are involved in speech and voice are involved in swallowing.

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2
Q

What is placement of food in the mouth for nutrition and hydration?

A

Oral intake

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3
Q

What is a bolus?

A

The food, liquid, or other material placed in the mouth for ingestion.

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4
Q

When does aspiration occur?

A

When the bolus penetrates the airway below the level of the true vocal folds.

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5
Q

What is laryngeal penetration?

A

Occurs when food/liquid penetrates the portion of the airway ABOVE the true vocal folds.

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6
Q

What is a functional swallow?

A

A swallow which may be abnormal but does not result in aspiration.

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7
Q

What is deglutition?

A

Refers only to acts associated with bolus transfer and transport.

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8
Q

What is the significance of the faucial arches?

A

This area on either side of the back of the tongue contains the sensory receptors for swallowing - when the bolus passes this area, it stimulates the pharyngeal swallow/response.

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9
Q

What are the pharyngeal constrictors responsible for?

A

Propelling the bolus downward.

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10
Q

What is the most inferior structure of the pharynx?

A

P-E segment/ cricopharyngeus muscle

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11
Q

What are the two purposes of the upper esophageal sphincter being in a state of platonic contracture?

A

1 - prevents air from entering the esophagus during respiration
2 - prevents material from refluxing into the pharynx

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12
Q

Where do the fibers of the inferior pharyngeal constrictors attach?

A

To the side of the thyroid cartilage anteriorly

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13
Q

What is the space that is formed between the inferior pharyngeal constrictor fibers and the sides of the thyroid cartilage?

A

Pyriform sinuses

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14
Q

What is directly behind the faucial arches?

A

Tonsils

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15
Q

What are the two layers of muscle that comprise the esophagus?

A

Inner circular and out longitudinal

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16
Q

What is at the bottom of the esophagus?

A

Lower esophageal sphincter

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17
Q

What is the LES also known as?

A

gastroesophageal juncture

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18
Q

What is the topmost structure of the larynx?

A

Epiglottis

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19
Q

What is the valleculae?

A

Wedge-shaped space that is formed between the base of the tongue and the epiglottis

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20
Q

What are known as the two pharyngeal recesses?

A

Valleculae and the pyriform sinuses

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21
Q

What is significant about the pharyngeal recesses?

A

If an individual has an inefficient swallow, we will see residue in these recesses

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22
Q

What is the opening into the top of the larynx called?

A

The laryngeal vestibule/aditus.

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23
Q

When the muscles that are attached to the hyoid bone contract, what happens?

A

The larynx is elevated

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24
Q

What are the 5 stages of swallowing?

A 
1 - anticipatory
2 - oral preparatory
3 - oral
4 - pharyngeal
5 - esophageal
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25
Q

What is the purpose of the oral preparatory stage?

A

To break down food and mix it with saliva.

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26
Q

What happens during the anticipatory stage of swallowing?

A

Make cognitive judgments about oral intake (rate of intake, amount per bite, etc.).

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27
Q

What is the linguavelar seal?

A

When the back of the tongue is elevated and the soft palate is pulled anteriorly against the tongue to keep material in the oral cavity.

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28
Q

What is the normal transit time for the bolus during the oral stage?

A

1 second

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29
Q

When does the oral stage terminate?

A

When the bolus passes the anterior faucial arches and the pharyngeal response is triggered.

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30
Q

Is the oral stage under voluntary or involuntary control?

A

voluntary

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31
Q

Is the oral prep stage under voluntary or involuntary control?

A

voluntary

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32
Q

What stage of swallowing is considered physiologically the most important?

A

Pharyngeal stage

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33
Q

What 3 important reasons make the pharyngeal stage the most important?

A

1 - airway protection
2 - opening of the esophagus
3 - downward propulsion of bolus

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34
Q

When does the pharyngeal stage begin?

A

With the triggering of the pharyngeal response

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35
Q

The cricopharyngeus opens as a result of what three things?

A

1 - relaxation of UES tone
2 - elevation of the larynx
3 - pulsion force of the bolus

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36
Q

Is the pharyngeal stage under voluntary or involuntary control?

A

Involuntary

37
Q

What is peristalsis?

A

Rhythmic contraction of muscles to move things through a tube.

38
Q

What are the two types of esophageal peristalsis?

A

Primary and secondary

39
Q

What is primary peristalsis initiated by?

A

The pharyngeal response

40
Q

What is the transit time during the esophageal stage?

A

8-20 seconds

41
Q

What is secondary peristalsis initiated by?

A

Response to local distention (being stretched)

42
Q

What is the difference between feeding and deglutition?

A

Feeding involves the anticipatory, oral prep, and oral stages of swallowing; deglutition is the process of moving the bolus from the oral cavity down into the esophagus (oral, pharyngeal, and esophageal stages of swallowing).

43
Q

What is the gag reflex triggered by?

A

Noxious or foreign stimuli

44
Q

What is the purpose of the gag reflex?

A

To eliminate foreign stimuli from the mouth or pharynx

45
Q

What is the protective reflex for the swallow?

A

Cough, NOT the gag!

46
Q

What are two reasons why the gag cannot predict the presence or adequacy of swallow?

A

1 - because the force of the gag is opposite of the swallow

2 - because normal subjects exhibit no gag reflex but have a normal and intact swallow

47
Q

What is the gag reflex useful for in our field?

A

Observing pharyngeal and palatal contraction.

48
Q

What are some of the main anatomical differences between the newborn and the adult mouth/pharynx?

A

Infants have a smaller oral space, a lower more retracted jaw, and sucking pads, which causes their tongue to take up more space in their mouth.

49
Q

Where is the base of the tongue located?

A

In the pharyngeal cavity

50
Q

How is the epiglottis and velum approximating in infants a protective mechanism?

A

Because it directs the bolus into the lateral channels, directing it away from the larynx and into the esophagus.

51
Q

What does the higher position of the larynx in newborns eliminate?

A

The need for a sophisticated laryngeal closure to protect the airway during swallowing

52
Q

What two types of reflexes are present in newborns?

A

Adaptive and protective

53
Q

What is the purpose of adaptive reflexes??

A

Assist in the acquisition of food (e.g., rooting reflex)

54
Q

What is the purpose of protective reflexes?

A

Protect the airway (e.g., cough)

55
Q

What is the rooting reflex?

A

Rubbing the side of the baby’s face and them turning toward the source of stimulation; used to find food

56
Q

What is the phasic bite reflex?

A

Rhythmic closing and opening of the jaws in response to stimulation; assists with positive pressure sucking

57
Q

What is the purpose of the gag reflex in infants?

A

Serves as a protective function in infants, preventing infant from ingesting solid food for which it is not ready

58
Q

Why do we assess an infant’s reflexes?

A

Gives us idea about their neurological maturity.

59
Q

What are the 2 types of sucking?

A

Nutritive sucking and non-nutritive sucking

60
Q

What is the purpose of nutritive sucking?

A

To obtain nourishment

61
Q

What is the purpose of non-nutritive sucking?

A

State regulation, satisfy sucking desire, and exploration

62
Q

What is the rhythm of nutritive sucking?

A

Initial continuous sucking burst, moving to intermittent sucking bursts with bursts becoming shorter and pauses longer over the coarse of feeding

63
Q

What is the rhythm of non-nutritive sucking?

A

Repetitive pattern of bursts and pauses; stable number of sucks per burst and duration of pauses

64
Q

What is the rate of nutritive sucking?

A

One suck per second, constant over course of feeding

65
Q

What is the rate of non-nutritive sucking?

A

Two sucks per second

66
Q

What is the suck:swallow ratio for nutritive sucking?

A

Young infant - 1:1, may be higher at end of feed

67
Q

What is the suck:swallow ratio for non-nutritive sucking?

A

Very high ratio; 6:1 or 8:1

68
Q

What is the difference between the tonic bite and the phasic bite reflex?

A

Tonic bite is abnormal - occurs in neurologically impaired children and adults.

69
Q

What pattern do strength and control develop in a baby’s mouth?

A

From back to front.

70
Q

As the anatomical position of the trachea/larynx/esophagus changes and head/neck control is established, what will the baby want during feeding?

A

To be held in a more vertical position

71
Q

What will always take precedence over swallowing?

A

Respiration

72
Q

What is the definition of aspiration?

A

Action of material penetrating the larynx and entering the airway BELOW the level of the true VF

73
Q

What is silent aspiration and what could it result in?

A

Aspiration in which a patient doesn’t have a cough reflex/doesn’t show any signs of aspiration during swallowing. May result in aspiration pneumonia

74
Q

For material to be aspirated, it must penetrate all 3 valves of the larynx. What are these 3 valves?

A

1 - aryepiglottic folds
2 - false VF
3 - true VF

75
Q

What three circumstances can aspiration occur during?

A

1 - before the swallow response is triggered when the larynx has not elevated to close the airway
2 - during the swallow if the laryngeal valves are not functioning adequately
3 - after the swallow when the larynx lowers and opens for inhalation

76
Q

Why is it important to know the timing of aspiration?

A

So we can properly treat it/rule in/out certain disorders

77
Q

What is the anterior sulcus?

A

The space between your teeth and lips

78
Q

What is piecemeal deglutition?

A

Taking two or more repeated swallows to empty the oral cavity (normal in healthy individuals)

79
Q

What is a delayed pharyngeal swallow?

A

It occurs when the head of the bolus enters the pharynx and the pharyngeal swallow has not been triggered.

80
Q

In a delayed pharyngeal swallow, when is the risk of aspiration?

A

Before the pharyngeal swallow response triggers

81
Q

What is an absent pharyngeal swallow response defined as?

A

A pharyngeal response delay of greater than 10 seconds

82
Q

When is the pharyngeal delay timed from?

A

Timed from the point where the bolus head passes the point where the lower edge of the mandible crosses the tongue base until the pharyngeal swallow is initiated (where laryngeal and hyoid elevation begin as part of the pharyngeal swallow).

83
Q

Contrast timing the delay vs. timing of aspiration.

A

Timing the delay is in seconds, and timing of aspiration we’re talking about in relation to when the pharyngeal swallow response occurs.

84
Q

Could reduced velopharyngeal closure result in aspiration?

A

No, because the food would be going into the nasal cavity.

85
Q

What is the only pharyngeal stage disorder that results in aspiration DURING the pharyngeal swallowing response? When do all of the rest of the occur?

A

The only one that is DURING is reduced laryngeal closure. All of the other pharyngeal disorders result in aspiration AFTER the pharyngeal swallowing response.

86
Q

Why would reduced laryngeal elevation result in residue in the pyriforms?

A

In order for the bolus to pass from the pyriform sinuses down into the esophagus, the UES opens. The UES opens because of laryngeal elevation, so if there is reduced laryngeal elevation, that could result in residue.

87
Q

If there is a disorder in the the oral prep stage, when is the risk of aspiration?

A

Before (only before!

88
Q

If there is a disorder in the oral stage, when is the risk of aspiration?

A

Before!

89
Q

If there is a disorder in the pharyngeal stage, when is the risk of aspiration?

A

They’re almost all after. However, delayed pharyngeal swallow could be before and reduced laryngeal closure is during.

Dysphagia (4 decks)

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