Final

Question 1

Swallowing is initiated voluntarily in the oral cavity. This is followed by involuntary control. This involuntary control is regulated by…

Answer 1

Bilateral cortical interhemispheric and brainstem connections

Question 2

Failure to close this sphincter during swallowing results in leakage of teh bolus or air into the nasopharynx and diminished ability to generate appropriate oropharyngeal pressures to propel the bolus through the oropharynx.

Answer 2

Velopharyngeal sphincter

Question 3

The tongue is made up of intrinsic muscles and extrinsic muscles. Together these muscles help the tongue to manipulate and collect the bolus. Which lingual muscles lower the tongue, protract it anteriorly, and elevate the tongue?

Answer 3

Extrinsic muscles: genioglossus, hyoglossus, styloglossus, palatoglossus muscles.

Question 4

At rest this sphincter is in a state of tonic contraction that minimizes the entrance of air into the gastrointestinal tract during respiration. The major component of this sphincter is the cricopharyngeal muscle. Relaxation of this sphincter begins after the onset of swallowing and lasts 0.5 to 1 second.

Answer 4

Upper esophageal sphincter

Question 5

These pharyngeal structures are involved in deglutition and form the posterior and lateral pharyngeal walls.

Answer 5

The superior, medial, and inferior pharyngeal constrictors.

Question 6

Swallowing can be visualized as the passage of the bolus through a series of dynamic chambers. These chambers are separated by sphincters (gates) that help to prevent spillage of the material before it enters the next chamber.

Answer 6

True

Question 7

Normal bolus movement through the oral and pharyngeal cavities is a combination of opening/closing of sphincters, pressure and tongue posture

Answer 7

True

Question 8

Which muscle is NOT involved in elevation of the hyoid/laryngeal complex?

Answer 8

Omohyoid

Question 9

The primary sensory (afferent) control of the tongue, lips, and mandible is via cranial nerve…

Answer 9

CN V Trigeminal

Question 10

Sensory and motor integration of the phases of swallowing suggests that…

Answer 10

Voluntary and involuntary aspects of swallowing may occur in parallel.

Question 11

If the hyoid elevates and moves forward, the larynx will move ______ and _____ unless it is stabilized or restricted by other muscles.

Answer 11

upward,forward

Question 12

The suprahyoid muscles are responsible for elevating the hyoid bone. Which of the following are suprahyoids?

Answer 12

Mylohyoid, Stylohyoid, and Digastrics

Question 13

The teeth are the primary manipulators of the bolus during the oral phase of swallowing.

Answer 13

false

Question 14

The tongue is made up of intrinsic muscles and extrinsic muscles. Together these muscles help the tongue to manipulate and collect the bolus. Which lingual muscles shape the tongue for management of various types of food and liquid? They also form a pocket to hold the bolus in place and keep it from falling into the cheek or spilling into the oropharynx.

Answer 14

Intrinsic muscles: transverse, vertical and longitudinal fibers

Question 15

There are four common patterns of respiration coordination in swallowing. Choose the most common (and also the most protective) pattern found in healthy adults during drinking.

Answer 15

EX/EX (expiration, apnea event, expiration)

Question 16

A clinical swallow screening can be performed and documented by a nurse, speech-language pathologist, or occupational therapist.

Answer 16

True

Question 17

Respiration has no influence on swallowing function and therefore need not be considered during patient examination.

Answer 17

false

Question 18

Which of the following is a part of the case history?

Answer 18

Gathering information on a family history of swallowing disorders, Gathering information on medications and their dosages, Gathering information on any recent weight changes, and Exploring reported evidence of trauma in the patient’s medical history and considering how a history of trauma may impact your relationship with the patient

Question 19

The clinical swallow evaluation…

Answer 19

Should be relied upon to detect silent aspiration.

Question 20

The presence of facial asymmetry can contribute to oral preparatory and/or oral phase dysphagia.

Answer 20

true

Question 21

Oral Phase: Lip Seal

Answer 21

Assess by eliciting a cheek puff from the client.

Question 22

Oral Phase: Tongue range of motion

Answer 22

Assess by eliciting the following movements: “Lateralize, elevate, and depress tip of tongue.”

Question 23

Oral Phase: Tongue strength

Answer 23

Assess by pressing the tongue against resistance (such as against a tongue depressor or gloved hand).

Question 24

oral phase: tongue sensation

Answer 24

Assess by lightly touching different parts of the tongue and oral cavity. Clinicans can also use flavored swabs on different parts of the tongue to assess taste.

Question 25

oropharynx: soft palate motion

Answer 25

Assess by asking the client to open the mouth. Observe movement during /a/ and "ah-ah-ah" phonation.

Question 26

oropharynx: soft palate sensation

Answer 26

Assess by touching the structure with a tongue blade or cotton swab. Ask the client if they felt the touch and where they felt it.

Question 27

Larynx: laryngeal elevation

Answer 27

Can't be fully assessed at the patient bedside. Requires use of a MBSS/VFSS or FEES for full assessment. Can assess broadly or grossly at the bedside by palpating the patient's thyroid prominence during swallowing.

Question 28

larynx: pooling of secretion

Answer 28

Cannot be observed at the patient bedside during a clinical swallow evaluation. Requires a VFSS/MBSS to fully assess. Can be assessed broadly or grossly at the bedside by listening to the patient vocal quality. A wet vocal quality is a red flag.

Question 29

larynx: vocal fold closure

Answer 29

Cannot be observed at the patient bedside during a clinical swallow evaluation. Requires a VFSS/MBSS to fully assess. May assess informally with laryngeal tasks. May be heard as a loud voice.

Question 30

During the oral examination, the 3 features of each organ that are assess are...

Answer 30

range of motion, strength, and sensory function

Question 31

During the pharyngeal phases of swallowing the larynx and hyoid bone move

Answer 31

upward and forward

Question 32

Five basic taste sensations exist: sweet, sour, salty, bitter, and "zest".

Answer 32

true

Question 33

When food or liquid penetrates to the level of the vocal folds, voice quality is likely to change. At the clinical bedside the SLP may hear the voice quality become wet or gurgly sounding.

Answer 33

true

Question 34

The reluctance to eat or fear of eating/drinking due to past swallowing problems, the inability to digest or absorb ingested nutritents, or the inability to swallow safety are all conditions that increase the risk of malnutrition.

Answer 34

true

Question 35

This validated self-assessment tool was developed specifically to evaluate the impact of dysphagia on the quality of life of patients with head and neck cancer. It takes about 10 to 15 minutes to administer and consists of 20 items divided into 4 subscales (1) global measure on the impact of swallowing ability (2) emotional (3) functional and (4) physical statements related to swallowing.

Answer 35

MD Anderson Dysphagia Inventory

Question 36

Community-acquired pneumonia is a pulmonary infection resulting from acute or chronic aspiration of fluids, foods or oral secretions from the mouth or from fluids arising in the stomach and flowering into the airway.

Answer 36

true

Question 37

This patient-reported outcome measure is used to measure dysphagia symptom severity. Each item is rated on a 5-point interval scale from 0=No problem to 4=Severe problem.

Answer 37

Eating Assessment Tool (EAT-10)

Question 38

The pharyngeal phase of swallow begins when the bolus reaches the level of the pyriform sinuses.

Answer 38

false

Question 39

Peristalsis is the sequential contraction of the esophagus and relaxation of the lower esophageal sphincter, characterized in the esophageal phase of swallowing. This type of peristalsis occurs when a swallow induces peristaltic activity.

Answer 39

primary peristalsis

Question 40

Postoperative anterior cervical spine surgery can cause dysphagia. Speech-language pathologists working with patients following ACSS must be aware that certain postural adjustments like the chin-tuck maneuver or turning the head to one side to facilitate a swallow may not be possible.

Answer 40

true

Question 41

Aspiration pneumonia is...

Answer 41

a condition in which a chemical inflammation or bacterial infection results in entry of foreign materials into the bronchi of the lungs.

Question 42

Term that indicates that the bolus has entered the airway but has not gone below the vocal folds.

Answer 42

penetration

Question 43

A tracheotomy is an operation during which the surgeon makes a cut or opening in the trachea. The removal of a tracheotomy tube is known as decannulation.

Answer 43

true

Question 44

Gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux disease (LPRD) are...

Answer 44

inflammatory disorders of the esophagus that affect structures within and above the esophagus.

Question 45

The collection of brainstem nuclei that coordinates the swallowing sequence is known as the central pattern generator.

Answer 45

true

Question 46

Autoimmune diseases may affect swallowing by causing intrinsic obstruction, external compression, abnormal motility, or inadequate lubrication of swallowing structures.

Answer 46

true

Question 47

Dysphagia after cervical spine surgery is due to...

Answer 47

Disruption of the motor and sensory innervations (pharyngeal plexus), pain, edema, and scarring in the pharynx

Question 48

Zenker diverticulum forms above the cricopharyngeal sphincter muscle. It is a pouch created by the failure of the upper esophageal sphincter (UES) to open before the propulsive wave, and due to weakness of the laryngeal elevators.

Answer 48

true

Question 49

The size and distribution of a stroke infarct (infarct = site of injury where brain cell death occurred) define the clinical presentation of the stroke. The size and distribution of the stroke are dependent on the degree and site of interrupted blood supply to the brain.

Answer 49

true

Question 50

Amyotrophic Lateral Sclerosis

Answer 50

a progressive disease involving degeneration of the upper and lower motor neurons. 73% of patients in this population will have dysphagia before requiring ventilator support. These patients usually have more problems with liquids and large pieces of food.

Question 51

Cerebrovascular Accident (CVA) (also known as stroke)

Answer 51

Most common cause of neurogenic oral and pharyngeal dysphagia. The trend is that the larger the area of infarction (lesion/damage), the greater the impairment of swallowing.

Question 52

Parkinson Disease

Answer 52

a progressive degenerative neuromuscular disorder characterized by the loss of striatal dopamine in an area of the brain known as the basal ganglia.Oral and pharyngeal dysphagia in this population is usually multifactorial - meaning caused by combination of cognitive impairment, reduced posture, dysmotility and impulsive feeding behaviors at times.

Question 53

Myasthenia Gravis

Answer 53

an acquired autoimmune disorder of neuromuscular transmission in which acetylcholine receptor antibodies attack the postsynaptic membrane of the neuromuscular junction. This leads to rapidly fatiguing muscles since the attack reduces the available muscle-activating neurotransmitter. Swallowing problems occurs in 1/3 of patients with this condition.

Question 54

The most severe swallowing problems in stroke patients are caused by strokes at the

Answer 54

brainstem

Question 55

CN V - Trigeminal Nerve (Motor)

Answer 55

Clinician may see slight weakness in muscles of mastication.

Question 56

CN VII - Facial Nerve

Answer 56

Clinician may see slight weakness in bolus control and weak lip closure.

Question 57

CN IX- Glossopharyngeal nerve (sensory)

Answer 57

Clinician may see failure for patient to trigger the pharyngeal stage of the swallow. May also see premature spill of material from the mouth into the airway (early bolus loss/premature loss of bolus).

Question 58

CN X - Vagus Nerve - Superior laryngeal nerve injury (sensory)

Answer 58

During instrumental assessment the clinician may see loss of the protective glottic closure and cough reflexes which our bodies involuntary use to protect the airway from material in the supraglottic larynx (upper larynx)

Question 59

CN X - Vagus Nerve (motor)

Answer 59

Clinician may see inadequate velopharyngeal closure, nasal regurgitation, incomplete clearing of residue in the hypopharynx, pooling of material above the vocal folds, aspiration once the vocal folds open

Question 60

CN XII - Hypoglossal Nerve

Answer 60

Clinician may see bolus control problems due to reduced tongue mobility and driving force

Question 61

facial

Answer 61

cn vii

Question 62

hypoglossal

Answer 62

cn xii

Question 63

glossopharyngeal

Answer 63

cn ix

Question 64

trigeminal

Answer 64

cn v

Question 65

Tracheotomy results in several changes to the physiology of swallowing. Which is NOT one of those changes?

Answer 65

Aspiration is eliminated