Final Exam Review Flashcards
Which cranial nerve innervates the mandible?
CN-V
Which cranial nerve innervates the lips?
CN-VIII
Which cranial nerve innervates the tongue?
CN-XII
Which cranial nerve innervates the soft palate/most palatal muscles?
CN-IX and X
Excessive lingual rocking and freezing is seen in patients with:
Parkinson’s Disease
Two statements are true about drug administration and absorption in pharmacokinetics:
- crushing the pills after the drug release and peak time
- aging related changes do not impact the drug ingestion
- risk of aspiration is highest in patients with CVA when taken pills with liquids or solids compared to consuming liquids or solids alone
- round shaped pills are easier to swallow compared to oval-shaped pills
the following can be seen in a person who has damage in bilateral inferior longitudinal muscles of the tongue:
they can curl their tongue upwards but NOT downwards
damage to either sphincter cases nasal regurgitation or material entering into the nasopharynx
velopharynx
clinical changes in swallowing seen in patients with tracheostomy (choose two):
- increased pharyngeal sensation
- increased subglottal pressure
- poor smell (olfaction) and taste; loss of appetite
- laryngeal tethering and risk of aspiration
which is true about achalasisa
- despite hyperfunction/spasms in esophagus, the primary peristalic waves are normal
- it gives a “cork-screw” appearance in esophageal barium swallow study
- all the mentioned above are true
- it is the failure of relaxation in lower esophageal sphincter (LES) which does not let the bolus enter into the stomach
During an oral mech exam, I placed a lemon water swab on Justin Bieber’s anterior 2/3rds of the tongue. He said, “yeah, I got that yummy-yum that yummy0yum..that yummy-yum but couldn’t sense the touch. What cranial nerve is most likely damaged?
- CN-X
- CN-IX
- CN-VII
CN-V
a cracked tongue indicates
dehydration
anterior tongue (in pharyngeal phase)
elevates
posterior tongue (in pharyngeal phase)
depresses
velopharynx (in pharyngeal phase)
elevation and retraction
epiglottis (in pharyngeal phase)
closure and inversion
hyolarynx (in pharyngeal phase)
excursion/elevation
UES/PE Segment (in pharyngeal phase)
relaxation and opening
a consequence of a swallowing disorder
dehydration and malnutrition
what does pre-prandial aspiration indicate?
delayed pharyngeal resposne
what does prandial aspiration indicate?
vocal fold paralysis
what does post-prandial aspiration indicate?
GERD
what does silent aspiration indicate?
sensory nerve lesions
which of the following is true about pharyngeal muscles?
- all of the options are true
- pharyngeal muscles contract creating a stripping wave to push the bolus into the esophagus
- when longitudinal pharyngeal muscles contract, it shortens the length of the pharynx
- when pharyngeal constrictor muscles contract, it decreases the diameter of the pharynx and makes it smaller
true or false:
the true incidence of swallowing disorder is unknown as dysphagia is a symptom following a primary diagnosis rather than a disease
what cranial nerve is CN-V?
trigeminal nerve
what cranial nerve is CN-VII?
facial nerve
what cranial nerve is CN-IX?
vestibucochlear nerve
what cranial nerve is CN-X?
vagus nerve
what cranial nerve is CN-XII?
hypoglossal nerve
which is the primary muscle to contract to increase buccal tension to hold the food while chewing and sucking?
buccinator
what is the term for difficulty swallowing?
dysphagia
which of the following are true about presbyphagia?
- reduced hyolaryngeal excursion shortens the relaxation times of UEs, which is compensated by longer durations of upper airway closure
- best swallow compensatory strategy to recommend for pill dysphagia is to crush the pills
- pill dysphagia could be common due to decreased salivary production along with xerostomia being a potential side effect in most prescribed medications
- presbyesophagus could impact the metabolism of drug and increases the drug sensitivity
- infrequent shallow laryngeal penetration might be seen
- presbyessophagys does not impact the meabolism of drug and decreases the drug sensitivity
- frequent deep laryngeal penetration might be seen
- oral and pharyngeal transit times does not change and are same as seen in younger individuals
what causes the relaxation or opening of UES?
- contraction of cricopharyngeus muscle
- posterior movement of posterior cricoid
- relaxation of cricopharyngeus muscle
- anterior movement of posterior cricoid
when you work with a patient on improving their swallow function, what are your primary goals? (choose 3 most important answer choices)
- improving their quality of life and maintain adequate nutrition
- swallow efficiency
- swallow safety
- eat and drink regular consistencies
- recommending for alternative nutritions
a muscular dehiscence is seen in the following condition between the thyropharyngeous and cricopharyngeus muscles which creates the outpouch in the hyopharyngeal space. common symptoms include regurgitation, globus sensation, and risk of post-prandial aspiration
zenker’s diverticulum
which of the following statements are TRUE (choose 2)
- if a person does not react to foods or liquids entering into the airways beyond the level of the true vocal folds, it is called silent aspiration
- when foods or liquids enter into the airways but NOT below the level of the true vocal folds, it is called aspiration
- when foods or liquids enter into the airways beyond the level of true vocal folds, it is called aspiration
- when foods or liquids enter into the airways beyond the level of true vocal folds, it is called laryngeal penetration
when a right hypoglossal nerve is damaged, the following is seen:
pocketing of food is seen on right buccal cavity
the following is normal and productive in the esophageal phase:
only primary and secondary peristalsis
______________ and ______________ are anterior and superior walls of pharynx respectively during the pharyngeal phase
base of tongue and velum
true or false: aspiration pnuemonia is caused only due to entry of foods or liquids into the lungs. So, if a person has aspiration pnuemonia, then they most certainly have dysphagia
false
a decline or demonstratable change in swallow function associated with normal aging is called
presbyphagia
during the drug absorption, the time required to reach its maximum serum concentration is called
time to peak concentration
true or false: a normal swallow is not at all possible in an individual with neurological or muscular damage
false
true or false: deglutition is the other word for swallowing
true
oral preparatory phase
mastication and bolus formation
oral transit phase
anterior to posterior bolus propulsion
pharyngeal phase
stripping wave, closure of upper airways/larynx and relaxation of UES
esophageal phase
peristalsis and relaxation of LES
the primary muscle which helps for velopharyngeal closure during the pharyngeal phase is:
palatopharyngeus (which makes up the posterior faucial arch)
what is the consequence of swallow inefficiency (choose two answers)
- trouble with mastication
- absence of residue
- presence of significant residue
- risk of residue falling into the airways after the swallow
what is the pre-requisite to assess before proceeding to oral swallow trials
cognitive-linguistic status
what is true about FEES? (select 4 choices)
- can assess the sensations and visualize the secretions
- canNOT evaluate velopharyngeal function
- can see pre-prandial, prandial, and post-prandial aspiration
- epistaxis and vasovagal syncope is rarely seen
- can evaluate velopharyngeal function
- very expensive, limited availability, and not portable
- can see pre- and post-prandial aspiration only
the hypotheses of NMES benefits are (select two choices)
- improved communication with brain through heightened sensory awareness and therefore muscle memory
- increases the swallow strength
- improved communication with brain through reduced sensory awareness and therefore muscle memory
- decreases the swallow muscle strength
during dysphagia therapy, what factor should be considered to analyze the tolerance of patient?
- all of the above
- overt clinical indicators such as coughing, choking, and vocal quality changes, and weak cough
- diagnostic lab profile and nutritional assessments
- changes in vitals such as lung sounds and temperatures
Julio Jones was seen with aspiration of thin liquids in 2/3 trials during MBSS. The aspiration is secondary to left vocal fold paralysis. What is the best compensatory strategy to try during the instrumentation?
head turn to left side
a self-assessment tool to obtain information on swallowing from patient’s persepctive
EAT-10
provale cup
flow regulation of liquids
universal cuff
intended for those who have absent grip
rheology
study of flow of matters
jujenal tube
severe pancreatis
effortful swallow
improves lingual and pharyngeal constriction pressures
supraglottic swallow
decreases the risk of prandial and post-prandial aspiration
mendelsohn maneuver
increases the duration of hyolaryngeal elevation and UES opening
masako
improves the function of posterior and base of tongue
super supraglottic swallow
decreases the risk of pre-prandial, prandial, and post-prandial aspiration
This involves use of radionucleotide to track the bolus transfer and quantify the aspiration amount.
PET/scintillography
NMES
submental electrical stimulation of muscles to improve swallow function
sEMG (Surface Electromyography)
measures the electrical activity of muscle response during the swallowing
PES (Pharyngeal Electrical Stimulation)
electrically stimulates the pharyneal area to improve the swallow function
IMS (intraamuscular stimulation)
invasive process and may involve implant of electrodes to increase muscle activity and improve the swallow function
write down the 4 steps of CBSSE
- case history and physical examination (include self-assessment)
- Clinical Bedside Examination
- Instrumental evaluation
- Oral trials (if applicable)
FEES
visualize the laryngeal structures and mucosa
MBSS
visualize the airways before, during, and after the swallowing
FEEEST
sensory function of larynx/upper airways
pharyngeal manometry
pressure sensors to measure the pharyngeal construction pressures
IOPI (iowa oral performance instrument)
measures the linguopalatal pressures
EMG (electromyography)
measures the electrical activity of the muscle response
decision making process of treatment requires
accurate observational skills, accurate outstanding of the disorder, and knowledge on when to use instrumental evaluation
examples of compensatory strategies
chin tuck and diet texture modifications
compensatory stratgeis
ensure safe swallows without directly improving the swallow physiology
rehabilitative strategies
long-term improvement of neuromuscular control of swallowing
principle of overload
slowly increasing the resistance through bolus volumes and consistencies
principle of specificity
training/exercising should be designed for specific impairments for a desired effect
what is the highest priority in dysphagia treatement
swallow efficiency, quality of life, and swallow safety
following technique improves the oral awareness and decreases the duration of swallow response
thermal tactile oral stimulation
low albumin and prealbumin
hyperdepletion of musclesat
arterial blood gas
measures the pH level of blood
respiratory acidosis
increased carbon dioxide retention in the body
creatine
metabolic waste
Saginaw Grant was seen with weak buccal tension in right side of his oral cavity which leads to pocketing/pooling of materials on the same side. What is the best compensatory strategy to evaluate and recommend?
head tilt to right side
Shun Li enjoys her dumpling soup so much. However, she aspirates on thin liquids secondary to reduced base of tongue function and occasional delayed swallow response. What is the best compensatory strategy that may be worth trying during MBSS?
chin tuck
what is true about MBSS
- can evaluate the oral, pharyngeal, and esophageal phases
- weight limitation with fluoro chair
- requires barium to trace the bolus
- can see pre-prandial, prandial, and post-prandial aspiration
four finger test primarily helps us to estimate this
hyolaryngeal elevation and excursion
