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Dysphagia > Interim 1 > Flashcards

Interim 1 Flashcards

1
Q

Define dysphagia

A

Dysphagia is an abnormality in the transfer of a bolus from the mouth to stomach, including abnormalities in the oral preparatory, oral, pharyngeal and/or esophageal stages

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2
Q

Define feeding disorder

A

A feeding disorder is
an impairment in the process of food transport outside of the alimentary system, e.g., weakness or incoordination of the arm to move food from the plate to the mouth

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3
Q

List overt characteristics of dysphagia

A 
Difficulty chewing
Difficulty with bolus preparation
Drooling
Choking
Regurgitation
Sense of food sticking in throat
Pain
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4
Q

List occult or covert characteristics of dysphagia

A

Silent laryngeal penetration and aspiration

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5
Q

Define incidence rate

A

number of new cases of a disease over a period of time divided by population at risk of the disease in the time period

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6
Q

Define prevalence rate

A

total number of cases of a disease at a given time divided by total population at risk at a given time

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7
Q

List consequences of dysphagia

A 
Aspiration pneumonia
Malnutrition >>> weight loss, poor healing, susceptibility to other illnesses
Dehydration
Airway obstruction
Death
Decreased quality of life
Health care costs
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8
Q

List the stages of swallowing

A

Oral preparatory
Oral
Pharyngeal
Esophageal

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9
Q

What is the relevance of bony structures in relation to speech/swallow?

A

Bony structures are anchor points for muscles involved in speech/swallow

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10
Q

List structures included in a visual inspection of the oral cavity

A 
Lips
Sulci
Gums
Dentition
Faucial pillars
Roof of mouth
Tongue
Posterior pharyngeal wall
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11
Q

List the points of attachment for muscles associated with bolus preparation/propulsion

A 
Temporal bones
Sphenoid bone
Maxillae
Mandible
Palatine bone
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12
Q

Describe the temporal bones

A

Form lateral sides of the cranium
Forms footing for the temporomandibular joint
Has three processes which are important attachment sites for muscles used during swallow

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13
Q

Describe the sphenoid bone

A

Located deep within cranium
Bat-shaped
Attachment sites for several muscles associated with swallowing

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14
Q

Give characteristics of the facial skeleton

A 
Comprised of the maxillae and mandible
Anchor sites for dentition
Attachment sites for muscles of facial expression and mastication
Vital role in oral stage
Grinding food
Bolus formation
Oral pressure generation
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15
Q

Describe the maxilla

A

Forms framework for anterior aspect of midface, initial portion of hard palate, inferior surface of orbital cavity, and lateral sides of nasal cavity
Meets zygomatic or cheek bone and adjoined by L-shaped palatine bones
Houses maxillary dentition
Serves as contact point for tongue during oral stage

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16
Q

Describe the mandible

A

U-shaped
Body, angle, ramus
Has ridges for muscle attachments
Lingual surface: attachment for extrinsic muscles of tongue and muscles of FOM

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17
Q

Describe the temporomandibular joint

A

Formed by articulation of condylar process of the mandible at the mandibular fossa of the temporal bone
Allows movement in three planes for rotary displacement of jaw
Depression/elevation
Protrusion/retraction
Lateralization

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18
Q

List structures associated with the palate

A

Palatine processes = three quarters of hard palate
Palatine bone = posterior one-quarter of hard palate
Attachment for palatal aponeurosis

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19
Q

What actions should be analyzed in a swallow study?

A 
Oral phase
Tongue-palate seal
Nasopharyngeal seal
Compression/propulsion of bolus
Hyoid/laryngeal elevation
Epiglottic tilt
Cricopharyngeal opening
Esophageal peristalsis
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20
Q

What structures should be analyzed in a swallow study?

A 
Tongue
Hard palate
Velum
Epiglottis
Hyoid/larynx
Pharyngeal constrictors
Cricopharyngeus/UES
Esophagus
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21
Q

List normal actions that occur in the oral phase

A

Lips engulf bolus
Bolus is held at rest in front of mouth
Masticate if needed
Tongue transfers bolus into pharynx

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22
Q

Describe a typical tongue-palate seal

A

Soft palate rests against posterior tongue blade without kinking

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23
Q

Describe a typical soft palate-pharyngeal seal

A

Soft palate elevates to appose Passavant’s cushion

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24
Q

Describe typical bolus compression and propulsion

A

Retraction of base of tongue

Progressive contraction of constrictors

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25
Q

Describe typical hyoid elevation, laryngeal closure, and epiglottic tilt

A

Larynx moves upward and forward as bolus enters oropharynx
Epiglottis moves horizontally
Epiglottis inverts
Airway is protected by “triple action”

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26
Q

Describe typical actions of the cricopharyngeal opening

A

Closed between swallows

Relaxes and opens completely to allow bolus to flow form pharynx into esophagus

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27
Q

Describe the typical action of the esophagus

A

Peristalsis

28
Q

List atypical actions of the esophagus

A

Dysmotility
Reflux
Spasm

29
Q

List characteristics involved in esophageal dysphagia

A

Stenosis (rings, webs, stricture, tumor, extrinsic compression)
-Solid food dysphagia
-Liquid dysphagia preceded by solid food ingestion
Diverticula
-Retention
-Regurgitation
-Halitosis

30
Q

List characteristics of structural abnormalities

A 
Is a structure:
Resected/absent
Replaced
Altered in some way
Thickened
Asymmetric
Too large/too small
Is there something there that shouldn’t be?
Pouch
Diverticulum
Mass
Foreign body
Fistula
31
Q

Describe the pharynx

A

Suspended from base of skull and attached to the top of sternum
Contiguous with oral cavity, palate, tongue, nasal cavity, eustachian tube
Formed by 26 pairs of striated muscles
Innervated by six cranial nerves and four cervical nerves

32
Q

Describe the nasopharynx

A

Extends from base of skull to pharyngeal isthmus
Demarcated by soft palate anteriorly and by a prominence in the posterior wall at first cervical body
Lies above velum

33
Q

Describe the oropharynx

A

Extends inferiorly from BOT to hyoid
Bordered by tongue anteriorly and by pharyngeal constrictors posteriorly
Separated from oral cavity by faucial arches

34
Q

Describe the hyppharynx

A

Extends from valleculae to pharyngo- esophageal segment (PES) inferiorly
Larynx forms the anterior wall

35
Q

Define pharyngeal constrictors

A

Fibers arise from median raphe in the midline of the posterior pharyngeal wall and run laterally to attach to bony and soft tissue structures anteriorly
Comprise external circular layer

36
Q

List the functions of the pharyngeal constrictors

A

Constrict or reduce the diameter of pharynx

Clear bolus through pharynx

37
Q

Name the pharyngeal constrictors

A 
Superior
Glossopharyngeus
Middle
Hypopharyngeus
Inferior
Thryopharyngeus
Cricopharyngeus
38
Q

Describe the internal longitudinal layer

A 
Salpingoharyngeus
Draws lateral wall of pharynx up
Palatopharyngeus
Draws muscular palate down
Stylopharyngeus
Elevates pharynx and to some extent larynx
39
Q

Define vallecula

A

Lateral recesses at the BOT on each side of epiglottis

40
Q

Give characteristics of the epiglottis

A

Extends from BOT into pharyngeal cavity
Attached to thyroid notch by a ligament
Deflects bolus stream laterally into pyriforms
Epiglottic folding occurs by laryngeal elevation, increased pressure in preepiglottic fat space, weight of bolus

41
Q

Describe the pyriform sinuses

A

Lateral recesses between larynx and anterior hypopharyngeal wall
Formed by attachment of inferior constrictors to thyroid cartilage

42
Q

Describe the cricopharyngeus

A 
Lies at transition between pharynx and esophagus
Acts as a sphincter
Tonic contraction at rest
Relaxes during swallowing
Inserts on cricoid and encircles pharynx
43
Q

Describe the larynx

A 
Anterior to hypopharynx at upper end of trachea
Cartilaginous
Hyoid
Thyroid
Cricoid
44
Q

List and desribe structures located in the larynx

A

Arytenoids are true synovial joints Positioned on rim of cricoid
Laryngeal aditus
Uppermost portion of entry to airway
Laryngeal vestibule
Supraglottic space between aditus and ventricular or false vocal folds
False vocal folds
Shelf of tissue
Separate laryngeal vestibule and ventricle
Laryngeal ventricle
Inferior margin is true vocal folds
True vocal folds
Composed of vocalis and thyroarytenoid muscles
Attached from the vocal processes of the arytenoids posteriorly to the inside surface of thyroid lamina laterally and to the thyroid notch laterally

45
Q

Describe extrinsic musculature

A 
Elevate hyoid
Suprahyoid muscles
Geniohyoid
Mylohyoid
Digastric
Stylohyoid
Depress hyoid
Infrahyoid muscles 
Thyrohyoid
Sternohyoid
Sternothyroid
Omohyoid
46
Q

Describe intrinsic musculature

A 
Abduction
Posterior cricoarytenoid
Adduction
Thryoarytenoid
Lateral cricoarytenoid
Transverse and oblique arytenoid
Thyromuscularis
Cricothyroid
Only laryngeal muscle supplied by the external branch of the superior laryngeal nerve rather than the recurrent laryngeal nerve
47
Q

Give characteristics of false vocal folds

A 
Outcroppings of mucosal tissue
Not muscular structures
Adducted when the arytenoid cartilages are displaced medially and anteriorly
Oblique interarytenoids
Aryepiglottic muscle
48
Q

Give characteristics of the esophagus

A 
Collapsed muscular tube 18-25 cm
Upper third
Striated
Controlled by CNS
Middle third
Combination of striated and smooth
Lower third
Smooth
Controlled by ANS
49
Q

List the muscles of the esophagus

A

Exterior
Longitudinal muscles
Interior
Circular muscles

50
Q

Define peristalsis

A

Constriction by contraction of circular muscles

Shortening by contraction of longitudinal muscles

51
Q

Describe the upper esophageal sphincter

A

High pressure zone between pharynx and esophagus
Formed by
Cricopharyngeus
Inferior fibers of inferior constrictor
Superior portion of longitudinal esophageal musculature

52
Q

Describe the lower esophageal sphincter

A

Junction between esophagus and stomach
Maintains resting tone to prevent regurgitation
Opens to permit liquid or food into stomach

53
Q

List the cranial nerves involved in speech and swallow

A 
Trigeminal V
Facial VII
Glossopharyngeal IX
Vagus X
Accessory XI
Hypoglossal XII
54
Q

Trigeminal nerve

A

Largest cranial nerve
Has three divisions
Ophthalmic (sensory)
Maxillary (sensory)
Mandibular (motor and sensory)
Motor to muscles of mastication, tensor tympani, tensor veli palatini, anterior digastric, mylohyoid
Sensory for eyes, nose, maxillary sinus, head, face, mouth, teeth, oral tongue

55
Q

Facial nerve

A

Motor to facial muscles, platysma, buccinator, stapedius, posterior belly of digastric, stylohyoid
Sensory to anterior two-thirds of tongue and soft palate
Motor autonomic to submandibular and sublingual glands

56
Q

Glossopharyngeal nerve

A

Motor to stylopharyngeus and PES
Sensory to oropharynx and posterior third of tongue
Parasympathetic to parotid

57
Q

Vagus nerve

A

Superior laryngeal nerve
Sensory to epiglottis, supraglottis, hypopharynx, posterior larynx, pyriforms
Inferior or recurrent laryngeal nerve
Motor to intrinsic laryngeal muscles, PES
Motor to heart, lungs, bronchii, GI tract, pharynx, BOT, larynx
Sensory to heart, lungs, bronchii, trachea, larynx, pharynx, GI tract, external ear

58
Q

Accessory nerve

A

Cranial portion
Motor to pharynx, upper larynx, uvula, palate
Sends fibers to recurrent laryngeal nerve and cardiac nerves
Spinal portion
Motor to upper portion of sternocleidomastoid and trapezius muscles
Sends branches to C 2-4

59
Q

Hypoglossal nerve

A

Motor to tongue and strap muscles of neck

60
Q

List atypical features of the oral phase

A 
Drooling (anterior loss of bolus)
Poor bolus formation
Multiple tongue movements
Prolonged oral stage
Difficulty initiating a swallow
Unable to propel bolus posteriorly
Reduced lingual movement
Failure to obliterate oral cavity
Loss of bolus into FOM
Loss of bolus through lips
Pooling or pocketing
Oral residue
Asymmetry of bolus at rest
61
Q

Characterize abnormal features of a tongue-palate seal

A

Kinking of soft palate
Loss of bolus over tongue
Premature leakage
Potential for aspiration

62
Q

Describe atypical features of the soft palate-pharyngeal seal

A

Sluggish elevation of the soft palate
Nasopharyngeal regurgitation
Dependent on strength of seal and inferior constrictors

63
Q

Give abnormal features of bolus compression and propulsion

A

Diminished constriction
Failure of lateral pharyngeal walls to come to midline
Unilateral asymmetry
Retention in vallecula and/or pyriforms

64
Q

List abnormal actions involved in hyoid elevation, laryngeal closure, and epiglottic tilt

A 
Absent or diminished hyoid to mandible apposition
Incomplete or absent epiglottal tilt
Vallecular retention
Vocal folds open during swallow
Laryngeal penetration/aspiration
65
Q

Describe abnormalities in the cricopharyngeal opening

A

Opens late or incompletely
Closes early
Cricopharyngeal prominence or “bar”
Trapping of bolus

Dysphagia (2 decks)

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