L13 Pulmonary Function

Question 1

It was previously thought that swallowing and breathing were mutually exclusive, but now we know _______

Answer 1

although they don’t occur simultaneously, they functions are complementary and overlap one another

Question 2

T or F;swallowing and breathing have common neural afferent and efferent pathways with brainstem CPG

Answer 2

true

Question 3

T or F: swallowing and respiratory dynamics are affected by bolus factors (volume and viscosity)

Answer 3

true

Question 4

What is the function of the genioglossus during swallowing?

Answer 4

protrudes tongue

Question 5

What is the function of the styloglossus during swallowing?

Answer 5

retracts tongue

Question 6

What is the function of the stylopharyngeus during swallowing?

Answer 6

elevates larynx

Question 7

What is the function of the cricopharyngeus during swallowing?

Answer 7

relaxes to increase compliance and stretch during hyolaryngeal elevation

Question 8

What is the function of the sternothyroid and omohyoid during swallowing?

Answer 8

hyolaryngeal return

Question 9

What is the function of the velopharyngeal port during swallowing?

Answer 9

closes to prevent nasal backflow

Question 10

What is the function of the base of tongue during swallowing?

Answer 10

propels bolus through the pharynx

Question 11

What is the function of the larynx during swallowing?

Answer 11

adducts for airway closure

Question 12

What is the function of the genioglossus, styloglossus and stylopharyngeus during breathing?

Answer 12

stiffens to maintain airway patency

Question 13

What is the function of the cricopharyngeus during breathing?

Answer 13

maintains tone to prevent air entry into esophagus during inspiration

Question 14

What is the function of the sternothyroid and omohyoid during breathing?

Answer 14

stabilizes larynx for quiet breathing

Question 15

What is the function of the velopharyngeal port during breathing?

Answer 15

opens for nasal breathing

Question 16

What is the function of the base of tongue during breathing?

Answer 16

maintains patent airway

Question 17

What is the function of the larynx during breathing?

Answer 17

abducts for airway opening

Question 18

In healthy adults, list the 4 breathing patterns around swallowing from most frequent to least frequent

Answer 18

E-E (75%)
I-E (20%)
E-I (4%)
I-I (1%)

Question 19

When eating solids, 50% of swallows occurred in the ________ half of the expiratory cycle at lower quiet breathing lung volumes

Answer 19

second

Question 20

What is are the advantages of an E-E pattern

Answer 20

increased safety, less risk of aspiration

-expiration prior to swallow may encourage medicalization of VFs

Question 21

How does the diaphragm affect swallowing?

Answer 21

Diaphragm remains contracted during initial part of respiration. The diaphragm pulls on the larynx when contracted. Therefore there is more resistance to hyolaryngeal excursion in the initial stages of expiration

Question 22

Liquids are generally swallowed during expiration at ______- lung volumes which may be advantageous if cough is required to clear liquids

Answer 22

high

Question 23

T or F: age can shift individuals from E-E to another pattern

Answer 23

true

Question 24

Respiratory pause can lengthen to nearly _______ in older patients swallowing liquids

Answer 24

double

Question 25

Can swallow patterns be retrained?

Answer 25

yes!

Question 26

Neural control centers responsible for coordination of breathing and swallowing are contained in the dorsomedial and ventrolateral medullary regions of the ________

Answer 26

brainstem

Question 27

T or F: Cortical structures also play an important role in facilitating and modulating the coordination of breathing and swallowing

Answer 27

True

Question 28

In Langmores study, the highest incidence of aspiration was found in the _________ and the lowest incidence was found in ___________

Answer 28

nursing home

outpatient

Question 29

List the 7 significant predictors of aspiration pneumonia

Answer 29

• dependent for feeding
• dependent for oral care
• number of decayed teeth
• tube feeding
• more than one medical diagnosis
• number of medications
• smoking

Question 30

Which is the single most significant predictor of aspiration pneumonia?

Answer 30

-dependent for feeding

Question 31

How might being dependent for feeding lead to aspiration pneumonia (AP)

Answer 31

• Marker for dependence for other activities of daily living
• Increased risk for aspiration
• may be fed too fast or too much food at once

Question 32

How might being dependent for oral care lead to AP

Answer 32

poor oral hygiene resulting in increased pathogens that can then be aspirated

Question 33

How might number of decayed teeth affect AP

Answer 33

-increased oral pathogens

Question 34

How might tube feeding affect AP

Answer 34

-reduced salivary flow and poor oral hygiene

Question 35

How might more than one medical diagnosis affect AP

Answer 35

-marker for compromised host immunity

Question 36

How might number of medications affect AP

Answer 36

• marker for compromised host immunity

- higher risk for xerostomia and increased concentration of oral pathogens

Question 37

How might smoking affect AP

Answer 37

reduced response to aspiration

Question 38

T or F: dysphagia itself is enough to cause pneumonia

Answer 38

FALSE

Question 39

T or F: if you aspirate you will develop pneumonia

Answer 39

FALSE - only 38% of people who aspirated developed AP

Question 40

T or F: you can only aspirate on food or drink

Answer 40

False you can micro-aspiration on saliva, plaque or reflux