LAST FINAL AS A FIRST YEAR!!!!!!!!!!!

Question 1

Esophageal physiology

Answer 1

• major function is transportation
• vagus nerve primary
• peristalsis or “squeezing”

Question 2

primary peristalsis

Answer 2

initiated by swallow

Question 3

secondary peristalsis

Answer 3

• clean up crew, clears material from first peristalsis and also clears reflux
• dry swallow can also start it
• second swallow inhibits it

Question 4

third form of peristalsis

Answer 4

• tertiary waves that don’t help move bolus
• ineffective waves (signal of disorder)
• happens frequently with reflux and stress

Question 5

common esophageal disorder symptoms

Answer 5

• sticking of food in throat
• coughing during or after meal
• globus sensation
• hiccups (huge sign of reflux)

Question 6

less common esophageal disorder symptoms

Answer 6

• chest pain
• shortness of breath
• respiratory symptoms
• odynophagia (painful swallowing)

Question 7

structural esophageal disorders (mostly solid food dysphagia)

Answer 7

• strictures
• rings and webs
• hiatal hernias
• CP Bars
• diverticulums

Question 8

motor abnormalities (motility)

Answer 8

• achalasia
• reflux
• scleroderma
• nonspecific esophagus

Question 9

diverticulum

Answer 9

• Zenker’s most common
• pouch or sac that branches off the esophagus
• increase pressure secondary to coordination of muscles

Question 10

esophageal web

Answer 10

• located in proximal or upper third of esophagus
• regurgitation, food sticking
• balloon dilation, diet

Question 11

esophageal stricture/obstruction

Answer 11

• stricture-narrowing of esophagus
• caused by scar tissue that builds up
• obstruction, usually food blockage
• balloon dilation/PPI Tx/removal of obstruction

Question 12

c-p bar (cricopharyngeal bar)

Answer 12

• hypertrophied c-p muscle due to overworked muscle, aging or dysfunctional UES
• myotomy/balloon dilation

Question 13

intraesophageal reflux

Answer 13

• delay in peristalsis

- backflow of bolus in esophagus

Question 14

gastroesophageal reflux

Answer 14

-backflow of stomach acid into esophagus

Question 15

laryngopharyngeal reflux

Answer 15

-stomach acid back flowing all the way into larynx

Question 16

which lung more susceptible to aspiration?

Answer 16

right. wider, more forward, and shorter

Question 17

pleura

Answer 17

2 thin layers of tissue that surround lungs. like saran wrap that protects and cushions and helps lungs expand and contract

Question 18

alveoli

Answer 18

clusters of ducts that contain air

Question 19

when does swallow occur?

Answer 19

interrupts expiratory phase

Question 20

swallow apnea

Answer 20

airway closes for fraction of a second. bigger bolus=longer apneic period. swallow and respiratory overlap and incoordination may lead to aspiration

Question 21

mucociliary clearance

Answer 21

movement of mucous through the respiratory tract by movement of cilia that lines bronchi. moves foreign matter, dirt and membranes and prevents infection

Question 22

who’s at risk for poor mucociliary clearance?

Answer 22

-head/neck cancer
-NPO
-trach/resp pts because not eating or drinking so dry mucous membranes and not making saliva
SALIVA IS KEY!!!!!!!!

Question 23

pulmonary toilet

Answer 23

body’s natural way of clearing secretions. cilia/mucociliary clearance, coughing, spitting. HYDRATION IS KEY!!!!

Question 24

artificial pulmonary toilets

Answer 24

suction, bronchoscopy, inhalers

Question 25

affects of intubation

Answer 25

redness, edema, decreased sensation, odynophagia. wait 24 hours for swallow eval due to pain, swelling, etc.

Question 26

tracheostomy tubes

Answer 26

patients who need longer time to gain respiratory status back AND used to reduce aspiration, protecting the lungs because able to suction. goal is to go smaller and smaller then pull it

Question 27

cuffed tube

Answer 27

inflated piece around tube. prevents air from escaping upper airway and assures patient is well oxygenated. cannot phonate and can swallow but not a natural swallow because they don’t feel the pressure. reduces but does not eliminate risk of aspiration. can still aspirate saliva and liquids around the cuff.

Question 28

cuffless tube

Answer 28

allows air exchange in upper airway. can phonate, swallow and cough.

Question 29

how does tube affect swallowing?

Answer 29

reduces subglottic pressure, possible reduction in laryngeal elevation, reduced smell and taste.

Question 30

order of progression for tube

Answer 30

1. cuff inflated
2. deflated or cuff less (optimal for SLP eval)
3. passy muir speaking valve
4. trach capped
5. decannulated

Question 31

swallow eval

Answer 31

optimal=cuff deflated. if they can’t tolerate then you may assess while inflated though its not very accurate. don’t eval inflated unless there’s no chance of weaning and they permanently need cuff inflated.

Question 32

disorders affecting respiratory

Answer 32

aging, COPD, head/neck cancer, neuro disease, stroke

Question 33

iatrogenic swallowing disorders

Answer 33

anti-psychotic drugs cause tardive dyskinesia (constant movement of tongue in and out of mouth) and alters transport.