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CSUS Speech-Language Pathology > Medical SLP - Exam 3 > Flashcards

Medical SLP - Exam 3 Flashcards

1
Q

What did VonLangenbeck develop for Laryngectomies?

A

T-shaped incision and ligature of blood vessels

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2
Q

Incidence v. Prevalence

A

I: the number of new cases diagnosed within a specific period of time

P: the number of people living with the disease/disorder/etc within a specific period of time

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3
Q

Incidence of Laryngeal Cancer

A

12,000/year

25% of all head and neck cancers

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4
Q

Incidence and Prevalence of Laryngectomies

A

I: 5-7,000/year

P: 60,000

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5
Q

Average age of Laryngeal cancer diagnosis

A

63 years

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6
Q

Normal Cell Circle of Life

A
  1. Normal Cell Division
  2. Gap 1 (shortest gap, 2 hours minimum)
  3. Synthesis period; DNA replicates
  4. Gap 2 (10 hours no matter what)
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7
Q

Apoptosis

A

cell death; normal death at the preprogrammed time so a new cell can take its place

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8
Q

Metastasis

A

when cancer cells move from the original area (e.g., laryngeal cancer cells move to the lungs). entered lymph or blood systems.

tumor must be 1 gram for detection.

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9
Q

Necrosis

A

when there is injury or disease that causes cell death

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10
Q

Abnormal cell life (cancer)

A

when cells don’t have or ignore their suicide program and the immune system doesn’t catch it. Cells go back through the life cycle and duplicates the cancerous cells which replicate more rapidly than normal cells.

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11
Q

cancer cells have _______ _______

A

genetic defects

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12
Q

What causes cancer?

A
  • inheritance (inherit the tendency to the loss of error control)
  • Carcinogens
  • Chemicals
  • Viruses (HIV, HPV)
  • Radiation
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13
Q

Risk factors for laryngeal cancer

A

smoke, alcohol, poor nutrition and GERD/bulimia

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14
Q

Glottic symptoms of laryngeal cancer

A

hoarseness, persistent cough, prolonged sore lump in the throat

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15
Q

Sub-Glottic symptoms of laryngeal cancer

A

dysphagia, persistent throat pain, persistent ear pain, dyspnea/stridor (loud noise while breathing) and unexplained weight loss

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16
Q

T, N, M Laryngeal Cancer Staging

A

T - Tumor (1,2,3,4 or x)
N - Nodes or neck (0,1,2,3 or x)
M - Metastasis (0 or 1)

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17
Q

Tx Cancer Stage

A

can’t be diagnosed; can’t accurately assess the staging

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18
Q

T1 Cancer Stage

A

tumor is in situ (on site), small, on surface. Larynx functionality is fairly normal. Mucosal wave is altered a little, leaving the voice hoarse. No effect on VF movement.

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19
Q

T2 Cancer Stage

A

tumor is larger and going into the muscle. movement of only the VFs may be slightly affected. voice starting to sound worse.

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20
Q

T3 Cancer Stage

A

tumor is moving through tissues (muscle and cartilage). effect on laryngeal movement (arytenoids, VFs). voice change. can involve tissues outside larynx (esophagus, tongue, jaw, neck)

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21
Q

T4 Cancer Stage

A

larynx practically frozen on one side; no movement. arytenoids frozen, no mucosal wave. tumor is large and can involve tissue outside larynx.

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22
Q

N0 Cancer Stage

A

nodes are not cancerous/malignant

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23
Q

Nx Cancer Stage

A

can’t be diagnosed; can’t accurately assess the stage

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24
Q

N1 Cancer Stage

A

ipsilateral side; node involvement (a few nodes are malignant but small). Cancer has entered the lymph nodes.

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25
Q

N2 Cancer Stage

A

ipsilateral side but more nodes are involved and the tumors are bigger.

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26
Q

N3 Cancer Stage

A

bilateral node involvement (# of nodes doesn’t matter – critical point: cancer is no longer confined to one side, lymph system is spreading it)

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27
Q

M0 Cancer Stage

A

cancer has not metastasized

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28
Q

Mx Cancer Stage

A

can’t be diagnosed; can’t accurately assess the stage

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29
Q

M1 Cancer Stage

A

cancer has metastasized and gone away from the neck (laryngeal commonly metastasizes to the lungs, sometimes brain)

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30
Q

Types of Cancer

A
  • Carcinoma
  • Sarcoma
  • Lymphoma
  • Leukemia
  • Blastoma
31
Q

Carcinoma

A

most frequently laryngeal cancer. Arise in the ectoderm (linings). Surfaces of the body.

32
Q

Sarcoma

A

a mesoderm cancer. Attacks the connective tissues/tendons/ligaments/bones/blood vessels.

33
Q

Lymphoma

A

cancer in the lymph system.

34
Q

Leukemia

A

blood cancer. Attacks bone marrow.

35
Q

Blastoma

A

a cancer that develops in precursor cells (blasts/blastocysts). Found in many places because you have blast cells in every organ and brain. Malignancies that occur in the blasts. Deadly. Tumors aren’t encapsulated.

36
Q

Leukoplakia

A

tissue change on epithelium that is a pre-malignant tissue. white. tissue changes are never good.

37
Q

Why are tissue changes never good?

A

tells you the genetic blueprint has been altered and reduplication isn’t happening the way it should.

38
Q

Detecting Cancer (4 things)

A
  • 1 gram
  • Leukoplakia
  • Stiffness/no vibration or mobility in VFs
  • start superficially
39
Q

Cancer Treatments

A

Surgery, Radiation and Chemotherapy

40
Q

Radiation Therapy

A
  • focus radiation right next to the tumor
  • sometimes used before surgery
  • 5-8 weeks with 50-80 gray’s total
  • affects ability to produce laryngeal voice
41
Q

Rads, Grays, Seiverts

A

measurements for radioation
Gy = Grays
100 Rads = 1 gray
100 seiverts = 1 rad

42
Q

Radiation Considerations

A
  • Spine is irritated
  • Cataracts
  • Hypothyroid
  • Blood pressure increase
43
Q

General effects of radiation

A

xerostomia (dry mouth), dysphagia, decreased tissue compliance (stiffness of tissue), speech/esophogeal effects

44
Q

Perfusion

A

stiffens walls of carotid artery and jugular veins, restricting blood flow/oxygen to the brain. may appear to have a cognitive disorder.

45
Q

Chemotherapy

A

poisons cells (not for laryngeal cancer)

46
Q

Angiogenesis

A

block the growth hormones that grow the new blood vessels

47
Q

Cordectomy

A

thyroid cartilage is cracked, opened and then remove smaller pieces of tissue. can be done through mouth.

T1, M0 and N0 cancer

48
Q

Upper Esophageal Sphincter (UES)

A

most inferior part of the muscle inferior pharyngeal constrictor. Innervated by CN X (vagus).

doesn’t want air to pass because of digestion

49
Q

Lower Esophageal Sphincter (LES)

A

cardiac sphincter. need to operate for swallow. sensitive to food or liquid but doesn’t care whether air passes.

50
Q

How long is the esophagus?

51
Q

Stricture

A

esophagus shrinks and becomes still in a few places, looks like rings

52
Q

Hemilaryngectomy

A

remove the anterior soft parts of the larynx in continuity with the underlying thyroid cartilage

53
Q

Supraglottic Laryngectomy

A

operation to remove the epiglottis, false vocal cords, and superior half of the thyroid cartilage.

54
Q

Why do they have to remove the whole larynx? Why not just part of it or just the tumor?

A

explain how a tube works and the tube behavior of the pharynx

its better to remove the whole thing

55
Q

Why won’t I be able to speak after my laryngectomy?

A

voice box was removed and cannot get enough air through mouth. there will be no sound or air coming out of the mouth.

56
Q

Esophageal Speech

A

swallow air and turn it around to use for voice (belching).

57
Q

Tracheoesophageal Sphincter

A

pushing air into esophagus to use it to speak (puncture made into esophagus)

58
Q

5 Stages of Grief

A
  • Denial (can’t hear you, won’t follow instructions)
  • Anger (listens and follows instructions, mad at themselves)
  • Bargaining (can hear you and follow instructions, get a lot done in tx)
  • Depression (can’t hear you, hopeless. check thyroid)
  • Acceptance (looking forward to future with positive outlook)
59
Q

Insufflation Testing

A

putting air into esophagus to see if patient can voice.lets you know if tracheoesophageal speech works for them.

60
Q

Continuous Passing Criteria for Esophageal Speech

A

continuous phonation of about 8 seconds on “ah” and/or the patient being able to count from 1-15 on one breath

61
Q

Consistent Passing Criteria for Esophageal Speech

A

being able to do continuous passing criteria repeatedly

62
Q

Hypertonicity

A

no voice/spastic voice. don’t keep filling esophagus with air. try botox.

63
Q

Myotomy

A

making small knick in cricopharyngeus

64
Q

Neurectomy

A

knick peripheral nerves that innervates cricopharyngeus

65
Q

How is a TE prosthesis measured?

A

length in mm, diameter in french (Fr)

66
Q

Esophageal Pressure Systems

A

1) atmospheric in oral cavity (positive)
2) tonic resistance of PE segment
3) intraesophageal pressure (negative)

difference between 1 and 3: 5mm Hg

67
Q

Pre-op/ Post-op client conserns

A
  • Highly curable
  • Tell patients that they have a excellent Dr.
  • Describe surgery- they will wake up in ICU
  • Stays in hospital 5-6 days
  • Will be fed through g-tube for a couple days
  • Patients wont be able to speak
68
Q

Artificial Larynx

A

Example: electrolarynx

69
Q

Esophageal speech:

A

swallow air and turn it around to use for voice…belching. Some can become very good at it

70
Q

Tracheoesophageal sphincter:

A

pushing air into esophagus to use it to speak. Puncture is made into esophagus so person can use it for speech. Problem: is a product intensive result (cleaning, tools, expensive…)

71
Q

Laryngectomy General care

A
  • Stoma Care: never rub, always dab
  • K-Y jelly if stoma becomes dry
  • Use shower guards
72
Q

Laryngectomy Counseling

A
  • Need team approach
  • Build trust with patient–> so them come back for further help
  • Monitor and facilitate a return to a normal life
  • help deal with diagnosis of cancer
73
Q

5 Stages of Grief

A

a. SLP must recognize the stage and its influence on interaction
b. Some of these stages mean they wont or cant listen to you
c. Denial
D. Anger
E. Bargaining
F. Depression
G. Acceptance
H. It difficult to counsel, but you have to

CSUS Speech-Language Pathology (23 decks)

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