Midterm Flashcards
1
Q
What does foramen mean?
A
hole or opening in bone
2
Q
What is the uvula made up of?
A
mucosa, glandilar tissue, adipose, vascular
3
Q
Does the uvula have a function?
A
No
4
Q
What is the pharynx made up of?
A
oropharynx, nasopharynx, hypopharynx
5
Q
What does the eustachian tube connect?
A
connects middle ear w/ pharynx
6
Q
What are the muscles of the VP?
A
- Levator Veli Palatini
- Superior Pharyngeal -Constrictor
- Palatopharyngeus
- Palatoglossus
- Musculus Uvulae
- Tensor Veli Palatini
7
Q
WHat does the levator veli palatini do?
A
Velar elevation
“sling”
8
Q
What does the superior pharyngeal constrictor do?
A
Constricts pharyngeal walls to narrow vp against
9
Q
What does the palatopharyngeus do?
A
Narrows the pharynx
10
Q
What does the palatoglossus do?
A
Depresses the velum or elevates the tongue
11
Q
What does the musculus uvulae do?
A
“bulges” for seal on nasal surface
12
Q
What does the tensor veli palatini do?
A
Opens the E-tubes
13
Q
Which VP nerves are motor?
A
- Trigeminal V
- Facial VII
- Glossopharyngeal IX
- Vagus X
- Accessory XI
14
Q
Which VP nerves are sensory?
A
- Glossopharyngeal IX
- Vagus X
15
Q
Which VP nerves are both sensory & motor?
A
- Glossopharyngeal IX
- Vagus X
16
Q
What are the physiological subsystems for speech?
A
- Respiration
- Phonation
- Resonation
- Articulation
- Prosody
17
Q
What types of movement is needed for VP physiology/closure?
A
- Velar movement
- Lateral pharyngeal wall movement
- Posterior pharyngeal wall movement
- Passavant’s Ridge
18
Q
What is a Passavant’s Ridge?
A
A shelf-like ridge of muscles projecting from posterior pharyngeal wall into pharynx.
19
Q
What are the VP closure variations?
A
- Coronal
- Sagittal
- Circular
- Circular with Passavant’s Ridge
20
Q
What is a coronal VP closure?
A
VP meeting posterior pharyngeal wall
21
Q
What is a sagittal VP closure?
A
Lateral walls
22
Q
What is a circular VP closure?
A
Sinched sac
23
Q
What types of activity is needed for VP closure?
A
- Speech
- Swallow
- Gag
- Vomit
24
Q
What is the timing for VP closure?
A
VP must be completely closed before phonation begins
25
What types of phonemes does the VP create the greatest force?
Fricatives and consonants
26
What is the ratio between Rate/Fatigue and closure force?
Increased rate and fatigue equals decreased closure force
27
What are factors that affect VP function?
- Lack of muscle bulk (esp. levator)
- Abnormal muscles insertion
- Malposition of repaired muscle
- Velum scar tissue
- Short velum
- Deep pharynx
28
Until when do facial bones continue growing?
Early adulthood
29
How long is a newborn pharynx compared to an adult?
Newborn is 4 cm long
| Adult is 20 cm long
30
What the changes in the nasopharynx through adulthood?
infancy>adult = +80% volume
31
T/F VP function deteriorates as a factor of aging
False it does not deteriorate
32
What is a cleft?
-an abnormal opening (fissure) in an anatomical structure that is typically closed
33
T/F There are missing structures/flesh in a cleft.
False: All structures are present, but not fused or developed normally
34
What is the prevalence of clefts in live births in the USA?
1:600
35
When is the lip and alveolus developed in embryological development?
6-7 weeks
36
When does the tongue begin to drop down in embryological development?
7-8 weeks
37
When is the palate developed in embryological development?
8-9 weeks
38
When is the fusion of the hard palate and velum complete in embryological development?
by 12 weeks
39
What are causes of cleft?
- Embryologic under-development
- Chromosomal disorders
- Genetic disorders_Maternal factors
- Environmental teratogens
40
What are two types of embryologic under-development?
1. Cell migration delay
| 2. Cell disruption
41
What are maternal factors of cleft occurrences?
- older age
- utero factors
- maternal malnutrition
42
What are environmental teratogens of cleft occurrences?
- Cigarette smoke
- Dilantin
- Thalidomide
- Valium
- Lead
- Corticosteroids
43
What are clefts of the primary palate?
lip and alveolus (structures anterior to the incisive foramen)
44
What are the cleft types of the primary palate?
- Complete (through to incisive foramen)
- Incomplete (e.g. lip only
- Unilateral and Bilateral
45
What is a cleft of the secondary palate?
Hard palate and velum
46
What are the cleft types of the secondary palate?
-Complete (uvula to incisive
foramen)
-Incomplete (bifid uvula into velum)
-Can be with or without cleft lip
47
What are the types of submucous cleft palate?
- Overt (bifid uvula, zona pellucida, posterior hard palate notch)
- Occult (hidden on nasal surface)
48
How is an overt submucous cleft palate and an occult submucous cleft palate identified?
Overt-intraoral exam
| Occult-nasoendoscopy
49
What types of facial clefts are there?
- Oblique
| - Midline (median)
50
What are oblique facial clefts?
- Unilateral or bilateral
- Affects skeletal and soft tissue
- Begins at mouth>lateral, horizontal, upward (extreme disfigurement)
51
What are midline facial clefts?
-Mild
52
What do midline facial clefts cause?
Cranial base anomalies
- Encephalocele
- Absent corpus callosum
53
Where is genetic material found?
In the nucleus of the cell
54
What does the nucleus of the cell communicate with?
With endoplasmic reticulum (a complex system of membranes that control transport of proteins and lipids)
55
What does DNA stand for?
Deoxyribonucleic acid (substance that carries hereditary information)
56
What is DNA made of?
A nucleic acid made of building blocks called nucleotieds
57
How is DNA arranged?
```
Double Helix
In antiparallel (opposite directions)
```
58
What is the process of DNA replication?
Process of creating two identical DNA molecules from one
59
How does DNA replication happen?
The two double strands separate and a newly synthesized strand is added, each original
60
How many nucleotieds must be precisely matched for each cell division in humans?
3.5 x 10^4 nucleotides
61
What is a mutation?
A change in the DNA sequence
62
What does RNA stand for?
Ribonucleic acid
63
What does RNA do?
Transports genetic information from the nucleus to the cytoplasm
64
How is RNA arranged differently than DNA?
RNA is a single stranded molecule rather than a double helix
65
How is RNA created?
Through Transcription
| -Creates a single complementary strand of a DNA template
66
What is the flow of genetic information?
Proceeds from DNA through transcription to RNA
67
What are chromosomes?
Linear double strands of DNA
68
How many human chromosomes are in most human cells?
46 chromosomes
69
How can we "see" chromosomes?
In karyotypes seen in visual profiles
70
What are the copies of 22 chromosomes called?
Autosomes
71
What is the 23rd pair of chromosomes?
The sex chromosomes (X and Y) because of their role in gender determination
72
What are types of chromosomal mutations of the changes in the copies of individual chromosomes?
- Monosomy
- Trisomy
- Mosaicism
- Deletions
- Duplications
- Inversions
- Translocations
73
What is monosomy?
Loss of one copy of an individual chromosome
74
What is Trisomy?
Gain of 1 extra copy of an individual chromosome for a total of three
75
What is mosaicism?
The presence of cells with 2 or more different genetic contents in a single individual
76
What do most monosmy and trisomy mutations result in?
Miscarriage
77
What does autosomal recessive inheritance mean?
All people carry genes with mutations capable of causing disease
Inheriting two copies of each gene with one copy that functions is sufficient
78
What does it mean to be a "carrier"?
Individuals that have one abnormal copy of the gene but no abnormalities
79
When do autosomal recessive conditions occur?
Only when mutations are present in both genes.
80
T/F: Males and females are affected equally in autosomal recessive conditions.
True
81
When does autosomal dominant inheritance occur?
When mutations are present in either of the two copies of a gene
82
T/F: In autosomal dominant inheritance, it often shows that one parent is affected.
True
83
T/F: Many autosomal dominant conditions have variable expressivity?
True
84
What is variable expressivity?
Individuals can present differently (Van der Woude Syndrome-lip pits, cleft lip, cleft palate, or a combination)
85
What is X-Linked Inheritance?
Mutations on the X chromosome
86
T/F: Females are most frequently affected by recessive conditions.
False, Males because they receive one X chromosome.
87
T/F: X-Linked dominant inheritance is rare.
True
88
T/F: Daughters of affected X-Linked males do not inherit the disorder.
False, all daughters inherit the disorder
89
What is multifactorial inheritance?
An interaction of multiple genes with environmental influences
90
What are teratogens?
Environmental factors that increase risk of birth defects.
91
What are examples of teratogens?
Ethanol, cigarettes, anti-epileptic meds, maternal diabetes, and congenital infections
92
What is the purpose of a genetic evaluation?
- Make a diagnosis
- Determine history of the condition to assist with management
- Determine recurrence risks for parents
- Provide genetic psychosocial counseling
93
What is involved in a genetics evaluation?
- Prenatal history
- Medical history
- Developmental History
- Feeding History
- Family History
- Physical Exam
- Lab and Imaging studies
- Genetic counseling
- Psychosocial counseling
94
T/F: Cleft Lip with or without Cleft Palate is a common birth defect/
True
95
T/F: Girls are affected more that boys in a ratio of 3:2.
False, boys are more affected than girls
96
T/F: Right sided cleft lips is more common than left sided cleft.
False, left sided cleft lip is more common
97
T/F: Left and Right sided cleft both occur more frequently than bilateral cleft lip/cleft palate.
True
98
Genetics of NONsyndromic Cleft Lip
Isolated and not generally associated with syndromes or other birth defects.
Increased risk of recurrence in siblings
99
Genetics of Syndromic Cleft Lip (+- palate)
Some are caused by genetic syndromes or part of a multiple congenital anomaly disorder
100
Genetics of Cleft Palate ONLY
Much more likely to be associated with underlying syndrome of other congenital anomaly
101
What does the feeding and swallowing function provide for the infant?
- Satisfies hunger
- Reflexive Sucking
- Sensory and motor stimulation
- Mother/caregiver-infant bonding
- Oral-motor skill development
102
T/F: Normal infant structures are smaller and closer in proximity.
True
103
What structures are ideal for sucking?
- Large tongue
- Large buccal pads
- No teeth
104
What structures are close in approximation in normal infants?
Close approximation of the
- tongue
- soft palate
- pharyngeal wall
105
In normal infants, the larynx is located where?
High and adjacent to C1-C3
106
How is the epiglottis shaped in normal infants?
Tubular and narrow
107
What is the physiology of infant feeding in the ORAL PHASE?
Sucking to stabilize nipple, create pressure gradient for fluid flow, control bolus before swallow
- Rooting reflex
- Nipple compression
- Negative pressure
108
What is the physiology of the PHARYNGEAL PHASE?
Coordination of nasal breathing, sucking, and swallowing.
109
What is the physiology of the ESOPHAGEAL PHASE?
UES and LES
110
What are s/s of pediatric dysphagia?
-Poor oral suction
-Inadequate volume of intake
-Lengthy feeding times
-Nasal regurgitation
-Excessive air intake (spit up or bloating)
-Coughing
-Choking
-Poor weight gain
-Excessive energy expenditure (fatigue)
Discomfort during feeding
-Stressful feeding
111
What are general feeding modifications?
- Relax
- Proper feeding equipment and methods
- Upright positioning
- Be consistent with feeding method
- Manage air intake
- Limit feedings to 30 minutes or less
112
What are some general feeding modifications for proper feeding equipment and methods?
- Assistive squeezing (EBM)
- Breaks to res or burp
- Adaptive nipples/bottles (slower and faster flow rates, pliability, shape/size)
113
What assessments are used to assess airway protection during feeds?
- Videofluoroscopy (MBSS)
| - Fiberoptic Endoscopic Eval of Swallow (FEES)
114
What types of developmental anomalies/deficits might you see?
- Dental
- ENT
- Language
- Cognition
- Psychosocial
115
What are deciduous teeth?
Primary Teeth
| 1st 20 teeth (10 maxillary and 10 mandibular)
116
When are deciduous teeth erupted?
by 29 months
117
How many permanent teeth are there?
```
Secondary Teeth
32 teeth (16 each earch)
```
118
When are permanent teeth erupted?
from 7-20 years old
119
What is a Class I occlusion?
Normal upper overlap
120
What is a Class I malocclusion?
Incorrect line (teeth don't match, are rotated, etc.)
121
What is a Class II Malocclusion?
Overbite
122
What is a Class III Malocclusion?
Under bite
123
What dental anomalies might you see with a cleft?
- Missing teeth
- Supernumerary teeth
- Ectopic teeth
- Rotated teeth
- Crowding
- Crossbite
- Class III malocclusion
- Open bite
- Protruding Premaxilla
124
What are supernumerary Teeth?
Extra teeth
125
What are ectopic teeth?
Erupt in abnormal positions
126
Why might a child with a cleft develop an open bite?
From missing teeth, finger/pacifier sucking, and skeletal deformities
127
What speech problems might you see with cleft?
Misarticulation/distortion of sibilants, labiodentals, alveolars, and bilabials
128
What is labioversion - Overjet?
Horizontal overlap of incisors (normal is 2mm)
-Lip closure problems & bilabial sound distortion
129
What is linguoversion - underjet?
Upper incisors lingual to lowers
-Distorts sibilants and alveolars
130
What is Macroglossia?
Narrow maxillary arch/teeth crowding
- Lateral lisp
- Frontal lisp
131
When does a lateral lisp occur with a cleft?
When opening is in line with cleft (air flows around)
132
When does frontal lisp occur with a cleft?
When maxillary central incisors are missing.
133
What are ear anomalies?
- Microtia
- Aural atresia
- Abnormal ossicle formation/fusion
- Otitis media
- Otic capsule abnormal development/ossification
134
What is ear microtia?
small, deformed pinna
Leads to conductive hearing loss
135
What is aural atresia?
Abnormal EAM and tympanic membrane
Leads to conductive hearing loss
136
Abnormal ossicle formation/fusion leads to what type of hearing loss?
Conductive hearing loss
137
What is otitis media from?
Malfunction of E-tube
Leads to tympanic membrane rupture and conductive hearing loss
138
What type of hearing loss does otic capsule abnormal development/ossification lead to?
Sensorineural hearing loss
139
What type of nose anomalies are there?
- External deformities (facial cleft)
- Abnormalities of nasal base (CL/CP)
- Internal derangement
140
What are examples of internal derangement?
- Deviated septum
- Pyriform aperture stenosis
- Choanal stenosis/atresia
141
What is a deviated septum?
Cleft palate-septum deflects into cleft side of nose
Resulting in hoponasality, cul-de-sace resonance
142
What is Pyriform Aperture Senosis?
Narrowed nares from overgrown maxilla
143
What is choanal stenosis/atresia?
Narrowed/blocked choanae
Leads to cholic/death
144
What are facial anomalies?
- Maxillary retrusion
| - Facial nerve paralysis (may be partial or complete
145
What are oral cavity anomalies?
- Lips
- Mouth
- Tongue (macro or ankylo-glossia)
- Palate-Fistula
- Tonsils and adenoids
146
What are throat/upper airway anomalies?
-Adenotonsillar/Adenoid/Tonsillar hypertrophy
147
What developmental factors occur with IQ and brain structure?
Rate of acquisition of all developmental milestones
148
What developmental factors occur with environmental stimulation?
Development of language skills in language-rich environment under age of 5
149
What developmental factors occur with hearing?
Perception leads to acquisition of oral language skills
150
What are those with a cleft palate more likely to develop (in regards to hearing)?
Chronic otis media
151
What developmental factors occur with motivation?
Need and desire to learn skills "motivation to talk"
Cleft tend to revert to gestures because difficulty with speech production
152
What developmental factors occur with attention?
Attend to environment
ADHD in 3-5% of children; most craniofcial syndromes + neuro at risk
153
What developmental factors occur with A and P?
Vocal tract, processes (respiration, phonation, resonance, artic), neuro function
154
What language and developmental learning deficits do you see?
- Early deficits in cognitive development
- Prelanguage skills
- Lower expressive language
- Common in syndromes
155
What phonological/articulation development deficits might you see?
- Disrupted tactile-kinesthetic-auditory feedback loop
- Less vocalization
- Predominant nasals for orals; glottals for plosives
- Habitual compensatory productions
- Age of palate repair
- Apraxia co-occurrence
156
What are some family psychosocial aspects of cleft?
- Initial shock and adjustment
| - Cleft as chronic medical condition
157
What are some psychosocial school aspects of cleft?
- Knowledge and expectation of teachers
- Learning ability and performance
- Social interaction
- Teasing
- Self-perception
158
What are some psychosocial society aspects of cleft?
- Physical attractiveness
- Speech quality
- Hearing impairment
- Stigma
- Behavioral issues
159
What causes hypernasality?
Coupling of oral and nasal cavities during non-nasal oral sounds
-"muffled" due to damping effect (sound absorption) through turbinates
160
What causes hyponasality?
Reduced nasal resonance of nasal sounds due to blockage "stuffed up"
161
What is/causes Cul-De-Sac resonance?
Structural obstruction, muffled, "potato-in- mouth"
162
What are mixed resonance disorders?
Combo on different sounds; common in apraxia
163
What is nasal air emission?
"rustle" due to VP leak or fistula on plosives, fricatives, and affricates
164
What is a nasal grimace?
Muscle contraction above nasal bridge in effort to achieve VP closure
165
What weak or omitted consonants a result of?
Reduced air pressure in oral cavity.
166
What causes short utterance length?
Frequent replacing of air pressure
167
What causes altered rate and duration?
Longer time for utterances, longer voice onset time (VOT)
168
What are some compensatory articulatory strategies?
- Middorsum palatal stop
- Backing
- Velar fricative
- Oral consonant nasalization
- Vowel nasalization
- Nasal snort
- Nasal sniff
- Pharyngeal
- Posterior nasal fricative
- Glottal stop
- /h/ for voiceless plosives
- Breathiness
169
How might dysphonia present in an individual with a cleft?
- Breathy
- Hypernasal
- Hoarse
- Low intensity
- Glottal fry
- Hyperfunctional
- Vocal fold nodules
170
What are factors that Impact VPI and Speech?
- Size of VP opening
- Inconsistency of VP closure
- Abnormal artic
- Abnormal phonation
171
What are causes of VPD related to the anatomy - structure of VPInsufficiency?
- Cleft Palate
- Short velum
- Deep pharynx (cranial base anomalies)
- Adenoid atrophy, irregularity, or adenoidectomy
- Hypertrophic tonsils or tonsillectomy (rare)
- Teeth malocclusion (Class III)
- Oral cavity tumor
172
What are causes of VPD related to phyiolofy - movement of VPIncompetence?
-Abnormal muscle insertion
-Hypotonia/poor pharyngeal wall movement
-Dysarthria, apraxia, and
neromuscular disorders
-Cranial Nerve defects (U velar paralysis/paresis)
-Velar fatigue
173
What are causes of VPD related to VP mislearning?
- Faulty artic
- Bad speech habits
- Hearing loss
