Midterm Review Flashcards
1
Q
A disorder of difficulty with swallowing
A
Dysphagia
2
Q
narrowing of the pharynx or esophagus
A
Constricta
3
Q
Eophageal compression by the right sub-clavian artery
A
Lusoria
4
Q
difficulty with propulsion from the mouth to the esophagus
A
Oropharyngeal
5
Q
Paralysis of muscles of mouth, pharynx, or esophagus
A
Paralytica
6
Q
Dysphagia from spasm of the pharynx or esophagus
A
Spastica
7
Q
Clinical characteristics of Dysphagia:
A
coughing & choking during or after a meal, food sticking, regurgitation, odynophagia, drooling, unexplained weight loss, nutritional deficiencies
8
Q
The result of a physiological change in the muscles needed for swallowing
A
Dysphgia
9
Q
Two hallmarks of Dysphagia include:
A
- Delay in propulsion of a bolus as it transits from the mouth the the stomach
- Misdirection of bolus
10
Q
bolus material entering the upper airway and/or lungs or material that enters the mouth, pharynx, esophagus during swallowing attempts but fails to reach the stomach
A
Misdirection
11
Q
An impairment of emotional, cognitive, sensory, and/or motor acts involved with transferring a substance from the mouth the stomach, resulting in failure to maintain hydration and nutrition, and posing a risk of choking and aspiration
A
Dysphagia
12
Q
an impairment in the process of food transport outside the alimentary system
A
feeding disorder
13
Q
______ is a symptom of a disease, not a primary disease.
A
Dysphagia
14
Q
This is characterized by a delay or misdirection of something swallowed as food moves from the mouth to the stomach
A
Dysphagia
15
Q
Dysphagia has both _______ and _________ consequences on a patients quality of life
A
medical
psychosocial
16
Q
The prevalence of dysphagia is highest in patients with ____________
A
neurologic disease
17
Q
Patients in _______ and _____ tend to be at highest risk for dysphagia.
A
acute-care intensive care units
skilled nursing facilities
18
Q
There may not be a clear link between dysphagic symptoms and the patients primary medical diagnosis in patients who reside in skilled nursing facilities.
A
.
19
Q
Patients in _______ are medically fragile, and their wallowing response can be easily decomponsated by fatigue or an acute medical condition such as infection
A
skilled nursing facilities
20
Q
_________ is the consequence of liquid and food entering the airway below the level of the vocal folds
A
Aspiration
21
Q
Aspirtion of liquid or food may or may not produce this lung infection
A
Aspiration Pneumonia
22
Q
Four stages of swallowing are:
A
Oral preparatory
Oral Stage
Pharyngeal
Esophageal
23
Q
Food is masticated in preparation for transfer
A
Oral Preparatory
24
Q
Transfer of material from the mouth to the oropharynx
A
Oral
25
material is transported away from the oropharynx, around an occluded laryngeal vestibule and through a relaxed cricopharyngeus muscle into the upper esophagus
Pharyngeal
26
material is transported through the esophagus into the gastric cardia
Esophageal
27
_______ Americans show some degree of Dysphagia
6-10 million
28
anorexia, bulimia, nervosa
Typically have difficulty with poor appetite, changes in dietary selections, and problems with the oral preparation of the bolus
Eating Disorder
29
impairment in the process of food transport outside the alimentary system
Result of weaknes or incoordination in the han or arm used to move the food from the plate to mouth
Feeding Disorder
30
Goal of most Dysphagia Treatment plans:
Goal of most treatment plans is to ensure that the patient can consume enough food and liquid to remain nourished and hydrated and that the consumption of these materials does not pose a threat to airway safety resulting in aspiration pneumonia.
31
lead role in managing dysphagia related to poor oral and pharyngeal swallowing mechanics
SLP
32
skilled in the evaluation of the upper digestive tract; may be involved with surgical placement and removal of tracheostomy tube
Otolaryngologist:
33
special interest in the esophagus; familiar with GERD or heartburn; perform the 24 hour pH monitoring test; responsible for the placemet of PEG tubes
Gastroenterologist:
34
provide dynamic and static imaging of the aerodigestive tract and lung fields; works with the SLP during modified barium swallow
Radiologist
35
important role in the identification and subsequent management of swallowing disorders
Neurologist:
36
may be the first to identify issue; can make appliances that will aid in the patients swallow
Dentist:
37
monitoring the amount of intake and recording it in the medical records
Nurse:
38
assesses the patients nutritional and hydration needs and monitors the patients response to those needs
Dietition:
39
retraining the parent to self-feed
OT
40
proper infant positioning to support neurodevelopmental tone and maturations
Neurodevelopmental Specialist:
41
Digestion involves braking down the food in what two ways:
Mechanical & Chemical
42
Primitive pattern =
| Secondary Pattern =
Munching
| Rotary Jaw Movement
43
3 Types of Salivary Glands:
Parotid
Submandibular
Sublingual
44
Connects the pharynx to the stomach
Esophagus
45
allows the esophagus to pass through the diaphragm
Oesophageal Hiatus
46
where the stomach the esophagus connect
Cardiac region
47
Circular muscle in the body that keeps a passage closed(relaxed to open and contracts to close)
Cardiac sphincter
48
Begins in the larynx and continues on down into the esophagus like a wave
Peristalsis
49
Nonmovement of bolus (retention; residual)
Stasis
50
the bolus moves past the tongue base and sits in the vallecular space before the swallow
Premature posterior leakage (PPL)
51
when the bolus is divided into one or more bolus
Segmented bolus transfer
52
though of something stuck in the throat
Globus
53
Drool
Sialorrhea
54
dy mouth
Xerostomia
55
UMN=
| LMN =
Spastic
| Flaccid
56
Sensorimotor Considerations for Swallowing Deficits in Hemispheric Stroke Patients:
Volitional motor control, paresis/ paralysis, sensory recognition, communication deficits
57
Swallowing Deficits in patients after Hemispheric Stroke:
1. Reduced ability to initiate a saliva swallow
2. Delayed triggering of pharyngeal swallow
3. Incoordination of oral movements in swallow
4. Increased pharyngeal transit time
5. Reduced pharyngeal constriction
6. Aspiration
7. Pharyngoesophagel segment dysfunction
8. Impaired lower esophageal sphincter relaxation
58
Swallowing Deficits seen in patients with Dementia:
1.Unexplained weight loss
2.Oral stage dysfunction
3.Phayngeal-stage dysfunction
4.Combined oral and pharyngeal dysfunction
Minor aspiration
Major aspiration
5.Feeding limitations
59
Swallowing Deviation seen in Mild-Stage Dementia:
Slow oral movement
Slow or delayed pharyngeal response
Overall Slow swallowing duration
60
Feeding Deviations seen in Mild-Stage Dementia:
Increased self-feeding cues (specifically related to food preparation or utensil use)
Direct assistance with utensil use for food preparation or convenience
Imitation of feeding behavior from the meal partner
61
Dysphagia considerations for patients with BG deficits:
1. Poor Bolus Control
2. Residue from inefficient Swallow
3. Difference among swallow types
4. Severity Dependent
62
Orpharyngeal swallowing Deficits seen in patients with BG Deficits (Parkinsonism):
```
Oral Stage = Lingual tremor
Repetitive tongue pumping
Prolonged ramplike posture
Piecemeal deglutition
Velar tremor
Buccal retention
```
```
Pharyngeal Stage = Vallecular retention
Piriform sinus retention
Impaired laryngeal elevation
Airway (supraglottic) penetration
Aspiration
Pharyngoesophageal segment dysfunction
```
63
Pharyngeal Swallowing Deficits in Patient after Brainstem Stroke:
```
Absent or delayed pharyngeal response
Reduced hyolaryngeal elevation
Reduced oropharyngeal constriction
Reduced pharyngeal constriction
Reduced laryngeal closure
Reduced pharynogoesophageal segment opening
Brief swallow event
Generalized incoordination (including respiration)
```
64
Hallmark of all dementias is:
progressive deterioration in cognitive abilities, including memory, judgment, abstract reasoning, and personality change.
65
form of dementia in which language and communication abilities deteriorate and are initially followed by deterioration of other functions
Primary Progressive Aphasia (PPA)
66
Treatment Considerations for Swallowing in Dementia Patients:
```
Special food preparations
Diet restrictions
Enhance taste and Flavor
Changing the mealtime environment
Increased mealtime supervision and cueing
```
67
Tests used in assessing the severity of neurotrauma:
Glasgow Coma Scale (GCS), Rancho Los Amigos Scale (RLAS), or the Functional Independence Measure (FIM)
68
typically results in diffuse neurologic deficits that affect several aspects of behavioral control.
TBI
69
Treatment considerations for Dysphagia in TBI:
Diet modifications, postural adjustments, feeding adaptations, and behavioral maneuvers and compensations
70
Damage to the _________ results in sensory deficits to the head and neck region in addition to motor deficits associated with both upper and lower motor neuron damage
brainstem
71
Two aspects to dysphagia in brainstem stroke:
incoordination presumably related to disruption of the swallowing center
Weakness resulting from damage to the cortibulbar system
Resulting swallow is called “incomplete swallow”
72
adjacent to the brainstem and is located posterior and slightly superior to most brainstem structures
Cerebellum
73
Damage to the Cerebellum results in:
Unsteadiness (ataxia)
Intention tremor (tremor that is exaggerated at the initiation of movement)
Hypotonia (low muscle tone)
74
Motor impairments at the muscle level
Myopathies
75
disease that reflects the relation between lower motor neuron impairment and dysphagia.
Amyotrophic lateral sclerosis (ALS)
76
Treatment of neurogenic dysphagias is often __________but relies heavily on a strong understanding of the underlying neurologic process. In many cases behavioral treatment interacts significantly with medical treatment.
symptomatic
77
Result of cell growth that is out of control
Cancer
78
Proliferation of cell growth
Hyperplasia
79
Traveling cells
Metastasis
80
Cancer is typically in the formation of this
Tumor
81
Two types of Tumor:
Benign and malignant
82
Process of determining how far the cancer has spread
Staging
83
TNM System stands for:
Tumor Nodes Metastasis
84
Teams with Head and Neck Cancer patients will typically include:
```
Head/Neck Surgeon
Radiation Oncologist
Medical Oncologist
Dentist
Social Workers
Rehabilitation Specialists
```
85
Warning Signs of Head/Neck Cancer:
```
Unexplained rapid weight loss
Fever
Fatigue
Pain
Change in bowel or bladder function
Sores that do not heal
Unusual bleeding or discharge
Thickening or a lump in any part of the body
Ingestion or difficulty swallowing
Recent change in a wart or mole
Nagging cough or hoarseness
```
86
Three primary treatment options for head/neck cancers:
Surgery, Radiation, Chemotherapy
87
removal of cancerous tumor and some of the surrounding healthy tissue referred to as the margin
Surgery
88
use of high energy x-rays to kill cancer cells
Radiation
89
Two ways Radiation can be administered:
External beam radiation
| Intensity-modulated radiation therapy
90
aiming a high-energy radiation beam at the tumor and surrounding tissues
External-beam radiation
91
allows more effective doses of radiation to be delivered to the tumor while hitting less healthy tissue
Intensity-modulated radiation therapy
92
involves implanting small pellets or rods containing radioactive material into the caner or near the cancer site
Internal radiation therapy (Brach therapy)
93
use of drugs to kill cancer
Chemotherapy
94
Side Effects of Surgery to treat Head/Neck Cancer:
Swelling of the mouth and/or throat, resulting in difficulty breathing
Impaired speech and/or voice
Difficulty chewing and swallowing
Facial disfigurement
Numbness in the face, neck, or throat
Reduced mobility in the neck and shoulder area
Decreased function of the thyroid gland
95
Side Effects from Radiation:
Redness and skin irritation in area treated
Permanent change to salivary gland leading to persistent dry mouth or thickened saliva
Bone Pain
Nausea and Vomiting
Fatigue
Mouth sores and/or sore throat
Dental problems
Painful swallowing
Loss of appetite
Reduced sense of taste (sometimes smell)
Earaches resulting from hardening of ear wax
Hypothyroidism
Fibrosis leading to reduced movement
Peripheral neuropathy
Bone, cartilage, soft tissue necrosis
96
Side effects of chemotherapy:
```
Fatigue
Nausea and vomiting
Hair loss
Dry mouth
Loss of appetite
Reduced sense of taste
Weakened immune system
Diarrhea and/or constipation
Open sore in the mouth potentially leading to infection
```
97
General Characteristics of Dysphagia Associated with Radiation Therapy:
```
Bolus control deficits (63%)
Small amounts per bolus and multiple swallow attempts
Increased meal times
Reduced frequency of swallowing
Dry mouth – Xerostomia (92%)
Pain (58%)
Altered tasted (75%)
```
98
patient characteristics that directly or indirectly have a negative impact on swallowing functions
Impact Factors
99
Some Impact Factors include:
Pain, Xerostomia, taste and smell deviation, fibrosis, nutritional status, psychological status
100
General Dysphagia Considerations in Patients with ALS:
Oral control of bolus
Reduced Transport
Residue
Airway Protection
101
Oropharyngeal Swallowing Deficits seen in patients with ALS:
Oral Stage: leakage, mastication, bolus formation, bolus transport, residual pooling
Pharyngeal Stage: nasopharyngeal regurgitation, valleculae pooling, piriform sinus pooling, airway spillage, ineffective airway clearance, shortness of breath
102
A muscular tube whose primary function is to transport food from oropharynx to stomach via peristalsis (Primary / Secondary)
Esophageal Structure
103
The esophagus has two sphincters which are:
- The upper esophageal sphincter (UES)
| - The lower esophageal sphincter (LES)
104
_______ Shares physiologic functions with the hypo pharyngeal musculature.
UES
105
The Muscular Wall of the esophageal structure is defined by:
Inner circular layer & Outer longitudinal layer
106
At the onset of swallow the longitudinal muscles ________ and _______ the esophagus
contract and shorten
107
At the onset of swallow the UES/LES become
active, open in relaxed state
108
At the onset of swallow the circular muscles initiate a _______proximally to distally
sequential peristaltic wave
109
At the onset of swallowing bolus propulsion from the pharynx to the stomach typically takes _____-
10-12 seconds
110
Esophageal/ GI Trends in Geriatric Popluation:
Strength of esophageal peristalsis decreases
Tension in the UES decreases
Capacity of stomach to resist damage decreases
Stomach cannot accommodate as much food because of decreased elasticity
Rate of GI clearance increases
Risk of acquired disease affecting GI system increases
111
Classifications of Esophageal disorders in Aging:
NEUROMUSCULAR DISORDERS
INTRINSIC OBSTRUCTIVE
EXTRINSIC OBSTRUCTIVE
112
Symptoms of Reflux include:
heartburn, regurgitation, chest pressure/pain, throat fullness, vocal changes, eructation (burping)
113
Nueromuscular Esophageal Disorders include:
Achalasia
Spastic Motor Disorder
Schleroderma
114
Incomplete LES/UES relaxations; Aperistalsis; Slow progressive dysphagia of solids and liquids, Obstruction; Restrograde aspiration; dilated with "bird beak" LES
Achalasia
115
condition in which non relaxing or incompletely relaxing LES prevents the passage of swallowed material into the stomach
Achalasia
116
Intermittent Dysphagia for liquids and solids
Esophageal Spasm
117
occasional painful muscle contractions affecting the esophagus accompanied by regurgitation of foods and liquids
Esophageal Spasm
118
Esophageal Spasm can progress to ________
Achalasia
119
a state of increased contraction pressures in the LES
Hypertensive LES
120
is the term for painfully strong contractions in the esophageal muscles; less likely to cause regurgitation of food and liquids.
Nutcracker Esophagus
121
Progressive systematic sclerosis; rare disease of the connective tissues of the entire body
Scleroderma
122
Some Intrinsic Obstructive Disorders:
```
Tumors
Diverticula
Strictures
Lower esophageal rings (Schatzki's ring)
Esophageal webs
Foreign bodies
```
123
Majority of these are acquired in adulthood as a consequence of esophagitis.
Benign esophageal stricture
124
inflammation of the lining of the esophagus
Esophagitis
125
Herniated sac or pouch in the esophagus of stretched tissue pushing outward through its muscular wall
Diverticulum
126
At risk for food collection and obstruction; risk of retrograde aspiration
Diverticulum
127
Pouch in the back of the throat above the circopharyngeal muscle; food and saliva can accumulate in the pouch causing it to grow
Zenkers Diverticulum
128
is a narrowing or tightening of the esophagus that causes swallowing difficulties
Esophageal Stricture
129
narrowing of the lower part of the esophagus caused by changes in the esophageal mucosa (lining of the esophagus)
Schatzkis Ring
130
A band of tissue composed of mucosa and submucosa located in the esophagus or hypopharynx
Esophageal Web
131
A band of tissue composed of mucosa and submucosa located at the esophagogastric junction
Esophageal Ring
132
Extrinsic Obstructive Disorders:
Vascular Compression
Mediastinal Masses
Cervical Osteoarththropy
133
Malformation of the aortic arch that results in vascular branches encircling the trachea and esophagus
VASCULAR RING
134
Can be caused by a change in the ability of the esophagus to fully open during swallowing, resulting a blockage of bolus passage.
Esophageal Dysphagia
135
a narrowing or restriction of the lumen of the esophagus that slows or impedes the passage of fluid and foods from the oral cavity to the stomach.
Esophageal Stenosis
136
normal movement of gastric contents into the esophagus
GER
137
occurs when stomach contents reach the laryngeal level, frequently resulting in odynophagia, hoarseness, sore throat, globes sensation, and chronic throat clearing q
Laryngopharyngeal Reflux
138
Medical and/or surgical complications that result in dysphagic complications can be classified as:
iatrogenic
139
Patients with compromised Respiratory Status may require special interventions to support basic life functions which include:
endotracheal or tracheostomy tubes
140
Long plastic, flexible tubes that are inserted through the mouth, through the vocal folds, and into the trachea to aid the patient in respiratory distress
Endotracheal tubes
141
These are connected to a respirator to help the patient breath
Endotracheal Tubes
142
Requires surgical placement between the second and third tracheal rings do that the tube is below the level of the vocal folds
Tracheostomy Tube
143
The larger the diameter of a Tracheostomy tube the more difficult it is to get air past the tube up to the vocal folds.
.
144
Different Tracheostomy Tube Sizes are:
8 6 and 4 mm
145
Complications of a trach include:
decreased sense of smell and taste, infection, increases secretions
146
Trachs can be cuffed or non cuffed.
.
147
portion on the end of the tracy tube that can be inflated with air externally by a syringe that seals off the entrance to the lungs
Cuff
148
A hole placed in the top of the tracheostomy tube to allow increased airflow to the upper airway, primarily for speaking
Fenestration
149
Factors that may place patients with a trach at greater risk for aspiration include:
- loss of subglottic air pressure
- poor laryngeal elevation
- loss of upper airway sensitivity
- loss of the normal laryngeal closure reflex during swallow
150
Surgical procedures Dysaphagia can result from include:
1. Edema that retracts movement of swallowing structures such as the pharynx
2. Interference to the peripheral nerve supply to the muscles of swallowing
3. loss of CNS innervation
4. Replacement of swallowing structures that also may interfere with peripheral CN
151
Disorders of _______ often affect swallowing because of the close relation between the two.
Breathing
152
Patients who require placements of trach may be at risk for_____ particularly if they have multiple medical complication.
Aspiration
153
________ that result in fractures of swallowing structures, dental trauma, and thermal burn injuries all may increase patients risk of swallow safety
Traumatic Injury
154
The side effects from ______ used to treat medical conditions may be the primary causative factor of dysphasia or may complicate preexisting dysphagia.
Medications
155
Patients with _______________ are at risk for dysphagia, especially during periods of acute exacberation, because of compromise to the respiratory system
Chronic Obstructive Pulmonary Disease
156
Three main components of the clinical evaluation of the patient with dysphagia:
1. medical history
2. physical inspection of the swallowing musculature
3. observations of swallowing competence with test swallows
157
Symptoms associated with Dysphagia:
Difficulty chewing, initiating swallow, drooling, nasal regurgitation, swallow delay, food sticking, coughing and choking, coughing when not eating, regurgitation, weight loss
158
Aspects of the swallowing process that the patient reports are problematic
Symptoms
159
aspects of the swallowing process that are objectively measured and determined to connote a swallowing Disorder
Signs
160
Common Dysphagic Symptoms include:
Globus sensation, heartburn, loss of pleasure associated with eating,special preparation such as excessive chewing, regurgitation, and chagnes in diet level.
161
Common Dysphagic Signs include:
drooling, choking, respiratory congestion after eating, increased need for suctioning, fatigue when eating, poor position when eating, loss of cognitive controls over the eating circumstance, under-nutrition and muscle wasting, and the presence of feeding, trach, and endotracheal tubes
162
Measures the oxygen saturation levels, cervical ausulation
Water Test
163
Standardized Tests for Oropharyngal dysphagia include:
Mann Assessment of Swalowing ability and the McGill Ingestive Skills Assessment
164
Removal or tumor and surrounding tissue
Primary Tumor Surgery
165
Removal of a piece of the jaw bone
Mandibulectomy
166
Splitting the mandible to gain access to tumor
Mandibulotomy
167
Removing all or parts of the hard palate
Maxillectomy
168
Removal of a tumor in thin slices, evaluating each slice under a microscope for cancer cells until all cancer cells are gone
Mohs surgery
169
Using a narrow, intense beam of light to remove cancer
Laser surgery
170
Removal of the entire larynx
Laryngectomy
171
removal of part of the larynx; supraglottic, hemilaryngectomy, supracricoid, vocal cord
partial laryngectomy
172
removal of larynx and pharynx
laryngopharyngectomy
173
establishing a hole in the anterior neck (stoma) into the trachea to establish an airway
tracheostomy
174
creating a fistula int the stomach by way of the abdominal wall often used to place a feeding tube
Gastrostomy
175
Removal of lymph nodes and other tissue in the neck considered at risk for metastatic disease
Neck Dissection
176
Any surgery that attempts to replace missing anatomy to improve function and/or appearance
Reconstructive Surgery
177
Different levels of Liquids
Pudding, Honey, Nectar, Thin
178
Different Diet Levels include:
```
Normal
Mechanical Soft
Mechanical Chopped
Mechanical Soft Ground
Textured Puree
Puree
```
179
removal of less than 50% of the tongue
Partial Glossectomy
180
Removal of more than 50% of the tongue
Total Glossectomy
181
Removal of less than 50% of soft palate
Palatal Resection
182
Reduce pharyngeal wall con stricture reduced elevation of hyoid/ larynx
Partial Pharyngeal Resection
183
Unilateral resection; Partial Airway Closure
Hemilaryngectomy
184
Incomplete posterior tongue movment, retricted artenoid motion, partial airway closure
Supraglottic Laryngectomy
185
Removal of vibratory source
Total Laryngectomy
186
Aspiration vs. Penetration
Penetration occurs above vocal folds
It happens first and is the pathway to aspiration
Aspiration occurs below the vocal folds
187
Overt Signs of Aspiration Include:
```
Coughing
Vomiting
SOB (shortness of breath)
Decreased oxygen sat (oxygen saturation level) – can use pulse oxymeter to measure this
Wet voice/respirations (gurgling)
```
188
Covert Signs of Aspiration include:
```
Tearing eyes/eye blinking
Sneezing (usually seen in babies)
Nasal flaring
Color change
Increased respiration rate
```
189
Not enough oxygen or too much carbon dioxide leads to inadequate oxygenation and inadequate ventilation
.
190
A ____________measures the amount of oxygen in your blood – typically 98
pulsox machine
191
The _______ of swallowing is the portion where you are not breathing
apnic period
192
________will show you both carbon dioxide and oxygen. ______ will only show you oxygen
Blood gases
| Pulsox
193
Congenital Stenosis
Narrowing
194
Blood filled sac or contusion
Hematoma
195
General swelling
Edema
196
Feeding tube typically used if the person is trached
Perchostomousgastronomy Tube
197
Hole in the trachea that goes through into the esophagus
Tracheoesophagel Fistulas
198
One way valve where air is facilitated upward and passes the vocal folds to give voicing
Passy-muir valve
199
Space between vocal folds
Glottis
200
Above the Epiglottis
Vallecular Space
201
Below epiglottis up to the point of the vocal folds
Laryngeal Vestibule
202
Segmented bolus transfer
Piecemeal deglutition
203
Alternating your liquids and your solids
Cyclic Ingestions
