Quizzes

Question 1

During an assessment, the patient was not able to produce voiced speech sounds. The SLP concludes that the vocal folds are not adducting. What are the two primary muscles responsible for vocal fold adduction?

Answer 1

The lateral cricoarytenoids and the transverse arytenoids are the primary muscles responsible for vocal fold adduction. Contraction of the lateral cricoarytenoids also increases medial compression of the vocal folds.

Question 2

In a normal swallow of a liquid bolus, the oropharynx is sealed the bolus is held in the oral cavity until the swallow begins. What anatomical structures create the seal that prevents the liquid from entering the oropharynx prematurely?

Answer 2

SOFT PALATE AND TONGUE

Although the lips are typically closed during a normal swallow, they are anterior to (in front of) the oral cavity and cannot prevent liquid from entering the oropharynx.

The tongue seals with the hard palate to prevent anterior leakage of a liquid bolus (i.e., liquid leaking out of the mouth). This seal is at the anterior of the oral cavity and cannot prevent liquid from entering the oropharynx.

The vocal folds are within the larynx, and therefore cannot seal liquid within the oral cavity.

Question 3

A patient explains that “when I swallow pills, it feels like they get stuck in my chest.” In the absence of complicated neurological etiologies, where is the pill most likely getting stuck?

Answer 3

In the upper esophagus or in a diverticulum

If the patient feels that the pill is stuck in their chest, the pill is most likely getting stuck in the upper esophagus or in a diverticulum. A diverticulum is a small protruding pouch that may trap food or pills in the esophagus.

Question 4

During an oral mechanism examination, the patient was not able to execute many of the movements of the tongue, such as elevation, retraction, and depression. What cranial nerve is likely involved?

Answer 4

CN XII

Cranial nerve V, the trigeminal nerve, contributes to the movement of the hyoid and the mandible, not the tongue.

Cranial nerve VII, the facial nerve, contributes primarily to the movements of the face, lips, and nose, but not the tongue.

Cranial nerve X, the vagus nerve, contributes to innervation and movement of the muscles of the pharynx, but not the tongue.

Question 5

During FEES, a patient could not feel the scope in the nasopharynx. Then, with further assessment with VFSS, the patient was found to have virtually no laryngeal elevation. Involvement of cranial nerve ____ might explain BOTH the sensory and movement deficits in this patient.

Answer 5

IX

The glossopharyngeal nerve supplies motor to the stylopharyngeus muscles which plays a role in laryngeal elevation, and sends sensory from the nasopharynx to the medulla.

Question 6

During the pharyngeal phases of swallowing, the larynx and hyoid bone move

Answer 6

upward and forward

The primary mechanism of hyolaryngeal excursion is elevation and anterior rocking.

Question 7

Which muscle contributes to hyolaryngeal depression?

Answer 7

sternohyoid

The muscles responsible for laryngeal depression are the infrahyoids, which include the sternohyoid, sternothyroid, omohyoid, and thyrohyoid.

Question 8

Following a car accident, a patient that is being treated by an SLP exhibits weakness in the obicularis oris and buccinator muscles. Which of the following problems would be the MOST LIKELY presentation of this patient’s dysphagia?

Answer 8

Oral incontinence with anterior and lateral residue

The obicularis oris and buccinator muscles are involved in the oral phase of the swallowing and therefore a patient with weakness in these muscles would most likely have anterior leakage issues.

Question 9

A patient has recently sustained lower motor neuron damage to his/her trigeminal nerve (CN V) and is experiencing difficulty with mastication. Which of the following muscles could be experiencing deficits secondary to the nerve damage?

Answer 9

The masseter muscle is a large muscle that forms a sling around the ramus of the mandible. Upon constriction of this muscle, the jaw is raised to assist with mastication.

Question 10

Cranial nerves can include motor functions, sensory functions, or a mix of both. Which of the following cranial nerves (CNs) serve both motor and sensory functions?

Answer 10

CN V, CN IX, CN X

Question 11

Which of the following is not a disorder of the pharyngeal phase of the swallow?

Answer 11

premature spillage over the base of the tongue

Question 12

Sarcopenia can be defined as

Answer 12

a reduction in lean skeletal muscle mass with a marked loss of strength and speed of movement.

Question 13

Which of the following is not a factor in predicting dysphagia in community dwelling elderly (CDE)?

Answer 13

they are all factors in predicting dysphagia

Question 14

As individuals age, they may experience lingual hypertrophy from fatty deposits and an increase in connective tissue. What is the potential impact of that on swallowing.

Answer 14

reduction in tongue mobility and tongue force

Question 15

Individuals with presbyphagia may demonstrate increase frequency of airway penetration. What could be a contributing factor to this?

Answer 15

reduction in laryngeal elevation resulting in decreased epiglottic inversion, change in sensory motor response of the thyroarytenoid muscle, delay in swallow initiation resulting in airway compromise

Question 16

According to the Martino et al. article regarding lesion site related to dysphagia, damage to which structures of the brain were most consistent with the presence of dysphagia in CVA survivors?

Answer 16

Pontine and medullary lesions

Question 17

According to the Altman et al. article, what aspect of a patient’s illness has a 40% increase when dysphagia is present?

Answer 17

length of hospital stay

Question 18

In the Zuercher article, which component is typically not a contributing factor to dysphagia in the ICU?

Answer 18

longer hospital stay

Question 19

Why would evaluating lab values be important during your chart review process?

Answer 19

looking at the WBC can provide information about the presence of an infection such as pneumonia

Question 20

Medications that may negatively contribute to level of alertness in a patient, making them unsuitable for a swallow assessment may include which of the following:

Answer 20

Morphine, Propofol, and Ativant

Question 21

In the Ramsey et al. article regarding silent aspiration, which factor was not implicated in the incidence of silent aspiration?

Answer 21

intact vocal fold motility

Question 22

When it comes to prandial aspiration and the elderly, the Feinberg, Knebl and Tully article concluded which of the following?

Answer 22

it is difficulty to differentiate between pneumonia and other respiratory complications when reading chest xrays of the elderly, Liquid prandial aspiration should not be directly correlated with pneumonia frequency in elderly nursing home residents, artificial feeding caused higher frequency of pneumonia

Question 23

Discharge planning is an important aspect of hospitalization due to the high cost of increased length of stay. What information from the Arnold et al. article would help inform you as a clinician regarding the specific aspect of discharge planning?

Answer 23

The presence of dysphagia resulted in less likelihood of discharge home.

Question 24

Which of the following contribute to increased risk of aspiration? (select three)

Answer 24

Decreased cough reflex, Gastroesophageal reflux, poor lingual control for propelling bolus

Question 25

A patient who is 2 weeks post-stroke presents with dysphagia. What is the most likely prognosis for this patient’s swallowing ability within the next 6 months?

Answer 25

It is most likely that the dysphagia will resolve by the end of 6 months, but there is a chance it will persist.

Question 26

Although aspiration during swallowing is a risk factor for developing aspiration pneumonia, not all patients who aspirate will develop aspiration pneumonia. Which of the following patient characteristics is least likely to predict the development of aspiration pneumonia?

Answer 26

wet voice after swallowing

Question 27

Which of the following diseases is a common consequence of dysphagia?

Answer 27

Pneumonia

Question 28

Which phase of the swallowing is characterized by cupping of the tongue to gather the bolus and anterior to posterior tongue movement to propel the bolus posteriorly toward the faucial arches?

Answer 28

Oral phase

Question 29

Dysphagia

Answer 29

is a symptom of a condition

Question 30

During a patient’s bedside swallowing evaluation, SLP notices that there is copious amounts of residue present in the patient’s oral cavity following their swallow. Which of the following parts of the oral phase is the patient most likely having difficulty with?

Answer 30

Bolus formation

Question 31

Which of the following findings from an oral mechanism examination would be most predictive of pharyngeal dysphagia symptoms in a patient who has suffered a stroke?

Answer 31

Breathy phonation

Question 32

A patient presents with complaints of difficulty chewing and swallowing food, as well as slurred speech. The problems were first noticed around 4 months ago and appear to be slowly worsening. The patient is not aware of any injuries. Evaluation indicates that cognition and language are intact, but a mixed flaccid-spastic dysarthria is present. Poor oral control and transport of a bolus is observed during a clinical swallow evaluation. Which of the following is the most likely origin of the patient’s difficulties?

Answer 32

Amyotrophic lateral sclerosis

Question 33

An SLP working in a long-term care facility is asked to evaluate an 87-year-old male resident with dementia. He has lost weight in recent months. He is given an oral diet with pureed foods and thin liquids. Staff note that he complains at mealtimes that his food doesn’t taste good and he often pockets food in the oral cavity. The SLP completes a clinical swallow evaluation in which she notes no signs or symptoms of aspiration on thin liquids, and no abnormalities in cranial nerve function or in oral structures. What is the most appropriate next step to take with this patient?

Answer 33

Observe the patient eating regular food

Question 34

The Robbins et al. article regarding chin tuck posture vs. thickened liquids brought to light several interesting points. Most significantly, the article determined which important point:

Answer 34

There was no definitive conclusion regarding which intervention worked “the best”

Question 35

Logemann et al’s finding that honey thickened liquids, when presented last, yielded aspiration could possibly be attributed to which factor?

Answer 35

muscle fatigue

Question 36

Ultimately, Logemann et al’s findings challenged which previously held belief

Answer 36

That the chin down maneuver was effective in preventing aspiration across patient types

Question 37

In evaluating a patient’s chart prior to the bedside swallow assessment, you note the presence of several diagnoses. Which diagnosis in the chart review might be a clinical indicator of low endurance?

Answer 37

cardiac surgery, respiratory insufficiency, traumatic brain injury

Question 38

In speaking to the nurse, it has been noted that the patient is demonstrating a poor appetite, family reported recent weight loss, and limited attention or desire to eat. Which member of the team will you want to be sure to consult with when approaching this case?

Answer 38

dietician

Question 39

A patient presents with a lower motor neuron impairment and has been referred for a swallow evaluation. Which phase of the swallow will most likely be the most impaired with this client?

Answer 39

oral phase

Question 40

A patient who has just suffered a stroke is asking the prognosis for recovery of her swallow function. Based on the research, you should feel comfortable quoting which of the following?

Answer 40

Up to 50% of stroke patients show persistent dysphagia 6 months post-stroke

Question 41

L.G. was admitted to the hospital with a left brain stroke. On admission, a nasogastric feeding tube was placed to provide nutrition and hydration. What are some possible explanations for the placement of the NG tube?

Answer 41

The stroke may have altered the patient’s level of responsiveness, warranting alternate nutrition and hydration, The patient may have failed a bedside swallow evaluation by the SLP and needed supplemental nutrition and hydration

Question 42

A 70 year old man admitted from the nursing home. He has a premorbid history of left CVA with aphasia, poor mobility and decubitus ulcers on his coccyx. He was previously on a mechanical soft diet at the nursing home and thin liquids. His medical record revealed an albumin of 3.0 g/dL, loss of 5% of his body weight in the last 2 weeks and hypernatremia. She concluded that he was undernourished and dehydrated.
While completing the bedside swallow examination, the patient fell asleep every minute and needed constant cues to stay awake and participate. He did tolerate various food items but consistently choked on the thin liquids.

What do you think will most likely be the SLPs recommendation?

Answer 42

Begin feeding through an NG tube since patient cannot adequately maintain nutritional needs with his poor level of alertness (LOA). Reassess for diet tolerance as he wakes up.

Question 43

A patient was referred for a swallow evaluation after a prolonged cardiac surgery that resulted in prolonged intubation for 3 days following the surgery. What will be the most important component to assess during your oral motor examination?

Answer 43

Vocal fold adduction and quality of voice

Question 44

An 86-year-old man recently had heart surgery. After surgery, he had a stroke affecting the premotor cortex of the left hemisphere. The man has a history of depression treated with an antidepressant. He also has a history of Bell’s palsy that affected the upper and lower half of the left side of his face. His vocal quality is hoarse and breathy, but he has an intact gag reflex. Which is not a probable observation during the swallow evaluation?

Answer 44

impaired velar elevation

Question 45

A patient complaining of odynophagia, hoarseness, sore throat and globus sensation may likely be experiencing what?

Answer 45

Laryngopharyngeal reflux

Question 46

A patient with Barrett’s esophagus should be monitored closely for which condition that could develop later?

Answer 46

esophageal adenocarcinoma

Question 47

An individual with a known history of Schatzki ring may complain of which of the following?

Answer 47

dysphagia of solid foods

Question 48

Cricopharyngeal bar would be most visible on which assessment?

Answer 48

Videofluoroscopic Swallow Evaluation

Question 49

Which of the following is a possible complication of a Zenker’s diverticulum?

Answer 49

Secondary aspiration of the material collected in the diverticulum

Question 50

Which statement best describes the role of the SLP in esophageal dysphagia management?

Answer 50

The SLP is a member of the team along with gastroenterology since some esophageal disorders impact the oropharyngeal swallow.

Question 51

The first clinical swallowing assessment that has evidence of adequate psychometric properties is the:

Answer 51

Mann Assessment of Swallowing Ability

Question 52

Which of the following diseases is a common consequence of dysphagia?

Answer 52

Pneumonia

Question 53

An SLP is completing a clinical bedside swallow evaluation with a patient with suspected dysphagia. The SLP has completed observations of the patient and evaluation of the cranial nerves. The patient is alert and cooperative and appears able to manage his secretions. Which of the following is the best next step in the evaluation?

Answer 53

Conduct a test swallow using crushed ice

Question 54

During cervical auscultation of swallowing, the clinician primarily listens for:

Answer 54

The presence and timing of three bursts of sound

Question 55

The 3-ounce water challenge is a screening for swallowing that assesses all but which of the following:

Answer 55

Ability to trigger a swallow reflex with thin liquids

Question 56

A hospital team develops a dysphagia screening tool and wishes to determine how well it works in patients. The best way to do this would be to:

Answer 56

Give both the new screening and a fiberoptic endoscopic evaluation of swallowing to patients who do and do not have dysphagia and compare the results.

Question 57

In patients who are ventilator-dependent, one common prevention strategy is to maintain oral hygiene. What is the primary purpose of this strategy?

Answer 57

To prevent the patient from developing pneumonia.

Question 58

Positioning a patient for oral intake can be a key step in preventing aspiration in individuals at risk for dysphagia. Which of the following positions is most likely to facilitate a safe swallow in a patient at risk for dysphagia due to neuromuscular weakness or incoordination?

Answer 58

sitting upright

Question 59

An SLP is looking for a new screening tool to identify dysphagia symptoms in patients who have had strokes. She finds a tool that reports 82% specificity and 87% sensitivity. The SLP should expect this tool to:

Answer 59

Correctly refer 87% of people who do have dysphagia for further assessment, but also incorrectly refer 18% of people who do not have dysphagia for further assessment.

Question 60

The primary purpose of assessing the ability to produce a volitional cough during a bedside swallow examination is:

Answer 60

To assess neuromuscular ability to protect the airway