Exam #1 Questions

Short Answer

List 2 differences between individuals with normal swallowing and those with dysphagia.

Foods may become lodged in the throat. Patients may experience regurgitation. Patients may experience slower eating than normal.

What are the differences between dysphagia and aphagia? Include at least  differences.

Dysphagia means the patient has difficulty in swallowing. Aphagia means the patient cannot swallow anything including liquids. In dysphagia, patients may be able to survive on a limited diet while aphagic patients will starve if they try to eat by mouth.

Aspiration occurs when foods or liquids:

Enter the airway below the level of the true vocal folds

List two ways in which aspiration is different from aspiration pneumonia.

Aspiration may involve food or liquid entering the airway but the patient can cough it out. Aspiration may occur in such small amounts that it will not soil the lungs. Aspiration pneumonia occurs when enough foreign material (foods or liquids) enter the lungs to cause an infection

Describe silent aspiration. Does it happen in otherwise normal individuals? Why or why not?

Silent aspiration occurs when food or liquid enters the airway without the patient feeling it and therefore does not cough it out. It does not happen in a normal individual because the sensory system triggers a response to cough.

List three contributors to dehydration.

1. Medications
2. lack of adequate water intake
3. fear of choking on liquids

List three reasons why dysphagia increases the severity of the primary disease or sickness of a patient.

1. The patient cannot regain strength due to lack of eating/drinking;
2. The risk of lung infection may alter the course of a disease
3. The patient has more difficulty coping with the primary disease due to distraction of the swallowing problem

Give three reasons for starting a swallowing intervention program early during the hospital admission of a patient following a CVA

1. It will most likely reduce to possibility of aspiration thus allowing the patient to eat more safely
2. The patient will not lose energy due to lack of nutrition
3. Reduction of pneumonia rates

What evidence did Wasserman and colleagues give for aggressive treatment of patients following surgery for cancer in the head or neck areas?

1. Accuracy in reporting patient status;
2. Reduces the length of hospital stay;
3. Weight is more likely maintained.

What is the main purpose of the SWAL-QOL? When would the SWAL-QOL not be a useful tool?

The main purpose of the SWAL-QOL is to identify the quality of life in a patient with a swallowing disorder. It may not be useful in a patient with dementia or one who has short term memory loss.

Name three types of research studies that are needed to determine the true effectiveness of an early intervention program in dysphagia.

1. Studies with control groups;
2. Studies with validated outcome measures;
3. Studies with randomized treatment groups;
4. Studies that are reprospective rather than retrospective

Parkinson's disease leads to increasing swallowing disorders because:

(1) There is a continuing decrease in neuromuscular control; (2) As Parkinson's disease becomes more severe, there is a decline in cognitive functioning.

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Why should weight loss in an elderly person be worked up by a dysphagia specialist even when the patient has no other complaints or obvious problems?

Because unplanned weight loss in an elderly patient may be due to a swallowing disorder such as silent aspiration. Elderly patients do not usually have unplanned weight changes for no reason.

To what did Aviv and colleagues attribute the high rate of swallowing disorders in cardiac patients in their 2005 study?

A large percentage of these patients had significant Vagus Nerve (CN-IO) sensory dysfunctions causing silent aspiration

List three reasons for beginning a nonoral (nothing by mouth) diet for a patient with dementia

1. Because they are unaware, they are likely to eat things that may cause aspiration;
2. it is important to prevent weight loss if they are suffering other conditions as well;
3. swallowing rehabilitation programs are likely to be minimally or noneffective with dementia patients.

List the four conditions of the elderly that are associated with dysphagia that should be evaluated by the swallowing specialists.

1. Weight loss;
2. avoidance of foods previously eaten;
3. nutritional status;
4. poor healing after injury;
5. increased length of meals

Why would a dysphagia specialist recommend against a huge insensate tissue flap in favor of a primary closure technique of a tumor site?

An insensate flap may result in the patient losing sensitivity and not recognizing the presence of food or liquid in the airway. Although some sensory loss can be tolerated, one never knows how much sensory loss will lead to silent aspiration.

The overall death rate from all types of pneumonia is approximately 2%. Give at least two reasons why the death rate is as high as 40% following readmission for pneumonia to a hospital.

The patient was sent to the nursing home before the swallowing problem was adequately treated in the hospital; (2) There may be a delay in transferring the patient from the nursing home to the acute center.

Dysphagia has been shown to lead to

All of the above (Depression, Social instability, loss of muslce bulk, & general; decline of health)

Current research on the financial impact of dysphagia is

unable to determine the true estimates of dysphagia rehabilitation.

Rehabilitation of the patient with dysphagia be limited by

All of the above (Medical knowledge, costs of treatment, patient’s ability to respond, & Family Support)

Of the following, which two groups of patients might not respond to treatment for their swallowing disorder? Include two answers.

Alzheimer’s Disease

Dementia

Nursing home residents have an increase in swallowing problems while living at the nursing home, primarily because of

Early discharge from the hospital after their surgery or disease

In today's society, weight loss

May have negative effects on hospitalized patients

The clinical swallowing examination

May be used as a screening tool to identify patients at risk for aspiration

Name the three distinct types of aspiration pneumonia and give an example.

Pneumonitis: Early lung infection with low grade fever. A common problem  in older adults who claim they do not feel well a day after eating heavily.

 

Lung abscess: Fluid in the lungs usually determined by x-ray examination. The person may be coughing heavily and production ga discolored sputum.

 

Empyema: Fluid in the pleura of the lungs. When it gets severe enough, the pleural walls may rupture. An example is someone who is in pain and is coughing heavily with productive sputum.

Define the following terms:

Preprandial

Prandial

Postprandial

1. **Preprandial - Entry of material into the airway below the true vocal folds before the swallow is triggered**
2. **Prandial - entry of material into the airway below the true vocal folds during the swallow**
3. **Postprandial - entry of material into the airway below the vocal folds at a time after the swallow**

Define penetration and aspiration. What is the major difference between the two conditions?

**Penetration - when the bolus enters the airway but now below the vocal folds**

**Aspiration - the passing of the bolus below the true vocal cords**

**Difference between the two: how far the bolus gets; in penetration food or liquid is resting on top of the vocal fold whereas in aspiration food or liquid is below the vocal folds**

What is the major difference between aspiration and aspiration pneumonia?

**Aspiration is when food or liquid goes below the vocal folds.**

**Aspiration pneumonia occurs when food or liquid is breathed into the airways or lungs, it is toxic.**

Name at least five factors that are related to the acquisition of aspiration pneumonia

* **strength of cough**
* **oral hygiene**  
* **size of bolus**
* **immune function**
* **depth of aspiration**
* **frequency of aspiration occurrence**

What is the major difference between community acquired pneumonia (CAP) and nosocomial acquired pneumonia?

**Community-acquired pneumonia (CAP) is defined as pneumonia that is acquired outside the hospital. Hospital-acquired pneumonia (HAP) or nosocomial pneumonia refers to any pneumonia contracted by a patient in a hospital at least 48-72 hours after being admitted.**