Quiz 1 - Feeding and Swallowing

Who is the mother of dysphagia?

Jeri Logemann

What are some disadvantage of MBSS/VFSS?

1. radiation - limits time for study (1.5-3 minutes)

2. accessibility limited - not portable

What are some disadvantages of FEES?

1. the oral phase cannot be observed

2. gag reflex may interfere with study

3. during swallow, there is a white out

What are some advantages of MBSS/VFSS?

1. you can observe the swallow in multiple positions

2. you can observe the oral phase

What are some advantages of FEES?

1. no radiation - no limit on time

2. it is accessible and portable

Who conducts a Barium Swallow Study (BSS)?

radiologist

What is the scope of practice for SLPs regarding feeding and swallowing?

We can evaluate and manage the oral and pharyngeal phases of swallowing

Where does our scope of practice begin for feeding/swallowing?

the lips

Where does our scope of practice end for feeding/swallowing?

cricopharyngeus muscle (upper esophageal sphincter)

Which cranial nerve innervates the cricopharyngeus muscle (UES)?

Vagus nerve (X)

The oral cavity is a shared system. Another word for this is an __________ system.

aerodigestive

The oral cavity is shared with ______ and _______.

respiration, swallowing

What is the ramus of mandible?

The second portion of the mandible that projects upward at an angle from the posterior part of each mandibular body.

Where is the pyriform sinus located?

above the epiglottis

Where is the valleculae?

located between the tongue and epiglottis - valley

What does NG tube stand for?

Nasogastric tube

Where is the duodenum tube located?

below the stomach

An NG tube is inserted through _________________

the nose

The NG tube (specifically nasoduodenal) is _________ in color

yellow

What is the NG tube used for?

feeding

What does PEG tube stand for?

percutaneous endoscopic gastrostomy tube

How is a PEG tube inserted?

through endoscopy

What does J tube stand for?

jejunum tube

How is a J tube inserted?

through general surgery - surpass stomach

NG tubes and nasoduodenal tubes are (short term/long term) solutions.

short term

PEG tubes, G tubes, and J tubes are (short-term/long-term) solutions.

long term

Can SLPs recommend any tube feeding?

No. We can recommend NPO - nil per os (nothing by mouth)

What are some common causes for feeding tubes?

swallowing problems, coma, stomach cancer, psychogenic problems

What is the definition of dysphagia?

difficulty in swallowing

True or false: Dysphagia is a primary medical diagnosis.

False; dysphagia is always a symptom

What are some common causes of dysphagia?

dementia, Parkinson's, head and neck injury, etc.

What are the 4 stages of swallowing?

1. oral preparatory phase

2. oral phase

3. pharyngeal phase

4. esophageal phase

What does the oral preparatory phase entail?

mastication and holding liquid

What does the oral phase entail?

The tongue starts moving, and the bolus goes from anterior to posterior

What does the pharyngeal phase entail?

The bolus enters the pharynx and continues to go toward the esophagus

Where does the pharyngeal cavity begin and the oral cavity end?

the anterior and posterior faucial pillars

The epiglottis is a ___________ cartilage

laryngeal

What is aspiration?

food or liquid passes below the VF into airway

What is penetration?

food or liquid enters the airway and stays above the vocal folds

What is choking?

complete obstruction of airway

What are the levels of the penetration-aspiration scale?

1-2: normal

3-5: penetration

6-8: aspiration

8: silent aspiration

What is a score of 1 on the penetration-aspiration scale?

material does not enter airway

What is a score of 2 on the penetration-aspiration scale?

material enters the airway, remains above the VF, and is ejected from the airway

What is a score of 3 on the penetration-aspiration scale?

material enters airway, remains above VF, and is not ejected from the airway

What is a score of 4 on the penetration-aspiration scale?

material enters airway, contacts the VF, and is ejected from the airway

What is a score of 5 on the penetration-aspiration scale?

material enters the airway, contacts the VF, and is not ejected from airway

What is a score of 6 on the penetration-aspiration scale?

material enters airway, passes below the VF, and is ejected into the larynx or out of the airway

What is a score of 7 on the penetration-aspiration scale?

material enters the airway, passes below the VF, and is not ejected from the trachea despite effort

What is a score of 8 on the penetration-aspiration scale?

material enters the airway, passes below the VF, and no effort is made to eject

What is white out on FEES?

the reflection of the epiglottic inversion

What is the Yale Swallow Protocol (3 oz water protocol)?

give client 3 oz of water to drink continuously, which is enough to produce a cough if aspirating

True or false: the Yale Swallow Protocol (3 oz water protocol) is pass/fail.

true; if the client stops or coughs, they fail

How much time does it take a bolus to go from the pharynx to the esophagus?

less than one second

What is a common breathing pattern in patients with COPD regarding swallowing?

Inhale instead of exhaling after swallowing

What is the first swallow exhalation pattern?

inhale - swallow - exhale

What is the second swallow exhalation pattern?

inhale - small exhalation - swallow - exhale

What is the first step in a clinical evaluation of swallowing?

medical chart review

What is the second step in a clinical evaluation of swallowing?

patient interview

What is the third step in a clinical evaluation of swallowing?

oral mech and cranial nerve exam

What is the final step in a clinical evaluation of swallowing?

performing the clinical swallow evaluation (bedside swallow)

What are signs of pharyngeal dysphagia?

coughing, throat clearing, voice change

How do SLPs diagnose pharyngeal dysphagia?

through instrument evaluation

Where are the three areas a liquid can go in a misdirection of swallowing?

-nasal cavity

-airway (trachea)

-out of mouth

What is the #1 cause of dysphagia?

stroke

Examples of neurological conditions that can lead to dysphagia

-stroke

-TBI

-dementia

-motor neuron disease

-Myasthenia Gravis

-Cerebral Palsy

-Guillain-Barre syndrom

-Poliomyelitis

-Infectious disorders

-Myopathy

-Progressive disorders (Parkinson's, Huntington's, etc.)

-age-related changes

Examples of connective tissue/rheumatoid diseases that can lead to dysphagia

1. polydermatomyositis

2. progressive systemic sclerosis

3. Sjorgren's disease

4. Scleorderma

5. Overlap syndromes

What is an iatrogenic diagnosis?

a side effect of other medical treatment

Examples of iatrogenic diagnoses that can lead to dysphagia

-radiation therapy

-chemo therapy

-intubation and tracheostomy

-post-surgical cervical spine fusion

-post-surgical CABG (coronary artery bypass grafting)

What are the three branches of the Vagus nerve?

pharyngeal nerve, superior laryngeal nerve, recurrent laryngeal nerve

The (left/right) side of the recurrent laryngeal nerve loops around the heart and goes back toward the vocal folds

left side

The (left/right) side of the recurrent laryngeal nerve loops around the subclavian artery and goes back to the vocal folds

right

All cranial nerves are __________

ipsilateral

What does ipsilateral mean?

belonging to or occurring on the same side of the body

If there is left vocal fold analysis, the patient can try a (left/right) head rotation during swallowing.

left

True or false: the superior laryngeal nerve innervates all intrinsic laryngeal muscles.

False; the recurrent laryngeal nerve innervates all intrinsic laryngeal muscles except the cricothyroid

The cricothyroid is innervated by the __________ nerve (a branch of the Vagus nerve)

superior laryngeal nerve

If a patient has difficulty in changing pitch and also has dysphagia, it may be an issue with the __________ muscle and _________ nerve

cricothyroid muscle; superior laryngeal nerve (Vagus)

What are the 4 muscles of mastication?

-temporalis

-masseter

-lateral pterygoid

-medial pterygoid

The _______ nerve innervates the muscles of mastication

trigeminal (V)

What are the three paired laryngeal cartilages?

-arytenoids

-corniculates

-cuneiforms

What are the three unpaired laryngeal cartilages?

-cricoid

-thyroid

-epiglottis