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MCQ 1.2 > Swallowing, Coughing And Vomiting > Flashcards

Swallowing, Coughing And Vomiting Flashcards

1
Q

What are the 3 protective mechanisms

A

Mucosa and mucociliary action
Immunological defences e.g. IgA, IgE
Neuromuscular reflexes e.g. swallowing, sneezing

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2
Q

How is the neuromuscular protective mechanism carried out

A

Mechano/chemoreceptors in the upper aerodigestive tract
Afferent pathways involving cranial nerves V and X
Complex brain stem interactions
Co ordinated largely involuntary response involving several discrete muscle groups

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3
Q

What are the 3 swallowing phases

A

Oral (preparatory) phase
Pharyngeal phase
Oesophageal phase

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4
Q

Which phase of swallowing is voluntary

A

Oral phase

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5
Q

What happens during the oral swallowing phase

A

Food is chewed with saliva to form bolus
Tongue pushes backwards to pharynx
Teeth brought together by muscles of mastication
Lips seal (normally)
Intrinsic tongue muscles push tip of tongue against palatal surface of upper incisors - a groove forms in tongue
Aided by Buccinator muscle to propel bolus back

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6
Q

Where is the nucleus ambiguus located

A

In cell bodies of motor nerves that innervate ipsilateral muscles of soft palate, pharynx, larynx and upper oesophagus

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7
Q

What are the 4 steps to the pharyngeal phase of swallowing

A

Sensory input (X and others)
Nucleus of the tractus solitarius
Nucleus ambiguus in the brain stem ‘swallowing centre’
Co ordinated swallowing response

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8
Q

What happens with a larger bolus

A

The upper oesophageal sphincter is open longer and movement of hyoid and larynx is greater and of longer duration

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9
Q

Which cranial nerves are affected by the nucleus solitarius

A

Facial, glossopharyngeal, vagus (taste)
Glossopharyngeal sensation pharynx
Vagus sensation larynx

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10
Q

Which cranial nerve is sensation for the tongue, oral cavity, hard and soft palate

A

Trigeminal

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11
Q

Which muscles are involved in swallowing

A

Temporalis
Masseter
Stylopharyngeus
Pharyngeal m
Strap muscles - C1-3

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12
Q

What happens during the pharyngeal phase of swallowing

A

Inhibition of respiration
Elevation of soft palate
Glottis closes sealing laryngeal opening
Elevation of larynx pulled upwards to position where food is less likely to enter
Vocal cords adducted
Contraction of aryepiglottic m pulling epiglottis over laryngeal opening
Opening os pharyngo oespohageal sphincter to allow passage of food
Activation of pharyngeal muscles in swallowing

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13
Q

What happens during the oesophageal phase of swallowing

A

Food propelled towards stomach by peristalsis
Wave of contraction of circular smooth muscle of oesophagus which is preceded by wave of relaxation
Gastro oesophageal sphincter opens
Food enters stomach
Gravity contributes to process

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14
Q

What is another word for swallowing difficulties

A

Dysphagia

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15
Q

What is achalasia

A

The failure of sphincter smooth muscle relaxation to allow bolus through

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16
Q

What is diffuse oesophageal spasm

A

Varies in severity and leads to inefficient movement of food and liquids along oesophagus
Can lead to regurgitation and chest pain

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17
Q

What is gastro oesophageal reflux

A

Inflammation and scarring of oesophageal wall due to acid contents of stomach leaking upwards
Symptoms include coughing during swallowing or on waking
May be due to pathology or behaviour

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18
Q

What does oesophageal cancer present as

A

Generally squamous cell carcinoma

19
Q

What happens during sneezing

A

Irritation of receptors in the nasal mucosa
Deep inspiration
Glottis closes
Uvula and soft palate depressed
Diaphragm contracts against a closed glottis
Glottis opens release of pressure

20
Q

What are the 3 stages of anatomy of the cough reflex

A

Receptors
Cough centre
Effector musculature

21
Q

What receptors take place in the anatomy of the cough reflex

A

Laryngeal and tracheobronchial, diaphragm, pleura, oesophagus rapidly adapting irritant receptors, non myelinated C fibres

22
Q

What happens at the cough centre of the cough reflex

A

Integration of afferent fibres in the medulla, separate to centres which control breathing

23
Q

What is involved in the effector musculature in the cough reflex

A

Expiratory muscles, diaphragm, larynx, bronchial SM

24
Q

What is stimulated by foreign bodies in coughing

A

Internal branches of recurrent laryngeal nerves which are afferent limbs of cough reflex

25
Q

How much air is taken in short inspiration during coughing

A

2.3 litres followed by immediate closure of rima glottidis to entrap air within lungs

26
Q

How much pressure is formed during forceful expiration during coughing

A

100mmHg below the vocal folds

27
Q

What can vomiting be induced by

A

Gastric irritation/distension
Mechanical stimulation of pharynx
Some drugs
Emotion

28
Q

What are the 3 stages of vomiting

A

Nausea
Retching/gagging
Emesis

29
Q

Where are the sensory signals that initiate vomiting

A

Pharynx
Oesophagus
Stomach
Upper portions of small intestines

30
Q

Why does nausea occur

A

Makes you think you are going to vomit
Due to loss of smooth muscle tone in stomach wall
Irritation impulses from GIT
Impulses that originate in lower brain associated with motion sickness
Impulses from cerebral cortex to initiate vomiting

31
Q

What is retching and gagging

A

Unpleasant/spasmodic and abortive respiratory movements against closed glottis

32
Q

What happens during emesis

A

Deep breath
Raising of hyoid bone and larynx
Relaxation of gastrointestinal oesophageal cardiac sphincter
Closure of epiglottis to prevent vomitus flow into lungs
Lifting of soft palate to close posterior nares

33
Q

What does the velopharyngeal mechanism do

A

Permits production of differentiated oral speech sounds without air escaping through nose

34
Q

Which cranial nerves are used for articulator in speech

A

V, VII, XII

35
Q

Which cranial nerves are used for the resonator of speech

A

X and IX

36
Q

Which cranial nerve is used for the vibrator in speech

A

X

37
Q

What does the laminate propria do in the vocal cord folds

A

Attaches mucosa loosely to muscle and contains vocal ligament

38
Q

What does the mucosal epithelium do in the vocal cord folds

A

Produces fluid and mucous to trap dust and keep lining and air moist and flexible and warm

39
Q

If speech is louder what happens

A

Higher airflow
Faster closure of folds
Greater impact and risk of damage

40
Q

What is rienkes space

A

Fluid retention in lamina propria

41
Q

What is laryngitis

A

The swelling of vocal folds reinkes oedema results in hoarseness and can have many causes
Curving edge of swollen folds elephant ear appearance

42
Q

Where does the articulator project from

A

Lips and tongue

43
Q

Where does the resonator project from

A

Mouth and throat

44
Q

Where does the vibrator project from

A

Larynx

MCQ 1.2 (34 decks)

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