Final Exam study guide

Question 1

What are the 3 phases of a swallow?

Answer 1

1. oral phase
2. pharyngeal phase
3. esophageal phase

Question 2

explain oral phase

Answer 2

•Form a bolus in your mouth on the top of your tongue, your lips seal, the tongue holds your food and velopharyngeal port closes
•The food or liquid is closed in your mouth
•This is a very contained phase
-no leakage or pocketing
•Everything stays in your mouth until the pharyngeal phase

Question 3

explain pharyngeal phase

Answer 3

oIs triggered as the bolus reaches the back of the tongue
•Negative air pressure
•Because you’ve closed the velopharyngeal port and lip seal you have closed off air participating in this swallow
•It helps drive the bolus backwards

Question 4

Explain esophageal phase

Answer 4

oThe esophagus is supposed to be a one way valve
oCharacterized by even more closure
oOnce food gets into the esophagus we are done

Question 5

The larynx is quadruple protected…

Answer 5

oThe tongue goes up and the epiglottis closes over the opening of the larynx
oThe epiglottis closes backwards and aryepiglottic folds close in to make the seal
oThe false VF close up
oThe true VS close up

Question 6

what is the single most important action in the pharynx to the swallow

Answer 6

• Larynx lifts and closes
• Most critical part of the pharynx
• It must pick up because that’s how it closes most tightly
• It is a sphincter action and it has to lift and close = peristaltic motion

Question 7

What is aspiration?

Answer 7

SOMETHING HAS PENETRATED BELOW THE LEVEL OF THE TRUE VF

Question 8

what is penetration?

Answer 8

i. The food may be sitting at the level of the true VF
ii. Because the food is in the vestibule
iii. Not below the level of the true—its AT the level

Question 9

what is residue?

Answer 9

i. What’s left over in the laryngeal area
ii. Can also be what’s left behind in the mouth
1. If it’s sitting on the tongue

Question 10

what is backflow?

Answer 10

i. Referring to the esophageal phase

ii. Food or liquid has gone into the esophagus and it’s coming back up again—it never got to the stomach

Question 11

what are extrinsic muscles?

Answer 11

supporting and fixing the larynx into place

•One attachment is outside the larynx and on is inside (to hyoid, thyroid, or thyrohyoid)

Question 12

What is are suprahyoids? name them

Answer 12

laryngeal elevators 
& critical swallow muscles 
digastricus 
mylohyoid 
stylohyoid
geniohyoid

Question 13

what do each of them do?

Answer 13

Digastricus: pulls hyoid up and slightly back

mylohyoid: elevates hyoid and moves down a little bit in contraction—anteriorly as well
stylohyoid: lifts hyoid and slightly posteriorly
geniohyoid: lift and pull slightly anteriorly

• ***Geniohyoid, mylohyoid, and anterior belly of digastricus→ pull hyoid bone forward
• **Posterior belly of digastricus and stylohyoid even out the pull a little bit—it pulls it backwards

Question 14

what are infrahyoids? name them

Answer 14

laryngeal depressors

1. Sternohyoid
2. Omohyoid
3. Thyrohoid
4. Sternothyroid

Question 15

Explain the infrahyoids

Answer 15

laryngeal depressors
1. Sternohyoid
•Strap muscle
•Downward pull of hyoid bone

2. Omohyoid
   Pull down and back a little bit
3. Thyrohoid
   •A cheating muscle because both attachments are in the larynx
   •Looks like a infra but acts like a supra
   •When it contracts it pulls larynx up to hyoid bone
   oIt is both intrinsic and extrinsic elevators
4. Sternothyroid
   Pull down and back a little bit

Question 16

What are the risks for dysphagia?

Answer 16

a. Lack of muscle control/function
i. Especially with lack of muscle function goes with lack of sensation
b. Lack of sensation
c. Lack of swallow reflex
i. Cough/clear reflex

Question 17

What is a screening eval tell you?

Answer 17

Yes/no evaluation for aspiration

i. Typically identifies that the patient is aspirating, but not why.
1. But then you do a study to determine why: what’s happening where?

Question 18

Name two types of swallow evals

Answer 18

b. Modified Barium swallow (MBS)
1. Laryngeal function
ii. Most popular eval
iii. It is an x ray
iv. Looking at lateral view of how they manipulate the bolus in the oral phase, when the pharyngeal phase triggers, when or does the larynx move up, does the tongue propel the bolus into the pharynx, is does the epiglottis close over?

2. FEES (1:24:00)
   i. Fibroptic endoscopic eval of swallow
   ii. Can be done by a SLP no radiologist necessary
   iii. Scope goes through the nose pass/lower to the level of the velopharyngeal port and watch the patient swallow
   iv. Anterior, posterior, and lateral view

Question 19

Both FEES and MBS are designed to do what?

Answer 19

1. Where is the abnormality in the anatomy and/or physiology
2. And give you an idea for treatment strategies might be
3. You can test the structures
   a. You can go through a list of treatment strategies and probe to see what works
4. But remember MBS is an x ray

Question 20

Signs and symptoms of aspiration

Answer 20

i. Coughing after swallowing
ii. History of pneumonia
iii. Diagnoses that put the patient at greater risk
iv. Food squirting out the tracheostomy
v. Some sort of neuroligcal disease that lead to paralysis, paresis, lessened sensation
vi. Stroke or TBI