chapter 5:Evaluation of Swallowing Disorders

Question 1

screening procedures are used to identify ___________ patients who require more assessment.

Answer 1

high risk

Question 2

screening procedures do not determine the nature of the patient’s______________

Answer 2

phisiology

Question 3

the procedure should identify individuals who _____ or have _______, known as true positives or _______________ ___________.

Answer 3

aspirate
residue
procedural sensitivity

Question 4

individuals who do not have these two symptoms are true negatives or ___________ _____________

Answer 4

procedural specificity

Question 5

false positive is an individual who:

Answer 5

is said to aspirate when no aspiration occured

Question 6

false negative is an individual who:

Answer 6

is said not to aspirate but does

Question 7

table 5.1 (pg 137) provides _______ and ______ results that are equal to other non-invasive procedures

Answer 7

sensitivity

specificity

Question 8

four abnormal behaviors during a screening procedure that need follow up study are:

Answer 8

a. rejection of food
b. food selectivity (picky eaters)
c. gagging
d. open mouth

Question 9

MBS is suited to study the ___________ of the swallow

Answer 9

physiology

Question 10

cineflurosocopy (motion picture film) was initially used before videofluroroscopy. while cine provided a better frame by frame analysis it did not record Voice. It uses higher doses of _______. and is no longer used

Answer 10

radiation

Question 11

frame by frame analysis and timing data can be provided if you use a _______-

Answer 11

video counter timer

Question 12

the purpose of an MBS is to 1) define ________ in anatomy or physiology that are causing the symptom and to 2) identify _________ strategies that may immediately improve the swallow

Answer 12

abnormalities

treatment

Question 13

_______ and ________ transit time are also assessed during an MBS

Answer 13

oral

pharyngeal

Question 14

also examined is the functioning of the following valves:

Answer 14

Velopharyngeal
laryngeal
UES

Question 15

the MBS attempts to determine where aspiration may occur from the following four areas:

a) reduced ________function
b) delayed or absent ____________ swallow
c) reduced _____________ closure at the entrance of the vocal folds
d) _______ dysfunction

Answer 15

lingual (spillage)
pharyngeal (trigger)
laryngeal
UES

Question 16

the clinician generallt places the food in the patients mouth using a plastic ____. special arrangements/ devices have to be made with infants or small children

Answer 16

spoon

Question 17

generally at least 3 viscosities are used in an MBS:
thin_______, barium __________, and material requiring ________.
some clinicians may add other levels of viscosity materials to swallow

Answer 17

liquid
paste/pudding
chewing

Question 18

generally for each viscosity, at least two swallows are required. for example logemann recommends two swallows of a thin liquid in these amounts:
__ mL, __ mL, __ mL and __mL.
these are followed by ____ drinking,

Answer 18

1, 3, 5, 10
cup
–some clinicians only do 3 and 5 ml amounts

Question 19

logemann also recommends two swallows of pudding (___ teaspoon) and two swallows of a cookie ( __ of a cookie)

Answer 19

1/3

1/4

Question 20

value of liquid is increased until or unless the patient _____

Answer 20

aspirates

Question 21

if a patient proceddes from liquids to the cookie without aspiration, some clinicians present the patient with honey thickened or _____-thickened liquids, also given in incremental amounts , including cup drinking

Answer 21

nectar

Question 22

there is little need to use incremental increases of pudding or cookie, because as viscosity of food increases the volume swallowed ______-

Answer 22

decreases

Question 23

sometimes it is wise to have a patient self feed to determine if there are any issues with the material researching the mouth or if the patient might __________ the mouth with food.

Answer 23

overstuff

Question 24

patients referred for MBS are often ill, have poor respiratory status, and are probably aspirating. if any large amount (more than__ teaspoon) of barium enters their airway, complications can occur, including respiratory _______

Answer 24

1

arrest

Question 25

in an MBS beginning with minimal amounts of liquids ensures that the material will not block the ________ if aspirated. some evidence suggests that pnemonia is less likely to result from aspiration of liquids than thicker foods. the lungs are better able to clear liquids than food from the trachea by a ______.

Answer 25

airway | cough

Question 26

the patient should be seated and initially viewed in the ________ plane.

Answer 26

lateral

Question 27

most likely the ___________ or the __________ will provide assistance in seating the person especially if accommodations need to be made

Answer 27

radiologist | nurse

Question 28

the image should show from the ____ to the level of the UES

Answer 28

lips

Question 29

the arms of the patient should be on the side not on the arms of the chair. elevated arms cause the _____ to also be elevated possibly covering the pharynx on the MBS

Answer 29

shoulders

Question 30

sometimes an MBS should be taken of the upper esophagus if _______ is suspected

Answer 30

reflux

Question 31

a lateral view allows for the measure of the oral and _________ transit time

Answer 31

pharyngeal

Question 32

the oral transit time is measured from the initiation of the posterior movement of bolus thou\rough the oral cavity until the leading edge of the bolus passes the point where the _________ crosses the tongue base.

Answer 32

mandible

Question 33

the pharyngeal phase/transit time begins when the pharyngeal swallow triggers and terminates when the bolus passes through the _____

Answer 33

UES

Question 34

the pharyngeal delay time is the time between the end of the ____ transit time until the ________________-

Answer 34

oral | pharyngeal swallow is triggered

Question 35

Video fluoroscopy permits analysis of patterns of ___________________ movement, gross estimate of the amount of vallecular residue and pyriform residue and an estimate of the amount of material _________per bolus

Answer 35

Lingual, pharyngeal, laryngeal | Aspirated

Question 35

esophageal disorders are usually treated ________ or surgically

Answer 35

medically

Question 36

Approximately ______% of normal swallower a swallow down only one side

Answer 36

20

Question 36

videofluroscopy permits analysis of patterns of ______________ movement, gross estimate of the amount of valecular residue and pyriform residue and an estimate of the amount of material _________ per bolus

Answer 36

lingual, pharyngeal, laryngeal | aspirated

Question 37

approximately ___% of normal swallowers swallow down only one side

Answer 37

20

Question 38

the P-A view is helpful in looking at asymmetries in function of the pharyngeal walls and _________ and in viewing residues in the __________ and in one or both _________________.

Answer 38

larynx valleculae pyriform sinuses

Question 39

in the P-A it is best to repeat only swallows that cause disturbances in order to reduce the amount of ___________ exposure

Answer 39

radiation

Question 40

it is helpful to have the patient tilt the head back and repeat /ah/ in order to determine the vocal folds ability to ________ and ________

Answer 40

abduct | adduct

Question 41

typically the patient is asked to hold the material in the mouth until told to __________

Answer 41

swallow

Question 42

_______ are generally the most easily material ___________ and yet the least likely to block the airway.

Answer 42

liquids | aspirated

Question 43

if a patient aspirates on a particular material/ volume the examiner should attempt __________ strategies on the same material/ volume

Answer 43

treatment

Question 44

if aspiration is eliminated on several swallows as the result of intervention the volume should be __________

Answer 44

increased

Question 45

if a patient cannot intake a material from a spoon a ______________ can be used

Answer 45

tongue blade

Question 46

with masticated material the patient is told to go ahead and swallow as soon as he or she has completed the _________

Answer 46

chewing

Question 47

in patients with dementia the oral stage may be missed on the videofluoroscopy but the _____________ stage will be captured

Answer 47

pharyngeal

Question 48

trial therapy includes consideration of attempting the following: a) position the ____ in a particular direction b) use sensory-__________ boluses c) ask the patient to follow specific ________ maneuvers d) _________ positions

Answer 48

head enhancing swallow postural

Question 49

total exposure in MBS trials and therap trials is generally less than ___ minutes

Answer 49

5

Question 50

any patients suspected of aspirating during the bedside exam should be __________.

Answer 50

referred

Question 51

t or f: the pharyngeal physiology cause of aspiration cannot be defined at bedside

Answer 51

true

Question 52

approximately ___% of patients who aspirated during video fluoroscopy were not identified as aspirating during the bedside.

Answer 52

40

Question 53

the ____________ therapist (SLP) and the radiologist should perform the exam together

Answer 53

swallowing

Question 54

the radiologist is trained to identify _________________

Answer 54

physical abnormalities

Question 55

the purpose of an MBS is to define the swallow _________ causing the _________

Answer 55

physiology | aspiration

Question 56

the clinician should select some _____ options that fit the patient's oropharyngeal swallowing abnormalities.

Answer 56

intervention

Question 57

postural techniques ________ food flow and change ________ dimensions

Answer 57

redirect | pharyngeal

Question 58

table 5-2

Answer 58

head positioning

Question 59

postural techniques work well with ___________ impaired, cancer patients, and patients of all ages

Answer 59

cognitively

Question 60

postures may also improve ____ and ___________ transit times

Answer 60

oral | pharyngeal

Question 61

postural effects on residue/aspiration might be seen before and after _____

Answer 61

FEEs

Question 62

sensory awareness techniques are generally used with the following patients: a) swallow _______ b) delayed onset of the oral ___________ c) delayed triggering of the ___________ swallow

Answer 62

apraxia propulsion pharyngeal

Question 63

sensory stimuli include : _________ pressure of the spoon, _____ bolus, ____ bolus, bolus requiring __________, larger _________ bolus, and _______________

Answer 63

``` increasing downward sour cold chewing volume thermal/tactie stimulation ```

Question 64

thermal stimulation utilizes size ____ laryngeal mirror that has been held in ___________ ice prior to the presentation of the bolus. the mirror is rubbed against the ________________

Answer 64

00 crushed faucil pillars

Question 65

this technique may result in a faster ______ of the pharyngeal swallow, reducing the delay for severl ________ thereafter.

Answer 65

trigger | swallows

Question 66

swallow maneuvers put the pharyngeal swallow physiology under _________ control

Answer 66

voluntary

Question 67

four options of swallow maneuvers include: a) supraglottic swallow designed to ________ b) super supraglottic swallow designed to _______ c) effortful swallow designed to _________ d) mendelsohn maneuver designed to___________

Answer 67

A) close the airway at the level of the vfs B) close the airway at the top of the larynx C) increase the posterior movement of tongue base D) increase the laryngeal elevation

Question 68

elimination of certain food consistencies from the diet should be the last ______

Answer 68

Resort

Question 69

range of motion exercises for the lips, tongue and or jaw do not have an immediate effect but typically show an effect after ______ weeks

Answer 69

2-3

Question 70

the report should include recommendations regarding management of _______ intake, type of _______ procedures to employ and possible _______

Answer 70

Nutrition Intervention Referrals