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dysphagia > Comps review > Flashcards

Comps review Flashcards

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1
Q

5 Stages of Pediatric Swallow

A
  1. Pre-Oral
    - Delivering food to oral cavity
  2. Oral
    - Sucking or chewing once food is received
  3. Pharyngeal
    - involuntary phase begins at tonsillar pillars
  4. Esophageal
    - Food enters esophagus
  5. Gastrointestinal
    - Food processed and delivered to stomach
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2
Q

4 Stages of Adult Swallow

A
  1. Oral prep
    - Mastication and bolus prep
  2. Oral Transit
    - bolus transported via action of tongue
  3. Pharyngeal
    - Begins when bolus reaches faucial arches
  4. Esophageal
    - Bolus propelled through esophagus by contraction above and relaxation below bolus
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3
Q

Muscles of Mastication

A
  • Masseter
  • Temporalis
  • Lateral pterygoid
  • Medial pterygoid
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4
Q

Laryngeal Inlet

A
  • Lateral borders > aryepiglottic folds > cuneiform cartilage contained within aryepiglottic folds
  • Anterior wall > thyroid cartilage
  • Vocal folds > below laryngeal inlet
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5
Q

Cranial Nerves Involved in Swallowing

A
  • Trigeminal
  • Facial
  • Glossopharyngeal
  • Vagus
  • Hypoglossal
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6
Q

Sphincters of the Swallow and Location - Adult Swallow

A
  • Lips
  • Velopharyngeal sphincter
  • Laryngeal sphincter
  • Upper esophageal sphincter
  • Lower esophageal sphincter
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7
Q

Penetration

A

Bolus contents pass into the larynx to a level ABOVE the level of the true vocal folds

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8
Q

Aspiration

A

Food, liquids, pills, secretions pass into airway BELOW the level of the true vocal folds

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9
Q

Silent Aspiration Possibilities

A
  • Hx of pneumonia combined with:
    – Weak or absent cough
    – Changes in body temp after eating
    – Wet vocal quality
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10
Q

Aspiration Pneumonia

A

Results from the entrance of foreign materials, usually foods, liquids, or vomit into the bronchi of the lungs with resultant infection

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11
Q

Negative Results of Aspiration

A
  • Aspiration pneumonia
  • Lung infections
  • Degydration
  • Malnutrition
  • Reduced enjoyment of eating
  • Reduced quality of life
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12
Q

Silent Aspiration

A
  • Penetration of food, liquid, or saliva to the subglottic area without the elicitation of a cough
  • 40% of dysphagia clients silently aspirate
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13
Q

Zenker’s Diverticulum

A
  • Typically results from increased pressure within the pharynx during swallowing
  • Often due to dysfunction in the mechanics of the UES
  • Cricopharyngeus muscle is a key component of the UES
    – Primary function is to relax and open to allow food to pass from the pharynx to the esophagus
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14
Q

Identification of Penetration on MBS/FEES

A
  • Material is below the epiglottis but above the vocal folds
  • Airway remains clear
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15
Q

GERD

A
  • Retrograde movement of gastric contents from stomach through the LES and into the esophagus
  • Most common symptom is heartburn
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16
Q

Symptoms of GERD

A
  • Noncardiac chest pain
  • Regurgitation of gastric contents
  • Water brash
  • Dysphagia
  • Odynophagia
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17
Q

Water Brash

A
  • Stimulated salivary secretion by esophageal acid
  • Excessive amount of saliva occurs and mixes with stomach acids that have risen to the throat
  • Causes bad taste in mouth and can lead to heartburn
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18
Q

Odynophagia

A
  • Pain upon swallowing
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19
Q

Globus

A
  • Sensation of a lump in the throat
  • May be caused by GERD
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20
Q

Esophagitis

A

Inflammation of the esophagus

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21
Q

Laryngopharyngeal Reflux Disease

A
  • Inflammatory disease of the larynx that originates in the stomach like other reflux disorders
  • Acid from stomach rises up to the level of the larynx and targets laryngeal tissues
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22
Q

LPRD Symptoms

A
  • Hoarseness
  • Vocal process granulomas
  • Coughing
  • Excessive phlegm in throat
  • Throat clearing
  • Severe cases
    – Excessive coughing
    – Occasional choking of liquids or foods
    – Globus
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23
Q

Barrett’s Esophagus

A
  • Lining of esophagus irritated and damaged from acid reflux
  • LES won’t close as tightly
  • Nonspecific complaints of heartburn and dyspepsia
  • Precursor to cancer
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24
Q

Dyspepsia

A

Indigestion

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25
Trigeminal (V) Sensory
- Tongue - Inferior alveolus - Buccal mucosa - Lower lip
26
Trigeminal (V) Motor
- Mastication muscles
27
Facial (VII) Sensory
- Anterior 2/3 of tongue (taste)F
28
Facial (VII) Motor
- Muscles of facial expression - Lip closure - Cheek tension - Lip movements - Grasping
29
Glossopharyngeal (IX) Sensory
- Oropharynx - Base of tongue -- Supports taste fibers at base of tongue
30
Glossopharyngeal (IX) Motor
- Stylopharyngeus muscle
31
Stylopharyngeus Muscle
Elevates pharynx
32
Vagus (X) - Recurrent Laryngeal Nerve
- Innervates all laryngeal muscles except cricothyroid - Responsible for glottic closure during swallow
33
Vagus (X) - Superior Laryngeal Nerve
- External division -- Tenses vocal folds - Internal division -- Sensation to larynx
34
Hypoglossal (XII) Motor
- Tongue -- Bolus control -- Lingual strength -- Lingual coordination
35
Pharyngeal Plexus
- Main motor and sensory nerve supply to muscles of soft palate and pharynx - Acts to coordinate swallowing and speech - Has both motor and sensory fibers - Important for muscles of soft palate and pharynxP
36
Pharyngeal Plexus - Bundle of Intersecting Nerves
- Pharyngeal branch of Vagus (X) - Accessory (XI) - Glossopharyngeal (IX)
37
Trigeminal (V) Motor - Result of Injury
Slight weakness in mastication
38
Facial (VII) - Result of Injury
- Slight weakness in bolus control - Weak lip closure
39
Glossopharyngeal (IX) Sensory - Result of Injury
- Failure to trigger pharyngeal stage of swallow - Premature spillage from mouth into airway
40
Glossopharyngeal (IX) Motor - Result of Injury
Deficit from loss of function of stylopharyngeus secondary to intact function of other elevators of the larynx
41
Hypoglossal (XII) - Result of Injury
- Bolus control problems - Crippled swallow if bilateral
42
Vagus (X) Superior Laryngeal Nerve - Result of Injury
Loss of protective glottic closure and cough reflex that protects airway from material on the supraglottic larynx
43
Vagus (X) Motor - Result of Injury
- Inadequate velopharyngeal closure, nasal regurgitation - Incomplete residue clearance in hypopharynx - Pooling above VF - Aspiration when VF open - Inadequate glottic closure during pharyngeal transit
44
Oral Cavity
Responsible for bolus containment and preparation
45
Oral Cavity Containment
- Lips -- Closure after bolus intake - Cheeks -- Adequate tension to assist in lip closure
46
Oropharynx
- Oropharyngeal Propulsion Pump - Velopharyngeal Function
47
Oropharyngeal Propulsion Pump
- Soft palate - Lateral pharyngeal walls - Base of tongue
48
Velopharyngeal Function
- Soft palate -- Elevates as tongue propels - Tongue elevation -- Necessary for propulsion
49
Hypopharynx
- Muscular propulsion - Larynx
50
Muscular Propulsion
- Pharyngeal constriction - Piriform sinuses - Cricopharyngeal function
51
Larynx
- Closure -- Glottis -- Ventricular folds -- Epiglottis - Pharyngeal squeeze - Hyoid elevation
52
Esophagus
- 1 UES opening - 2 primary peristaltic wave - 3 secondary peristaltic wave
53
Oral Cavity
- Buccinator - Orbicularis Oris - Soft palate - Tongue
54
Buccinator
- Seals lips - Keeps food on tongue
55
Orbicularis Oris
- Seals lips - Keeps food on tongue
56
Soft Palate
Lowers and creates seal to prevent early leaking or spillage into oropharynx
57
Tongue
- Oral portion innervated by hypoglossal nerve (XII) - Base portion innervated by vagus nerve (X)
58
Orbicularis Otis Muscle
- Tenses cheeks - Lateral movement of corners of mouth
59
Pharyngeal Constrictors
- Superior pharyngeal constrictor - Medial pharyngeal constrictor - Inferior pharyngeal constrictor
60
Masseter
- Powerful jaw closure - Sling muscle with pterygoid - Jaw closing
61
Temporalis
- Biting and tearing food - Lateral movements of jaw - Jaw closing
62
Medial Pterygoid
- Powerful jaw closure -- Sling muscle with masseter - Jaw protrusion -- With lateral pterygoid - Jaw closing
63
Lateral Pterygoid
- Protrusion of jaw -- with internal pterygoid - Mandibular lateralization - Oral cavity opening - Jaw opening/jaw retraction
64
Digastric, anterior belly
- Depress and retract the mandible when the hyoid bone is fixed - Jaw opening/retraction
65
Digastric, posterior belly
- Elevates hyoid bones and moves it forward - Jaw opening/retraction
66
Mylohyoid
- Depress and retracts the mandible when the hyoid bone is fixed - Jaw opening/retraction
67
Geniohyoid
- Depresses and retracts the mandible when the hyoid bone is fixed - Jaw opening/retraction
68
Oral Prep - Adult
Mastication and bolus preparation
69
Oral Transit - Adult
Bolus transported via action of tongue
70
Pharyngeal - Adult
- Bolus is transferred from oral cavity to pharynx - Begins when bolus reaches faucial arches
71
Esophageal - Adult
Bolus propelled through esophagus by contraction above bolus and relaxation below bolus
72
Oral Prep - Poor Lip Closure
- Anterior spillage - Poor bolus control - Poor anterior/posterior propulsion - Lack of cohesive bolus - Premature spillage into pharynx - Stasis in pharynx - Possible decreased speech of moevement through esophagus
73
Oral Prep - Poor Lip Closure Intervention (Oral Motor Exercises)
- Lip closure tasks - Pucker swing - Puffing cheeks - Sucking and blowing exercises
74
Oral Prep - Decreased Buccinator Strength
- Pocketing on the affected side - Possible anterior spillage
75
Oral Prep - Decreased Buccinator Strength Intervention (Oral Motor Exercises)
- Lingual sweep - Finger sweep - Use of mirror - Digital assistance - NMES
76
Oral Prep - Poor Lingual Lateralization
- Decreased ability to move bolus from molars to tongue - Decreased ability to break down consistency of bolus - Inability to clear pocketed material - Poor bolus control
77
Oral Prep - Poor Lingual Lateralization intervention (Oral Motor Exercises)
- Lateral tongue exercises -- Alternate puffed cheeks and suck in on cheeks -- Tongue in cheek -- Circles in cheek with tongue - Lingual sweep - Finger sweep - Use of mirror
78
Oral Prep - Premature Spillage into Pharynx Intervention (Oral Motor Exercises)
- Chin tuck - Thermal stim - Hard fast swallow - Masako - Velar exercise
79
Oral Transit - Decreased Anterior/Posterior Lingual Movement
- Poor tongue propulsion of bolus - Potential stasis in pharynx
80
Oral Transit - Decreased Anterior/Posterior Lingual Movement Intervention (Oral Motor Exercises)
- Alternating protrusion/retraction of tongue - Masako - Hard /k/ productions
81
Oral Transit - Head/Neck Cancer
- Poor population of the bolus
82
Oral Transit - Head/Neck Cancer Intervention
- Head position backward - Glossectomy - Spoon - Oral motor exercises
83
Pharyngeal - Decreased Pharyngeal Peristalsis Intervention
- Masako - Effortful swallow - Hard/fast swallow
84
Pharyngeal - Stasis in Pyriform Sinus Intervention
- Multiple swallows - Alternate liquids/solids - Effortful swallow - Masako - Hard fast swallow - Head turn to affected side - Head tilt to strong side
85
Pharyngeal - Stasis Just Above UES Intervention
- Mendelsohn maneuver - Multiple swallows - Shaker exercise
86
Pharyngeal - Penetration Intervention
- Masako - Hard fast swallow - Chin tuck -- If due to premature spillage - Supraglottic swallow - Mendelsohn maneuver - Modify diet -- Thickened liquids
87
Pharyngeal - Delayed Initiation of Swallow Intervention
- Chin tuck - Thermal stim - Hard fast swallow - Masako
88
Esophageal - Poor Opening of UES Intervention
- Mendelsohn maneuver - Multiple swallows - Shaker exercises
89
Esophageal - Dysmotility of Esophagus Intervention
- Alternate consistencies - Diet modifications - GI referral
90
Pharyngeal - Stenosis of Esophagus Intervention
- Alternate consistencies - GI referral
91
Pharyngeal - Zenker's Diverticulum Intervention
- Diet modificaitons - ENT and/or GI consult
92
Pharyngeal - Refl

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