Dysphagia

Question 1

There are 3 stages to swallowing, also called deglutination. Which of the following is NOT one of these stages?

1 - oral
2 - pharyngeal
3 - oesophageal
4 - glossopharyngeal

Answer 1

4 - glossopharyngeal

Question 2

The oral phase is the first phase of swallowing/deglutination. Which of the following is NOT a feature of what happens here? happens here and is this voluntary or involuntary?

1 - voluntary movement
2 - peristalsis of food bolus
3 - tongue pushes against hard palate
4 - pushing propels bolus into oropharynx

Answer 2

2 - peristalsis of food bolus

Question 3

The pharyngeal phase is the 2nd phase of swallowing/deglutination. What structure in the brain is stimulated by this?

1 - corpus callosum
2 - midbrain
3 - medulla oblongata in brain stem
4 - pons

Answer 3

3 - medulla oblongata in brain stem

Question 4

The pharyngeal phase is the 2nd phase of swallowing/deglutination. All of the following nerves innervate this, EXCEPT which nerve?

1 - hypoglossal nerve (CN 12)
2 - vagus nerve (CN 10)
3 - trigeminal nerve (CN 5)
4 - glossopharyngeal nerve (CN 9)

Answer 4

Question 5

Once we have swallowed/deglutination, what is the basic steps of how the bolus is propelled?

1 - soft palette elevates over posterior nares.
2 - epiglottis is raised closing off the larynx
3 - respiration is temporarily inhibited
4 - upper oesophageal sphincter relaxes
5 - pharyngeal muscle contraction propels bolus into oesophagus
6 - all of the above

Answer 5

6 - all of the above

Question 6

The oesophageal phase is the 3rd phase of swallowing/deglutination. How is the bolus moved throughout the oesophageal phase?

1 - primary phase = smooth muscle contractions
2 - secondary phase = if primary is not sufficient then stretch receptors will propel bolus into stomach innervated by vagal nerve
3 - all of the above

Answer 6

3 - all of the above

Question 7

ENT doctors are involved in dysphagia when the problem is thought to be higher up. Which of the following is NOT a cause of dysphagia due to Extraluminal (outside walls of the pharynx and oesophagus)?

1 - large goitre (enlarged thyroid)
2 - enlarged lymph nodes
3 - malignancy
4 - achalasia

Answer 7

4 - achalasia
This is Intramural

a condition in which the muscles of the lower part of the oesophagus fail to relax, preventing food from passing into the stomach

Question 8

ENT doctors are involved in dysphagia when the problem is thought to be higher up. Which of the following is NOT a cause of dysphagia due to Intramural (part of the walls of the pharynx and oesophagus)?

1 - pharyngeal pouch
2 - enlarge thyroid
3 - stricture (benign/malignant)
4 - achalasia
5 - neurological: Motor neuron disease

Answer 8

2 - enlarge thyroid
This is Extraluminal

Question 9

ENT doctors are involved in dysphagia when the problem is thought to be higher up. Which of the following is NOT a cause of dysphagia due to Intraluminal (within the pharynx and oesophagus)?

1 - pharyngeal pouch
2 - foreign body
3 - pharyngeal cancer
4 - oesophageal cancer

Answer 9

1 - pharyngeal pouch
This is intramural

Question 10

Which of the following is not a diagnostic option when trying to diagnose dysphagia?

1 - radiological water soluble contrast swallow
2 - CT/MRI
3 - ultrasound
5 - examination in theatre (pharyngoscopy/oesophagoscopy)

Answer 10

3 - ultrasound

Not overly useful

Question 11

Pharyngeal pouches can form when there is weakness in the walls of the oesophagus called pulsion diverticulum that occurs in a weakness (Killian’s dehiscence). Which of the following do these patients NOT typically present with?

1 - dysphagia
2 - haemoptysis
3 - regurgitation of undigested food 4 - halitosis (bad breathe)
5 - aspiration/recurrent chest infections

Answer 11

2 - haemoptysis

Typically diagnosed clinically with a CT water soluble contrast swallow, where there will be pooling of contrast in pouch

Question 12

Pharyngeal pouches can form when there is weakness in the walls of the oesophagus called pulsion diverticulum that occurs in a weakness (Killian’s dehiscence). All of the following are treatment options for this, EXCEPT which one?

1 - SALT - assess swallow and modify 2 - Antibiotics for chest infection
3 - Liquid only diet
4 - Surgical

Answer 12

3 - Liquid only diet

Surgical options:
- Endoscopic stapling
- Open approach excision of pouch

Question 13

Laryngopharyngeal is inflammation of the pharynx and larynx, where reflux typically irritates the glottis and vocal cords. Which of the following do patients typically present with?

1 - catarrh (mucus build up)
2 - excessive throat clearing
3 - voice changes
4 - globus pharyngeus
5 - chronic cough
6 - always associated with gastroesophageal reflux symptoms

Answer 13

6 - always associated with gastroesophageal reflux symptoms

Can occur, BUT is not always present

globus pharyngeus = sensation of lump in the throat

Question 14

In Laryngopharyngeal reflux is oedema and erythema present?

Answer 14

• yes

Inflammation causes oedema and redness

Question 15

Which 2 of the following are the investigations of choice in Laryngopharyngeal reflux?

1 - endoscopy with biopsy
2 - water soluble contrast swallow
3 - pH manometry
4 - ultrasound

Answer 15

2 - water soluble contrast swallow
3 - pH manometry

pH manometry = gold standard

Question 16

Which of the following is NOT part of the normal management of patients with Laryngopharyngeal reflux?

1 - lifestyle change (reduce triggers)
2 - surgery
3 - stop smoking and alcohol intake
4 - proton pump inhibitors (omeprazole)
5 - gaviscon advance

Answer 16

2 - surgery

Sleeping in an upright position may also be helpful