Interim 1

Question 1

Define dysphagia

Answer 1

Dysphagia is an abnormality in the transfer of a bolus from the mouth to stomach, including abnormalities in the oral preparatory, oral, pharyngeal and/or esophageal stages

Question 2

Define feeding disorder

Answer 2

A feeding disorder is
an impairment in the process of food transport outside of the alimentary system, e.g., weakness or incoordination of the arm to move food from the plate to the mouth

Question 3

List overt characteristics of dysphagia

Answer 3

Difficulty chewing
Difficulty with bolus preparation
Drooling
Choking
Regurgitation
Sense of food sticking in throat
Pain

Question 4

List occult or covert characteristics of dysphagia

Answer 4

Silent laryngeal penetration and aspiration

Question 5

Define incidence rate

Answer 5

number of new cases of a disease over a period of time divided by population at risk of the disease in the time period

Question 6

Define prevalence rate

Answer 6

total number of cases of a disease at a given time divided by total population at risk at a given time

Question 7

List consequences of dysphagia

Answer 7

Aspiration pneumonia
Malnutrition >>> weight loss, poor healing, susceptibility to other illnesses
Dehydration
Airway obstruction
Death
Decreased quality of life
Health care costs

Question 8

List the stages of swallowing

Answer 8

Oral preparatory
Oral
Pharyngeal
Esophageal

Question 9

What is the relevance of bony structures in relation to speech/swallow?

Answer 9

Bony structures are anchor points for muscles involved in speech/swallow

Question 10

List structures included in a visual inspection of the oral cavity

Answer 10

Lips
Sulci
Gums
Dentition
Faucial pillars
Roof of mouth
Tongue
Posterior pharyngeal wall

Question 11

List the points of attachment for muscles associated with bolus preparation/propulsion

Answer 11

Temporal bones
Sphenoid bone
Maxillae
Mandible
Palatine bone

Question 12

Describe the temporal bones

Answer 12

Form lateral sides of the cranium
Forms footing for the temporomandibular joint
Has three processes which are important attachment sites for muscles used during swallow

Question 13

Describe the sphenoid bone

Answer 13

Located deep within cranium
Bat-shaped
Attachment sites for several muscles associated with swallowing

Question 14

Give characteristics of the facial skeleton

Answer 14

Comprised of the maxillae and mandible
Anchor sites for dentition
Attachment sites for muscles of facial expression and mastication
Vital role in oral stage
Grinding food
Bolus formation
Oral pressure generation

Question 15

Describe the maxilla

Answer 15

Forms framework for anterior aspect of midface, initial portion of hard palate, inferior surface of orbital cavity, and lateral sides of nasal cavity
Meets zygomatic or cheek bone and adjoined by L-shaped palatine bones
Houses maxillary dentition
Serves as contact point for tongue during oral stage

Question 16

Describe the mandible

Answer 16

U-shaped
Body, angle, ramus
Has ridges for muscle attachments
Lingual surface: attachment for extrinsic muscles of tongue and muscles of FOM

Question 17

Describe the temporomandibular joint

Answer 17

Formed by articulation of condylar process of the mandible at the mandibular fossa of the temporal bone
Allows movement in three planes for rotary displacement of jaw
Depression/elevation
Protrusion/retraction
Lateralization

Question 18

List structures associated with the palate

Answer 18

Palatine processes = three quarters of hard palate
Palatine bone = posterior one-quarter of hard palate
Attachment for palatal aponeurosis

Question 19

What actions should be analyzed in a swallow study?

Answer 19

Oral phase
Tongue-palate seal
Nasopharyngeal seal
Compression/propulsion of bolus
Hyoid/laryngeal elevation
Epiglottic tilt
Cricopharyngeal opening
Esophageal peristalsis

Question 20

What structures should be analyzed in a swallow study?

Answer 20

Tongue
Hard palate
Velum
Epiglottis
Hyoid/larynx
Pharyngeal constrictors
Cricopharyngeus/UES
Esophagus

Question 21

List normal actions that occur in the oral phase

Answer 21

Lips engulf bolus
Bolus is held at rest in front of mouth
Masticate if needed
Tongue transfers bolus into pharynx

Question 22

Describe a typical tongue-palate seal

Answer 22

Soft palate rests against posterior tongue blade without kinking

Question 23

Describe a typical soft palate-pharyngeal seal

Answer 23

Soft palate elevates to appose Passavant’s cushion

Question 24

Describe typical bolus compression and propulsion

Answer 24

Retraction of base of tongue

Progressive contraction of constrictors

Question 25

Describe typical hyoid elevation, laryngeal closure, and epiglottic tilt

Answer 25

Larynx moves upward and forward as bolus enters oropharynx Epiglottis moves horizontally Epiglottis inverts Airway is protected by “triple action”

Question 26

Describe typical actions of the cricopharyngeal opening

Answer 26

Closed between swallows | Relaxes and opens completely to allow bolus to flow form pharynx into esophagus

Question 27

Describe the typical action of the esophagus

Answer 27

Peristalsis

Question 28

List atypical actions of the esophagus

Answer 28

Dysmotility Reflux Spasm

Question 29

List characteristics involved in esophageal dysphagia

Answer 29

Stenosis (rings, webs, stricture, tumor, extrinsic compression) -Solid food dysphagia -Liquid dysphagia preceded by solid food ingestion Diverticula -Retention -Regurgitation -Halitosis

Question 30

List characteristics of structural abnormalities

Answer 30

``` Is a structure: Resected/absent Replaced Altered in some way Thickened Asymmetric Too large/too small Is there something there that shouldn’t be? Pouch Diverticulum Mass Foreign body Fistula ```

Question 31

Describe the pharynx

Answer 31

Suspended from base of skull and attached to the top of sternum Contiguous with oral cavity, palate, tongue, nasal cavity, eustachian tube Formed by 26 pairs of striated muscles Innervated by six cranial nerves and four cervical nerves

Question 32

Describe the nasopharynx

Answer 32

Extends from base of skull to pharyngeal isthmus Demarcated by soft palate anteriorly and by a prominence in the posterior wall at first cervical body Lies above velum

Question 33

Describe the oropharynx

Answer 33

Extends inferiorly from BOT to hyoid Bordered by tongue anteriorly and by pharyngeal constrictors posteriorly Separated from oral cavity by faucial arches

Question 34

Describe the hyppharynx

Answer 34

Extends from valleculae to pharyngo- esophageal segment (PES) inferiorly Larynx forms the anterior wall

Question 35

Define pharyngeal constrictors

Answer 35

Fibers arise from median raphe in the midline of the posterior pharyngeal wall and run laterally to attach to bony and soft tissue structures anteriorly Comprise external circular layer

Question 36

List the functions of the pharyngeal constrictors

Answer 36

Constrict or reduce the diameter of pharynx | Clear bolus through pharynx

Question 37

Name the pharyngeal constrictors

Answer 37

``` Superior Glossopharyngeus Middle Hypopharyngeus Inferior Thryopharyngeus Cricopharyngeus ```

Question 38

Describe the internal longitudinal layer

Answer 38

``` Salpingoharyngeus Draws lateral wall of pharynx up Palatopharyngeus Draws muscular palate down Stylopharyngeus Elevates pharynx and to some extent larynx ```

Question 39

Define vallecula

Answer 39

Lateral recesses at the BOT on each side of epiglottis

Question 40

Give characteristics of the epiglottis

Answer 40

Extends from BOT into pharyngeal cavity Attached to thyroid notch by a ligament Deflects bolus stream laterally into pyriforms Epiglottic folding occurs by laryngeal elevation, increased pressure in preepiglottic fat space, weight of bolus

Question 41

Describe the pyriform sinuses

Answer 41

Lateral recesses between larynx and anterior hypopharyngeal wall Formed by attachment of inferior constrictors to thyroid cartilage

Question 42

Describe the cricopharyngeus

Answer 42

``` Lies at transition between pharynx and esophagus Acts as a sphincter Tonic contraction at rest Relaxes during swallowing Inserts on cricoid and encircles pharynx ```

Question 43

Describe the larynx

Answer 43

``` Anterior to hypopharynx at upper end of trachea Cartilaginous Hyoid Thyroid Cricoid ```

Question 44

List and desribe structures located in the larynx

Answer 44

Arytenoids are true synovial joints Positioned on rim of cricoid Laryngeal aditus Uppermost portion of entry to airway Laryngeal vestibule Supraglottic space between aditus and ventricular or false vocal folds False vocal folds Shelf of tissue Separate laryngeal vestibule and ventricle Laryngeal ventricle Inferior margin is true vocal folds True vocal folds Composed of vocalis and thyroarytenoid muscles Attached from the vocal processes of the arytenoids posteriorly to the inside surface of thyroid lamina laterally and to the thyroid notch laterally

Question 45

Describe extrinsic musculature

Answer 45

``` Elevate hyoid Suprahyoid muscles Geniohyoid Mylohyoid Digastric Stylohyoid Depress hyoid Infrahyoid muscles Thyrohyoid Sternohyoid Sternothyroid Omohyoid ```

Question 46

Describe intrinsic musculature

Answer 46

``` Abduction Posterior cricoarytenoid Adduction Thryoarytenoid Lateral cricoarytenoid Transverse and oblique arytenoid Thyromuscularis Cricothyroid Only laryngeal muscle supplied by the external branch of the superior laryngeal nerve rather than the recurrent laryngeal nerve ```

Question 47

Give characteristics of false vocal folds

Answer 47

``` Outcroppings of mucosal tissue Not muscular structures Adducted when the arytenoid cartilages are displaced medially and anteriorly Oblique interarytenoids Aryepiglottic muscle ```

Question 48

Give characteristics of the esophagus

Answer 48

``` Collapsed muscular tube 18-25 cm Upper third Striated Controlled by CNS Middle third Combination of striated and smooth Lower third Smooth Controlled by ANS ```

Question 49

List the muscles of the esophagus

Answer 49

Exterior Longitudinal muscles Interior Circular muscles

Question 50

Define peristalsis

Answer 50

Constriction by contraction of circular muscles | Shortening by contraction of longitudinal muscles

Question 51

Describe the upper esophageal sphincter

Answer 51

High pressure zone between pharynx and esophagus Formed by Cricopharyngeus Inferior fibers of inferior constrictor Superior portion of longitudinal esophageal musculature

Question 52

Describe the lower esophageal sphincter

Answer 52

Junction between esophagus and stomach Maintains resting tone to prevent regurgitation Opens to permit liquid or food into stomach

Question 53

List the cranial nerves involved in speech and swallow

Answer 53

``` Trigeminal V Facial VII Glossopharyngeal IX Vagus X Accessory XI Hypoglossal XII ```

Question 54

Trigeminal nerve

Answer 54

Largest cranial nerve Has three divisions Ophthalmic (sensory) Maxillary (sensory) Mandibular (motor and sensory) Motor to muscles of mastication, tensor tympani, tensor veli palatini, anterior digastric, mylohyoid Sensory for eyes, nose, maxillary sinus, head, face, mouth, teeth, oral tongue

Question 55

Facial nerve

Answer 55

Motor to facial muscles, platysma, buccinator, stapedius, posterior belly of digastric, stylohyoid Sensory to anterior two-thirds of tongue and soft palate Motor autonomic to submandibular and sublingual glands

Question 56

Glossopharyngeal nerve

Answer 56

Motor to stylopharyngeus and PES Sensory to oropharynx and posterior third of tongue Parasympathetic to parotid

Question 57

Vagus nerve

Answer 57

Superior laryngeal nerve Sensory to epiglottis, supraglottis, hypopharynx, posterior larynx, pyriforms Inferior or recurrent laryngeal nerve Motor to intrinsic laryngeal muscles, PES Motor to heart, lungs, bronchii, GI tract, pharynx, BOT, larynx Sensory to heart, lungs, bronchii, trachea, larynx, pharynx, GI tract, external ear

Question 58

Accessory nerve

Answer 58

Cranial portion Motor to pharynx, upper larynx, uvula, palate Sends fibers to recurrent laryngeal nerve and cardiac nerves Spinal portion Motor to upper portion of sternocleidomastoid and trapezius muscles Sends branches to C 2-4

Question 59

Hypoglossal nerve

Answer 59

Motor to tongue and strap muscles of neck

Question 60

List atypical features of the oral phase

Answer 60

``` Drooling (anterior loss of bolus) Poor bolus formation Multiple tongue movements Prolonged oral stage Difficulty initiating a swallow Unable to propel bolus posteriorly Reduced lingual movement Failure to obliterate oral cavity Loss of bolus into FOM Loss of bolus through lips Pooling or pocketing Oral residue Asymmetry of bolus at rest ```

Question 61

Characterize abnormal features of a tongue-palate seal

Answer 61

Kinking of soft palate Loss of bolus over tongue Premature leakage Potential for aspiration

Question 62

Describe atypical features of the soft palate-pharyngeal seal

Answer 62

Sluggish elevation of the soft palate Nasopharyngeal regurgitation Dependent on strength of seal and inferior constrictors

Question 63

Give abnormal features of bolus compression and propulsion

Answer 63

Diminished constriction Failure of lateral pharyngeal walls to come to midline Unilateral asymmetry Retention in vallecula and/or pyriforms

Question 64

List abnormal actions involved in hyoid elevation, laryngeal closure, and epiglottic tilt

Answer 64

``` Absent or diminished hyoid to mandible apposition Incomplete or absent epiglottal tilt Vallecular retention Vocal folds open during swallow Laryngeal penetration/aspiration ```

Question 65

Describe abnormalities in the cricopharyngeal opening

Answer 65

Opens late or incompletely Closes early Cricopharyngeal prominence or “bar” Trapping of bolus