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Dysphagia > Quiz 1 > Flashcards

Quiz 1 Flashcards

1
Q

What are the two types of nervous systems

A

Central nervous system and peripheral nervous system

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2
Q

What are the two types of peripheral nervous systems

A

Autonomic nervous system and somatic nervous system

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3
Q

What are the two autonomic nervous system divisions

A

Sympathetic and parasympathetic

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4
Q

What are the two somatic nervous system divisions

A

Sensory and motor

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5
Q

Central nervous system

A

Integrates information received from the body and coordinates the activity

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6
Q

Peripheral nervous system

A

Connects the CNS to the limbs and organs; relay system between the brain and the extremities

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7
Q

Autonomic system

A

Involuntary responses that influence function of the internal organs

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8
Q

Somatic system

A

Communicates with sense organs and is primarily responsible for voluntary muscle movements

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9
Q

Parasympathetic nervous system

A

Responsible for the “rest and digest” action when the body is at rest

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10
Q

Sympathetic nervous system

A

Stimulate “flight or fight” response

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11
Q

Afferent/sensory

A

Impulses from peripheral tissues toward brainstem

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12
Q

Efferent/motor

A

Impulses from brainstem to muscles

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13
Q

Is swallowing voluntary or involuntary?

A

Both! Autonomic drive to eat and drink, sensory processing of bolus, reward component

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14
Q

What cranial nerves are involved in swallowing?

A

IV TRIGEMINAL, VII FACIAL, IX GLOSSOPHARYNGEAL, X VAGUS, XII HYPOGLOSSAL

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15
Q

Central pattern generator (CPG)

A

Houses the nucleus tractus solitarius (NTS) and nucleus ambiguus (NA)

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16
Q

Nucleus tractus solitarius (NTS)

A

Receives cranial nerve sensory input involved in swallowing

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17
Q

Nucleus ambiguus (NA)

A

Organizes motor components

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18
Q

Brainstem (CNS)

A

Houses the nuclei of the cranial nerves; also houses, respiratory centers and central pattern generators for chewing, respiration and pharyngeal swallow

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19
Q

Parts of brainstem

A

Medulla, pons and midbrain

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20
Q

Parts of the cortex

A

Limbic system, insula, thalamus, hypothalamus, basal, ganglia, cerebellum

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21
Q

Limbic system

A

Controls motions and drives

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22
Q

Insula

A

Monitors taste; modulate aspects of swallow

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23
Q

Thalamus

A

Relay station

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24
Q

Hypothalamus

A

Helps integrate the actions of the autonomic nervous system

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25
Q

Basal ganglia

A

Nuclei deep within the brain; important for motor control and movement

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26
Q

Cerebellum

A

“Little brain”; coordinating movement

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27
Q

“Control circuits”

A

Basal ganglia and cerebellum

28
Q

Cortex

A

Sensory, motor, limbic, cognitive

29
Q

Main goals of swallowing

A

Bolus efficiency and airway protection

30
Q

Normal swallow

A

Involves movement of 50+ muscles in the oral cavity, pharynx, larynx and esophagus; movements controlled by cranial nerves and peripheral (C1-C3 nerves)

31
Q

Stages of swallow

A
  1. Oral preparatory stage
  2. Oral stage
  3. Pharyngeal stage
  4. Esophageal stage
32
Q

Oral prep phase

A

Food manipulation and mastication; bolus mixes with saliva and divides for transport; almost entirely voluntary, can be interrupted anytime

33
Q

Oral prep muscles

A

Zygomaticus major and minor; buccinator; masseter; orbicularis oris

34
Q

Oral transport/oral phase

A

Propulsion/transit of the bolus; tongue contracts against hard palate; tongue serves as anchor during hyoid elevation and UES opening

35
Q

Tongue

A

Muscular hydrostat (no skeletal support, used for food manipulation); all muscles innervated by hypoglossal nerve

36
Q

Muscles of the tongue

A

4 intrinsic
4 extrinsic

37
Q

Intrinsic tongue muscles

A

Superior longitudinal, inferior longitudinal, vertical, transverse

38
Q

Extrinsic tongue muscles

A

Genioglossus, styloglossus, hyoglossus, palatoglossus

39
Q

Anterior tongue

A

Formation, placement and manipulation of the bolus in the oral cavity

40
Q

Posterior tongue

A

Containment of the bolus in the oral cavity and propulsion into the pharynx

41
Q

Masseter

A

Elevates the mandible

42
Q

Temporalis

A

Elevates and retract the mandible

43
Q

Medial pterygoid

A

Closes the jaw by raising the mandible against the maxilla

44
Q

Lateral pterygoid

A

Assists in opening the mouth by drawing the condyle and articular disc forward

45
Q

Salvation

A

Motor response controlled by the salivary nucleus in the brainstem; activated by stimulation of taste receptors on anterior 2/3 of the tongue; contains enzymes for digesting starches and mucous for lubrication

46
Q

Successful prep phase

A
  1. Labial seal
  2. Buffaloes and facial tone
  3. Adequate and appropriate tongue movements
  4. Lowering the velum
  5. When necessary, mastication of the material, with lateral and rotary motion of the mandible.
47
Q

Primary goal of the oral cavity for oropharyngeal swallowing

A
  1. Processing food for safe swallowing
  2. Posteriorly propelling the food into the pharynx to be swallowed (tongue)
48
Q

Pharyngeal phase

A

Shortest, but most complex; reflexive/automatic, irreversible motor event; requires 1-1.5 seconds to complete;

49
Q

Pharyngeal phase: affects the following automatic reactions

A

Velopharyngeal closure, closure of larynx, pharyngeal, peristalsis, elevation and anterior pull of the larynx, relaxation of UES/PES

50
Q

Velopharyngeal closure

A

Contracts tensor veli palatini, lavatory veli palatini, musculus uvulus

51
Q

Closure of larynx

A

True VFs adduct, 0.3-2.5 seconds of apnea occurs; epiglottis directs bolus toward UES/PES and protects airway; pharyngeal peristalsis begins before laryngeal elevation

52
Q

Airway protection

A

Epiglottis inversion; aryepiglottic fold bunching; arytenoid anterior pivoting; arytenoid adduction

53
Q

Larynx innervation

A

All muscles innervated by Vagus

Superior laryngeal nerve (SLN) and recurrent laryngeal nerve (RLN)

54
Q

What is a cough?

A

A defensive respiratory event that begins with a brief inspiration, followed by expiration against a closed glottis, which produces large increases in intrapulmonary pressures

55
Q

Bolus efficiency

A

Laryngeal elevation —> UES traction (stretching)

56
Q

Muscles of the pharynx

A

Semicircular muscles (3 sets), paired muscles (2)

57
Q

Semicircular muscles

A

Constriction

Superior constrictor, middle constrictor, inferior constrictor

58
Q

Paired muscles of the pharynx

A

Shortening and elevation

Salpingopharyngeus, stylopharyngeus, palatopharyngues

59
Q

Key muscles in pharyngeal phase

A

Palatopharyngeal, thyrohyoid, middle pharyngeal constrictor, inferior pharyngeal constrictor, stylopharyngeus, salpingopharyngeus, cricopharyngeus

60
Q

Pharyngeal constriction and elevation

A

Via sequential contraction of superior, middle, then inferior constrictors

Approximately 400 msec

61
Q

Motor innervation

A

All muscles of the pharynx, except stylopharyngeus innervated by the pharyngeal plexus

62
Q

Suprahyoids

A

Hyolaryngeal elevators; “sling muscles”

Anterior digastric, posterior digastric, mylohyoid, geniohyoid, stylohyoid

63
Q

Infrahyoids

A

Hyolaryngeal depressors; “strap muscles”

Omohyoid, sternohyoid, sternothyroid, thyrohyoid

64
Q

Pharyngeal phase

A

Bolus hits anterior faucial pillars; airway protection; pharyngeal muscles contract raising the pharynx; tongue base retracts to PPW; pharyngeal constrictors are activated in to steal-caudal direction causing pharyngeal peristalsis; suprahyoid muscles contract and hyoid moves superioly and anteriorly; thyroid contracts and larynx moves towards the hyoids creating negative pressure below bolus to “suck” it towards the esophagus; epiglottis inverts; laryngeal and pharyngeal elevation pull cricoid away from PPW opening the cricopharyngeus muscle; if labial and nasopharyngeal seal are intact the UES opening creates more “suction force” that combine with driving force of the tongue and pharyngeal stripping wave to enhance bolus efficiency

65
Q

Esophageal phase

A

Starts after bolus passes through UES; relaxation of crisopharyngeus lasts 0.5-1.2 seconds; cricopharyngeus goes back to contracted state to avoid any retrograde flow; esophageal peristalsis is then activated and bolus is propelled towards the LES and stomach; peristaltic wave travels, inferiorly squeezing bolus through esophagus; after hypopharyngeal pressure peaks the LES is triggered to relax and bolus is squeezed into stomach; several secondary waves occur up to an hour after the swallow to clear any esophageal residue

In healthy adults esophageal transit time is between 8 and 13 seconds

Dysphagia (2 decks)

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