Quiz #12

Question 1

Oral preparatory stage

Answer 1

• voluntary stage of swallow
• length depends on substance eaten
• food is placed in mouth and prepared for swallowing
• labial seal produced
• oral breathing ceases and nasal breathing takes its place

Question 2

Oral prep stage: mastication

Answer 2

• CN V (mandibular branch) innervates muscles for mastication (chewing)

Question 3

Mandibular elevators

Answer 3

masseter
temporalis
pterygoids

Question 4

Masseter

Answer 4

closes mandible
cutting food with teeth

Question 5

Temporalis

Answer 5

prime muscles for grinding

Question 6

Pterygoids

Answer 6

prime muscles for grinding

Question 7

Mandibular depressors

Answer 7

mylohyoid
anterior belly of digastric muscle

Question 8

Mylohyoid

Answer 8

support floor of mouth and elevates hyoid bone, impacts tongue for bolus movement

Question 9

Anterior belly of digastric muscle

Answer 9

elevates hyoid

Question 10

Oral stage

Answer 10

• voluntary stage of swallow
• lasts 1 second
• begins once mastication ends
• tongue forms ramp and moves bolus from the oral cavity to the pharyngeal cavity
• labial seal and nasal breathing mantained

Question 11

Oral stage: labial seal

Answer 11

• facial muscles, including lip muscles, controlled by facial nerve (CN VII)
• main lip muscle is the obicularis oris
• labial seal is important for keeping bolus in the oral cavity

Question 12

Oral stage: tongue retraction

Answer 12

• CN V helps retract tongue
• controls digastric and mylohyoid muscles (tongue muscles)
• helps tongue form into a ramp to move the bolus posteriorly

Question 13

Oral stage: anterior-posterior bolus movement

Answer 13

• hypoglossal nerve (CN XII) controls most of the intrinsic and extrinsic tongue muscles
• helps form tongue ramp
• innervates tongue to squeeze bolus from the anterior part of the mouth to the posterior part of the mouth

Question 14

Pharyngeal stage

Answer 14

• involuntary stage
• lasts 1 second
• as bolus contacts faucial arches:
  soft palate elevates
  vocal cords adduct
  respiration pauses
  larynx elevates
  cricopharyngeus relaxes

Question 15

Pharyngeal stage: soft palate closure

Answer 15

• crucial in keeping food/liquid out of nasal cavity
• 5 muscles are involved in soft palate movement and 3 CN’s: CN V, X, XI

Question 16

Pharyngeal stage: pharyngeal constriction

Answer 16

• CN X and XI control the following pharyngeal muscles:
  superior pharyngeal constrictor
  middle pharyngeal constrictor
  inferior pharyngeal constrictor
• this constricting movement accounts for the squeezing sensation we feel in the throat during the pharyngeal swallow
• the bolus is squeezed through the pharynx

Question 17

Esophageal stage: esophageal opening

Answer 17

• upper esophageal sphincter controlled by cricopharyngeus
• innervated by the vagus nerve
• normally contracted muscle, but relaxes and opens when bolus moves through the pharynx

Question 18

Brainstem involvement

Answer 18

• 2 important brainstem nuclei: nucleus tractus solitarius (NTS) and nucleus ambiguous (NA)
• NTS and NA are often discussed as a functional unit and called the swallowing center of the medulla

Question 19

Nucleus tractus solitarius (NTS)

Answer 19

• located in medulla
• acts as swallowing sensory center
• receives afferent information from CN V, VII, IX, X
• afferent information includes taste and touch as well as respiratory and cardiovascular input
• sends information to second muscles

Question 20

Nucleus ambiguous (NA)

Answer 20

• located in medulla
• motor swallowing center
• innervates the swallowing muscles via CN IX, X, XII

Question 21

Primary motor cortex (BA 4) activates

Answer 21

voluntary muscles of swallowing

Question 22

Primary sensory cortex (BA 1-3) processes

Answer 22

sensation of eating

Question 23

Insula mediates

Answer 23

motor and sensory information involved in swallowing as well as provide some level of swallowing control

Question 24

Anterior cingulate cortex provides

Answer 24

attention needed in swallowing

Question 25

Premotor cortex (BA 6)

Answer 25

plays a role in motor planning of swallowing

Question 26

Thalamus and basal ganglia incorporate

Answer 26

sensory info from food and liquid into swallowing as food and liquid pass through the swallowing structures

Question 27

Neurology of cough response

Answer 27

3 main components: 1. afferent vagus fibers convey sensory info from cough receptors in the swallowing tract 2. this information goes to a cough center in the brainstem (medulla) 3. efferent signals are sent from cough center to respiratory muscles and larynx to generate cough

Question 28

Cough receptors

Answer 28

larynx and posterior wall of pharynx, specifically epiglottis, and where pharynx and esophagus meet

Question 29

Neurology of silent aspiration

Answer 29

- aspiration occurs when the bolus penetrates the airway below the level of the vocal cords - about 1/3 of dysphasic patients aspirate without any signs (i.e., no cough) - neurological damage can suppress the couch response system

Question 30

Clinical indicators of aspiration

Answer 30

1. dysphonia 2. dysarthria 3. abnormal gag reflex 4. abnormal volitional cough 5. cough after swallow 6. voice change after swallow

Question 31

Dysphonia

Answer 31

a voice disturbance in the parameters of vocal quality, pitch, or intensity

Question 32

Dysarthria

Answer 32

a speech disorder resulting from disturbances in muscular control affecting the areas of respiration, articulation, phonation, resonance, or prosody

Question 33

Abnormal gag reflex

Answer 33

either absent or weakened velar or pharyngeal wall contraction, unilaterally or bilaterally, in response to tactile stimulation of the posterior pharyngeal wall

Question 34

Abnormal volitional cough

Answer 34

a weak response, verbalized response, or no response when given the command to cough

Question 35

Cough after swallow

Answer 35

cough immediate or within 1 minute of ingestion of calibrated volumes of water (5, 10, and 20 mL presented in duplicate)

Question 36

Voice change after swallow

Answer 36

alteration in vocal quality following ingestion of calibrated volumes of water

Question 37

Swallowing problems associated with neurological damage: oral prep stage

Answer 37

- difficulty chewing - food falling out of mouth (poor lip seal)

Question 38

Swallowing problems associated with neurological damage: oral stage

Answer 38

- food remaining in mouth (pocketing) - difficulty forming bolus - difficulty moving bolus backwards in mouth

Question 39

Swallowing problems associated with neurological damage: pharyngeal stage

Answer 39

- swallow delay - swallow absence - pooling of bolus

Question 40

Swallowing problems associated with neurological damage: esophageal stage

Answer 40

- bolus staying in esophagus (dysmotility due to lack of peristaltic waves)

Question 41

Stroke symptoms in the cortex

Answer 41

weakness or paralysis and loss of sensory information, resulting in: - poor oral prep stage - residue due to sensory deficits - slow oral transit - delayed swallow initiation - weak pharyngeal phase - weakness/paralysis of vocal cords

Question 42

Stroke symptoms in the cortex: Apraxia

Answer 42

- impairment in the motor planning for swallowing - will be unable to complete a dry swallow on evaluation but often do better with trials

Question 43

Stroke symptoms in the subcortex

Answer 43

impaired motor control of oral structures may result in: - slow oral phase - slow oral transit - delayed pharyngeal phase

Question 44

Stroke symptoms in the brainstem

Answer 44

impaired center for automatic swallow response may result in: - functional oral and oral prep stage - complete loss of or delayed swallow response

Question 45

Stroke symptoms in the cerebellum

Answer 45

loss of coordination may result in: - poor oral phase due to difficulty coordination formation of bolus - discoordination of swallow response in pharyngeal phase