Week 1

Question 1

What is Dysphagia

Answer 1

difficulty with propulsion from the mouth to the esophagus

Question 2

oral phase of swallowing

Answer 2

liquids: first bolus is sealed in the oral cavity anteriorly and hard palate posteriorly
solids: not sealed in oral cavity as it undergoes mastication

oral propulsion: tongue elevates to move the bolus posteriorly into oropharynx

Question 3

pharyngeal phase of swallowing

Answer 3

rapid phase of muscle contraction to propel the bolus through the upper esophageal sphincter and into esophagus

Question 4

esophageal phase of swallowing

Answer 4

relaxes during swallowing and lets the bolus pass

Question 5

patient reported symptoms (what they complain about)

Answer 5

coughing and choking during and/or after a meal
-food sticking
-regurgitation
-pain on swallowing
-unexplained weight loss
-nutritional deficiencies

Question 6

clinical signs

Answer 6

delay in propulsion
-misdirection of bolus
-reduction in tongue strength
-reduction in esophageal motility

Question 7

perceptible changes in eating habits

Answer 7

downgrading of diet

Question 8

medical complications

Answer 8

under-nutrition or aspiration pneumonia

Question 9

factors not related to mechanics of swallowing

Answer 9

reduced alertness and abnormalities in behavior

Question 10

feeding disorder

Answer 10

impairment of the food transport outside the alimentary canal

Question 11

eating disorder

Answer 11

usually does not have complaints of swallowing issues

Question 12

incidence

Answer 12

reported frequencies of new cases over a long period of time

Question 13

prevalence

Answer 13

of cases in a population over a short period of time

Question 14

why is frequency important

Answer 14

guides medical and healthcare practice

Question 15

prevalence in community

Answer 15

16-22%

Question 16

prevalence in geriatric health care

Answer 16

29-87%

Question 17

prevalence in acute care hospitals

Answer 17

13-33%

Question 18

prevalence in rehab

Answer 18

33% overall

Question 19

swallowing is a process that happens in 3 distinct stages

Answer 19

false

Question 20

prevalence in acute stroke

Answer 20

50%

Question 21

prevalence in subacute stroke

Answer 21

10-28%

Question 22

prevalence in long term stroke

Answer 22

10-15%

Question 23

prevalence in head and neck cancer

Answer 23

very high in acute phase and high percentage (30-60%) with persistent problems

Question 24

prevalence in head injury

Answer 24

acute is 78% and long term is 5%

Question 25

prevalence in progressive neurological disease

Answer 25

low in early disease due to it being pretty localized -increases with progression PD: 50-82% MND and MS: all in late stage MG: 30%

Question 26

prevalence in premature infants

Answer 26

up to 90% of low birth weight babies

Question 27

additional populations with high prevalence

Answer 27

muscular dystrophy, polymyositis, RA, scleroderma, sjogrens syndrome

Question 28

medical consequences

Answer 28

aspiration pneumonia: lung infection (bolus particles in airway and can't get out causing an infection -dehydration: mental confusion, organ failure -malnourishment: compromised immunity

Question 29

psychosocial consequences

Answer 29

eating is pleasurable -social limitations: loss of QOL, depression impact on spouse and family: burden

Question 30

clinical management: identification

Answer 30

screening: aims to identify those at risk (nurses screen) -clinical examinations: aim to determine if problem exists, including history taking, physical exam, food trials -instrumental examination: video fluoroscopy, endoscopy, manometry

Question 31

what type of treatment

Answer 31

behavioral: rehab and compensatory dietary: diet modifications medical surgical

Question 32

level of care

Answer 32

impacts -frequency of dysphagia -role of professional -access to medical specialities -management approach -duration of stay

Question 33

acute level of care

Answer 33

history taking, clinical eval, diagnosis, objective assessment

Question 34

NICU level of care

Answer 34

emphasizes coordinated team approach, cluster care

Question 35

Sub-acute level of care

Answer 35

implements therapy plans, Amy aim to restore oral feeding

Question 36

rehab level of care

Answer 36

usually patients good with physical stamina

Question 37

skilled nursing facility level of care

Answer 37

not candidates for rehab, high prevalence, chronic dysphagia, medical fragile, preventative goal, advance directive