Week 8.1

Question 1

Describe the appearance of a T1 weighted brain MRI.

Answer 1

white matter is hyperintense

Question 2

Describe the appearance of a T2 weighted brain MRI.

Answer 2

white matter is hypo intense and CSF is hyperintense

Question 3

Describe the appearance of a FLAIR MRI.

Answer 3

white matter and CSF is hypointense

Question 4

What is the density of water on CT?

Answer 4

0 Hounsfield units

Question 5

What are the major risks of angiopathy?

Answer 5

• vascular injury
• ischemic stroke
• intracerebral hemorrhage
• iodinated contrast complications
• prolonged x-ray exposure

Question 6

What is true of all enhancing lesions?

Answer 6

they have disrupted the BBB

Question 7

Why are CT angiograms less risky than conventional catheter angiograms?

Answer 7

because they involve a venous rather than an arterial injection

Question 8

What are the primary risks of CT?

Answer 8

• ionizing radiation exposure

- iodinated contrast exposure

Question 9

What are the potential complications of iodinated contrast exposure?

Answer 9

• allergic reaction

- nephrotoxicity

Question 10

What is a diffusion weighted MRI?

Answer 10

One in which areas of restricted fluid diffusion appear hyperintense

Question 11

What are the primary risks of MRI?

Answer 11

• claustrophobia
• long scan time
• ferromagnetic metals can’t go through
• gadolinium-associated sclerosing dermopathy in those with renal failure

Question 12

An fMRI measures what?

Answer 12

changes in oxygen delivery

Question 13

What is SPECT imaging?

Answer 13

• single photon emission CT
• inject a radioactive compound into the blood
• follow it, much like an fMRI

Question 14

How can you identify the medulla on MRI?

Answer 14

it is at the level of the cerebellum and is smaller (compared to the pons)

Question 15

How can you identify the third ventricle on MRI?

Answer 15

it is connected to the lateral ventricles and is superior compared to the more inferior fourth ventricle

Question 16

Name the four phases of swallowing.

Answer 16

• preparatory
• oral
• pharyngeal
• esophageal

Question 17

The preparatory phase of swallowing involves which cranial nerves?

Answer 17

V, VII, XII

Question 18

What does the oral phase of swallowing involve?

Answer 18

elevating the tongue to the palate and propelling the bolus into the pharynx while also closing the soft palate

Question 19

The pharyngeal phase of swallowing is initiated by what?

Answer 19

the food bolus contacting the pharynx

Question 20

What happens during the pharyngeal phase of swallowing?

Answer 20

• vocal folds close
• larynx elevates
• epiglottis shuts
• peristaltic contraction of pharyngeal constrictors
• relaxation of the cricopharyngeus muscle (UES)

Question 21

Which brainstem nuclei mediate swallowing?

Answer 21

• hypoglossal
• solitary
• ambiguous

Question 22

The pharyngeal phase of swallowing involves primarily which CN?

Answer 22

the vagus

Question 23

What is the role of the reticular formation in swallowing?

Answer 23

coordinate activity of the involved brainstem nuclei

Question 24

What is the purpose of the ambiguous nucleus in swallowing?

Answer 24

innervate branchial-derive muscles

Question 25

What is the role of CN IX in swallowing?

Answer 25

visceral afferent to help control swallowing

Question 26

The solitary nucleus plays what role in swallowing?

Answer 26

obtains sensory input to modulate swallowing

Question 27

Describe the input of corticobulbar tracts on swallowing?

Answer 27

bilateral innervation of the RAS

Question 28

What two things can cause delayed initiation of swallow reflex?

Answer 28

- weakness of tongue | - numbers of posterior palate and pharynx

Question 29

What two things can cause nasal reflux during swallow?

Answer 29

- weakness of palatal elevators | - weakness of upper pharyngeal constrictors

Question 30

Problems with which cranial nerve contribute most to nasal reflux during swallowing?

Answer 30

the vagus which innervates the palatal elevators and superior pharyngeal constrictors

Question 31

What two problems can lead to aspiration during swallowing?

Answer 31

- weakness of pharyngeal and laryngeal muscles | - pharyngeal numbness

Question 32

Name three complications of dysphagia.

Answer 32

- airway obstruction - aspiration pneumonia - poor nutrition

Question 33

Four methods for identifying dysphagia?

Answer 33

- patient self-reporting - CN exam - bedside swallow test - modified barium swallow

Question 34

Signs and symptoms of dysphagia.

Answer 34

- difficulty swallowing - weight loss - failure to finish meals - coughing while eating

Question 35

Problems swallowing liquids suggest what compared to problems swallowing solids.

Answer 35

- liquids: neurologic | - solids: mechanical problem (e.g. esophageal stricture)

Question 36

Bedside swallow test is abnormal if what occurs?

Answer 36

- coughing during or within 1 minute | - wet/hoarse quality to the person's voice after

Question 37

What are the five dietary textures?

Answer 37

- liquid - thickened liquid - puree - mechanical soft - regular

Question 38

What texture of food is often best for stroke patients?

Answer 38

a middle texture like puree

Question 39

Why can't stroke patients handle liquids or solids?

Answer 39

- liquids pose an aspiration risk | - solids are unlikely to be cleared and therefore obstruct the airway

Question 40

Name five swallowing maneuvers that can help those with dysphagia.

Answer 40

- sit fully upright - chin tuck/chin up - head turn - small bites - double swallow

Question 41

The chin up feeding maneuver is best for who?

Answer 41

those with a weak tongue and struggling with the oral phase

Question 42

The chin tuck feeding maneuver is best for who?

Answer 42

those with weak pharyngeal muscles because it narrows the pharyngeal space

Question 43

What are the cons go NG tubes?

Answer 43

- uncomfortable and pulled out - increased gastric reflux - increased saliva - interferes with airway protection