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Dysphagia

mathieteal Englisch 206 Karten

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  1. 1dysphagia is a symptom or a diagnosis?always a symptom
  2. 2Is dysphagia it's own separate diagnosis?No, it is always part of some disease
  3. 3Name three people on the dysphagia team?primary physician, client, SLP, OT, PT, dietician, family, nurse, radiologist,
  4. 4How many phases to a swallow?3
  5. 5what are the three phases of a swallow?1. oral
    2. pharyngeal
    3. esophogeal
  6. 6what happens during the oral phase of the swallow?form a bolus, mastication, oral transit
  7. 7what happens during oral transit?Food is moved by back 3rd of tongue to the faucial pillars to prep for a swallow
  8. 8What part of the body may be weak and cause the oral phase of a swallow not to work?The tongue
  9. 9Which phase (1, 2, 3) is the actual swallow of a swallow?2 - pharyngeal,.
  10. 10If your esophogus doesn't work, can you swallow?No.
  11. 11Can you see the submucus cleft when you open your mouth?Yes
  12. 12Vocal folds, abduct or adduct during a swallow?adduct
  13. 13vocal folds add or abd when you say "Ah"?Abduct
  14. 14Can you diagnose someone if they can't say "ah"? or have no voice?No. You need an ENT to see what is happening with the vocal folds.
  15. 15Should you help a person with no voice before knowing what their vocal folds look like?No. May have nodes, polyps, tumors. Wait for an ENT to investigate
  16. 16What happens during the pharyngeal phase of the swallow?You move the food down the throat into the esophagus.
  17. 17Can you see the pharyngeal phase of the swallow?no. You can feel it by palpitating their throat.
  18. 18Someone says food gets stuck in the chest, which phase of the swallow is this?esophageal
  19. 19food is stuck in the throat, which phase of the swallow?Phayngeal
  20. 20Slurred speech is related to what diagnosis?Dysarthria
  21. 21Who can diagnosis dysarthria?Neurologist
  22. 22Do you worry about the swallow of an apraxic or dysarthric person?Dysarthric... they have a nuerological problem.
  23. 23What disorder is this: the person can talk with great fluidity, but nothing is intelligible?Apraxia
  24. 24You can talk, but you can't get the words out, what is this known as?Dispraxia
  25. 25Do you worry about a dispraxic person?No... tongue movement is strong, but off. They will have the strength to swallow.
  26. 26Which, L/R, CVA is related to apraxia?Left CVA
  27. 27Which, L/R, CVA is related to dysarthria?R CVA
  28. 28Do you worry about the L or R CVA patient first for swallowing?R CVA - dysarthria.
  29. 29Which nerves are important to swallow? (how many?)Five, 5, 7, 9, 10, 12
  30. 30What is CN V?Facial Nerve
  31. 31CN V controls what?muscles of expression
  32. 32Physicians Test, Corneal Reflex, what nerves are they testing?CN V & VII
  33. 33How can you test CN VII? (Not the Corneal Reflex test)Wrinkle brow
    Smile
    purse lips
    puff cheeks
    frown
    squeeze eyes closed
    look for facial symmetry in patient
  34. 34CN VII - expression - is efferent. Where does it come from?Brainstem, the pons
  35. 35What is the motor function of CN VII?Control and relax muscles
  36. 36Name the two muscles of CNVII?Digastric and stylohyoid
  37. 37What is the role of the digastric muscle?Elevates the hyoid bone
  38. 38Where is the hyoid bone located?Top of the larynx
  39. 39Is the hyoid bone necessary for a swallow to occur?Yes!
  40. 40The digastric muscle also depresses what?Mandible
  41. 41What are the sensory parts of CN VII?Nervus intermedius
  42. 42Nervus intermedius has what two components?Sensory and parasympathetic
  43. 43CN VII also supplies a small amount of sensory input where?Oral pharynx
  44. 44Where is the oral pharynx located?Below palatine tonsil
  45. 45How many branches does the CN VII have?5
  46. 46The 5 branches of the CN VII are located where?Parotid gland
  47. 47Name the 5 branches of CN VII:1. sygomatic
    2. temporal
    3. buccal
    4. marginal mandibular
    5. cervical
  48. 48CN V is called what?Trigeminal nerve
  49. 49which nerve is the largest?CN V - trigeminal
  50. 50CN V does what?Supplies sensation to the face, mucous membranes, head
  51. 51Which nerve is the longest and most complex?CN V - Trigeminal
  52. 52CN V innervates what?Muscles of mastication
  53. 53What areas of mastication does CN V innervate? (4)1. myohoid
    2. tensor tympani
    3. tenso veli palatini
    4. anterior belly of the digastric
  54. 54There are how many branches of the trigeminal?3
  55. 55What are the 3 branches of the trigeminal called?1. opthalmic
    2. Maxillary
    3. Mandibular
  56. 56CN V: Opthalmic is for:Sensation of the scalp/forehead.
  57. 57CN V: Maxillary is for:sensation of the lower eyelid, cheek, sinuses, palate, root of the pharynx
  58. 58CN V: Mandibular is for:mixed motor and sensory branch.
  59. 59Which part of the trigeminal nerve is the longest branch?Mandibular
  60. 60What are the three branches of the trigemina?1. Opthalmic
    2. Maxillary
    3. Mandibular
  61. 61Opthamlic provides sensation of the ...?Scalp and forehead
  62. 62Maxillary has sensation of the...lower eyelid, cheek, sinuses, palate, roof of the pharynx
  63. 63Mandibular has mixed motor and sensory. It innervates?mylohyoid
  64. 64Mandibular is the anterior/posterio belly of what?Anterior belly of the digastric
  65. 65What does the mandibular provide sensation to?molars, premolars, incisors, chin
  66. 66Where does the mylohyoid run from?mandible to the hyoid
  67. 67Mylohyoid provides what?Forms the floor of the oral cavity
  68. 68What does the mylohyoid elevate?The hyoid bone and the tongue
  69. 69What happens if the hyoid is fixed in place by other muscles, the mylohyoid will do what?Depresses the mandible
  70. 70What does the anterior belly of the digastric do?Elevates the hyoid
  71. 71If the anterior belly of the digastric has the hyoid fixed in place by other muscles, what will it do?Depress the mandible.
  72. 72What portion of the tongue controls taste?anterior 1/3
  73. 73How can you get dysphagia? Name a few...cancer, stroke, nuerological damage, surgery, incubated, dementia, prematurity, hospitalization, tracheostomy, vent dependecy.
  74. 74Is dysphagia always similar?No, can be mild to severe, can have an ability to eat to no ability to eat.
  75. 75What is the #3 reason of cause of death?Stroke
  76. 76How many patients have difficulty swallowing post stroke?30-40%
  77. 77How many stroke patients die of aspiration in the first year?20%
  78. 78How many stroke patients die of aspiration pneumonia after the 1st year?10-15%
  79. 79Which part of the brain has the highest rate of damage causing dysphagia?Brainstem
  80. 80If you get damaged to this part of the brain, it's often unremitting, what is it?Brainstem.
  81. 81Which hemisphere post CVA causes oral phase disorders?L hemisphere
  82. 82Which hemisphere post CVA has pharyngeal phase disorders?Right
  83. 83Rank in order of concerns for swallowing: L CVA, Brainstem, R CVABrainstem, R CVA, L CVA
  84. 84What are aspects of cognition?Attention, memory, concentration, comprehension, problem solving
  85. 85What is nosocomial pneumonia caused from and what is it associated with?not due to aspiration and associated wtih flus
  86. 86What % of normal elderly people have problems swallowing?50%
  87. 87Why may an older person have difficulty swallowing?- false teeth
    - teeth don't work to chew food
    - misfitted dentures
    - gum disease
  88. 88What is the best plan for a person w/ dysphagia?A plan they can follow!
  89. 89Explain what a supraglottic swallow is?suck in air, swallow, cough the exhale out
  90. 90What is the Shakir Exercise?lay on your back and lift your head
  91. 91Can people in acute care do the shakir exercise?No, they are compromised.
  92. 92Which patients should you NOT take risks with?Critically ill
  93. 93Where are 95 % of tumors located for people with swallowing problems?aerodigestive tract
  94. 94What is NPO?You're allowed nothing by mouth
  95. 95reasons why someone may be NPO?- absent swallow
    - chocking when swallowing
    - can't breathe
  96. 96CN V supplies general sensation or taste from the anterior 2/3 of tongue?Sensation
  97. 97CN V or VII supplies taste from anterior 2/3 of the tongue?CN VII
  98. 98What part tenses the soft palate and assists the levator veli palatini to close the nasopharynx so food does not come out the nose?Tensor Levator Palatini
  99. 99What depresses the mandible and protrudes the jaw?Lateral Pterygoid
  100. 100What muscle pulls hyoid backward and elevates the tongue?Stylohoid
  101. 101What CN is the stylohoid innervated by?CN VII
  102. 102What is it called when you have an inability to open your jaw?Trismus
  103. 103Trismus is caused by what?Radiaton post head and neck cancer.
  104. 104What disease happens in CN V?Trigeminal neuralgia
  105. 105What is a symptom of trigeminal nueralgia?Sudden executing pain in the face.
  106. 106What side of the face does trigeminal neuralgia occur in women?RIght
  107. 107Trigeminal neuralgia is not common bilateral, what disease of faical pain is?MS
  108. 108What is known as laterally medullary syndrome?Wallenberg
  109. 109What are symptoms of Wallenberg?Pain and temperature sensation loss over entire or partial face
  110. 110Name 4 diseases commonly associated w/ CN V?Myasthenia Gravis, Lou Gehrig, Spinal Bulbar, Muscular Atrophy
  111. 111Diseases related to CN V have what kinds of symptoms?weakness of jaw closing, fatigue while chewing.
  112. 112CN VII or V is related to sinuses, tears, taste?CN VII
  113. 113What is the most common CN VII disorder?Bells palsy
  114. 114What are other common CN VII problems?Dry eyes, dysphagia, oropharyngeal swallow function
  115. 115Causes for facial palsy?birth trauma, congenital developmental abnormalities, skull fractures, latrogenic injuries during surgery, Guillian Barre Syndrome, middle ear tumor in kids, infections.
  116. 116What are abnormal facial moments? Dy...Dyskinetic and Dystonic
    TIcs
  117. 117Are tics psychogenic or an associated dysfunction?Psychogenic - tourette is an associated dysfunction
  118. 118What are fassiculations?Spontaneous twitches.
  119. 119CN IX motor innervates what?stylopharyngeus
  120. 120What is the role of the stylopharyngeus?Elevates the larynx
  121. 121CN IX and X innervate what?Pharyngeal constrictors
  122. 122CN IX supplies taste/sensation to the POSTERIOR 1/3 of the tongue and pharynx?taste
  123. 123IX supplies sensation to what?tonsillar region, posterior palatal region, soft palate, nasopharync, tragus of the ear
  124. 124What branch of the CN IX supplies sensation to the eustachian tube, TM, and mastoid region?Typmanic branch
  125. 125Where does the CN IX originate from and innervate to?Medulla near X, travels through foramen juglar, ascends on lateral side of the pharynx, winds around and supplies stylopharyngeus.
  126. 126What does CN IX penetrate to reach the base of the tongue?Pharyngeal constrictors.
  127. 127Is the clinical exam of CN X easy?Nope
  128. 128Which two nerves work together?IX and X
  129. 129What is X and IX working together called?Pharyngeal plexus
  130. 130Rare or common to have a glossopharyngeal lesion?Rare... X and IX usually work together not seperate
  131. 131Name of CN X?Vegus
  132. 132Nickname of the vegus?Wanderer
  133. 133Where does X emerge from?medulla slow to IX
  134. 134X sends motor fibers to __ and __.Pharync and soft palate
  135. 135X does NOT send motor fibers to what in the soft palate?Stylopharyngeus and tensor veli palatini muscles
  136. 136SLN arises from which CN?Vegus - X
  137. 137SLN sends sensory fibers to ___ and motor fibers to ___.larynx, cricothyroid muscle
  138. 138X follows what in the neck?Carotid arteries down to the aorta and to the cardiac plexus.
  139. 139Where in the body are the recurrent laryngeal nerves given off?Neck
  140. 140R or L recurrent laryngeal nerve bends up to ascend tracheoesophageal sulcus?R recurrent
  141. 141L or R recurrent laryngeal nerve passes beneath the aortic arch?L
  142. 142Does the recurrent or superior laryngeal nerve supply all of the muscles of the larynx?Recurrent
  143. 143SLN or RLN supply cricothyroid muscle?SLN
  144. 144What nerve supplies the striated muscles of the soft palate, pharynx, and larynx?Vegus
  145. 145Which nerve supplies the tensor veli palatini?V
  146. 146Which CN supplies the stylopharyngeus?IX
  147. 147Which nerve supplies taste from epiglottis, hard and soft palate?Vegus
  148. 148Which nerve supplies general visceral sensation to the oropharynx, larynx, lining of thoracic and abdominal viscera?X
  149. 149Name what the Vegus parasympathetic fibers innervate...pharynx, esophagus, trachea, bronchi, lungs, heart, stomach, small intestine, ascending and transverse colon, liver and pancreas
  150. 150What nerve are you testing to see if the soft palate elevates symmetrically and no deviation of the uvula?X
  151. 151Which nerve is important for pharyngeal contraction during swallow and phonation?Vegus - X
  152. 152Which nerve causes vocal quality to be impacted? You have an inability to reach upper pitchSuperior laryngeal nerve damage
  153. 153If you can't produce a volitional cough, respiration is impacted, and there is laryngeal closure during laryngoscopy - which nerve is effected?Vegus - X
  154. 154There are how many things to look for in a unilateral vegus lesion?5
  155. 155Unilateral X lesion will have what with the palatal arch?1. ipsilateral flattening of palatal arch
  156. 156unilateral X lesion will have what happen with the palate during phonation?palate fails to elevate with phonation
  157. 157The uvula will go where during unilateral X lesion?retracts toward the non-paretic side
  158. 158What are signs of unilateral X lesion? 2.dysphagia and hypernasality.
  159. 159where does the vocal cord stay with a unilateral X lesion?ipsilateral vocal cord stays midway between add and abd
  160. 160what is the gag reflex like in a unilateral X lesion?5. Reduced
  161. 161in a unilateral X lesion, a volitional cough is increased/reduced?Reduced
  162. 162Can a vegus lesion be devastating to swallow and voice?Yes
  163. 163Vegal lesions can be cuased by what?nuclear and brainstem lesions
  164. 164What some some vegus brainstem and nuclear lesions?Wallenberg syndrome, tumor, motor neuron disease
  165. 165Where the Vegus emerges from the brainstem is called what?posterior fossa
  166. 166A lesion in the posterior fossa (where X emerges) can include what diseases?menigitus, guillian barre syndrome, trauma
  167. 167Where can the trunk of the Vegus be injured?In the neck
  168. 168What blood supplies are impacted when Vegus injury occurs at the trunk - neck - ?internal carotid artery dissection, carotid artery aneurysm, trauma.
  169. 169What can happen to the voice in a vegus lesion?Vocal cord paralysis and loss of sensation to the larynx, on the same side.
  170. 170What happens to the palate in a bilateral vegus lesion?no palatal movement on phonotation
  171. 171Where does air escape when there is a bilateral Vegus lesion?nasal emission
  172. 172Bilateral lesion will cause what kind of dysphagia? Where will liquids go?Profound and nasal regurgitation of liquids will occur.
  173. 173What is the vocal quality of bilateral vegus lesion?Hoarsness
  174. 174What is a cough like in a bilateral vegal lesion?Poor cough response ability
  175. 175Respiration with a bilateral vegus lesion is slightly or severely compromised?Severely
  176. 176Can you test sensation of the epiglottis? What nerve does/doesn't this allow you to test?No. Therefore you can't test sensation of the Vegus.
  177. 177How can you have a lesion to the SLN?trauma and surgery trauma.
  178. 178SLN innervates what?Cricothyroid
  179. 179If the SLN has a lesion, what will vocal quality sound like?mild hoarseness and weak voicing.
  180. 180SLN or RLN are easily injured? How?RLN, has an intra thoracic route
  181. 181What can cause a RLN lesion?Aneurysm of aortic arch or subclavian artery.
  182. 182Which is damaged more often, R or L recurrent N? Which is longer?L, L.
  183. 183Vocal quality of a Unilateral RLN is?Hoarseness.
  184. 184What is flaccid dysphonia?harsh, breathy, short phrases, hypophonia, mild stridor on inhalation, normal articulation
  185. 185A unilateral RLN injury has unilateral paralysis of all laryngeal muscles except? Why?Cricothyroid.
    SLN controlled.
  186. 186Add of abd often affected first in a RLN lesion?adductors
  187. 187What is it called wehn you have fatigue and weakness from a heart rate of <60?Bradycardia.
  188. 188Syncope (sudden loss of conciousness due to loss of blood pressure) can be a symptom of what?Glossopharyngeal or vegus nerve metastatic involvement. (spread of cancer from one region of the body to another)
  189. 189Syncope with CN X metastasis often accompanies what kind of cancer?Head and neck
  190. 190Sudden pain in the neck, ear, and side of the head is with a syncope due to sudden hypotension may be caused by? (disease)bradycardia
  191. 191Swallow syncope and Vegus: can result from involvement of what nerve?IX or X sensory from metastasis to the esophagus.
  192. 192What are the three divisions of the larynx?1. nasopharynx
    oropharynx
    laryngopharynx
  193. 193where does the nasopharynx start and end?base of skill to the soft palate
  194. 194where does the oropharynx start and end?hard palate to hyoid bone
  195. 195where does the laryngopharynx start and end?upper border of the epiglottis to lower border of cricoid cartilage
  196. 196other name for the nasopharynx?eopharynx
  197. 197other name for the laryngopharynx?hypopharynx
  198. 198what is the oropharynx situated behind?oral cavity
  199. 199The laryngopharynx is divided into how many parts?3
  200. 200What are the divisions of the laryngopahrynx?1. pyriform sinus (fossa)
    2. post cricoid region
    3. posterior pharyngeal wall
  201. 201The lower part of the pharynx is situated behind and partially on the sides of what?larynx
  202. 202What can you work on if a person has NO swallow?voice exercises - help to strengthen the larynx
  203. 203Give them what if they have no swallow?gum, popsicles, ice cubes, help them control their droop and increase their swallowing abilities.
  204. 204role of the frennulum?holds the tongue down.
  205. 205doors open how for the posterior crico arytenoid ligament?from the back
  206. 206intrinsic/extrinsic are close to the surface? are embedded?intrinsic, extrinsic

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Swallowing and swallowing disorders for speech language pathology
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