1
, PREMIUM STUDY GUIDE
THE A+ ADVANTANGE: ACE YOUR 2026/2027 NURS 5461
EXAMINATION COMPLETE STUDY GUIDE WITH
COMPREHENSIVE QUESTIONSA AND ANSWERS
◉ Dysphagia Types. Answer: oropharyngeal (above the oesophagus) and
oesophageal-->most common is achalasia-disorder of oesophageal
nerves preventing food movement.
Structural starts with solids r/o malignancy (adenocarcinoma distal
oesophagus) infection involves PAINFUL swallowing, viral
(CMV usually immunosuppressed) or fungal (candida-inhaled
asteroid)
◉ Chewing [mastication]. Answer: involves CNV [trigeminal], CNVII
[facial], CNIX [glossopharyngeal], and CNXII [hypoglossal], in addition
to muscles of jaw, cheeks, tongue and palate
◉ Clinical characteristics of Dysphagia. Answer: Problems in the oral
phase include - Poor bolus control - Spillage from lips or into pharynx -
Dry oral membranes (xerostomia) - Pocketing of oral residue - Difficulty
with chewing
Pharyngeal dysphagia results from weakness
or poor coordination of pharyngeal muscles,
which can cause→ - Delayed swallowing
- Failure of airway protection
2
,- Nasal or oral regurgitation
- Residue remaining in pharynx after swallowing manifested as
coughing, choking or gurgling
◉ Clinical Presentation. Answer: - Short duration with weight loss
suggests malignancy - Abrupt onset associated with neuro changes
suggests CVA ¼ - ½ of new stoke patients will have dysphagia gradual
progressive onset-PD, ALS, MG
◉ medications that can contribute to Dysphagia. Answer:
Antidepressants, Antihistamines, Fosamax, NSAIDS, K, Fe, Nitrates,
BB,
CCB
◉ diagnostics for dysphagia. Answer: Cineesophagram (video swallow
study or videofluoroscpy) Modified barium swallow, endoscopy NOT
helpful, alone but may need to r/o other causes
◉ DDx dysphagia. Answer: Acute inflammation [infection; bone and
mucosal disorders] Stroke syndromes and vascular disorders Myasthenia
Gravis Dementias Chemical agents Parkinson's disease Neuromuscular
oesophageal disorders Multiple Sclerosis Medications Huntington's
disease Scleroderma Tuberculosis Muscle anomalies Tetanus Achalasia
Syphilis Pharyngoesophageal diverticulum ALS Diffuse spasm
Neoplasms Carcinoma Recurrent laryngeal neuropathies Degenerative
disorders Irradiation Guillain-Barre' syndrome Psychopathology
3
, PREMIUM STUDY GUIDE
Oesophageal stenosis Diabetes Feeding phobias Oesophageal webs,
rings or stricture Cerebral palsy Sensory deficits
◉ Management of Dysphagia. Answer: Medication review, particularly
focusing on anticholinergic drugs Oropharyngeal dysphagia:
Swallowing rehabilitation, dietary modifications such as thickening
liquids, or careful hand feeding Achalasia: Surgical or endoscopic
myotomy (SOE=A); injection of the lower oesophageal sphincter with
botulinum toxin may provide months of symptomatic relief in patients
who are not surgical candidates Spastic motility disorders: Calcium
channel blockers or phosphodiesterase inhibitors may provide relief
(SOE=B) Strictures: Endoscopic dilation has a very high success rate,
although patients often require ongoing medical treatment of the
underlying cause as well Aspiration and Nonoral Feeding in Dysphagia
of Functional Origin - Patients with severe aspiration, which is not
treatable with dietary or positional modifications, should receive nonoral
feedings to prevent aspiration Head positioning, swallowing
manoeuvres and dietary textural modifications seem to demonstrate
clear evidence of benefit in treating functional dysphagia - Refer to
speech pathologist for evaluation
◉ Indications for Hospitalization/Referral. Answer: Dietary consultation
GI consult Will need intervention if patient has structural problem
Speech therapy Neurology may be needed
◉ Dyspepsia (heartburn). Answer: Most commonly associated with
peptic ulcer disease, GERD, biliary colic, or medication-induced
discomfort Whether gastritis due to Helicobacter pylori can cause
4
, PREMIUM STUDY GUIDE
THE A+ ADVANTANGE: ACE YOUR 2026/2027 NURS 5461
EXAMINATION COMPLETE STUDY GUIDE WITH
COMPREHENSIVE QUESTIONSA AND ANSWERS
◉ Dysphagia Types. Answer: oropharyngeal (above the oesophagus) and
oesophageal-->most common is achalasia-disorder of oesophageal
nerves preventing food movement.
Structural starts with solids r/o malignancy (adenocarcinoma distal
oesophagus) infection involves PAINFUL swallowing, viral
(CMV usually immunosuppressed) or fungal (candida-inhaled
asteroid)
◉ Chewing [mastication]. Answer: involves CNV [trigeminal], CNVII
[facial], CNIX [glossopharyngeal], and CNXII [hypoglossal], in addition
to muscles of jaw, cheeks, tongue and palate
◉ Clinical characteristics of Dysphagia. Answer: Problems in the oral
phase include - Poor bolus control - Spillage from lips or into pharynx -
Dry oral membranes (xerostomia) - Pocketing of oral residue - Difficulty
with chewing
Pharyngeal dysphagia results from weakness
or poor coordination of pharyngeal muscles,
which can cause→ - Delayed swallowing
- Failure of airway protection
2
,- Nasal or oral regurgitation
- Residue remaining in pharynx after swallowing manifested as
coughing, choking or gurgling
◉ Clinical Presentation. Answer: - Short duration with weight loss
suggests malignancy - Abrupt onset associated with neuro changes
suggests CVA ¼ - ½ of new stoke patients will have dysphagia gradual
progressive onset-PD, ALS, MG
◉ medications that can contribute to Dysphagia. Answer:
Antidepressants, Antihistamines, Fosamax, NSAIDS, K, Fe, Nitrates,
BB,
CCB
◉ diagnostics for dysphagia. Answer: Cineesophagram (video swallow
study or videofluoroscpy) Modified barium swallow, endoscopy NOT
helpful, alone but may need to r/o other causes
◉ DDx dysphagia. Answer: Acute inflammation [infection; bone and
mucosal disorders] Stroke syndromes and vascular disorders Myasthenia
Gravis Dementias Chemical agents Parkinson's disease Neuromuscular
oesophageal disorders Multiple Sclerosis Medications Huntington's
disease Scleroderma Tuberculosis Muscle anomalies Tetanus Achalasia
Syphilis Pharyngoesophageal diverticulum ALS Diffuse spasm
Neoplasms Carcinoma Recurrent laryngeal neuropathies Degenerative
disorders Irradiation Guillain-Barre' syndrome Psychopathology
3
, PREMIUM STUDY GUIDE
Oesophageal stenosis Diabetes Feeding phobias Oesophageal webs,
rings or stricture Cerebral palsy Sensory deficits
◉ Management of Dysphagia. Answer: Medication review, particularly
focusing on anticholinergic drugs Oropharyngeal dysphagia:
Swallowing rehabilitation, dietary modifications such as thickening
liquids, or careful hand feeding Achalasia: Surgical or endoscopic
myotomy (SOE=A); injection of the lower oesophageal sphincter with
botulinum toxin may provide months of symptomatic relief in patients
who are not surgical candidates Spastic motility disorders: Calcium
channel blockers or phosphodiesterase inhibitors may provide relief
(SOE=B) Strictures: Endoscopic dilation has a very high success rate,
although patients often require ongoing medical treatment of the
underlying cause as well Aspiration and Nonoral Feeding in Dysphagia
of Functional Origin - Patients with severe aspiration, which is not
treatable with dietary or positional modifications, should receive nonoral
feedings to prevent aspiration Head positioning, swallowing
manoeuvres and dietary textural modifications seem to demonstrate
clear evidence of benefit in treating functional dysphagia - Refer to
speech pathologist for evaluation
◉ Indications for Hospitalization/Referral. Answer: Dietary consultation
GI consult Will need intervention if patient has structural problem
Speech therapy Neurology may be needed
◉ Dyspepsia (heartburn). Answer: Most commonly associated with
peptic ulcer disease, GERD, biliary colic, or medication-induced
discomfort Whether gastritis due to Helicobacter pylori can cause
4
