CD 663 (HEATHER_CORNISH24) FINAL
EXAM QUESTIONS AND ANSWERS
What questions should you ask post-eval? - Answer-- PO vs NPO? (if yes, what diet is
most appropriate?)
- Is the pt a candidate for tx? (can be PO or NPO pts)
- What type of tx is most appropriate?
Considerations for determining who is a candidate for treatment - Answer-- medical
dx/prognosis
- pt choice/ethical issue/QOL
- ability to follow directions
- reaction to compensatory strategies
- severity of problem
- respiratory function
- caregiver support
- patient motivation
VFSS (bedside): s/s of dysphagia in oral stage - Answer-- food falls out of mouth
- bolus spreads through oral cavity
- residue/food on tongue or falls into sulcus
- residue on hard palate
- no lingual movement when food in mouth
- generalized difficulties in moving bolus in AP
- premature spillage
- slow oral transit times
physiologic explanation of food falling out of mouth - Answer-o poor closure of lips due
to muscular weakness
o sensation is gone
o not aware food is inside
physiologic explanation of bolus spreading through oral cavity - Answer-o Reduced
tongue coordination to form bolus
o Reduced oral sensation
o Reduced buccal tension
physiologic explanation of residue/food falling into sulcus - Answer-o Inability to
lateralize bolus with tongue (tongue weakness)
physiologic explanation of residue on hard palate - Answer-weakness of tongue
physiologic explanation of no lingual movement when food in mouth - Answer-o
Sensation issue
,o Verbal apraxia (noted random movement)
o Dementia (not recognize food in mouth
physiologic explanation of generalized difficulties in moving bolus in AP - Answer-o
Tongue cannot move back properly
o Coordination and weakness of tongue musculature
physiologic explanation of premature spillage - Answer-- weakness of BOT (did not rise
up enough)
physiologic explanation of slow oral transit time - Answer-o Tongue cannot move back
properly
o Coordination and weakness of tongue musculature
VFSS (bedside): s/s of dysphagia in trigger/pharyngeal stage - Answer-- delayed
triggering of pharyngeal swallow
- nasal regurgitation
- residue in valleculae
- residue on one/both sides of pharynx
- reduced displacement of larynx
- residue in pyriform sinuses bilaterally
- penetration and/or aspiration
physiologic explanation of delayed triggering of pharyngeal swallow - Answer-o CN IX X
impaired sensation
physiologic explanation of nasal regurgitation - Answer-o CN X poor closure of VP port
o Weakness with velar coordination
physiologic explanation of premature spillage/residue in valleculae - Answer-o Poor
tongue base contraction to PPW
o Weakness of base/back of tongue
physiologic explanation of residue on one/both sides of pharynx - Answer-o Paralysis on
one/both side of pharynx
physiologic explanation of reduced displacement of larynx - Answer-o Poor
upward/forward movement
o Weak suprahyoid muscles
physiologic explanation of residue in pyriform sinuses - Answer-o Poor laryngeal
coordination/elevation
o Weak muscle contraction on pharyngeal constrictors/muscles
physiologic explanation of penetration and/or aspiration - Answer-o No airway protection
o Can be poor vf closure
, o Delayed trigger
o Reduced laryngeal elevation
Overall goal of management? - Answer-safe (non aspirative) oral intake/feeding while
maintaining adequate nutrition and hydration
goals of management for pts who are NPO - Answer-- re-establishing oral feeding
*total oral feeding may not be possible
* focus is NOT on getting pt on "regular" diet
* tx techniques to ensure safe swallow
Goals of management for all pts with dysphagia - Answer-- resume prior level of diet
- tolerate a least restrictive diet
- ensure safe swallow
- optimize QOL
Who carries out management - Answer-- pts
- caregiver/family
- nursing/staff
- SLP
Types of approaches to management - Answer-- medical (
- behavioral
types of medical management - Answer-- surgical
- nonsurgical (e.g. medication)
Types of behavioral management - Answer-- compensatory strategies
- therapeutic/rehabilitative techniques
Explain medical management - Answer-- techniques to improve disorders caused by
anatomic/physiologic abnormalities
- procedures to control for prolonged, unremitting aspiration
- surgical procedures to provide nutrition and hydration via nonoral means
What are the 2 types of external non-oral feeding - Answer-- PEG tube (percutaneous
endoscopic gastrostomy)
- (temporary) solution for dysphagic-related or nondysphagic-related causes)
purpose of laryngeal/airway-related procedures - Answer-- improving glottal closure
- protecting the airway
Name some laryngeal/airway-related procedures - Answer-- vocal cord injection
- laryngeal closure
- tracheotomy (prevent aspiration)
EXAM QUESTIONS AND ANSWERS
What questions should you ask post-eval? - Answer-- PO vs NPO? (if yes, what diet is
most appropriate?)
- Is the pt a candidate for tx? (can be PO or NPO pts)
- What type of tx is most appropriate?
Considerations for determining who is a candidate for treatment - Answer-- medical
dx/prognosis
- pt choice/ethical issue/QOL
- ability to follow directions
- reaction to compensatory strategies
- severity of problem
- respiratory function
- caregiver support
- patient motivation
VFSS (bedside): s/s of dysphagia in oral stage - Answer-- food falls out of mouth
- bolus spreads through oral cavity
- residue/food on tongue or falls into sulcus
- residue on hard palate
- no lingual movement when food in mouth
- generalized difficulties in moving bolus in AP
- premature spillage
- slow oral transit times
physiologic explanation of food falling out of mouth - Answer-o poor closure of lips due
to muscular weakness
o sensation is gone
o not aware food is inside
physiologic explanation of bolus spreading through oral cavity - Answer-o Reduced
tongue coordination to form bolus
o Reduced oral sensation
o Reduced buccal tension
physiologic explanation of residue/food falling into sulcus - Answer-o Inability to
lateralize bolus with tongue (tongue weakness)
physiologic explanation of residue on hard palate - Answer-weakness of tongue
physiologic explanation of no lingual movement when food in mouth - Answer-o
Sensation issue
,o Verbal apraxia (noted random movement)
o Dementia (not recognize food in mouth
physiologic explanation of generalized difficulties in moving bolus in AP - Answer-o
Tongue cannot move back properly
o Coordination and weakness of tongue musculature
physiologic explanation of premature spillage - Answer-- weakness of BOT (did not rise
up enough)
physiologic explanation of slow oral transit time - Answer-o Tongue cannot move back
properly
o Coordination and weakness of tongue musculature
VFSS (bedside): s/s of dysphagia in trigger/pharyngeal stage - Answer-- delayed
triggering of pharyngeal swallow
- nasal regurgitation
- residue in valleculae
- residue on one/both sides of pharynx
- reduced displacement of larynx
- residue in pyriform sinuses bilaterally
- penetration and/or aspiration
physiologic explanation of delayed triggering of pharyngeal swallow - Answer-o CN IX X
impaired sensation
physiologic explanation of nasal regurgitation - Answer-o CN X poor closure of VP port
o Weakness with velar coordination
physiologic explanation of premature spillage/residue in valleculae - Answer-o Poor
tongue base contraction to PPW
o Weakness of base/back of tongue
physiologic explanation of residue on one/both sides of pharynx - Answer-o Paralysis on
one/both side of pharynx
physiologic explanation of reduced displacement of larynx - Answer-o Poor
upward/forward movement
o Weak suprahyoid muscles
physiologic explanation of residue in pyriform sinuses - Answer-o Poor laryngeal
coordination/elevation
o Weak muscle contraction on pharyngeal constrictors/muscles
physiologic explanation of penetration and/or aspiration - Answer-o No airway protection
o Can be poor vf closure
, o Delayed trigger
o Reduced laryngeal elevation
Overall goal of management? - Answer-safe (non aspirative) oral intake/feeding while
maintaining adequate nutrition and hydration
goals of management for pts who are NPO - Answer-- re-establishing oral feeding
*total oral feeding may not be possible
* focus is NOT on getting pt on "regular" diet
* tx techniques to ensure safe swallow
Goals of management for all pts with dysphagia - Answer-- resume prior level of diet
- tolerate a least restrictive diet
- ensure safe swallow
- optimize QOL
Who carries out management - Answer-- pts
- caregiver/family
- nursing/staff
- SLP
Types of approaches to management - Answer-- medical (
- behavioral
types of medical management - Answer-- surgical
- nonsurgical (e.g. medication)
Types of behavioral management - Answer-- compensatory strategies
- therapeutic/rehabilitative techniques
Explain medical management - Answer-- techniques to improve disorders caused by
anatomic/physiologic abnormalities
- procedures to control for prolonged, unremitting aspiration
- surgical procedures to provide nutrition and hydration via nonoral means
What are the 2 types of external non-oral feeding - Answer-- PEG tube (percutaneous
endoscopic gastrostomy)
- (temporary) solution for dysphagic-related or nondysphagic-related causes)
purpose of laryngeal/airway-related procedures - Answer-- improving glottal closure
- protecting the airway
Name some laryngeal/airway-related procedures - Answer-- vocal cord injection
- laryngeal closure
- tracheotomy (prevent aspiration)
