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Flashcards by mathieteal, updated more than 1 year ago
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Created by mathieteal
almost 10 years ago
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| Question | Answer |
| dysphagia is a symptom or a diagnosis? | always a symptom |
| Is dysphagia it's own separate diagnosis? | No, it is always part of some disease |
| Name three people on the dysphagia team? | primary physician, client, SLP, OT, PT, dietician, family, nurse, radiologist, |
| How many phases to a swallow? | 3 |
| what are the three phases of a swallow? | 1. oral 2. pharyngeal 3. esophogeal |
| what happens during the oral phase of the swallow? | form a bolus, mastication, oral transit |
| what happens during oral transit? | Food is moved by back 3rd of tongue to the faucial pillars to prep for a swallow |
| What part of the body may be weak and cause the oral phase of a swallow not to work? | The tongue |
| Which phase (1, 2, 3) is the actual swallow of a swallow? | 2 - pharyngeal,. |
| If your esophogus doesn't work, can you swallow? | No. |
| Can you see the submucus cleft when you open your mouth? | Yes |
| Vocal folds, abduct or adduct during a swallow? | adduct |
| vocal folds add or abd when you say "Ah"? | Abduct |
| Can 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. |
| Should 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 |
| What happens during the pharyngeal phase of the swallow? | You move the food down the throat into the esophagus. |
| Can you see the pharyngeal phase of the swallow? | no. You can feel it by palpitating their throat. |
| Someone says food gets stuck in the chest, which phase of the swallow is this? | esophageal |
| food is stuck in the throat, which phase of the swallow? | Phayngeal |
| Slurred speech is related to what diagnosis? | Dysarthria |
| Who can diagnosis dysarthria? | Neurologist |
| Do you worry about the swallow of an apraxic or dysarthric person? | Dysarthric... they have a nuerological problem. |
| What disorder is this: the person can talk with great fluidity, but nothing is intelligible? | Apraxia |
| You can talk, but you can't get the words out, what is this known as? | Dispraxia |
| Do you worry about a dispraxic person? | No... tongue movement is strong, but off. They will have the strength to swallow. |
| Which, L/R, CVA is related to apraxia? | Left CVA |
| Which, L/R, CVA is related to dysarthria? | R CVA |
| Do you worry about the L or R CVA patient first for swallowing? | R CVA - dysarthria. |
| Which nerves are important to swallow? (how many?) | Five, 5, 7, 9, 10, 12 |
| What is CN V? | Facial Nerve |
| CN V controls what? | muscles of expression |
| Physicians Test, Corneal Reflex, what nerves are they testing? | CN V & VII |
| How 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 |
| CN VII - expression - is efferent. Where does it come from? | Brainstem, the pons |
| What is the motor function of CN VII? | Control and relax muscles |
| Name the two muscles of CNVII? | Digastric and stylohyoid |
| What is the role of the digastric muscle? | Elevates the hyoid bone |
| Where is the hyoid bone located? | Top of the larynx |
| Is the hyoid bone necessary for a swallow to occur? | Yes! |
| The digastric muscle also depresses what? | Mandible |
| What are the sensory parts of CN VII? | Nervus intermedius |
| Nervus intermedius has what two components? | Sensory and parasympathetic |
| CN VII also supplies a small amount of sensory input where? | Oral pharynx |
| Where is the oral pharynx located? | Below palatine tonsil |
| How many branches does the CN VII have? | 5 |
| The 5 branches of the CN VII are located where? | Parotid gland |
| Name the 5 branches of CN VII: | 1. sygomatic 2. temporal 3. buccal 4. marginal mandibular 5. cervical |
| CN V is called what? | Trigeminal nerve |
| which nerve is the largest? | CN V - trigeminal |
| CN V does what? | Supplies sensation to the face, mucous membranes, head |
| Which nerve is the longest and most complex? | CN V - Trigeminal |
| CN V innervates what? | Muscles of mastication |
| What areas of mastication does CN V innervate? (4) | 1. myohoid 2. tensor tympani 3. tenso veli palatini 4. anterior belly of the digastric |
| There are how many branches of the trigeminal? | 3 |
| What are the 3 branches of the trigeminal called? | 1. opthalmic 2. Maxillary 3. Mandibular |
| CN V: Opthalmic is for: | Sensation of the scalp/forehead. |
| CN V: Maxillary is for: | sensation of the lower eyelid, cheek, sinuses, palate, root of the pharynx |
| CN V: Mandibular is for: | mixed motor and sensory branch. |
| Which part of the trigeminal nerve is the longest branch? | Mandibular |
| What are the three branches of the trigemina? | 1. Opthalmic 2. Maxillary 3. Mandibular |
| Opthamlic provides sensation of the ...? | Scalp and forehead |
| Maxillary has sensation of the... | lower eyelid, cheek, sinuses, palate, roof of the pharynx |
| Mandibular has mixed motor and sensory. It innervates? | mylohyoid |
| Mandibular is the anterior/posterio belly of what? | Anterior belly of the digastric |
| What does the mandibular provide sensation to? | molars, premolars, incisors, chin |
| Where does the mylohyoid run from? | mandible to the hyoid |
| Mylohyoid provides what? | Forms the floor of the oral cavity |
| What does the mylohyoid elevate? | The hyoid bone and the tongue |
| What happens if the hyoid is fixed in place by other muscles, the mylohyoid will do what? | Depresses the mandible |
| What does the anterior belly of the digastric do? | Elevates the hyoid |
| If the anterior belly of the digastric has the hyoid fixed in place by other muscles, what will it do? | Depress the mandible. |
| What portion of the tongue controls taste? | anterior 1/3 |
| How can you get dysphagia? Name a few... | cancer, stroke, nuerological damage, surgery, incubated, dementia, prematurity, hospitalization, tracheostomy, vent dependecy. |
| Is dysphagia always similar? | No, can be mild to severe, can have an ability to eat to no ability to eat. |
| What is the #3 reason of cause of death? | Stroke |
| How many patients have difficulty swallowing post stroke? | 30-40% |
| How many stroke patients die of aspiration in the first year? | 20% |
| How many stroke patients die of aspiration pneumonia after the 1st year? | 10-15% |
| Which part of the brain has the highest rate of damage causing dysphagia? | Brainstem |
| If you get damaged to this part of the brain, it's often unremitting, what is it? | Brainstem. |
| Which hemisphere post CVA causes oral phase disorders? | L hemisphere |
| Which hemisphere post CVA has pharyngeal phase disorders? | Right |
| Rank in order of concerns for swallowing: L CVA, Brainstem, R CVA | Brainstem, R CVA, L CVA |
| What are aspects of cognition? | Attention, memory, concentration, comprehension, problem solving |
| What is nosocomial pneumonia caused from and what is it associated with? | not due to aspiration and associated wtih flus |
| What % of normal elderly people have problems swallowing? | 50% |
| Why may an older person have difficulty swallowing? | - false teeth - teeth don't work to chew food - misfitted dentures - gum disease |
| What is the best plan for a person w/ dysphagia? | A plan they can follow! |
| Explain what a supraglottic swallow is? | suck in air, swallow, cough the exhale out |
| What is the Shakir Exercise? | lay on your back and lift your head |
| Can people in acute care do the shakir exercise? | No, they are compromised. |
| Which patients should you NOT take risks with? | Critically ill |
| Where are 95 % of tumors located for people with swallowing problems? | aerodigestive tract |
| What is NPO? | You're allowed nothing by mouth |
| reasons why someone may be NPO? | - absent swallow - chocking when swallowing - can't breathe |
| CN V supplies general sensation or taste from the anterior 2/3 of tongue? | Sensation |
| CN V or VII supplies taste from anterior 2/3 of the tongue? | CN VII |
| What 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 |
| What depresses the mandible and protrudes the jaw? | Lateral Pterygoid |
| What muscle pulls hyoid backward and elevates the tongue? | Stylohoid |
| What CN is the stylohoid innervated by? | CN VII |
| What is it called when you have an inability to open your jaw? | Trismus |
| Trismus is caused by what? | Radiaton post head and neck cancer. |
| What disease happens in CN V? | Trigeminal neuralgia |
| What is a symptom of trigeminal nueralgia? | Sudden executing pain in the face. |
| What side of the face does trigeminal neuralgia occur in women? | RIght |
| Trigeminal neuralgia is not common bilateral, what disease of faical pain is? | MS |
| What is known as laterally medullary syndrome? | Wallenberg |
| What are symptoms of Wallenberg? | Pain and temperature sensation loss over entire or partial face |
| Name 4 diseases commonly associated w/ CN V? | Myasthenia Gravis, Lou Gehrig, Spinal Bulbar, Muscular Atrophy |
| Diseases related to CN V have what kinds of symptoms? | weakness of jaw closing, fatigue while chewing. |
| CN VII or V is related to sinuses, tears, taste? | CN VII |
| What is the most common CN VII disorder? | Bells palsy |
| What are other common CN VII problems? | Dry eyes, dysphagia, oropharyngeal swallow function |
| Causes for facial palsy? | birth trauma, congenital developmental abnormalities, skull fractures, latrogenic injuries during surgery, Guillian Barre Syndrome, middle ear tumor in kids, infections. |
| What are abnormal facial moments? Dy... | Dyskinetic and Dystonic TIcs |
| Are tics psychogenic or an associated dysfunction? | Psychogenic - tourette is an associated dysfunction |
| What are fassiculations? | Spontaneous twitches. |
| CN IX motor innervates what? | stylopharyngeus |
| What is the role of the stylopharyngeus? | Elevates the larynx |
| CN IX and X innervate what? | Pharyngeal constrictors |
| CN IX supplies taste/sensation to the POSTERIOR 1/3 of the tongue and pharynx? | taste |
| IX supplies sensation to what? | tonsillar region, posterior palatal region, soft palate, nasopharync, tragus of the ear |
| What branch of the CN IX supplies sensation to the eustachian tube, TM, and mastoid region? | Typmanic branch |
| Where 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. |
| What does CN IX penetrate to reach the base of the tongue? | Pharyngeal constrictors. |
| Is the clinical exam of CN X easy? | Nope |
| Which two nerves work together? | IX and X |
| What is X and IX working together called? | Pharyngeal plexus |
| Rare or common to have a glossopharyngeal lesion? | Rare... X and IX usually work together not seperate |
| Name of CN X? | Vegus |
| Nickname of the vegus? | Wanderer |
| Where does X emerge from? | medulla slow to IX |
| X sends motor fibers to __ and __. | Pharync and soft palate |
| X does NOT send motor fibers to what in the soft palate? | Stylopharyngeus and tensor veli palatini muscles |
| SLN arises from which CN? | Vegus - X |
| SLN sends sensory fibers to ___ and motor fibers to ___. | larynx, cricothyroid muscle |
| X follows what in the neck? | Carotid arteries down to the aorta and to the cardiac plexus. |
| Where in the body are the recurrent laryngeal nerves given off? | Neck |
| R or L recurrent laryngeal nerve bends up to ascend tracheoesophageal sulcus? | R recurrent |
| L or R recurrent laryngeal nerve passes beneath the aortic arch? | L |
| Does the recurrent or superior laryngeal nerve supply all of the muscles of the larynx? | Recurrent |
| SLN or RLN supply cricothyroid muscle? | SLN |
| What nerve supplies the striated muscles of the soft palate, pharynx, and larynx? | Vegus |
| Which nerve supplies the tensor veli palatini? | V |
| Which CN supplies the stylopharyngeus? | IX |
| Which nerve supplies taste from epiglottis, hard and soft palate? | Vegus |
| Which nerve supplies general visceral sensation to the oropharynx, larynx, lining of thoracic and abdominal viscera? | X |
| Name what the Vegus parasympathetic fibers innervate... | pharynx, esophagus, trachea, bronchi, lungs, heart, stomach, small intestine, ascending and transverse colon, liver and pancreas |
| What nerve are you testing to see if the soft palate elevates symmetrically and no deviation of the uvula? | X |
| Which nerve is important for pharyngeal contraction during swallow and phonation? | Vegus - X |
| Which nerve causes vocal quality to be impacted? You have an inability to reach upper pitch | Superior laryngeal nerve damage |
| If you can't produce a volitional cough, respiration is impacted, and there is laryngeal closure during laryngoscopy - which nerve is effected? | Vegus - X |
| There are how many things to look for in a unilateral vegus lesion? | 5 |
| Unilateral X lesion will have what with the palatal arch? | 1. ipsilateral flattening of palatal arch |
| unilateral X lesion will have what happen with the palate during phonation? | palate fails to elevate with phonation |
| The uvula will go where during unilateral X lesion? | retracts toward the non-paretic side |
| What are signs of unilateral X lesion? 2. | dysphagia and hypernasality. |
| where does the vocal cord stay with a unilateral X lesion? | ipsilateral vocal cord stays midway between add and abd |
| what is the gag reflex like in a unilateral X lesion? | 5. Reduced |
| in a unilateral X lesion, a volitional cough is increased/reduced? | Reduced |
| Can a vegus lesion be devastating to swallow and voice? | Yes |
| Vegal lesions can be cuased by what? | nuclear and brainstem lesions |
| What some some vegus brainstem and nuclear lesions? | Wallenberg syndrome, tumor, motor neuron disease |
| Where the Vegus emerges from the brainstem is called what? | posterior fossa |
| A lesion in the posterior fossa (where X emerges) can include what diseases? | menigitus, guillian barre syndrome, trauma |
| Where can the trunk of the Vegus be injured? | In the neck |
| What blood supplies are impacted when Vegus injury occurs at the trunk - neck - ? | internal carotid artery dissection, carotid artery aneurysm, trauma. |
| What can happen to the voice in a vegus lesion? | Vocal cord paralysis and loss of sensation to the larynx, on the same side. |
| What happens to the palate in a bilateral vegus lesion? | no palatal movement on phonotation |
| Where does air escape when there is a bilateral Vegus lesion? | nasal emission |
| Bilateral lesion will cause what kind of dysphagia? Where will liquids go? | Profound and nasal regurgitation of liquids will occur. |
| What is the vocal quality of bilateral vegus lesion? | Hoarsness |
| What is a cough like in a bilateral vegal lesion? | Poor cough response ability |
| Respiration with a bilateral vegus lesion is slightly or severely compromised? | Severely |
| Can 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. |
| How can you have a lesion to the SLN? | trauma and surgery trauma. |
| SLN innervates what? | Cricothyroid |
| If the SLN has a lesion, what will vocal quality sound like? | mild hoarseness and weak voicing. |
| SLN or RLN are easily injured? How? | RLN, has an intra thoracic route |
| What can cause a RLN lesion? | Aneurysm of aortic arch or subclavian artery. |
| Which is damaged more often, R or L recurrent N? Which is longer? | L, L. |
| Vocal quality of a Unilateral RLN is? | Hoarseness. |
| What is flaccid dysphonia? | harsh, breathy, short phrases, hypophonia, mild stridor on inhalation, normal articulation |
| A unilateral RLN injury has unilateral paralysis of all laryngeal muscles except? Why? | Cricothyroid. SLN controlled. |
| Add of abd often affected first in a RLN lesion? | adductors |
| What is it called wehn you have fatigue and weakness from a heart rate of <60? | Bradycardia. |
| Syncope (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) |
| Syncope with CN X metastasis often accompanies what kind of cancer? | Head and neck |
| Sudden pain in the neck, ear, and side of the head is with a syncope due to sudden hypotension may be caused by? (disease) | bradycardia |
| Swallow syncope and Vegus: can result from involvement of what nerve? | IX or X sensory from metastasis to the esophagus. |
| What are the three divisions of the larynx? | 1. nasopharynx oropharynx laryngopharynx |
| where does the nasopharynx start and end? | base of skill to the soft palate |
| where does the oropharynx start and end? | hard palate to hyoid bone |
| where does the laryngopharynx start and end? | upper border of the epiglottis to lower border of cricoid cartilage |
| other name for the nasopharynx? | eopharynx |
| other name for the laryngopharynx? | hypopharynx |
| what is the oropharynx situated behind? | oral cavity |
| The laryngopharynx is divided into how many parts? | 3 |
| What are the divisions of the laryngopahrynx? | 1. pyriform sinus (fossa) 2. post cricoid region 3. posterior pharyngeal wall |
| The lower part of the pharynx is situated behind and partially on the sides of what? | larynx |
| What can you work on if a person has NO swallow? | voice exercises - help to strengthen the larynx |
| Give them what if they have no swallow? | gum, popsicles, ice cubes, help them control their droop and increase their swallowing abilities. |
| role of the frennulum? | holds the tongue down. |
| doors open how for the posterior crico arytenoid ligament? | from the back |
| intrinsic/extrinsic are close to the surface? are embedded? | intrinsic, extrinsic |
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