Dysphagia

Pregunta	Respuesta
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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