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Dyspagia Final 7-11
| Question | Answer |
|---|---|
| SLPs should follow the principles of evidence-based practice in making clinical decisions | true |
| nonsurgical dysphagia management is a team effort that is led by the SLP | true |
| It is ethical to withhold (otherwise available) treatment program to patients for the sake of collecting scientific evidence. | false: it is unethical to withhold necessary treatment from patients |
| Poor oral hygiene and dysphagia are both risk factors for aspiration pneumonia, especially in the elderly | true |
| Compensatory therapy aims to improve the long term physiology of swallowing | false: compensatory therapy aims to ensure safe swallowing |
| 6. Compensatory therapy is only effective for the oral preparatory and oral phases of swallowing. | False: Postural changes may also change the pharyngeal phase |
| 7. The supraglottic swallow maneuver is an effective technique for achieving vocal fold closure for a swallow. | True |
| 8. Nonsurgical treatments for swallowing disorders are for patients with strokes and neurological disorders exclusively. | False: treatment can be for any clinical population |
| 9. A head tilt strategy during swallow to the stronger side of the pharynx will direct a bolus down the weak side. | False: head tilt to the strong side will direct the bolus to the strong side |
| 10. Implementing a swallow postural technique to dysphagic patients should be done after an instrumental swallow assessment is conducted to confirm its effectiveness. | true |
| 11. Bolus modification has been shown to be a more effective method of preventing penetration and aspiration compared to the chin-tuck posture in the elderly. | true |
| 12. All individuals who aspirate with liquids or solids develop aspiration pneumonia. | False: not everyone who aspirates will develop aspiration pneumonia, other factors such as amount aspirated and oral hygiene contribute as well. |
| 13. Swallowing cold water compared to body temperature water has been shown to increase the overall speed of swallowing. | true |
| 14. Oral motor exercises can be used to increase endurance of lip seal. | true |
| 15. Currently, there is no evidence to support the use of lingual exercises for patients with swallowing disorders. | false: a number of studies have found these exercises to be efficacious |
| 16. LSVT may be useful for both swallowing and for speech improvement in patients who have parkinson disease and other neurological disorders. | true |
| 17. Occasional aspiration is to be expected in patients undergoing rehab swallowing therapy | true |
| 18. Practicing timing movements with placing an empty cup to the lips and removing it will not improve labial function in swallowing. | False: this exercise helps to prepare patient to coordinate lips opening |
| 19. The Shaker exercise has been shown to increase the opening of the UES and decrease the hypopharyngeal bolus pressure | true |
| 20. Allowing a specified time to pass in post-cancer patients with head and neck cancer is preferred to immediate treatment. | False: treatment should be preventative and concurrent to medical therapy, and begin before surgical or radiation therapy is carried out. |
| 21. OT's role in dysphagia management involves | recommending environmental modifications to improve mealtime experience |
| 22. Changes in treatment may be affected by | treatment technique, passage of time, strength of the patient and types of food eaten |
| 23. Compensatory swallowing therapy involves all of the following except: | improving oral strength |
| 24. Compensatory swallowing is limited by which of the following: | willingness to follow the recommendations |
| 25. Swallowing postures are used as they have been shown to | reduce residue post swallow |
| 26. Thermal tactile oral stimulation is an exercise to stimulate: | oral awareness to the brainstem |
| 27. The primary outcome from studies using the Shaker exercise is | decrease in the hypopharyngeal intrabolus pressure |
| 28. When should therapy begin for patients diagnosed with head and neck cancer? | as soon as the diagnosis is made |
| 29. EMST can be suggested for | patients with degenerative neuro disorders, elderly individuals with sarcopenia, and children with neuromuscular disorders |
| 30. What are the four steps of EBP? | 1. generate, 2. search, 3. review, 4. integrate |
| 31. Which two steps should SLPs take to ensure their recommended treatement methods are effective for the patients? | 1. obtain baseline set of patient performance; 2. document changes across the treatment process |
| 32. What are the four prereqs for a patient to undergo compensatory swallowing therapy? | 1. adequate memory and attention, 2. caregivers available to assist, 3. no severe cognitive impairments, 4. motivated to change and follow recommendations |
| 33. How does the super-supraglottic swallow differ from the supraglottic swallow maneuever? | addition of bearing down after breath holding |
| 34. How does the Mendelsohn maneuver reduce residue during swallowing? | opens the UES and extends duration of laryngeal elevation |
| 35. The majority of research has been done on various postures for swallowing and the one that has been found to be most useful in protecting the airway has been the | chin tuck |
| 36. One way to move the cricoid away from the posterior pharyngeal wall in order to lower the resting sphincter pressure is to: | rotate the head to one side to allow a greater esophageal opening on the other side |
| 37. What are the four general principles of neuromuscular rehab that drive rehab swallowing therapy? | 1. use it or lose it. 2. use it and improve it. 3. specificity, 4. transference |
| 38. What are three rationales for using oral motor exercises to target swallowing disorders? | 1. control passage of bolus, 2. increase awareness of bolus, 3. maximize driving force of bolus to oropharynx |
| 39. Tongue strengthening exercises can improve at least 3 functions in the oral phase of swallowing: | 1. bolus manipulation, 2. bolus mastication, 3. bolus clearance. |
| 1. Swallow safety is the top priority of the dysphagia management team, together with maintaining nutrition and quality of life of the patient | true |
| 2. Proper nutrition can be achieved by a combination of oral and non-oral diet | true |
| 3. as a fluid becomes more viscous, it is more easily deformed | False: it becomes more difficult to deform |
| 4. Most foods or fluids that are eaten are non-newtonian. | true |
| 5. one of the purposes of the International Dysphagia Diet Standardization Initiative is to restrict the levels of consistencies for testing when doing fluoroscopic swallow studies. | false: IDDSI is to allow consistent testing and documentation for comparisons across time, patients and studies |
| 6. Thickened fluids retain their consistency with time. | False: this depends on the type of thickener used. |
| 7. Extremely thick (level 4) liquids are suggested for those with poor tongue control, but will increase the risk of post swallow residue | true |
| 8. SLPS should provide guidelines on modified food and drink preparation to other health care professionals only. | false: the patient and his/her family members should be given guidelines as well |
| 9. Food texture is not related to chemical senses of taste or odor | true |
| 10. All foods and drinks behave similarly in persons with different types and severity levels of dysphagia | false; foods and drinks may behave differently. |
| 11. Even when limits are set for an elderly patients oral diet to ensure swallow safety, they shouldn't be so restrictive as to discourage oral intake. | true |
| 12. After the initial diagnosis and recommendation for safer feeding, the clinician no longer needs to see the patient again, | false: regular follow-ups are necessary |
| 13. A gastrotomy is a permanent fixture once it is in place. | false: a gastrotomy may be a temporary solution while the patient recovers and improves with therapy. |
| 14. Nasogastric feeding tubes are usually used in patients who will be on longterm nonoral diets. | false: nasogastric tubes can be uncomfortable and cosmetically undesirable for long-term use |
| 15. Choice of a nonoral diet via feeding tube is made based on the findings of the instrumental swallow examination. | False: other factors such as dentition, living situation, and physical disabilities should also be considered |
| 16. Once a feeding tube is in place in the elderly, it is best to discontinue swallow exercises as they only make the patient more frustrated because he.she can't eat orally. | false: even with elderly patients, all attempts to encourage oral feeding should be part of the swallow treatment plan |
| 17. Patients with degenerative neuromuscular diseases should be placed on a feeding tube after they can no longer eat anything by mouth and show signs of malnutrition | False: they should be on a feeding tube when they have the desire to maintain nutrition |
| 18. Getting the prescribed amount of calories will allow a patient to recover from malnutrition | true |
| 19. Malnutrition in hospital patients has comorbitdities unrelated to the underlying diagnosis | true |
| 20. A pH test of tube aspirate is recommended for all types of tube-feeding | false: only for nasogastric tubes |
| 21. Elderly patients should be allowed to eat a liberal diet in order to maintain their social status and outside living activities as long as safety of swallowing is preserved in the diet. | true |
| 22. Which professional is mainly responsible for monitoring the nutritional status of the patient? | registered dietician |
| 23. Proper nutrition: | provides increased strength and builds immune status |
| 24. Standardization of foods through analysis of their properties will help in all of the following ways except: | reducing aspiration during testing |
| 25.the key to recommending thickened fluids is to | protect the airway and ensure maximal swallow safety and to minimize residue post swallow |
| 26. viscosity represents a characteristic of a liquid that can be described more simply as | thickness |
| 27. what factors might limit a patient's intake of recommended thickened fluids? | limited access to thickened fluids, patient is unused to the change in taste and texture, and patient feels that thickened fluids don't quench their thirst |
| 28. Who may benefit from the Free Water Protocol? | only individuals who are mobile and have good cognitive functions |
| 29. Examples of minced and moist foods include: | thick smooth cereal and mashed banana |
| 30. for patients who require long-term nonoral feeding, gastrostomy tubes are preferred as | they last longer and therefore require less replacing, they are more comfortable than other forms of enteral feeding, they are more fixed in place and don't dislodge easily, and patients don't find them as disfiguring. |
| 31. regular food texture | daily foods of different textures |
| 32. pureed food texture | blended food with any type of additional liquid to achieve a smooth,extremely thick fluid |
| 33. soft food texture | foods that require little chewing, can be naturally so or processed to achieve this texture |
| 34. minced and moist food texture | finely mashed or minced solids with thick and smooth sauces |
| 35. liquidized food texture | blended food with any type of additional liquid to achieve a smooth, moderately thick fluid. |
| 36. intravenous/peripheral parenteral nutrition; central total parenteral nutrition | peripheral veins (entry and end point) |
| 37. jejunostomy | external opening on the abdomen to the small intestines (entry and end point) |
| 38. gastrostomy/percutaneous endoscopic gastrostomy | external opening on the abdomen to the stomach (entry and end point) |
| 39. nasogastric tube | nose to stomach (entry and end point) |
| 40. nasoduodenal/nasojejunal | nose to the intestines (entry and end point) |
| 41. define rheology | the study of deformation and flow of matter |
| 42. what are the two variables in rheology that influence the properties of a liquid? | viscosity and density |
| 43. Diets catering to patients with dysphagia should take into consideration: | a. amount, b. viscosity, c. consistency, d. timing |
| 44. thickeners are used in treating swallowing disorders to change what property of the liquid or food? | viscosity |
| 45. a creep test is used to determine how materials ______________ when put under stress. | deform |
| 46. a fluid with no single constant value of viscosity is called a ______________ | non-newtonian fluid |
| 47. list three categories of foods that aren't well tolerated by those with dysphagia | 1. crumbly and non-cohesive, 2. mixed consistencies 3. sticky foods |
| 48. feeding that occurs by way of entering through the intestine is called | jejunostomy |
| 49. Define presbyphagia | changes in swallowing function due to natural aging. |
| 1. Surgical treatment of swallowing disorders is used to improve glottal closure techniques to aid in the prevention of aspiration. | true |
| 2. Vocal fold medialization will improve swallowing but not voice quality. | false: it usually improves voice quality also |
| 3. The primary goal of vocal fold medialization is to improve the loudness of the voice. | false: primary goal is to improve glottic closure |
| 4. Vocal fold injection is risky because it involves putting the patient to sleep with general anesthesia. | false: there is a risk when using anesthesia but these techniques can be done with a local anesthesia and not requiring general anesthesia. |
| 5. When recovery of a paralysis is expected, no injection or medialization should be done. | False: an injection with a temporary material is a good option to improve recovery. |
| 6. Over-injection of a vocal fold with a temporary or permanent substance will likely increase the risk of aspiration early after the injection | true |
| 7. Teflon is no longer an option for vocal fold injection | false: It can be used in patients where life may be short due to other diseases |
| 8. One advantage of vocal fold injection over other procedures is that it doesn't require general anesthesia | true |
| 9. Medialization laryngoplasty is best done under general anesthesia | false: it should be done under local to test the sound of the voice |
| 10. Arytenoid adduction improves closure of the anterior vocal folds. | false: posterior |
| 11. Arytenoid adduction with medialization laryngoplasty will improve both voice quality and swallowing | true |
| 12. Arytenoid adduction can change the anatomical level of the vocal fold. | true |
| 13. Over-medialization using a Silastic implant is a temporary glottic closure problem that resolves in one to two weeks. | false: it may take longer to resolve or it may require surgery to remove the implant and replace it |
| 14. One way to make sure the vocal folds close at the same level is to do an arytenoid adduction and medialization | true |
| 15. Lack of sensation in the larynx is associated with post swallow aspiration. | true |
| 16. Nonoral feeding using PEG provides safe nutrition without aspiration | false: patients can aspirate |
| 17. A change in the rate of breathing is normal for a patient wearing an expiratory speaking valve | false: it's a warning of a breathing disorder |
| 18. A fenestrated tracheostomy tube may be used indefinitely until the patient recovers from extensive surgery and can begin to breathe on his/her own. | false: it may lead to bleeding, granulation tissue, or inflammation |
| 19. Tracheotomy is a safe and effective way of preventing aspiration in a patient following lingual surgery for partial removal of the tongue | false: a tracheostomy shouldnt be expected to completely resolve an aspiration problem in most patients |
| 20. One year after radiation therapy for an oral or lingual cancer, patients should be expected to swallow a normal diet without aspirating but with slowed eating. | false: swallowing problems have been found to persist even one year after radiation therapy |
| 21. Medialization laryngoplasty has all of the following advantages over vocal fold injection except | reversal is easy even after long term implantation |
| 22. Medialization laryngoplasty is least likely to improve swallowing if | if there is a loss of sensation in the larynx |
| 23. Surgical or neural damage to the soft palate will lead to: | regurgitation, speech distortion, delayed bolus propulsion |
| 24. Tracheostomy provides which of the following? | airway and ease of suctioning |
| 25. Treatment of the paralyzed vocal fold may include | voice therapy, vocal fold medialization, postural swallowing exercises |
| 26. Intractable aspiration is best treated by? | laryngotracheal separation |
| 27. Respiratory obstruction may be relieved by: | tracheotomy and cricothyrotomy |
| 34. A growth of tissue resulting from a reaction to inflammation or irritation from a foreign substance or device is called a | granuloma |
| 35. When there is a large posterior gap after vocal fold medialization, what is the surgeon's most likely next procedure? | arytenoid adduction |
| 36. surgery to improve upper esophageal sphincter relaxation consists of a | cricopharyngeal myotomy |
| 37. List three factors other than a glottal gap that may be risk factors for aspiration | 1. pharyngeal motor control, 2. sensory loss, 3. cricopharyngeal constriction |
| 38. A major contraindication for a cricopharyngeal myotomy is: | gastroesophageal reflux disease. |
| 39. To improve relaxation in the upper esophageal sphincter, the best non-surgical treatment is the | shaker exercise |
| 40. A surgical procedure in which a muscle is cut or trimmed to make it smaller is called a | myotomy |
| 41. GERD is the common abbreviation for | GERD : gastroesophageal reflux disease |
| 42. An abnormal passageway sometimes caused by surgical accident or tissue breakdown is called a | Fistula |
| 43. Elevation and retraction of the soft palate is the primary responsibility of the ________________ nerve | Vagus |
| 44. A surgical procedure in which tissue is adhered to another by surgical glue or stitching is called a | Pexy procedure |
| 45. the most common reason for a tracheostomy is | prolonged mechanical ventilation |
| 46. List four advantages of using an expiratory valve on a tracheostomy tube | 1. verbal communication, 2. maintain airflow, 3. increased pressure during the swallow, 4. increased vocal fold adduction |
| 47. The most effective way to improve swallowing in a patient with a tracheostomy tube is | decannulation: although this may not always be possible |
| 48. Medical grade flexible substance used by otolaryngologists to insert in patients undergoing medialization laryngoplasty | medical grade Gore-Tex |
| 49. The gold standard for treating a patient with aspiration due to glottic insufficiency is | laryngeal framework surgery or medialization laryngoplasty |
| 50. a treatment that is also used to treat patients with glottic insufficiency but may not be permanent is called | vocal fold augmentation or vocal fold injection |
| 1. Therabite is an object to aid the patient in increasing tongue pressure | False: it's used to improve jaw opening |
| 2. oral prosthetics is the science of providing suitable substitutes for missing, lost or removed structures in the oral cavity | false: oral prosthodontics |
| 3. the use of special utensils to aid in swallowing is part of prosthetic management of swallowing disorders | true |
| 4. The role of the SLP in prosthetic management of swallowing disorders is limited primarily to observation of the prosthetic fitting. | false: the role of the SLP is to assess swallow function before, during and after the fitting of the device. An additional role may be to treat the speech problem if the prosthetic device has altered oral structures and thus disrupt articulation. |
| 5. following tumor resection for oral cancer, the patient can expect to have both speech and swallowing problems. | true |
| 6. Patients can maintain a diet adequate in calories and in weight control without the need for dentures | true |
| 7. Quality of life will not change in a patient who has been on a liquid-only diet and who can now have a more normal diet with the addition of dentures. | false: adding dentures will improve the quality of life |
| 8. The palatal reshaping prosthesis is mostly used to life the palate to allow liquids to flow more freely. | false: it's used to lower the palatal vault and create contact are with the tongue |
| 9.implanted dentures are more expensive than and not as useful as standard dentures as they will slop and move with changing age of the patient | false: implanted dentures will stay fixed and have greater stability over time. |
| 10. Prosthetic fitting should be done at the time of surgery if possible rather than waiting until the patient begins oral feeding | true |
| 11. A prosthetic palate-shaping device used to improve swallowing will usually also help to improve speech production | true |
| 12. A properly fitted dental appliance cannot improve the speed of eating, only the types of food consistencies | false: it will improve speed,types of consistency, and safety |
| 13. Prosthetic management of the hard palate for swallowing usually begins 2 to 3 weeks after the surgical area has healed. | false: it can begin at the time of surgery with a temporary device |
| 14. following total glossectomy, patients will | only be able to swallow liquids |
| 15. A speaking valve over the open tracheotomy provides which of the following: | increased subglottic pressure during swallowing, increased loud ness of the voice, and increased strength of cough |
| 16. Prosthetic management of patients following head and neck surgery includes all but | the reduction of thick secretions once the prosthetic device is in place |
| 17. Following the diagnosis of a tumor in the tongue and surgery to remove part of the tongue, the SLP's role is to | conduct a clinical evaluation of swallowing |
| 18. The incidence of swallowing problems following oral surgery is | greater than the incidence of speech problems, more severe as the size of the tumor is larger, more severe following surgery to posterior tongue compared to anterior. |
| 19. The use of properly fitting dentures will improve swallowing in at least 3 ways. | 1. increase tongue control, 2. allow for more flexible diet, 3. increase the rate of eating |
| 20. The palate-lowering prosthesis improves two phases of swallowing and one aspect of speech. What are they? | 1. oral preparatory phase, 2. oral phase, 3. speech intelligibility |
| 21. A device used to build a palatal prosthesis so that it can make contact with the tongue is called an | obturator |
| 22. A soft palate prosthesis extending posterior helps to increase the sphincteric action of the | tongue to soft palate |
| 23. the major effect of a tongue prosthesis when the majority of the tongue has been removed is | reduce the pooling of secretions that may lead to post-swallow aspiration |
| 24. patients with a tracheostomy tube may get improved propulsion of the bolus with the addition of a __________ placed on the tracheotomy tube | speaking valve or one-way speaking valve |
| 25. A head tilt to which side of the body may improve swallowing in patients with partial or total glossectomy? | side least affected |
| 26. Name four speech sounds that would be helpful to practice to improve both speech and swallowing in patients with partial glossectomy? | /t,d,g,k/ |
| 27. What is the best type of imaging for use by the prosthodontist when shaping the prosthesis for a patient with removal of oral structures? | CT 3-dimensional images |
| 28. The physical and environmental factors such as chairs and utensils that enhance swallowing in the patient who has had head and neck surgery are usually managed by the | physical and occupational therapist |
| Therabite is a device used to aid a patient in improving jaw opening. | true |
| Prosthetic management of patients following head and neck surgery includes all but: | The reduction of thick secretions once the prosthetic device is in place. |
| The Shaker exercise was designed primarily to: | Increase the opening of the UES |
| compensatory swallowing therapy is limited by which of the following? | Willingness to practice independently. |
| The use of the chin tuck to improve swallowing safety: | Increases the speed of the bolus to the upper esophageal sphincter |
| Following total glossectomy,patients will: | Only be able to swallow liquids. |
| Swallowing warm water has been shown to increase the overall speed of the swallow response. | false |
| Occasional aspiration is to be expected in patients undergoing rehabilitative swallowing therapy. | true |
| The Shaker exercise has been shown to increase hypolaryngeal bolus pressure. | false |
| A prosthetic device used to improve swallowing typically has no impact on speech production or intelligibility. | false |
| The use of properly fitting dentures will improve swallowing in several ways. Which of the following is not improved by use of dentures? | Sense of taste and smell. |
| A properly fitted dental appliance cannot improve the speed of eating, only the types of food consistencies. | false |
| The primary reason for treating a patient with a swallowing disorder is to improve the safety of their swallow. | true |
| The super-supraglottic swallow maneuver is the best technique for achieving vocal fold closure for a swallow. | true |
| Physical and environmental factors such as chairs and utensils that enhance swallowing in patients with head and neck cancer are usually managed by a physical or occupational therapist | true |
| For patients with partial glossectomy, practicing the /p/, /b/, /k/ and /g/ sounds can help improve both swallowing and speech. | false |
| Dental implants are less expensive than dentures and typically they slip and move as the patient ages or loses weight. | false |
| Which of the following disorders are considered a disorder of the pharyngeal stage of the swallow? | aspiration |
| LSVT therapy may be useful for both swallowing and for speech improvement in patients who have Parkinson disease and other neurological disorders. | true |
| The incidence of swallowing problems following oral surgery is more severe following surgery to the posterior tongue compared to the anterior. | true |
| Even when recovery of a paralyzed vocal cord is expected, injection of the vocal fold or medialization may be a good temporary management solution | true |
| Patients who are on total parenteral nutrition can still eat by mouth. | false |
| When a patient is fed non-orally through a tube going into the stomach this is referred to as a: | PEG tube |
| The prime variable for studying the properties of liquids is: | viscosity |
| Patients with swallowing disorders should avoid all of the following except: | milk |
| A device used to measure the resistance to flow of a material is called a rheometer. | false |
| Medialization laryngoplasty will not improve swallowing if: | There is a loss of sensation in the larynx |
| Tracheostomy provides which of the following: | A patent airway Easier suctioning |
| Nasogastric tubes are usually used with patients who will be on long term non-oral diets. | false |
| Adding milk to foods will decrease the viscosity of the food. | true |
| A surgical procedure in which a muscle is cut or trimmed to make it smaller is called myotomy. | true |
| Nonoral feeding using a PEG does not necessarily prevent aspiration. | true |
| Unlike typical powdered thickeners, Simply thick is gel based and when used to thicken carbonated beverages, the carbonation is retained. | true |
| Surgical or neural damage to the soft palate will lead to: | Nasal regurgitation Speech distortion Delayed bolus propulsion |
| When a food substance changes as a result of chewing, we can say that its viscosity changes | true |
| Elevation and retraction of the soft palate is the primary responsibility of the facial nerve. | false |
| Vocal fold medialization will improve swallowing but not voice quality. | false |
| Teflon is no longer an option for vocal fold injection. | false |
| Intractable aspiration is best treated by: | Laryngotracheal separation |
| Standardization of foods through analysis of their properties will help in all of the following ways except: | Reducing aspiration during testing. |
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