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Worksheets

Dr. Cohick Midterm

Total questions: 228

Worksheet time: 12hrs 32mins

Name
Class
Date
1.

Which of the following does NOT apply to Dysphasia?

a)

Inability to suck, chew and/swallow

b)

Difficulty moving food from the mouth to the stomach

c)

May occur across all age groups

d)

May result from acquired or developmental disorders

e)

None of the above

2.

Which of the following does NOT apply to Dysphagia?

a)

Inability to suck, chew and/swallow

b)

Difficulty moving food from the mouth to the stomach

c)

May occur across all age groups

d)

May result from acquired or developmental disorders

e)

Difficulty moving food from the plate to the mouth

3.

Think about populations effected by dysphagia: What population am I describing? CVA, TBI, Multiple Sclerosis, Muscular Dystrophy, degenerative diseases

a)

Persons with neurological disorders

b)

Persons with structural anomalies

c)

Persons with developmental disorders

d)

None of the above

4.

Think about populations affected by dysphagia: What population am I describing? Oral and Laryngeal cancer, cleft palate

a)

Persons with neurological disorders

b)

Persons with structural anomalies

c)

Persons with developmental disorders

d)

None of the above

5.

Think about populations affected by dysphagia: What population am I describing? Cerebral palsy, down syndrome, respiratory problems such as pneumonia, and COPD.

a)

Persons with neurological disorders

b)

Persons with structural anomalies

c)

Persons with developmental disorders

d)

None of the above

6.

Select all that apply:

Which of the following stage of swallowing is under cortical control?

a)

Oral preparatory phase

b)

Oral phase

c)

Pharyngeal phase

d)

Esophageal phase

7.

Select all that apply:

Which of the following stage of swallowing is reflexive?

a)

Oral preparatory phase

b)

Oral phase

c)

Pharyngeal phase

d)

Esophageal phase

8.

What begins at AP propulsion.

a)

Oral prepatory phase

b)

oral phase

c)

pharyngeal phase

d)

esophageal phase

9.

Which of the following does not apply to the physiology of the oral preparatory phase

a)

Manipulation and/or mastication of food in the mouth

b)

Labial seal

c)

rotary and lateral movement of tongue and mandible

d)

Larynx and pharynx elevated

e)

adequate facial muscle tone

10.

Which of of the following is not part of the necessary anatomy for the oral preparatory phase?

a)

lips and cheeks

b)

tongue and alveolar ridge

c)

hard and soft palate

d)

epiglottis and valleculae

11.

Which of the following muscles is not part of the oral preparatory phase?

a)

Facial muscles

b)

Mandibular muscles

c)

tongue muscles

d)

soft palate muscles

e)

pharyngeal muscles

12.

Which of the following is Not part of the oral phase physiology?

a)

It begins with posterior movement of the bolus (AP propulsion)

b)

Stripping Action: Pushing of tongue against roof of mouth. Tongue creates shoot towards pharynx

c)

Lateral edges of tongue tip are anchored against the alveolar ridge

d)

The transit time takes about 3-5 seconds depending on the viscosity/ consistency of the item

13.

Which of the following is NOT part of the oral phase anatomy

a)

Lips and cheecks

b)

Tongue

c)

Hard palate

d)

elevated soft palate

e)

They all are part of it.

14.

True or False: The mandibular and tongue muscles are the only muscles involved in the oral phase

a)

True

b)

False

15.

In which phase does the velum elevate

a)

Oral preparatory

b)

Oral

c)

Pharyngeal

d)

Esophageal

16.

Which of the following is correct about the pharyngeal stage physiology?

a)

It begins when the leading head of the bolus passes any point between the posterior faucial arches and triggers a swallow response

b)

When the bolus head passes the point where the tongue base crosses the upper rim of the mandible (this is for 60 years and up)

c)

None of the above

d)

All of the above

17.

What is deglutition?

a)

The act or processes of chewing

b)

The act or process of swallowing

c)

Disorders related to chewing and swallowing

d)

Disorders related to the esophageal phase

18.

True or False: Disorder of deglutition can only occur during the oral phase, triggering of the pharyngeal swallow, or the pharyngeal stage

a)

True

b)

False

19.

Fill in the blank:

____ is when we see it occur

a)

Sign

b)

Sypmptom

20.

Fill in the blank:

____ is when the patient reports it

a)

Sign

b)

Sypmptom

21.

Select the corresponding oral preparation sign/symptom and the disorder.

a)

Can't hold food in mouth anteriorly

b)

can't hold a bolus

c)

reduced lip closure (neurological or muscular issue)

d)

Reduced range of tongue motion or coordination

22.

Select the corresponding oral preparation sign/symptom and the disorder.

a)

Can't hold food in mouth anteriorly

b)

can't hold a bolus

c)

risk of aspiration before the swallow of spillage into the pharynx

d)

reduced tongue coordination; reduced anterior soft palate positioning

23.

Select the corresponding oral preparation sign/symptom and the disorder.

a)

Abnormal hold position

b)

can't form a bolus

c)

reduced labial or buccal tension

d)

reduced range of tongue motion or coordination

24.

Select the corresponding oral preparation sign/symptom and the disorder.

a)

food falls into anterior or lateral sulcus

b)

can't form a bolus

c)

reduced labial or buccal tension

d)

reduced range of tongue motion or coordination

25.

Select the corresponding oral preparation sign/symptom and the disorder.

a)

Abnormal hold position (holding bolus between teeth and tongue)

b)

can't form a bolus

c)

reduced tongue control; tongue thrusts

d)

reduced range of tongue motion or coordination

26.

Fill in the blank: Tongue ______ are associated with dementia, cerebral palsy, and down syndrome

a)

scarring

b)

thrusts

c)

rigidity

d)

spasms

27.

Thinking about the oral phase, select the sign/symptom and the corresponding disorder

a)

Delayed oral onset

b)

Apraxia; reduced sensation

c)

tongue moves forward

d)

reduced labial or buccal tension/strength

28.

Thinking about the oral phase, select the sign/symptom and the corresponding disorder

a)

tongue thrusts

b)

Apraxia; reduced sensation

c)

tongue moves forward

d)

reduced labial or buccal tension/strength

29.

Thinking about the oral phase, select the sign/symptom and the corresponding disorder

a)

residue in anterior or lateral sulcus

b)

Apraxia; reduced sensation

c)

residue on floor of mouth

d)

reduced labial or buccal tension/strength

30.

Thinking about the oral phase, select the sign/symptom and the corresponding disorder

a)

residue in anterior or lateral sulcus

b)

reduced tongue coordination

c)

residue on floor of mouth

d)

tongue scarring

31.

Thinking about the oral phase, select the sign/symptom and the corresponding disorder

a)

incomplete tongue-palate contact

b)

reduced tongue coordination

c)

residue mid-tongue

d)

tongue scarring

32.

Thinking about the oral phase, select the sign/symptom and the corresponding disorder

a)

incomplete tongue-palate contact

b)

residue on hard palate

c)

reduced tongue elevation/strength

d)

tongue scarring

33.

True or False: As viscosity increases, so does the likelihood that there will be residue

a)

True

b)

False

34.

True or False: Reduced tongue elevation/strength is associated with both stroke victims and individuals with parkinsons.

a)

True

b)

False

35.

Thinking about the oral phase, select the sign/symptom and the corresponding disorder

a)

Reduced tongue coordination

b)

lingual rocking/rolling action

c)

reduced A-P movement

d)

reduced tongue control

36.

(Hint: Select 3 for this one)

Thinking about the oral phase, select the sign/symptom and the corresponding disorder

a)

Reduced tongue control

b)

lingual rocking/rolling action (bolus is broke in half

c)

reduced A-P movement

d)

Parkinson's disease

37.

Thinking about the oral phase, select the sign/symptom and the corresponding disorder

a)

Reduced tongue control

b)

lingual rocking/rolling action (bolus is broke in half

c)

risk of penetration/aspiration before the swallow

d)

uncontrolled bolus/premature loss of liquid into the pharynx

38.

If the client cannot hold a bolus, when might we see penetration/aspiration in relation to the swallow?

a)

Before

b)

During

c)

After

39.

If the client has uncontrolled bolus/premature loss of liquid into the pharynx, when might we see penetration/aspiration in relation to the swallow?

a)

Before

b)

During

c)

After

40.

True or False: If there is spillage to the voleculae, this is disordered and needs to be noted.

a)

True

b)

False

41.

True or False: Talking while eating may indicate elevated cognitive skills

a)

True

b)

False

42.

Select all that apply:

Where can a swallow be triggered?

a)

Faucial Arches

b)

Where tongue base meets the mandible

c)

The voleculae

d)

Pyriform sinuses

43.

Select all that apply:

When is there a disorder due to delayed pharyngeal swallow?

a)

Occurs when the head of the bolus enters the pharynx and the pharyngeal swallow has not been triggered

b)

Bolus will land in the pyriform sinus, valleculae, or open airway with a potential for aspiration

c)

None of the above

d)

All of the above

44.

Thinking about the pharyngeal stage, select the sign/symptom and the corresponding disorder

a)

Nasal penetration

b)

Residue on one side of the pharynx and pyriform sinus

c)

VPI (velopharyngeal incompetence)

d)

Reduced tongue base movement

45.

Thinking about the pharyngeal stage, select the sign/symptom and the corresponding disorder

a)

Nasal penetration

b)

Residue on one side of the pharynx and pyriform sinus

c)

VPI (velopharyngeal incompetence)

d)

unilateral pharyngeal wall weakness.

46.

Select all that apply about a client who has residue on one side of the pharynx and pyriform sinus?

a)

Unilateral pharyngeal wall weakness

b)

Hemiparesis: think stroke and TBI

c)

You should do an AP view fluoro to see if localized to one side

d)

All of the above

47.

Thinking about the pharyngeal stage, select the sign/symptom and the corresponding disorder

a)

Bony outgrowth

b)

Residue on one side of the pharynx and pyriform sinus

c)

VPI (velopharyngeal incompetence)

d)

cervical osteophytes

48.

Select the sign related to cervical osteophytes

a)

Bony Outgrowth

b)

Patient reports things getting stuck in throat

49.

Select the symptom related to cervical osteophytes

a)

Bony Outgrowth

b)

Patient reports things getting stuck in throat

50.

Thinking about the pharyngeal stage, select the sign/symptom and the corresponding disorder.

a)

Coating on the pharyngeal wall

b)

Residue on one side of the pharynx and pyriform sinus

c)

reduced pharyngeal contraction bilaterally

d)

cervical osteophytes

51.

Why might a client have reduced pharyngeal contration bilaterally

a)

ALS

b)

Dementia

c)

Parkinsons

d)

A neurological disorder that does not cause a hemiparesis

e)

All of the above

52.

Thinking about the pharyngeal stage, select the sign/symptom and the corresponding disorder.

a)

Vallecular residue after the swallow

b)

Coating in a depression

c)

Reduced tongue base movement (retraction)

d)

Reduced laryngeal elevation

53.

Thinking about the pharyngeal stage, select the sign/symptom and the corresponding disorder.

a)

Vallecular residue after the swallow

b)

Coating in a depression

c)

Scar Tissue

d)

Reduced laryngeal elevation

54.

Thinking about the pharyngeal stage, select the sign/symptom and the corresponding disorder.

a)

Vallecular residue after the swallow

b)

residue at top of airway

c)

Scar Tissue

d)

Reduced laryngeal elevation

55.

True or False: There is a relationship between the UES and laryngeal elevation

a)

True

b)

False

56.

How much laryngeal elevation should we expect in a typical swallow?

a)

2-4 cm

b)

3-5cm

c)

2-4 inches

d)

4-6 inches

57.

Fill in the blank:

If there is residue in the valleculae after the swallow, the ______ and posterior phaygeal wall are not meeting

a)

Velum

b)

tongue base

c)

oral tongue

d)

None of the above

58.

True or False: Another name of the bottom of the airway is the laryngeal vestibule?

a)

True

b)

False

59.

If the client has residue at the top of the airway, when might we see penetration/aspiration

a)

Before

b)

During

c)

After

60.

Select all that apply:

When there is laryngeal closure, we should see

a)

The arytenoids tight

b)

The epiglottis coming down

c)

3-5cm elevation of the larynx

d)

brisk laryngeal elevation

61.

(Select all that apply)

Thinking about the pharyngeal stage, select the sign/symptom and the corresponding disorder.

a)

Stricture

b)

residue in the pyriform sinuses

c)

Cricopharyngeal dysfunction

d)

Reduced anterior laryngeal motion (elevation)

e)

Residue throughout the pharynx

62.

(Select all that apply)

Thinking about the pharyngeal stage, select the sign/symptom and the corresponding disorder.

a)

residue at top of airway

b)

generalized dysfunction

c)

scar tissue

d)

Residue throughout the pharynx

63.

Fill in the blank:

______ means that half of all structures related to the larynx are removed

a)

Hemilaryngectomee

b)

Laryngectomee

c)

peristalsis

d)

None of the above

64.

Laryngeal penetration and aspiration during the pharyngeal stage is due to :

a)

Reduced closure of the airway entrance

b)

Over tightening of the airway entrance

c)

None of the above

d)

all of the above

65.

Fill in the blank:

_______ is whe food or liquid enters teh laryngeal vestibule but not below the levels of the true vocal folds

a)

Penetration

b)

Aspiration

c)

Peristalsis

d)

Mastication

66.

Fill in the blank:

_______ is the entry of food/liquid into the airway below the true vocal folds

a)

Penetration

b)

Aspiration

c)

Peristalsis

d)

Mastication

67.

True or False: When we do fluoro or fees for penetration/aspiration, we are trying to find the physiological cause.

a)

True

b)

False

68.

Think about etiologies of laryngeal penetration:

Select which ones can cause it DURING the swallow

a)

Decreased laryngeal elevation

b)

Inadequate forward tilt of arytenoid cartilages

c)

Slow laryngeal elevation

d)

Delayed trigger of pharyngeal swallow

69.

Think about etiologies of laryngeal penetration:

Select which ones can cause it before the swallow

a)

Decreased laryngeal elevation

b)

Inadequate forward tilt of arytenoid cartilages

c)

Slow laryngeal elevation

d)

Delayed trigger of pharyngeal swallow

70.

Aspiration before the swallow can be caused by:

a)

Loss of control of the bolus with the tongue

b)

Delayed/absent swallow reflex

c)

All of the above

d)

None of the above

71.

Aspiration during the swallow can be caused by:

a)

Loss of control of the bolus with the tongue

b)

Delayed/absent swallow reflex

c)

All of the above

d)

None of the above

72.

Which of the following is NOT a level the larynx closes at during the pharyngeal swallow?

a)

The true vocal folds

b)

The false vocal folds

c)

Deflection of the epiglottis

d)

The velum

73.

True or False: If aspiration happens during the swallow, it is due to reduced laryngeal closure

a)

True

b)

False

74.

If the client has residue, when are they at risk for penetration/aspiration

a)

Before

b)

During

c)

After

75.

If the client has residue in the pharynx when might penetration/aspiration occur

a)

Before

b)

During

c)

After

76.

Select all that apply:

Aspiratin after the swallow is associated with

a)

reduced peristalsis

b)

reduced laryngeal elevation

c)

unilateral pharyngeal damage

d)

cricopharyngeal dysfunction

77.

Which of the following is NOT an esophageal phase disorder?

a)

Esophageal-to-pharyngeal backflow

b)

Tracheoesophageal fistula

c)

Zenker's Diverticulum

d)

Gastroesopheal reflux disease (GERD)

e)

Decreased laryngeal elevation

78.

If a client complains about pain in their chest after eating, which esophageal phase disorder is this associated with?

a)

Esophageal-to-pharyngeal backflow

b)

Tracheoesophageal fistula

c)

Zenker's Diverticulum

d)

Gastroesopheal reflux disease (GERD)

79.

I which esophageal phase disorder am I explaining?

A hole in the common wall between the trachea and esophagus

a)

Esophageal-to-pharyngeal backflow

b)

Tracheoesophageal fistula

c)

Zenker's Diverticulum

d)

Gastroesopheal reflux disease (GERD)

80.

Which esophageal phase disorder am I explaining?

A side pocket that forms when the pharyngeal or esophageal muscle herniates

a)

Esophageal-to-pharyngeal backflow

b)

Tracheoesophageal fistula

c)

Zenker's Diverticulum

d)

Gastroesopheal reflux disease (GERD)

81.

Which esophageal phase disorder am I explaining?

regurgitation of esophageal contents back into the larynx and pharynx

a)

Esophageal-to-pharyngeal backflow

b)

Tracheoesophageal fistula

c)

Zenker's Diverticulum

d)

Gastroesopheal reflux disease (GERD)

82.

Which esophageal phase disorder am I explaining?

The regurgitation of gastric contents into the esophagus

a)

Esophageal-to-pharyngeal backflow

b)

Tracheoesophageal fistula

c)

Zenker's Diverticulum

d)

Gastroesopheal reflux disease (GERD)

83.

Which of the following is NOT part of the pharyngeal stage physiology?

a)

Velopharyngeal closure

b)

Elevation and anterior movement of the hyoid and larynx

c)

closure of the larynx. Tongue base and pharyngeal wall action

d)

Cricopharyngeal opening/UES

e)

Lateral edges and tongue tip are anchored against the alveolar ridge.

84.

True or False: The hypoid bone is the only bone in the body not connect to another bone. We should expect about 2 inches of elevation

a)

True

b)

False

85.

Thinking about the UES, is it open or closed when relaxed

a)

Open

b)

closed

86.

Think about the anatomy of the pharyngeal stage. Which of the following is NOT involved

a)

Soft palate (elevated)

and epiglottis (deflated)

b)

Pyriform simus and laryx

c)

Valleculae and aryepiglotic fold

d)

criocpharyngeal muscle

e)

Hard palate

87.

Think about the muscles of the pharyngeal stage. Which of the following is NOT involved

a)

Tongue muscles

b)

soft palate muscles

c)

pharyngeal muscles

d)

laryngeal muscles

e)

None of the above

88.

Fill in the blank:

_______ is the wave-like motion of the esophagus to push food to the stomach. It is the esophageal muscles working together.

a)

Penetration

b)

Aspiration

c)

Peristalsis

d)

Mastication

89.

What stage/phase beings with the bolus entering the esophagus at the cricopharyngeal juncture and ends with the bolus enters the stomach

a)

Oral preparatory

b)

Oral

c)

Pharyngeal

d)

Esophageal

90.

Fill in the blank: The trasnit time of the esophageal stage varies from ______ seconds depending on the consistency and amount of bolus

a)

15-30

b)

8-20

c)

20-32

d)

5-15

91.

True or False: Peristalsis is part of the physiology of the esophageal phase

a)

True

b)

False

92.

True or False: SLPs treat and/or diagnose esophageal disorders

a)

True

b)

False

93.

Which of the following is a normal variate in swallowing

a)

Infants and young children

b)

Older adults

c)

volume effects

d)

viscosity

e)

All of the above

94.

Select all that apply:

Which is true about normal swallowing variations in older adults?

a)

Structural changes

b)

Arthritic changes

c)

Oral stage is slightly longer

d)

Trigger of swallow takes longer than in younger adults

e)

Small increase in oral and pharyngeal residue

95.

Ossification of the cricoid, thyroid, or the epiglottis in older adults is an example of:

a)

Structural changes

b)

Arthritic changes

c)

Oral stage is slightly longer

d)

Trigger of swallow takes longer than in younger adults

e)

Small increase in oral and pharyngeal residue

96.

In older adults, cervical vertebrae can develop osteophytes which make the larynx smaller and take more effort for the bolus to go through the larynx. The person may have residue and may need to do a double swallow or alternate food and liquid. this is an example of:

a)

Structural changes

b)

Arthritic changes

c)

Oral stage is slightly longer

d)

Trigger of swallow takes longer than in younger adults

e)

Small increase in oral and pharyngeal residue

97.

True or False: In older adults, the oral stage may take longer. This may be due to increased strength and sensitivity. This is not really an issue unless there is increased residue. In which case, the client may need strategies such as alternating food and liquid or a dry/double swallow.

a)

True

b)

False

98.

Fill in the blank:

As bolus viscosity increases, muscular activity ________

a)

Decreases

b)

Increases

c)

Stays the same

99.

Fill in the blanks Small volumes progress through the phase of swallowing ____A___. WIth larger volumes, oral and pharyngeal activity occurs ____B___

a)

A) Simultaneously

B) Sequentially

b)

A) Sequentially

B) Simultaneously

c)

A) Sequentially

B) Sequentially

d)

A) Simultaneously

B) Simultaneously

100.

Select that swallow assessment methods

a)

Screening

b)

Bedside evaluation

c)

videofluoroscopic swallow study (vfss)

d)

Fiberoptic Endoscopic Evalution of Swallowing (FEES)

e)

All of the above

101.

True or False: An SLP does not need a physician's order to do a screening or beside evaluation

a)

True

b)

False

102.

True or False: You can explain why a person has a swallow disorder by doing the bedside.

a)

True

b)

False

103.

True or False: A dysphagia screening tool may or may not be standardized

a)

True

b)

False

104.

Select all that apply:

What are the goals of a swallow screening?

a)

To determine the likelihood the dysphagia is present

b)

To determine the need for formal swallow evaluation

c)

To determine when it is safe to recommend resumption of oral alimentation

d)

To find out why a person is having trouble swallowing

105.

According to ASHA, what comprises a swallow screening? (Select all that apply)

a)

Interview or questionnaire

b)

Observation of the signs and symptoms of oropharyngeal swallowing dysfunction

c)

Formulation of appropriate recommendations, including the need for a full swallow function assessment

d)

Communication of results and recommendations to the team responsible for the individual's care.

e)

To determine the predictive value

106.

Why do we do a chart review for a bedside evaluation

a)

Relevant prior history (for example their medications, do they have a history of cancer -indication against fluoro)

b)

To see their diagnosis -if they had a stroke, TBI, Laryngeal cancer. Do they have respirator or esophageal disorders (ex: GERD)

c)

To check lab results especially their blood cell count, glucose, and blood urea nitrogen

d)

All of the above

e)

Nutritional status

107.

When we do a case history, we are looking NOT for:

a)

Did the patient have a stroke in the past

b)

Doe they have recurrent dysphagia

c)

Do they have an neurological issues? Do they have a history of intubation? Are they on oxygen, do they have nasal cannula or over mouth CO2?

d)

Do they have any respiratory issues such as COPD, pneumonia, emphysema, or anything pulmonary related

e)

None of the above

108.

Fill in the blank:

At the end of a screening we want to have a _______. We may want to skip the bedside, so we need a rationale to give

a)

Diagnosis

b)

Reason why there is a swallow disorder

c)

recommendation

d)

All of the above

e)

none of the above

109.

True of False: When we do a screening for aspiration or oropharyngeal dysphagia, we find out if they can tolerate an oral diet safely. If we're not sure, we need to get more information

a)

True

b)

False

110.

When we do a screening or a bedside swallow exam, we get ____ evidence.

a)

Indirect

b)

direct

111.

What makes a good screening tool?

a)

It is easy to administer

b)

It is inexpensive

c)

It is accurate

d)

It is easy and accurate

e)

All of the above

112.

When we think about the accuracy of a good screening took, which of the following is NOT considered

a)

Sensitivity

b)

Specificity

c)

Positive predictive value

d)

Negative predictive value

e)

Inexpensive

113.

Which swallow assessment method do you not need a physician's order to do

a)

Screening

b)

Bedside evaluation

c)

videofluoroscopic swallow study (vfss)

d)

Fiberoptic Endoscopic Evalution of Swallowing (FEES)

e)

None of them

114.

A highly (a)   test means that there are few cases of false negative results, and thus fewer cases of the disease are missed

115.

A high sensitivity value means a negative result on the clinical test should rule (a)   the diagnosis

116.

A highly (a)   test means that there are few false positive results

117.

A high specificity value means that a positive result for a clinical measure should rule (a)   the diagnosis

118.

fill in the blank:

______ predictor value for a clinical test for detecting aspiration, as confirmed by instrumental assessment, is the proportion of patients who fail the 3oz test who also aspirate on instrumental exam

a)

Positive

b)

Negative

c)

Accurate

d)

False

119.

True or False: With a Positive Predictor value (PPV), screening is positive for aspiration and is confirmed by VFSS or FEES.

a)

True

b)

False

120.

fill in the blank:

______ predictor value for a clinical test is the proportion of patients who pass the 3oz test who do not aspirate on VFSS or FEES.

a)

Positive

b)

Negative

c)

Accurate

d)

False

121.

True or False: With a Negative Predictor value (NPV), screening is negative for aspiration and shows aspiration on VFSS or FEES.

a)

True

b)

False

122.

Which of the following is NOT a model for screening?

a)

Trained Nurse-administered screening

b)

physician-administered screening

c)

Model A or B (where all patients are automatically referred to SLP for assessment within a set amount of time regardless of screening results.

d)

No prior screening. Patients are automatically sent to SLP for assessment and not prior screening is needed

e)

Model C: Patient fills out a questionnaire and self reports swallowing issues. Based on questionnaire results, patient is seen by SLP or not.

123.

Which of the following is NOT an easy, inexpensive, and accurate dysphagia screening tool?

a)

Toronto bedside swallow screening test.

Modified Mann Assessment of Swallowing Ability.

b)

None of the above

c)

Barnes Jewish Hospital Stroke Dysphagia Screen

d)

Yale Swallow Protocol

e)

Guggling Swallow Screen

124.

Which dysphagia screening and I describing:

Vocal quality assessment before and after the swallow, tongue symmetry, water swallows (10 individual teaspoons)

a)

Toronto bedside swallow screening test.

b)

Modified Mann Assessment of Swallowing Ability.

c)

Barnes Jewish Hospital Stroke Dysphagia Screen

d)

Yale Swallow Protocol

e)

Guggling Swallow Screen

125.

Which dysphagia screening and I are describing:

Physician conducted physical examination, including 12 of 24 items from MASA, not boluses are presented

a)

Toronto bedside swallow screening test.

b)

Modified Mann Assessment of Swallowing Ability.

c)

Barnes Jewish Hospital Stroke Dysphagia Screen

d)

Yale Swallow Protocol

e)

Guggling Swallow Screen

126.

Which dysphagia screening and I are describing:

Glasgow coma scale examination, oral mechanism examination, and 3oz water test

a)

Toronto bedside swallow screening test.

b)

Modified Mann Assessment of Swallowing Ability.

c)

Barnes Jewish Hospital Stroke Dysphagia Screen

d)

Yale Swallow Protocol

e)

Guggling Swallow Screen

127.

Which dysphagia screening and I are describing:

Exclusion criteria, brief cognitive screening, oral mechanism examination, and a 3oz water challenge.

a)

Toronto bedside swallow screening test.

b)

Modified Mann Assessment of Swallowing Ability.

c)

Barnes Jewish Hospital Stroke Dysphagia Screen

d)

Yale Swallow Protocol

e)

Guggling Swallow Screen

128.

Which dysphagia screening and I are describing:

Part one: Vigilance, voluntary cough, throat clear, and alive swallow.

Part two: Trials of semisold, liquid, and solid tectures

a)

Toronto bedside swallow screening test.

b)

Modified Mann Assessment of Swallowing Ability.

c)

Barnes Jewish Hospital Stroke Dysphagia Screen

d)

Yale Swallow Protocol

e)

Guggling Swallow Screen

129.

Which dysphagia screening am I describing:

Developed for use with patients with stroke.

It can be administered across healthcare settings

Items included: vocal quality assessment before and after the swallow, tongue symmetry (could be decreased sensitivity or hemiplegia) water swallows (10 individual teaspoons)

-Determine if assessment is needed.

a)

Toronto bedside swallow screening test.

b)

Modified Mann Assessment of Swallowing Ability.

c)

Barnes Jewish Hospital Stroke Dysphagia Screen

d)

Yale Swallow Protocol

e)

Guggling Swallow Screen

130.

Which of the following is true about the Yale swallow Protocol?

a)

It does not determine whether a formal swallow evaluation is needed

b)

It allows timely, appropriate oral diet change recommendations with FEES, VFSS, or full beside evaluation

c)

It is easy to administer, reliable, but not evidence based

d)

none of the above

e)

All of the above

131.

Which of the following is part of the Yale swallow Protocol?

a)

Exclusionary Criteria including questions about alertness and head of bed restrictions

b)

Administration instructions including brief cognitive screening, oral mechanism examination, perform 3-oz water swallow challenge

c)

Pass/fail criteria

Pass: complete and uninterrupted drinking of all 3 ounces of water without overt signs of aspiration

Fail: Inability to drink the entire 3 ounces in sequential swallows due to stopping/starting or patient exhibits overt signs of aspiration

d)

none of the above

e)

All of the above

132.

True or False: If a patient is not silently aspirating, it is easy to identify them.

a)

True

b)

False

133.

True or False: You do not need a referral to do a screening, but if positively identified, then you send the information to the doctor so you can get a referral to do a bedside or other assessment.

a)

True

b)

False

134.

True or False: The Yale Swallow Protocol has evidence from both VFSS and FEEs based studies. The VFSS is from 2014 and the FEEs study is from 2008

a)

True

b)

False

135.

Thinking about chart review and lab reports, what am I describing?

It indicates the possibility of infection

a)

White blood cell count

b)

Red blood cell count

c)

Blood Urea Nitrogen

d)

Albumin

136.

Thinking about chart review and lab reports, what am I describing?

If there is an increase it indicates the possible exposure to hypoxia (limited oxygen)

IF decreased, then indicates possible anemia or hypothyroidism

a)

White blood cell count

b)

Red blood cell count

c)

Blood Urea Nitrogen

d)

Albumin

137.

Thinking about chart review and lab reports, what am I describing?

It is related to protein metabolism; it is eliminated by the kidney and produced by the liver.

When it is low, it indicates low protein intake and overhydration (ex: anorexia or alcoholism)

If it is high, it indicates an issue with the liver. This is more concerning for aspiration pneumonia/dehydration.

a)

White blood cell count

b)

Red blood cell count

c)

Blood Urea Nitrogen

d)

Albumin

138.

Thinking about chart review and lab reports, what am I describing?

It is the major protein in plasma. It is the best indicator of long-term nutritional status - like three weeks of nutritional status.

If it is low, it indicates malnutrition and possible overhydration. Then this client is more prone to bed/pressure sores.

If it is high, it indicates dehydration.

a)

White blood cell count

b)

Red blood cell count

c)

Blood Urea Nitrogen

d)

Albumin

139.

True or False: People with dyphagia commonly have dehydration because they are not eating or drinking.

a)

True

b)

False

140.

Which of the following is NOT a sign/sympton of dysphagia?

a)

Increased alterness

b)

Changes in approach to food. For example, ager two bites, they are coughing and won't eat anymore

c)

Patient complains or you see something through observation. Foe example, the patient reports that they feel food stuck in chest

d)

Manifestations of impaired oropharyngeal function. Do they have any issues that would impact oral or pharyngeal function?

e)

None of the above

141.

If you saw in a patient's chart that they had a history of silent aspiration, what would you do?

a)

Beside

b)

screening

c)

FEEs or Fluoro

142.

What are these associated with?

-Coma

-Stupor

-Dementia, delirium

-Playing with food

-Inappropriate bolus size

-talking while eating

a)

Decreased alterness

b)

Decreased attention

c)

Changes in approach to food

d)

Manifestations of impaired oropharyngeal function

143.

What is the earliest rancho level that you could attempt to do a screening?

a)

3 or 4 (confused/agitated)

b)

5 or 6

c)

2 or 3

d)

any level is appropriate

144.

True or False: With stupor, Dementia, and delirium (can be reversed), they may not be able to follow directions, which could be an issue for doing the step necessary to do a bedside swallow exam.

a)

True

b)

False

145.

Which of the following is Not a change in approach to food?

a)

Avoid food in the company of others. They may avoid specific consistencies

b)

Their meal time may increase and they may require fewer breaks

c)

They may have repetitive swallows

d)

They may cough for choke during meals

e)

They may have throat clearing that may get progressively worse as the mean goes on from increased fatigue.

146.

Which of the following is NOT correct regarding patient complaints or observations?

a)

Difficulty initiating a swallow. The patient may report sensation of food sticking in throat or chest

b)

Regurgitation of food/liquid. Unexplained weight gain

c)

Impaired breathing after meals

d)

Pain during swallowing

e)

Leakage of food/liquid at tracheotomy site. This is below the vocal folds and trachea leads to lungs, so if food here, it's aspiration.

147.

True or False, if you observe that a client has impaired breathing during or after meals, this indicates aspiration, and the right upper lobe of the lungs is where aspiration settles, so listen with a stethoscope.

a)

True

b)

False

148.

Which of the following is NOT a physiologic sign of aspiration?

a)

Unexplained weight loss (about 10% of body weight in 1-2 weeks)

b)

Spiked temperature that hovers around 103 degrees which indicates infection

c)

Changes in breathing. You may be able to hear stridor. Stridor is a high-pitched, turbulent sound that can happen on an inhale or exhale.

d)

None of the above

149.

True or False: Dysarthria and dysphagia often co-occur because the same muscles are being used.

a)

True

b)

False

150.

Which of the following is NOT a manifestation of impaired oropharyngeal function?

a)

Dysarthria.

Wet, hoarse vocal quality

b)

Dysfunction of musculature for example facial asymmetry or tongue deviates to ons side.

c)

Drooling or oral spillage. Pooling, pocketing of food

d)

Frequent throat clearing/coughing.

Watery eyes and runny nose

e)

None of the above

151.

True or False: We only try strategies in FEEs or Fluoro so we can see if it is effective and why.

a)

True

b)

False

152.

Which of the following is NOT a purpose of the bedside clinical evaluation

a)

Determine the site of the problem (what phase/stage)

b)

Determine appropriate diagnostic tools

c)

Determine therapy techniques and/or strategies

d)

To gather direct evidence about the issue causing the dysphagia

153.

Select all the Types of Bedside Clinical Evaluations

a)

Non-standardized in nature (done most often)

b)

The Mann Assessment of Swallowing Ability (MASA) standardized assessment tool

c)

Yale Swallow Protocol

d)

Gugging Swallow Screen

154.

True or False: For a bedside clinical evaluation, you need to gather patient history and do a physical exam/oral mech

a)

True

b)

False

155.

True or False: When doing a beside clinical evaluation, you want to find out what, why (even though we can't fully know because we can't see), and are there any ways to eliminate what seeing (strategies)

a)

True

b)

False

156.

Which of the following is not part of patient history?

a)

Patient/family input. For example, the patient may be cognitively impaired and may not know or have issues remembering. They may have limited language to express themselves.

b)

Site/timing of problem

c)

Onset/frequency

d)

Aggravating factors and associated symptoms

e)

None of the above

157.

True or False: When we think about site/timing, we are thinking about which phase of swallowing is the issue.

a)

True

b)

False

158.

Think about site/timing: Which phase am I describing?

Problems chewing, forming bolus, initiation. We may see pocketing, anterior spillage, problems chewing, difficulty forming the bolus, having trouble getting swallowing going. They may have tongue thrusting.

a)

Oral preparatory/oral phase

b)

Pharyngeal

c)

Esophageal

159.

Think about site/timing: Which phase am I describing?

Problems immediately upon swallowing, choking after delay, and residue. We may hear throat clearing or coughing

a)

Oral preparatory/oral phase

b)

Pharyngeal

c)

Esophageal

160.

Think about site/timing: Which phase am I describing?

Seconds after the swallow, behind the chest bone. Problems after the swallow

a)

Oral preparatory/oral phase

b)

Pharyngeal

c)

Esophageal

161.

Think about the onset and frequency of a problem. Which is NOT true/accurate

a)

We want to think about duration:

if it is sudden, then this indicates tumor dementia, Parkinsons

If it is gradual, we think acute neurological diagnosis.

b)

We want to think about the frequency: does it happen all the time or every once and a while. If it is always, that is an issue

c)

We want to think about progression in terms of nutrition, hydration, and food consistency.

d)

None of the above

162.

Which of the following is NOT an aggravating factor?

a)

Temperature: Too hot or cold. Hot can trigger swallow reflex better.

b)

Techniques spontaneously used - doe they have a strategy they use. For example, drinking water after swallowing food

c)

Fatigue - Are they fine at the beginning, but then slow down near end? May suggest 5-6 smaller meals throughout the day.

d)

Fatigue - They complain about vocal issues at the end of the day.

163.

Select all of the following signs/symptoms associated with dysphagia

a)

Change in voice/speech. May have a wet vocal quality or breathy suddenly

b)

Weakness:

in muscular, facial asymmetry, non-use (been on feeding tube)

c)

Repetitive swallows for example, do they swallow twice for applesauce - they shouldn't need two swallows

d)

Regurgitation and tightness in the throat (could be residue)

e)

Pain (usually UES or GERD)

164.

Think about the physical examination associated with the bedside clinical swallow evaluation. Which of the following is NOT part of it/inaccurate?

a)

General status. wHAT IS THE CURRENT AND POST HEALTH.

b)

Mental status, look at the their orientation to person, purpose, place, and time.

c)

Physical mobility. If they are physically mobile, then less chance of aspiration

d)

Tracheostomy: hole in trachea below vocal folds

Intubation: oral or nose. Will be hoarse. If after 5-7 days, and still hoarse, they need to see an ENT

e)

None of the above

165.

Think about the bedside clinical evaluation, which is inaccurate or not part of the oral examination?

a)

Labial: puff out cheeks, make a kiss face.

Buccal: puff out cheeks and push the cheeks to see if air stays

b)

Lingual: Stick out tongue. Is it deviating to weak side? On protrusion it deviates to the strong side. ON retraction it deviates to weak side.

Move tongue side to side

c)

Velar: open mouth and say ahhh. Look for symmetrical elevation of soft palate. Look for nasal emissions.

d)

oral sensitivity: raise your hand when you feel me touch. You may do faucial arches, pils, inside mouth

e)

oral reflexes: Biting (use rubber spoon), sucking, chewing, rooting (all should be inhibited by 1 year) May come back with TBI

166.

True or False: The absence of the gag reflex is part of dysphagia

a)

True

b)

False

167.

When thinking about food trials for the bedside clinical evaluation, which of the following is true regarding posture

a)

Upright at 90 degrees is best. As long as the client is greater than 30 degrees then not it in the chart and say why. If they do okay at 40 degrees they will only do better at 90 degrees

b)

It can only be done at 90 degrees. Anything less will give inaccurate results

c)

Upright at 75 degrees is best. As long as the client is greater than 30 degrees then not it in the chart and say why. If they do okay at 40 degrees they will only do better at 75 degrees

d)

Upright at 90 degrees is best. As long as the client is greater than 30 degrees then not it in the chart and say why. If they do okay at 40 degrees they may do worse at 90 degrees

168.

When thinking about food trials for the bedside clinical evaluation, which of the following is true order of thin to thick:

a)

thin, honey, nectar, pudding, puree, cookie/cracker

b)

Thin, nectar, honey, puree, pudding, cookie/cracker

c)

Thin, nectar, honey, pudding, puree, cookie/cracker

d)

thin, nectar, honey, puree, cookie/cracker, pudding

169.

When thinking about food trials for bedside clinical evaluation, which of the following are part of the liquid section

a)

thin

b)

nectar

c)

honey

d)

puree and pudding

e)

cookie/cracker

170.

When thinking about food trials for bedside clinical evaluation, which of the following are part of the food section

a)

thin

b)

nectar

c)

honey

d)

puree and pudding

e)

cookie/cracker

171.

True or False: If a client has been intubated and their voice is hoarse or breathy after 10-14 days, we want to do a fluoro to see their vocal folds

a)

True

b)

False

172.

Select the reasons why you might skip a bedside clinical evaluation.

a)

They have a history of silent aspiration

b)

History of pulmonary issues and can't give a cough on command or clear throat.

c)

They have a wet gurgly quality of voice.

173.

True or False, in a bedside clinical evaluation, if they have food in front of them you should not use it as this may effect reliability of results.

a)

True

b)

False

174.

If a person has poor oral control, should we give them thicker or thinner foods?

a)

Thinner

b)

Thicker

175.

If a person has delayed trigger of swallow, should we give them thicker or thinner foods?

a)

Thinner

b)

Thicker

176.

If a person has reduced tongue base retraction, should we give them thicker or thinner foods?

a)

Thinner

b)

Thicker

177.

Which of the following is the least restrictive?

a)

Thin liquid with chin tuck

b)

No thin liquids, only honey thick

178.

True or False: Using a straw does not require a lot of coordination, so this is a good option for many clients.

a)

True

b)

False

179.

If the client has reduced sensitivity, do we place the bolus on the reduced side or the other side? Then we note it in file

a)

Reduced

b)

non-reduced

180.

Fill in the blank ________% of patients are silent aspirators

a)

40-50

b)

60-70

c)

55-60

d)

50-60

181.

Thinking about observations during food trials during the bedside clinical evaluation. Where are your fingers during the four finger placement?

a)

Index on oral tongue

Middle on top of hyoid

ring on top of thyroid cartilage

Pinky on bottom of thyroid cartilage/top of cricoid cartilage.

b)

None of the above

c)

Index on tongue base

Middle on top of thyroid

ring on top of cricoid cartilage

Pinky on bottom of thyroid cartilage/top of cricoid cartilage.

d)

Index on tongue base

Middle on top of hyoid

ring on top of thyroid cartilage

Pinky on bottom of thyroid cartilage/top of cricoid cartilage.

182.

Thinking about observations during food trials during the bedside clinical evaluation. What are we assessing (select all that apply)?

a)

Time elapsed between tongue initiation and trigger of pharyngeal swallow (< 1 second) You will feel tongue moving around.

b)

Vocal quality after swallow: Have them talk right after and see if there is a change in the vocal quality

c)

Residual material.

In oral cavity

If in voleculae to clear, put chin up. This widens the voleculae Then they may clear throat of cough. If in pyriform sinus, have them turn their head to the left and right. The may cough or clear throat

d)

If coughing, suspect aspiration. If you can eliminate cough with posture, maneuver, or diet change, they can still receive food by mouth

e)

Oral sensitivity

183.

Thinking about recommendations during the bedside clinical evaluation and how you will get an indication if there is a disorder in the oral or pharyngeal phase, which one warrants a more objective means of assessment?

a)

Oral

b)

pharyngeal

184.

True or False, if a bedside clinical evaluation results in the recommendation that a more objective assessment is warranted, you would do a videofluoroscopy or fiberoptic endoscopic evaluation of swallowing.

a)

True

b)

False

185.

True or False, the MASA is a standardized bedside evaluation that can only be administered in acute care settings

a)

True

b)

False

186.

Thinking about the standardized bedside evalation - the Mann Assessment of Swallowing Ability, the 24 clinical items address all of the following except:

a)

Evaluation of oromotor/sensory aspects of swallowing

b)

Functional assessment of swallow

c)

None of the above

d)

Dietary recommendations and responsive risk rating

187.

Thinking about the standardized bedside evalation - the Mann Assessment of Swallowing Ability, all of the following materials are needed except

a)

tongue depressor

b)

flashlight and glove

c)

various food consistencies and water

d)

chart review

e)

Honey Thick liquids

188.

What does NBM mean?

a)

Nothing but milk

b)

nothing by mouth

c)

Normal breathing measured

d)

none of the above

189.

If a client has orders of NBM does that mean you cannot give them a swallow assessment?

a)

Yes

b)

No

190.

What does NAD mean?

a)

Need Another Doctor

b)

No altered diet

c)

Nill abnormality detected

d)

none of the above

191.

Thinking about the standardized bedside evalation - the Mann Assessment of Swallowing Ability,which of the following is true

a)

It takes about 15-20 minutes

b)

It is done in 1 session

c)

There is a score of 200 possible points

d)

All of the above

192.

Which of the following is the purpose of the VFSS?

a)

To identify abnormalities in anatomy. physiology causing the symtoms

b)

To identify and evaluate therapy strategies that may immediately enable safe eating

c)

It indicates the presence of penetration/aspiration and the related cause

d)

All of the above

193.

When doing a VFSS, you want to see

a)

Transit time for oral, pharyngeal, and possibly esophageal

b)

Penetration and/or aspiration

c)

Residual material

d)

All of the above

194.

What is the order for least to most restrictive strategies

a)

Postural, increasing oral sensation, swallowing maneuvers, food consistency changes

b)

Increasing oral sensation, Postural, swallowing maneuvers, food consistency changes

c)

swallowing maneuvers, food consistency changes, Postural, increasing oral sensation

d)

Swallowing maneuvers, Postural, increasing oral sensation, food consistency changes

195.

True or False: Strategies are typically temporary as anatomy/physiology will improve - strength, coordination, timing

a)

True

b)

False

196.

Select all that apply:

Why do we do postural techniques?

a)

Redirect food flow and change pharyngeal dimensions

b)

May effectively eliminate aspiration on liquids/foods

c)

May improve oral transit times

d)

Works well with patients (post neurological impairment, post head/neck cancer recession, of all ages)

197.

Which posture am I describing?

Inefficient oral transit

a)

Head back

b)

head down

c)

head rotated to damage side

d)

laying down on one (stronger) side

198.

Which posture am I describing?

Delayed trigger of pharyngeal swallow

Reduced tongue base posterior movement

Aspiration during swallow

Reduced laryngeal closure

a)

Head back

b)

head down

c)

head rotated to damage side

d)

laying down on one (stronger) side

199.

Which posture am I describing?

Aspiration during swallow

Residue on one side of the pharynx

Residue in pyriform sinuses

a)

Head back

b)

head down

c)

head rotated to damage side

d)

laying down on one (stronger) side

200.

Which posture am I describing?

Reduced pharyngeal contraction

a)

Head back

b)

Double swallows and alternating liquid/solid

c)

head rotated to damage side

d)

laying down on one (stronger) side

201.

Which posture am I describing?

Residue in mouth, valleculae, posterior pharyngeal wall.

a)

Head back

b)

Double swallows and alternating liquid/solid

c)

head rotated to damage side

d)

laying down on one (stronger) side

202.

Select the correct response regarding increasing sensory awareness

a)

it is used with patients with swallow apraxia, delayed onset of oral swallow (oral transit time), delayed triggering of pharyngeal swallow (trigger)

b)

It provides preliminary sensory stimulus prior to initation of the oral phase of swallowing.

c)

None of the above

d)

All of the above

203.

Which of the following is NOT a specific sensory technique?

a)

Increasing downward pressure of spoon.

Presentation of sweet bolus

b)

Presentation of cold bolus.

Presentation of bolus requiring chewing

c)

Presentation of a larger volume bolus.

d)

Thermal-tactile stimulation

204.

True or False: Swallowing maneuvers places specific aspects of pharyngeal swallow physiology under voluntary control.

a)

True

b)

False

205.

Which maneuver and I describing?

Designed for late vocal fold closure.

Procedure:

Take a deep breath and hold it

Keep holding your breath

Hold breath while you swallow

Immediatly cough after you swallow

a)

Supraglottic

b)

Super-supraglottic

c)

Effortful swallow

d)

Mendelsohn maneuver

206.

Which maneuver and I describing?

Tilts the arytenoids anteriorly towards teh epiglottis before and during the swallow and closes the false vocal cords tightly.

Procedure:

Inhale and hold your breath very tightly and bear down (push hands together/push on bottom of chair

Keep holding your breath/bearing done during swallow

Cough after swallowing

a)

Supraglottic

b)

Super-supraglottic

c)

Effortful swallow

d)

Mendelsohn maneuver

207.

Which maneuver and I describing?

Increases posterior motion of tongue base during pharyngeal swallow improving clearance of the valleculae

Procedure:

As your swallow, squeeze all your musces

a)

Supraglottic

b)

Super-supraglottic

c)

Effortful swallow

d)

Mendelsohn maneuver

208.

Which maneuver and I describing?

It increases the amount of time the PES is open

Procedure:

Swallow your salive several times and pay attention yo your neck as your swallow

Tell me if you can feel your voice box lifting and lowing

Now when you swallow, don't let your adam's apple drop. hold it for seval seconds

a)

Supraglottic

b)

Super-supraglottic

c)

Effortful swallow

d)

Mendelsohn maneuver

209.

What food consistency should I change based on the issue:

Oral tongue dysfunction (can't propel food), reduced tongue base retration, reduced pharyngeal contraction, reduced laryngeal elevation, reduced pharyngeal contration

a)

Thin liquids

b)

Thickened liquids

c)

Purees/pudding/thickened liquids.

210.

What food consistency should I change based on the issue:

oral tongue dysfunction (decread strength, range, coordination, poor tongue control of bolus), delayed pharyngeal swallow.

a)

Thin liquids

b)

Thickened liquids

c)

Purees/pudding/thickened liquids.

211.

What food consistency should I change based on the issue:

delayed pharyngeal swallow, reduced laryngeal closure

a)

Thin liquids

b)

Thickened liquids

c)

Purees/pudding/thickened liquids.

212.

Select the pro of VFSS

a)

Assesses all phases of swallow

b)

Exposure to radiation

c)

Tolerance/fatigue

213.

Select the con(s) of VFSS

a)

Assesses all phases of swallow

b)

Exposure to radiation

c)

Tolerance/fatigue

214.

What am I describing?

Measure of oral prep and oral transit phases

Infer pharyngeal function

a)

Bedside

b)

VFSS

215.

What am I describing?

Assess all phases of swallow directly

a)

Bedside

b)

VFSS

216.

On the penetration aspiration scale, what is WORSE

a)

1

b)

8

217.

True or False: With FEES, you may want to use topical anesthetic to increase the client's swallow response.

a)

True

b)

False

218.

What are these contraindications for:

Bleeding disorder

Agistation

Movement disorder

Small nasal passage

History of faining

Acute cardiac problems

a)

Screening

b)

Bedside clinical evaluation

c)

FEES

d)

VFSS

219.

Which of the following is part of FEES

a)

Examine nasal cavity to determine path

b)

Velopharyngeal closure during speech and swallowing

c)

Pharyngeal assessment

d)

All of the above

220.

What assessment am I describing?

You look at the hypopharynx, lateral channels, pyriform sinus, arytenoids, true and fold folds

a)

Screening

b)

Bedside clinical evaluation

c)

VFSS

d)

FEES

221.

Which of the following is NOT part of the pharyngeal assessment for FEES?

a)

Structures at rest

b)

Airway protection: couch, hold breath, hold breath tightly, hold breath for 5 seconds.

c)

Phonation: movement: functional vs disordered, loudness and pitch levels, have patient sniff and inhale

d)

Food trials:

Milk, nectar, honey water. Applesauce, sandwich or other.

e)

None of the above

222.

True or False: With FEES you can see penetration/aspiration

a)

True

b)

False

223.

What are these the indications for:

Endoscopy unavailable/patient won't tolerate

The oral stage needs to be visualized

Esophageal stage problems

Need nonfiction about the presence or amount of aspiration

Need comprehensive evaluation of all phases

When endoscopy does not fully answer clinical questions

Possible cricoesphageal problems (EX: GERD)

a)

Screening

b)

Bedside clinical evaluation

c)

VFSS

d)

FEES

224.

What are these the indications for:

Transportation and positioning is problematic

Concern about excess radiation exposure (cancer)

Patiion with sever dysphagia who has a lot of secretions.

Post-intubation or surgery where involvement of the vagus nerve is suspected.

Tracheostomy where laryngeal competence is supsected

Need to assess fatigue impact

Biofeedback/Therapeutic in nature

When the hypernasal/VPI, hoarse wet vocal quality, suspect aspiration of secretions.

When VFSS does not fully answer clinical questions

a)

Screening

b)

Bedside clinical evaluation

c)

VFSS

d)

FEES

225.

Which of the following is NOT an example of "other instrumental procedures)

a)

EMG

b)

EGG

c)

Cervical auscultation

d)

Pharyngeal manometry

e)

EKG

226.

Which "other instrumental procedure" am I describing?

Listening to sounds made by various body structures

Uses a stethescope

Can be used in two ways: sound of resipation or sounds of swallowing

a)

EMG

b)

EGG

c)

Cervical auscultation

d)

Pharyngeal manometry

e)

EKG

227.

What part of cervical auscultation am I describing?

Use of a stethoscope to listing to inhalation, exhalation, and occurrence of the pharyngeal swallow.

Seretions in airway can be heard

Changes in level or secretions before and after swallowing can help identify potential aspiration.

a)

Sounds of respiration

b)

sounds of aspiration

c)

sounds of swallowing

d)

sounds of penetration

228.

What part of cervical auscultation am I describing?

Acoustic procedure used to assess temporal measures of swallowing

Presnt 10cc water and listen 3 times to each swallow: before, during, and after.

There are two clicks/bursts:

1: water enters pharynx

2: water leaves pharynx and enters UES

a)

Sounds of respiration

b)

sounds of aspiration

c)

sounds of swallowing

d)

sounds of penetration

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