CD 5530 Swallowing Disorders
Final Exam
Summer 2002

 

Name __________________________________ Score _________/100

 

_____/15 Describe the innervation for the normal swallow. Include the specific aspect of the swallow (anatomical structure & function) to which each cranial nervevcontributes.

_____/10 You have (finally!) received your CCC and have taken a job in a relatively new regional hospital. To your chagrin, no system is currently in place for identification or instrumental assessment of swallowing function (i.e., no dysphagia team, no MBS's, no FEES). You approach the hospital administration to present a case for the development of a dysphagia team and the acquisition of materials/equipment for instrumental assessment. However, as the conversation progresses, the administrator interrupts you, remarking, " Wait a minute, what is 'dysphagia'?"

In appropriate language, write exactly how you would explain to the administrator what dysphagia is and why it should be important to the administration that the problem is addressed.

____ / 10 Column one lists the complaints described by the patient during the interview. In column two, list the impairment(s) you suspect are contributing to the complaint. In the following columns, put a check for each of the assessment tools that allow you to directly observe that impairment. Put an X if you could confidently infer that impairment from observations made, even if the impairment was not directly observable. (Include checks and x's for each impairment listed, not just for each complaint).

Complaint

Suspected impairment(s)

Bedside Clinical Evaluation

MBS

FEES

Other

Coughing with liquids


.

1.


2.



3.

.

.

.

.

Can't get swallow started

1.


2.

.

.

.

.

Food sticks in my throat

1.


2.



3.

.

.

.

.

Food comes back up after I swallow

1.


2.

.

.

.

.

____/10 Develop a diagram to depict the impact of the presence of tracheostomy on swallowing function.

____/10 True/False

_____ Patients with total laryngectomy breathe through a hole in their neck

_____ Hemilaryngectomy involves removal of one side of the larynx

_____ It is impossible for patients with total laryngectomy to aspirate

_____ Patients with supraglottic laryngectomy are at risk for aspiration before the swallow

_____ Patients with hemilaryngectomy are at risk for aspiration during the swallow

_____ Patients with total laryngectomy are at risk for aspiration during the swallow

_____ Patients with hemilaryngectomy may have disrupted vocal function

_____ Supraglottic laryngectomy disrupts laryngeal elevation

_____ Disrupted UES function is associated with total and supraglottic laryngectomy

_____ Patients with total laryngectomy are not at risk for dysphagia

_____/35 In the first column below a technique for addressing swallowing difficulties is listed. In the second column, list an impairment or sign for which that technique would be indicated. In column 3, indicate if the term listed in column 2 is an impairment (I) or sign (S). In column 4, indicate whether the listed intervention is a compensatory technique (C), therapeutic technique (T), or both (B). In the last column, discuss why the intervention will be effective for the impairment/sign identified.

Column 1

Col 2

Col 3

Col 4

Col 5

Intervention Technique

Impairment/Sign for which it is indicated

I/S

C/T/B

Rationale

chin tuck

.

.

.

.

thermal stimulation

.

.

.

.

Mendelsohn

.

.

.

.

head tilt to left

.

.

.

.

puree diet

.

.

.

.

supraglottic swallow

.

.

.

.

laryngeal adduction exercises

.

.

.

.

tongue exercises

.

.

.

.

alternating solids and liquids

.

.

.

.

______/10 Discuss the swallowing deficits most commonly associated with Parkinson's Disease.