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1.

Which of the following communication disorders is frequently associated with significant dysphagia?

A.

Aphasia
B.

Ataxic dysarthria
C.

Flaccid dysarthria
D.

Psychogenic Mutism
E.

Organic voice tremor

Correct Answer
C. Flaccid dysarthria

Explanation
Flaccid dysarthria and dysphagia are both disorders likely to be characterized by flaccidity or weakness of the oromotor and laryngeal mechanism resulting from cranial nerve damage. These two disorders frequently co-exist.
We know that its not aphasia because that is a language impairment
Ataxic dysarthria occurs from cerebellar damage and dysphagia typically does not co-occur with this type of damage
Pyshcogenic mutism is not caused by a neurological disorder
Organic voice tremor is a laryngeal dysfunction that does not affect oromotor function

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2.

A videofluoroscopic study of a client with dysphagia revealed pooling of liquids in the valleculae. Which of the following is the most likely overt symptom the client will experience?

A.

Watery eyes during swallowing
B.

Oral pocketing of food
C.

Coughing after swallowing
D.

Neuralgia
E.

Esophageal reflux

Correct Answer
C. Coughing after swallowing

Explanation
The valleculae are depressions that lie lateral to the median epiglottal folds. Pooling of the liquids in the valleculae gives a person the feeling that there is material remaining in the respiratory pathway, so coughing would be a natural reaction to expect in this case

Neuralgia or nerve pain is rarely associated with dysphagia and the other answers are incorrect because they address symptoms related to dysphagia that are not a direct result of pooling of liquids in the valleculae.

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3.

Ms. Badea, a 55-year-old woman with dysphagia, has a delayed swallowing reflex. Which of the following is a technique that most often is useful for temporary remediation of such a delayed swallowing reflex?

A.

Cricopharyngeal myotomy
B.

Chin tuck
C.

Thermal stimulation
D.

The Mendelssohn maneuver
E.

Placing the client in a supine position during the swallowing

Correct Answer
C. Thermal stimulation

Explanation
Empirical data demonstrates that thermal stimulation results in temporary facilitation of the swallowing reflex
Cricopharyngeal myotomy opens the upper esophageal sphinctor but does not facilitate the swallowing reflex
The chin tuck, Mendelssohn maneuver and supine position do not decrease delayed swallowing reflexes

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4.

Of the following, which is generally the most appropriate treatment goal for a client with a larnygectomy?

A.

Acceptance of the alaryngeal status
B.

Production of a esophageal voice
C.

Use of a voice prosthesis
D.

Participation in a support group
E.

Restoration of oral communication

Correct Answer
E. Restoration of oral communication

Explanation
The most important and most basic treatment goal for a client with a laryngectomy is the restoration of oral communication
The other answers, while viable each one depends on the particular situation or patient.

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5.

Which of the following is NOT useful for the assessment of swallowing ability?

A.

Videofluoroscopy
B.

Bedside evaluation
C.

Fiber optic endoscopy
D.

Gastrostomy
E.

Scintigraphy

Correct Answer
D. Gastrostomy

Explanation
Gastrostomy ivolves the opening of a stoma in the stomach wall when normal food ingestion is impossible or ill advised.
Videofluoroscopy is useful when assessing swallowing because it can identify the specific nature of the dysphagia
Bedside evaluation is useful because it can define oral abnormalities and pharyngeal wall impairments
Fiber optic endoscopy provides direct observation of pharyngeal activity during swallowing
Scintigraphy is a diagnostic procedure that produces an image of the swallowing mechanism

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6.

Which of the following is generally considered most effective and appropriate for viewing the vocal folds during phonation?

A.

Stroboscopy
B.

Endoscopy
C.

Fluoroscopy
D.

Radiology
E.

Laryngeal Mirror examination

Correct Answer
A. Stroboscopy

Explanation
Stroboscopy is generally the most efficient and effective instrument for viewing the vocal folds during phonation
Endoscopy could give a view of the vocal folds during phonation, but stroboscopy provides a more detailed picture
Fluroroscopy and Radiology will not display the vocal folds vibrating so they are incorrect
A laryngeal mirror examination does present the vocal folds in motion it does not leave with a detailed enough account that can be viewed after the client has left the office

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7.

Mr. Leone is an 82-year-old man with dysphagia. He is fed via a percutaneuos endoscopic gastrostomy (PEG) tube because he is at risk for aspiration of thin liquids. From a modified barium swallow study, it was determined that he has laryngeal penetration for nectar-thick liquids in amounts greater than one teaspoonful. Mr. Leone’s daily hydration needs would be best met by

A.

PEG tube primarily
B.

Thin liquids perorally in portions of a half teaspoon or less
C.

Nectar-thick liquids perorally in portions of a teaspoon or less
D.

Honey-thick liquids perorally in portions of a teaspoon or less
E.

Pudding-thick liquids perorally in portions of a teaspoon or less

Correct Answer
A. PEG tube primarily

Explanation
Sufficient hydration for this patient will be accomplished by a PEG tube only.
The other answer choices offer an amount of hydration in meager amounts that would be insufficient for this patient, regardless of the thickness of thinness of the liquids

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8.

Which of the following is the best action to take initially with a client who presents with poor oral control of liquids and solids, coughing and choking during feeding, and a history of hospitalizations associated with pneumonia?

A.

Thicken liquids so that the client will be better able to control oral movements for swallowing.
B.

Obtain a modified barium swallow study to determine whether oral feedings are appropriate for the client.
C.

Evaluate the client’s eating of a variety of foods in order to determine which foods are safest to eat
D.

Teach the client’s caregivers how to control the client’s mandibular function while feeding the client
E.

Prescribe that the client be NPO, since aspiration is present

Correct Answer
B. Obtain a modified barium swallow study to determine whether oral feedings are appropriate for the client.

Explanation
An assessment of the problem must be undertaken before treatment is provided and the best way to do this is to obtain a modified barium swallow study.
All the other choices represent actions that might be taken after the results of the assessment have been determined. Proceeding with any of these treatment options before the appropriate study has been completed could be dangerous to the patients health

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