CSG Dysphagia & Swallowing Disorders 2 — Questions and Answers
Question 1: Which bedside screening test for dysphagia requires the patient to drink 3 ounces of water without stopping?
- Mann Assessment of Swallowing Ability (MASA)
- 3-oz water swallow test (Correct answer)
- Standardized Swallowing Assessment (SSA)
- Toronto Bedside Swallowing Screening Test (TOR-BSST)
Correct answer: 3-oz water swallow test
The 3-oz water swallow test screens for aspiration risk by observing for coughing, voice change, or desaturation after drinking 90 mL of water in a single continuous effort.
Question 2: Videofluoroscopic Swallowing Study (VFSS) is the gold-standard instrumental assessment for dysphagia. Which contrast medium is used to visualize the swallowed bolus?
- Gadolinium-based contrast
- Technetium-99m radiolabel
- Barium sulfate (Correct answer)
- Water-soluble iodine contrast (Gastrografin)
Correct answer: Barium sulfate
Barium sulfate is mixed with various food and liquid consistencies during VFSS to provide radiographic contrast, allowing real-time visualization of bolus flow and aspiration events under fluoroscopy.
Question 3: Silent aspiration is particularly dangerous in older adults because:
- It causes immediate laryngospasm detectable by caregivers
- It only occurs with thin liquids and is easily prevented
- It occurs without cough reflex activation, making it undetected until pneumonia develops (Correct answer)
- It triggers an immediate gag reflex that alerts clinicians
Correct answer: It occurs without cough reflex activation, making it undetected until pneumonia develops
Silent aspiration occurs when food or liquid enters the airway below the vocal folds without triggering a cough response, commonly due to reduced laryngeal sensitivity in older adults, leading to undetected aspiration pneumonia.
Question 4: A patient on a pureed dysphagia diet is at greatest risk for deficiency of which nutrient compared to peers eating a regular diet?
- Sodium
- Dietary fiber (Correct answer)
- Potassium
- Vitamin B12
Correct answer: Dietary fiber
Pureed diets typically exclude high-fiber foods like whole grains, raw vegetables, and legumes, placing patients at significant risk for dietary fiber deficiency, which can worsen constipation.
Question 5: A wet or gurgling vocal quality heard immediately after swallowing a bolus is a clinical sign most indicative of:
- Oral phase impairment with pocketing
- Pharyngeal residue or aspiration of material onto the vocal folds (Correct answer)
- Cricopharyngeal bar obstruction
- Esophageal dysmotility
Correct answer: Pharyngeal residue or aspiration of material onto the vocal folds
A wet or gurgling voice post-swallow indicates residue or aspirated material is resting on or near the vocal folds, altering their vibration during phonation.
Question 6: The Shaker exercise (sustained head-lift exercise) is a rehabilitative technique used to improve dysphagia by:
- Strengthening the tongue tip for better lip seal
- Improving hyolaryngeal excursion and upper esophageal sphincter opening (Correct answer)
- Increasing salivary flow to aid bolus formation
- Reducing oropharyngeal transit time
Correct answer: Improving hyolaryngeal excursion and upper esophageal sphincter opening
The Shaker exercise strengthens suprahyoid muscles, which improves hyolaryngeal elevation and anterior excursion, leading to better upper esophageal sphincter (UES) opening during swallowing.
Question 7: Which medication class commonly prescribed to older adults is associated with drug-induced esophagitis and increased dysphagia risk, particularly if not taken with adequate water and in an upright position?
- ACE inhibitors
- Bisphosphonates (e.g., alendronate) (Correct answer)
- Thiazide diuretics
- Beta-adrenergic blockers
Correct answer: Bisphosphonates (e.g., alendronate)
Bisphosphonates such as alendronate can adhere to the esophageal mucosa if not taken with a full glass of water in an upright position, causing chemical esophagitis and secondary dysphagia.
CSG Dysphagia & Swallowing Disorders 2
Which bedside screening test for dysphagia requires the patient to drink 3 ounces of water without stopping?