SLP - Speech-Language Pathology Swallowing and Feeding Disorders Questions and Answers — Questions and Answers
Question 1: An SLP is conducting a clinical bedside swallowing evaluation on an 82-year-old male post-CVA. When the patient is trialed with a small sip of thin liquid from a cup, he immediately coughs. What is the most immediate and appropriate next step for the SLP?
- Document the cough and continue the trial with larger sips of thin liquid to confirm the response.
- Modify the liquid consistency to nectar-thick and administer a small sip to assess the patient's response. (Correct answer)
- Immediately make the patient NPO (nothing by mouth) and recommend a videofluoroscopic swallow study (VFSS).
- Assume the patient is aspirating and begin implementing the Mendelsohn maneuver.
Correct answer: Modify the liquid consistency to nectar-thick and administer a small sip to assess the patient's response.
The most appropriate action is to systematically test a hypothesis. Since the patient coughed on thin liquid, the next logical step in the diagnostic process is to trial a thicker consistency to see if it improves swallowing safety. Continuing with a liquid that caused a problem is unsafe, making the patient NPO is a significant restriction that may be premature, and implementing a therapeutic maneuver is inappropriate before completing the diagnostic assessment.
Question 2: Which of the following is a key diagnostic feature that distinguishes a pediatric feeding disorder from typical "picky eating"?
- The child refuses to eat vegetables but accepts a variety of fruits.
- The child's accepted food repertoire consists of fewer than 30 different foods.
- The child's nutritional intake is compromised, leading to weight loss, failure to thrive, or specific nutrient deficiencies. (Correct answer)
- The child exhibits occasional tantrums during mealtimes when presented with a non-preferred food.
Correct answer: The child's nutritional intake is compromised, leading to weight loss, failure to thrive, or specific nutrient deficiencies.
The critical distinction between picky eating and a pediatric feeding disorder is the impact on the child's health and development. A feeding disorder results in measurable negative consequences such as poor weight gain, nutritional deficiencies, or reliance on supplements. The other options describe behaviors that are common in typical picky eaters but do not, by themselves, constitute a disorder.
Question 3: A 55-year-old female patient with a tracheostomy tube is referred for a swallowing evaluation in the ICU. She is ventilator-dependent and cannot be safely transported to the radiology suite. The primary concerns are managing copious secretions and assessing laryngeal function during swallowing attempts. Which instrumental assessment is the most appropriate choice?
- Fiberoptic Endoscopic Evaluation of Swallowing (FEES) (Correct answer)
- Videofluoroscopic Swallow Study (VFSS)
- High-Resolution Pharyngeal Manometry (HRM)
- Cervical Auscultation
Correct answer: Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
FEES is the most appropriate choice because it is a portable procedure that can be performed at the bedside, which is essential for a patient who is ventilator-dependent and cannot be transported. It provides a superior view of the larynx and pharynx, allowing for direct visualization of secretion management and laryngeal anatomy, which are the primary concerns in this case.
Question 4: The oral preparatory phase of swallowing, which involves manipulating and chewing the bolus, is primarily dependent on motor innervation from which cranial nerve?
- CN IX (Glossopharyngeal)
- CN X (Vagus)
- CN XII (Hypoglossal)
- CN V (Trigeminal) (Correct answer)
Correct answer: CN V (Trigeminal)
The Trigeminal nerve (CN V), specifically its mandibular branch (V3), provides motor innervation to the muscles of mastication (e.g., masseter, temporalis, pterygoids), which are essential for chewing. While other nerves are involved in the overall swallow, CN V is the primary motor nerve for mastication.
Question 5: A patient is observed to have significant post-swallow residue in the valleculae during a videofluoroscopic swallow study (VFSS). Which of the following compensatory maneuvers would be most effective for clearing this specific residue?
- Chin tuck
- Head turn to the weak side
- Supraglottic swallow
- Effortful swallow (Correct answer)
Correct answer: Effortful swallow
The effortful swallow is designed to increase tongue base retraction and pressure generation during the pharyngeal swallow. This action effectively helps to clear residue from the vallecular spaces, which are located between the base of the tongue and the epiglottis. A chin tuck primarily widens the valleculae, a head turn redirects the bolus, and a supraglottic swallow is focused on airway protection.
Question 6: An SLP evaluates a 92-year-old resident of a long-term care facility who has advanced dementia and is aspirating thin liquids. The resident consistently refuses thickened liquids, becoming agitated when they are offered. She derives significant pleasure from drinking regular coffee with her family. The family understands the risks but wishes to prioritize her comfort and quality of life. What is the most appropriate and ethical approach for the SLP?
- Insist on a pureed diet and nectar-thick liquids to eliminate all aspiration risk, regardless of the resident's preference.
- Discharge the resident from speech therapy services due to non-compliance with recommendations.
- Collaborate with the patient, family, and medical team to develop a comfort-focused feeding plan that balances safety with quality of life, which may include options like a Frazier Free Water Protocol. (Correct answer)
- Document that the family is refusing recommendations and have them sign a waiver to absolve the facility of all responsibility.
Correct answer: Collaborate with the patient, family, and medical team to develop a comfort-focused feeding plan that balances safety with quality of life, which may include options like a Frazier Free Water Protocol.
The most ethical approach is patient-centered and collaborative, prioritizing the patient's quality of life and autonomy, especially in the context of advanced dementia or end-of-life care. A comfort-focused plan, which might include a carefully managed free water protocol, respects the patient's preferences while managing risk. The other options are overly rigid, punitive, or fail to engage in the shared decision-making process required in complex ethical situations.
SLP - Speech-Language Pathology Swallowing and Feeding Disorders Questions and Answers
An SLP is conducting a clinical bedside swallowing evaluation on an 82-year-old male post-CVA.
When the patient is trialed with a small sip of thin liquid from a cup, he immediately coughs.
What is the most immediate and appropriate next step for the SLP?