SLP Swallowing and Feeding Disorders 2 — Questions and Answers
Question 1: A patient with Parkinson's disease presents with reduced tongue base retraction and pharyngeal residue after the swallow. Which compensatory strategy is MOST appropriate?
- Chin tuck posture
- Head rotation to the stronger side
- Effortful swallow (Correct answer)
- Supraglottic swallow
Correct answer: Effortful swallow
The effortful swallow increases posterior tongue base movement and helps clear pharyngeal residue, directly targeting the impairment in Parkinson's disease.
Question 2: During a modified barium swallow study (MBSS), the clinician observes contrast material entering the airway before the swallow is triggered. This finding is classified as:
- Aspiration after the swallow
- Silent aspiration
- Penetration
- Pre-swallow aspiration (Correct answer)
Correct answer: Pre-swallow aspiration
Material entering the airway before the pharyngeal swallow is triggered is called pre-swallow (or pre-deglutitive) aspiration, typically due to reduced lingual control or premature spillage.
Question 3: Which structure acts as the primary sphincter protecting the airway during the pharyngeal phase of swallowing?
- True vocal folds (Correct answer)
- False vocal folds
- Epiglottis
- Aryepiglottic folds
Correct answer: True vocal folds
The true vocal folds form the primary sphincter of airway protection during swallowing, with the false folds and aryepiglottic folds providing secondary protection.
Question 4: A 6-month-old infant who was born prematurely demonstrates arching away from the bottle, limited lip seal, and frequent coughing during feeds. The MOST likely contributing factor is:
- Oral hypersensitivity
- Laryngomalacia
- Physiologic disorganization from prematurity (Correct answer)
- Gastroesophageal reflux disease (GERD)
Correct answer: Physiologic disorganization from prematurity
Premature infants often have physiologic disorganization characterized by immature coordination of suck-swallow-breathe, leading to feeding difficulties and coughing.
Question 5: The Mendelsohn maneuver is designed to improve swallowing function primarily by:
- Increasing tongue base retraction
- Prolonging laryngeal elevation to improve UES opening (Correct answer)
- Reducing pharyngeal transit time
- Improving cricopharyngeal muscle strength
Correct answer: Prolonging laryngeal elevation to improve UES opening
The Mendelsohn maneuver involves voluntarily sustaining laryngeal elevation at its peak, which prolongs UES opening and improves bolus passage through the pharyngoesophageal segment.
Question 6: Which cranial nerve is primarily responsible for sensory innervation of the posterior pharyngeal wall, which is critical for triggering the pharyngeal swallow reflex?
- CN V (Trigeminal)
- CN VII (Facial)
- CN IX (Glossopharyngeal) (Correct answer)
- CN XII (Hypoglossal)
Correct answer: CN IX (Glossopharyngeal)
CN IX (Glossopharyngeal) provides sensory innervation to the posterior pharyngeal wall and posterior tongue, which are key trigger zones for the pharyngeal swallow reflex.
Question 7: A patient demonstrates piecemeal deglutition when eating solid foods. This behavioral pattern suggests difficulty with:
- Esophageal motility
- Oral bolus formation and cohesion (Correct answer)
- Laryngeal vestibule closure
- Cricopharyngeal relaxation
Correct answer: Oral bolus formation and cohesion
Piecemeal deglutition — swallowing food in multiple small portions — indicates impaired oral bolus formation and the inability to gather food into a cohesive mass for a single swallow.
SLP Swallowing and Feeding Disorders 2
A patient with Parkinson's disease presents with reduced tongue base retraction and pharyngeal residue after the swallow.
Which compensatory strategy is MOST appropriate?