SLP Swallowing and Feeding Disorders 3 — Questions and Answers
Question 1: On a fiberoptic endoscopic evaluation of swallowing (FEES), the clinician observes white secretions pooling in the pyriform sinuses bilaterally at rest. This finding MOST suggests:
- Reduced pharyngeal sensation
- Impaired pharyngeal peristalsis with bilateral pharyngeal weakness (Correct answer)
- Unilateral vagal nerve lesion
- Reduced epiglottic retroflexion
Correct answer: Impaired pharyngeal peristalsis with bilateral pharyngeal weakness
Bilateral pooling in the pyriform sinuses indicates reduced pharyngeal contraction bilaterally, which fails to clear residue from both sides of the pharynx.
Question 2: Which texture/liquid modification in the IDDSI (International Dysphagia Diet Standardisation Initiative) framework corresponds to Level 4?
- Thin liquids
- Pureed foods (Correct answer)
- Minced and moist foods
- Mildly thick liquids
Correct answer: Pureed foods
IDDSI Level 4 corresponds to 'Pureed' foods, which are smooth, moist, and have no lumps, requiring no chewing.
Question 3: Cervical auscultation is used during bedside swallowing evaluation primarily to:
- Confirm silent aspiration
- Detect changes in swallowing sounds suggestive of dysphagia (Correct answer)
- Measure pharyngeal transit time precisely
- Replace the need for instrumental assessment
Correct answer: Detect changes in swallowing sounds suggestive of dysphagia
Cervical auscultation uses a stethoscope placed on the neck to detect acoustic features of swallowing that may suggest abnormality, but it cannot confirm or rule out aspiration definitively.
Question 4: A patient with ALS presents with fasciculations of the tongue, severe dysarthria, and progressive dysphagia. The dysphagia pattern in ALS is primarily attributed to:
- Upper motor neuron lesion only
- Lower motor neuron lesion only
- Combined upper and lower motor neuron involvement (Correct answer)
- Cerebellar pathology
Correct answer: Combined upper and lower motor neuron involvement
ALS affects both upper and lower motor neurons, causing a mixed pattern of spasticity and flaccidity that results in progressive bulbar dysfunction and dysphagia.
Question 5: During a MBSS, a clinician observes the bolus coating the laryngeal surface of the epiglottis without penetrating below the level of the true vocal folds. Using the Penetration-Aspiration Scale (PAS), this is rated as:
- PAS 1
- PAS 2 (Correct answer)
- PAS 5
- PAS 8
Correct answer: PAS 2
PAS 2 is assigned when material enters the airway above the level of the vocal folds and is ejected from the airway (material enters the laryngeal vestibule without reaching the cords and is cleared).
Question 6: The Shaker exercise (head-lift exercise) is an evidence-based dysphagia treatment that targets which physiologic impairment?
- Reduced tongue base retraction
- Weak suprahyoid muscles leading to reduced UES opening (Correct answer)
- Impaired laryngeal adduction
- Decreased pharyngeal squeeze pressure
Correct answer: Weak suprahyoid muscles leading to reduced UES opening
The Shaker exercise strengthens suprahyoid muscles, improving anterior and superior hyolaryngeal excursion and consequently increasing upper esophageal sphincter opening diameter.
Question 7: A 4-year-old child refuses all textured foods, gags at sight of new foods, and eats fewer than 20 food items. This presentation is MOST consistent with:
- Structural dysphagia
- Avoidant/Restrictive Food Intake Disorder (ARFID) (Correct answer)
- Neurogenic dysphagia
- Oral hypersensitivity disorder only
Correct answer: Avoidant/Restrictive Food Intake Disorder (ARFID)
ARFID is characterized by severely limited food variety/volume driven by sensory aversions or fear, without body image disturbance, and requires interdisciplinary intervention.
SLP Swallowing and Feeding Disorders 3
On a fiberoptic endoscopic evaluation of swallowing (FEES), the clinician observes white secretions pooling in the pyriform sinuses bilaterally at rest.
This finding MOST suggests: