SLP Swallowing and Feeding Disorders 4 — Questions and Answers
Question 1: Which phase of swallowing is entirely under voluntary control?
- Oral preparatory phase (Correct answer)
- Pharyngeal phase
- Esophageal phase
- All phases are reflexive
Correct answer: Oral preparatory phase
The oral preparatory phase, which includes mastication and bolus formation, is fully voluntary; the pharyngeal and esophageal phases are primarily reflexive once triggered.
Question 2: A patient receives a G-tube recommendation due to severe aspiration pneumonia. As the SLP, your PRIMARY role at this stage is to:
- Make the final decision about G-tube placement
- Provide information about swallowing status, risks, and options to support the patient's informed decision (Correct answer)
- Defer all decisions to the gastroenterologist
- Recommend NPO status permanently
Correct answer: Provide information about swallowing status, risks, and options to support the patient's informed decision
The SLP's role is to provide objective data about swallowing function, aspiration risk, and prognosis so the patient and team can make an informed, patient-centered decision.
Question 3: Which neuromuscular disease is associated with myotonic discharges, ptosis, and progressive dysphagia particularly affecting the pharyngeal and esophageal phases?
- Myasthenia Gravis
- Myotonic Dystrophy (DM1) (Correct answer)
- Duchenne Muscular Dystrophy
- Polymyositis
Correct answer: Myotonic Dystrophy (DM1)
Myotonic Dystrophy Type 1 (DM1) causes pharyngeal and esophageal dysphagia, ptosis, and myotonia, and is one of the most common muscular dystrophies affecting swallowing in adults.
Question 4: In neonatal feeding, the suck-swallow-breathe (SSB) ratio for a term infant during nutritive sucking is typically:
- 1:1:1 (Correct answer)
- 2:1:1
- 3:1:1
- 1:2:1
Correct answer: 1:1:1
A term infant coordinates a 1:1:1 suck-swallow-breathe ratio during nutritive sucking, reflecting mature neuromuscular coordination of feeding.
Question 5: Zenker's diverticulum causes dysphagia primarily because:
- It compresses the trachea from behind
- It creates a false lumen that traps food superior to an incompletely relaxing cricopharyngeus (Correct answer)
- It reduces esophageal peristaltic pressure
- It causes esophageal spasm below the UES
Correct answer: It creates a false lumen that traps food superior to an incompletely relaxing cricopharyngeus
Zenker's diverticulum is a pharyngeal pouch that forms due to cricopharyngeal dysfunction; food accumulates in the pouch rather than passing through the UES, causing dysphagia and regurgitation.
Question 6: When performing a clinical swallowing evaluation (CSE), which finding is MOST strongly associated with aspiration risk?
- Reduced oral sensation
- Wet/gurgly vocal quality after swallowing (Correct answer)
- Delayed oral transit time
- Anterior bolus spillage
Correct answer: Wet/gurgly vocal quality after swallowing
A wet or gurgly voice quality after swallowing (wet dysphonia) suggests material has entered the laryngeal area, and is one of the strongest clinical predictors of aspiration.
Question 7: A patient with right hemispheric stroke presents with impulsive eating behavior, eating too quickly, and stuffing the mouth. This behavioral feeding pattern is BEST explained by:
- Apraxia of swallowing
- Right hemisphere attentional and executive function deficits (Correct answer)
- Left hemisphere language deficits affecting self-monitoring
- Cerebellar dysfunction affecting timing
Correct answer: Right hemisphere attentional and executive function deficits
Right hemisphere damage frequently causes impulsivity, reduced self-monitoring, and inattention, which manifest as behavioral feeding problems such as eating too fast and overstuffing.
SLP Swallowing and Feeding Disorders 4
Which phase of swallowing is entirely under voluntary control?