SLP Swallowing and Feeding Disorders 5 — Questions and Answers
Question 1: The primary difference between penetration and aspiration on the Penetration-Aspiration Scale (PAS) is defined by:
- Whether the patient coughs in response
- Whether material passes below the level of the true vocal folds (Correct answer)
- Whether material is silent or produces a wet voice
- Whether material reaches the trachea or bronchi
Correct answer: Whether material passes below the level of the true vocal folds
Penetration is defined as material entering the laryngeal vestibule above the vocal folds, while aspiration is defined as material passing below the level of the true vocal folds into the trachea.
Question 2: Which of the following best describes 'silent aspiration'?
- Aspiration of thin liquids only
- Aspiration without any cough or behavioral response (Correct answer)
- Aspiration during sleep
- Aspiration of secretions in unconscious patients
Correct answer: Aspiration without any cough or behavioral response
Silent aspiration occurs when material passes below the vocal folds without triggering a cough or any overt protective response, making it detectable only through instrumental assessment.
Question 3: For a patient with unilateral pharyngeal weakness following a lateral medullary (Wallenberg) syndrome stroke, the MOST effective positional compensatory strategy during swallowing is:
- Chin tuck
- Head tilt toward the weak side
- Head rotation toward the weak side (Correct answer)
- Head rotation toward the strong side
Correct answer: Head rotation toward the weak side
Head rotation toward the weak side closes the pyriform sinus on that side and directs the bolus down the stronger side of the pharynx, reducing residue and aspiration risk.
Question 4: Which instrumental assessment provides the BEST visualization of esophageal phase dysphagia, including strictures, rings, and webs?
- Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
- Modified Barium Swallow Study (MBSS)
- Esophagram (barium esophagram/upper GI series) (Correct answer)
- High-resolution manometry
Correct answer: Esophagram (barium esophagram/upper GI series)
A barium esophagram evaluates the full length of the esophagus and is the appropriate study for identifying esophageal structural abnormalities such as strictures, rings, webs, and motility disorders.
Question 5: Thermaltactile stimulation (TTS) applied to the anterior faucial pillars is used in dysphagia intervention to target which impairment?
- Reduced tongue base retraction
- Delayed pharyngeal swallow onset (Correct answer)
- Weak velopharyngeal closure
- Reduced hyolaryngeal excursion
Correct answer: Delayed pharyngeal swallow onset
TTS uses cold stimulation (typically with a chilled laryngeal mirror) on the anterior faucial pillars to heighten sensory input and reduce the delay in pharyngeal swallow triggering.
Question 6: A patient with dementia exhibits complete refusal to open the mouth for feeding despite appearing hungry. This behavior is MOST appropriately interpreted as:
- Aspiration risk requiring NPO status
- Volitional refusal indicating competent decision-making
- A neurologically mediated behavioral feeding symptom requiring environmental and approach modifications (Correct answer)
- Evidence of esophageal dysphagia
Correct answer: A neurologically mediated behavioral feeding symptom requiring environmental and approach modifications
Mouth clamping and feeding refusal in dementia are often neurologically mediated behaviors (apraxia, agnosia, or behavioral dysregulation), not volitional decisions, and respond to modified feeding approaches.
Question 7: Which muscle is the primary contributor to upper esophageal sphincter (UES) resting pressure and must relax during swallowing to allow bolus passage into the esophagus?
- Thyropharyngeus muscle
- Cricopharyngeus muscle (Correct answer)
- Palatopharyngeus muscle
- Stylopharyngeus muscle
Correct answer: Cricopharyngeus muscle
The cricopharyngeus muscle, the main component of the UES, maintains tonic resting pressure to prevent reflux and must relax reflexively during swallowing to allow bolus transit into the esophagus.
SLP Swallowing and Feeding Disorders 5
The primary difference between penetration and aspiration on the Penetration-Aspiration Scale (PAS) is defined by: