SLP Swallowing & Dysphagia Management 2 — Questions and Answers
Question 1: A patient with Parkinson's disease presents with festinating swallowing and reduced tongue base retraction. Which compensatory strategy is MOST appropriate as a first-line intervention?
- Chin-tuck posture
- Mendelsohn maneuver
- Effortful swallow (Correct answer)
- Head rotation to the weaker side
Correct answer: Effortful swallow
The effortful swallow increases tongue base retraction and posterior pharyngeal wall pressure, directly targeting the impaired biomechanics seen in Parkinson's disease.
Question 2: During a Modified Barium Swallow Study (MBSS), penetration to the laryngeal vestibule is observed with thin liquids but the material is immediately expelled. How is this classified using the Penetration-Aspiration Scale?
- Score of 1 — material does not enter the airway
- Score of 2 — material enters the airway, remains above the cords, and is ejected (Correct answer)
- Score of 4 — material enters the airway, contacts the vocal folds, and is not ejected
- Score of 6 — material passes below the vocal folds and is ejected into the larynx
Correct answer: Score of 2 — material enters the airway, remains above the cords, and is ejected
A PAS score of 2 indicates material enters the airway above the vocal folds and is successfully expelled, representing penetration without aspiration.
Question 3: A 78-year-old patient post-CVA demonstrates silent aspiration of thin liquids on MBSS. Which thickened liquid consistency per IDDSI Level is typically trialed FIRST?
- IDDSI Level 1 (Slightly Thick)
- IDDSI Level 2 (Mildly Thick) (Correct answer)
- IDDSI Level 3 (Moderately Thick)
- IDDSI Level 4 (Extremely Thick)
Correct answer: IDDSI Level 2 (Mildly Thick)
IDDSI Level 2 (Mildly Thick / nectar consistency) is typically the first thickened liquid trialed because it slows bolus flow while maintaining relative palatability.
Question 4: Which pharyngeal phase landmark indicates the onset of the pharyngeal swallow response during videofluoroscopic study?
- Lip closure around the bolus
- Tongue tip elevation to the alveolar ridge
- Hyoid bone anterior and superior excursion
- Velopharyngeal closure (Correct answer)
Correct answer: Velopharyngeal closure
Velopharyngeal closure marks the onset of the pharyngeal swallow response, as it prevents nasal regurgitation and signals the beginning of pharyngeal stage events.
Question 5: A patient with head and neck cancer post-radiation presents with cricopharyngeal dysfunction. FEES reveals residue in the pyriform sinuses bilaterally after swallowing. Which intervention targets the cricopharyngeal muscle MOST directly?
- Shaker exercise (head lift) (Correct answer)
- Thermal-tactile application
- Tongue resistance training
- Supraglottic swallow technique
Correct answer: Shaker exercise (head lift)
The Shaker (head-raising) exercise strengthens the suprahyoid musculature, which pulls the cricopharyngeus open during swallowing, directly targeting UES dysfunction.
Question 6: On FEES, 'white-out' or loss of image occurs during which phase of swallowing?
- Oral preparatory phase
- Oral transit phase
- Pharyngeal phase — at the moment of pharyngeal contraction (Correct answer)
- Esophageal phase
Correct answer: Pharyngeal phase — at the moment of pharyngeal contraction
During the pharyngeal phase, the pharyngeal walls contact the endoscope causing a brief whiteout; clinicians assess residue immediately before and after this period.
Question 7: A 65-year-old patient with ALS has intact cognition but progressive bulbar weakness. Diet modification alone is being considered. What is the PRIMARY long-term consideration that should be discussed proactively with this patient?
- Return to normal diet after voice therapy
- Candidacy for and timing of PEG tube placement (Correct answer)
- Surgical repair of the cricopharyngeus
- Increasing IDDSI texture level to accommodate chewing deficits
Correct answer: Candidacy for and timing of PEG tube placement
In ALS, bulbar dysfunction is progressive and irreversible; proactive discussion of PEG tube placement before nutritional or respiratory compromise is critical for patient safety and quality of life.
SLP Swallowing & Dysphagia Management 2
A patient with Parkinson's disease presents with festinating swallowing and reduced tongue base retraction.
Which compensatory strategy is MOST appropriate as a first-line intervention?