Dysphasia
A 75-year-old patient with a history of chronic obstructive pulmonary disease underwent a three-vessel coronary artery bypass graft surgery. The patient needed to be intubated for three days following surgery. After extubation, the medical team requested a swallow consultation to determine if it was safe for the patient to take oral medications and initiate oral nutrition. Based on the patient's condition, which of the following assessment procedures is most appropriate for an SLP to practice?
A.Administering a clinical bedside swallow evaluation and recommending an oral diet as there were no clinical signs or symptoms of aspiration during the evaluation
B.Deferring the evaluation for 24 hours because the patient was just extubated to allow a possible improvement in the patient's swallow function before evaluation
C.Completing a clinical bedside swallow evaluation to determine patient readiness for an instrumental evaluation and then completing the instrumental evaluation if the patient is ready
D.Determining any preexisting dysphagia with the patient and the patient's family; if there is no history of dysphagia, recommending to advance the patient's diet
Option (C) is correct. Several studies using instrumental assessment have concluded that some patients recover airway protection and swallow function within 24 hours of extubation and others much later than 24 hours post-extubation following prolonged endotracheal intubation, suggesting that a 24-hour "deferral time" benchmark is not particularly useful.
Which of the following communication diagnoses would most likely require a treatment program that is focused on improving auditory language comprehension?
A.Right-hemisphere communication impairment
B.Global aphasia
C.Wernicke's aphasia
D.Broca's aphasia
An SLP engages in inter-professional practice in a large health care center and works with a neurologic rehabilitation team to treat a patient who is status post left-hemisphere stroke. The SLP's primary focus on the team is to
A.lead the interdisciplinary team to improve patient care
B.reduce costs and the number of professionals working at the site
C.obtain licenses in multiple areas of practice to engage in a range of services
D.improve the patient experience and outcome of care at the siteOption (D) is correct. The primary goal of inter-professional practice is to improve patient care.Which of the following communication diagnoses would most likely require a treatment program that is focused on improving auditory language comprehension?
A.Right-hemisphere communication impairment
B.Global aphasia
C.Wernicke's aphasia
D.Broca's aphasiaOption (C) is correct. The hallmark of Wernicke's aphasia is deficits in auditory comprehension, because the site of lesions is most typically the left superior temporal gyrus.
A 75-year-old man presents with conversational speech characterized by prolonged silent intervals and hypophonia. Resonance is normal, but voice quality is rough and tremulous. Pitch is relatively unaffected. There is no evidence of speech deterioration over time. Which of the following diagnoses is the most reasonable based on the patient's data?
Inappropriate silences, imprecise consonants, variable rate, short rushes of speech, increased rate in segments, and hoarse and tremulous voice quality are common characteristics of hypokinetic dysarthria. Speech deterioration over time and resonance are not typically affected.
A 28-year-old classroom teacher complaining of frequent voice loss is seen by an SLP and an otolaryngologist. It is determined the patient's symptoms are linked to significant vocal demands. Which of following recommendations is the most appropriate first step to treat the underlying disorder?
A.Advising the patient to undergo complete voice rest until the nodules improve or resolve
B.Educating the patient on the importance of hydration and behavioral antireflux strategies
C.Recommending voice amplification with resonant voice therapy
D.Training strategies to increase vocal loudness
C.Recommending voice amplification with resonant voice therapy
A 35-year-old female is referred for an outpatient swallowing evaluation after having a thyroidectomy. Her complaints include coughing when drinking and dysphonia. Which of the following evaluation options is the most appropriate post-treatment follow-up for the patient?
A. Completing a clinical swallow evaluation
B. Setting up an appointment for a pharyngeal manometry test
C. Using the fiberoptic endoscopic evaluation of swallowing (FEES)
D. Recording the patient during a videofluoroscopic swallow study (VFSS)
C
The patient exhibits clinical reasons or indications for choosing a FEES exam, such as recently having her thyroid removed and experiencing a hoarse voice.
An assessment of a patient with suspected neurodegenerative disease who presents with language problems as the primary symptom reveals the following.
Impaired single-word retrieval in speech
Naming that includes phonological errors
Impaired repetition of sentences and phrases
Spared single-word comprehension and object knowledge
Spared motor speech abilities
Which of the following disorders is the most accurate diagnosis of the patient?
A.Broca's aphasia
B.Anomic aphasia
C.Primary progressive aphasia
D.Transcortical motor aphasia
The patient's symptoms represent the diagnostic criteria of primary progressive aphasia (PPA). By definition, they exclude the other variants of PPA and Alzheimer's disease.
An SLPS L P works at a hospital with the adult acute-care inpatient team. During a clinical bedside swallow evaluation, a patient asks the SLPS L P how common it is for adults to experience a swallowing disorder. The SLPS L P tells the patient that recent research indicates the prevalence of adults with swallowing problems each year is
A.1 in 25
B.1 in 50
C.1 in 100
D.1 in 200
A.1 in 25
A 60-year-old male is referred to the SLP in an acute rehabilitation center for a videofluoroscopic swallowing study (VFSS) following a first-time stroke: a lateral medullary stroke damaging the right nucleus ambiguus and other centers. The clinical examination revealed ptosis of the left eye, soft palate elevation to the right of midline, symmetrical lingual protrusion, and a breathy dysphonia with precise articulation of all consonants. The patient is unable to swallow his saliva and coughs when he attempts to do so.
Based on the stroke type and clinical examination observations, which THREE of the following swallow impairments would the SLP likely observe on the VFSS?
A.Incomplete clearance of material from the oral cavity
B.Impaired or absent opening of the upper esophageal sphincter
C.Anterior loss of bolus contents during the oral preparatory stage
D.Nasopharyngeal regurgitation during the pharyngeal stage
E.Adequate excursion of the hyolaryngeal complex
F.Unilateral pharyngeal paralysis
B, D, F
A 65-year-old-male who is hospitalized with pneumonia completed a videofluoroscopic swallowing study. Findings showed aspiration after the swallow due to a reduced upper esophageal sphincter opening diameter separating the bolus tail, which was then retained in the pyriform sinuses. Which of the following interventions was designed to and is shown to improve upper esophageal sphincter opening?
A.Effortful swallow
B.Valsalva (breath hold)
C.Shaker (head lift) exercise
D.Lingual resistance exercise
C
Shaker et al. (2002) showed that the head lift exercise significantly increased the diameter of the upper esophageal sphincter opening in people with dysphagia.