The primary purpose of a dysphagia screening is to:
Diagnose the swallowing disorder
Determine aspiration severity
Identifying patients at high risk who need instrumental eval
Identify indiv. who require a full swallowing evaluation
Infants with poor state regulation during feeding (e.g., falling asleep quickly, irritability) often have difficulty because:
They have immature esophageal motility only
Feeding requires high energy & coordinated resp. effort
Their oral reflexes are absent
They cannot tolerate puree textures
Aspiration that occurs before the swallow is usually due to:
Delayed swallow initiation
Reduced epiglottic inversion
Poor esophageal motility
Weak vocal fold adduction
The rooting reflex typically disappears around:
3–4 months
1–2 months
9–10 months
6–7 months
Neuromuscular electrical stimulation (NMES) is used to:
Replace traditional therapy
Airway closure at the level of the true & false vocal folds
Facilitate muscle contraction in weak swallowing musculature
Improve sensory reflexes only
Thickening formula for infants should be used cautiously because:
It reduces aspiration risk consistently
It may increase caloric density and GI burden
It improves breathing rate
It does not affect gastrointestinal motility
Aspiration after the swallow is MOST often associated with:
Vocal fold paralysis
Delayed reflex
Residue spilling into the airway
Cricopharyngeal spasms
A patient undergoing radiation therapy complains of increasing dryness and difficulty clearing food. The SLP should suspect:
Early UES over-relaxation
Hyperfunctional laryngeal closure
Xerostomia contributing to reduced bolus formation
Upright or semi-upright feeding and frequent burping
Diet modifications are MOST appropriate when:
Strengthening exercises are ineffective
Immediate airway safety is a concern
The patient refuses all other therapy
The disorder is rapidly improving
The Masako maneuver is used to strengthen:
Esophageal peristalsis
Pharyngeal wall contraction
UES opening by strengthening suprahyoids
Laryngeal closure
In dementia, the PRIMARY goal of dysphagia management is:
Use muscle-strengthening exercises exclusively
Restore normal diet levels
Cure the swallowing disorder
Ensure safe intake and maintain quality of life
Videofluoroscopic Swallow Study (VFSS) allows the clinician to evaluate:
Excessive residue or spillage before the swallow
Timing, pressure, & transit of the bolus
Aspiration with no effort to eject material
Peripheral nerve pathways
The ability to transition from suckle to true suck is usually seen around:
3 months
4–6 months
9 months
1 month
An SLP observes prolonged chewing time and fatigue. A likely contributing factor is:
Oral apraxia
Reduced laryngeal elevation
Reduced labial sensation
Lingual discoordination and weak mastication
The Mendelsohn maneuver targets improvement in:
Narrowing the airway entrance and reducing aspiration
Increase sensory input to improve swallow initiation
Oral bolus formation
Sustained laryngeal elevation and UES opening
Videofluoroscopic Swallow Study (VFSS) is the gold-standard test for evaluating:
Trismus
Aspiration with no effort to eject material
Excessive residue or spillage before the swallow
Oral, pharyngeal, & some esophageal phases
A patient demonstrates repeated coughing after swallowing thin liquids. The MOST likely physiological impairment is:
Weak jaw closure
Poor initiation of the pharyngeal swallow
Monitoring muscle effort during swallow exercises
Reduced UES clearance leading to residue spilling in airway
A key advantage of VFSS over FEES is that VFSS:
Provides a dynamic view of all the swallowing stages
Does not require radiation
Can be done at bedside
Allows direct viewing of vocal folds
The primary purpose of the Yale Swallow Protocol is to:
Reduce UES clearance leading to residue spilling in airway
Confirm esophageal motility problems
Screen for asp. risk using a standardized water swallow
Determine diet consistency
During FEES, the “white-out” period corresponds to:
Bolus transport
Epiglottic inversion
Premature spillage
Upper Esophageal Sphincter opening
A water swallow test is MOST useful for:
Evaluating epiglottic inversion
Determining Upper Esophageal Sphincter dysfunction
Confirming silent aspiration
Identifying patients at high risk who need instrumental eval
A preterm infant demonstrating “arching, pulling away, and grimacing” during feeding is showing signs of:
Aspiration without distress
Generating negative intraoral pressure for sucking
Stress cues indicating autonomic instability
Disorganized suck–swallow pattern
In infants, the BEST indicator of dysphagia during feeding is:
Increased drooling
Slow oral transit
Coughing, oxygen desaturation, or color changes
Severity level of gag reflex
A wet or gurgly vocal quality after swallowing MOST strongly suggests:
Laryngeal penetration or possible aspiration
Vocal fold nodules
Esophageal reflux
Cranial nerve IX (glossopharyngeal) lesion
When recommending non-oral feeding, the SLP’s primary consideration must be:
Ease of caregiver implementation
Airway protection & adequate nutrition/hydration
Patient and family preference
Reducing pharyngeal contraction & prolonged oral transit
The Effortful Swallow primarily increases:
Narrowing the airway entrance and reducing aspiration
Nasal closure
Jaw opening
Tongue base retraction and pharyngeal pressure
The MOST appropriate initial treatment for infants with reflux-related feeding stress is:
Thermal-tactile stimulation
Monitoring muscle effort during swallow exercises
Upright or semi-upright feeding & frequent burping
Increasing bolus viscosity
A delay in jaw grading (controlled opening/closing) MOST often impacts:
Feeder–infant bonding
Maintaining upright sitting and show tongue lateralization
Compression without suction
Textural transitions & chewing development
Aspiration during the swallow typically results from:
Reduced Upper Esophageal Sphincter opening
Backflow from esophagus
Premature bolus loss to pharynx
Incomplete laryngeal closure
Excessive anterior spillage during the oral phase is commonly due to:
Poor lip seal
Reduced vocal fold closure
Weak jaw closure
Impaired timing of swallow reflex
The extrusion (tongue-thrust) reflex must disappear before:
Drinking thin liquids
Initiating cup drinking
Introduction of spoon-feeding
Self feeding with forks and spoons
Mastication skills begin emerging when infants can:
Do up–down tongue movement with stronger intraoral suction
Reflexive pharyngeal contractions
Accept purees only
Maintain upright sitting & show tongue lateralization
The primary purpose of the sucking reflex is to:
Develop chewing
Teach breathing coordination
Strengthen tongue base retraction
Support early nutrition & regulate pressure during feeding
A persistent tonic bite reflex MOST interferes with:
Strengthening tongue base retraction
Spoon-feeding due to strong, involuntary jaw closure
Suck–swallow–breathe coordination
Bottle feeding
Surface electromyography (sEMG) biofeedback is MOST helpful for:
Xerostomia contributing to reduced bolus formation
Monitoring muscle effort during swallow exercises
Measuring UES opening diameter
Weak mastication
In bottle-feeding intervention, external pacing is MOST appropriate when the infant:
Has reduced hunger cues
Consumes too little volume
Fatigues after solids
Sucks continuously without pausing to breathe
A major goal for infants with dysphagia in the NICU is to:
Maintain physiologic stability during feeding
Maximize oral stimulation only
Reduce crying behaviors
Sucking continuously without pausing to breathe
Supraglottic swallow compensates for:
Delayed airway closure
Poor UES function
Reduced tongue strength
Reduced mastication
The BEST procedure for assessing secretion management is:
Videofluoroscopic Swallow Study (VFSS)
Ultrasound
Scintigraphy
Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
Appropriate therapy for infants with poor suck–swallow–breathe coordination includes:
Thickened solids
Facilitate muscle contraction in weak swallowing musculature
Side-lying bottle hold
Pacing & controlled flow nipple systems
The BEST feeding position for an infant with poor SSB coordination is:
Upright 90°
Fully supine
Prone
Neutral head with slight chin flexion
Suckle patterns are characterized by:
Circular rotary motion
In–out tongue motion only
Up–down tongue movement with stronger intraoral suction
Primarily vertical tongue movement
Adaptive utensils, modified cups, and environmental changes are part of:
Sensory training
Compensation
Strength-based therapy
Rehabilitation
A baby with cleft palate is MOST likely to experience difficulty with:
Color changes, bradycardia, or oxygen desaturation
Managing thickened liquids
Generating negative intraoral pressure for sucking
Chewing solid foods
Thickened liquids help reduce aspiration risk by:
Increasing pharyngeal pressure
Slowing bolus flow
Increasing airway opening
Eliminating residue
The Shaker (head-lift) exercise promotes improved:
Pharyngeal wall contraction
Tongue base retraction and pharyngeal pressure
Esophageal clearance
UES opening by strengthening suprahyoids
In adults with Parkinson’s disease, the MOST consistent swallowing impairment is:
Xerostomia contributing to reduced bolus formation
Excessive tongue base pressure
Hyperactive gag reflex
Reduced pharyngeal contraction & prolonged oral transit
Super-supraglottic swallow improves:
Airway closure at the level of the true & false vocal folds
Anterior hyoid movement
Reduced mastication
UES opening by strengthening suprahyoids
The Logemann “chin-down while drinking thin liquids” strategy is MOST effective for patients with:
Cricopharyngeal hypertrophy
Upright or semi-upright feeding & frequent burping
Poor esophageal motility
Delayed airway closure or premature spillage
Which patient would benefit MOST from a FEES rather than a VFSS?
A patient with concern for cricopharyngeal dysfunction
A patient needing evaluation of esophageal motility
A patient who cannot be transported to radiology
A patient with suspected reduced tongue base contact
The phasic bite reflex is elicited by:
Stroking the cheek
Touching the lateral gum ridge
Placing the infant supine
Self feeding with forks and spoons
A clinician suspects esophageal dysphagia. The MOST appropriate next step is:
Oral motor exam only
FEES
Mandible ROM testing
Referral for GI consultation
A hallmark sign of aspiration in infants that is different from adults is:
Color changes, bradycardia, or oxygen desaturation
Immediate coughing
Audible wheezing
Wet vocal quality
During a bedside swallow evaluation, the MOST important safety component is assessing:
Secretion management & airway protection
Diadochokinesis
Tongue strength
Maximum phonation time
Thermal-tactile stimulation is designed to:
Narrowing the airway entrance and reducing aspiration
Increase sensory input to improve swallow initiation
Reduce vallecular residue
Sustained laryngeal elevation and UES opening
A key limitation of a bedside swallow exam is:
It requires specialized equipment
It cannot directly visualize pharyngeal physiology
It overestimates aspiration
It is invasive
A total laryngectomy patient requires:
No airway protection strategies
Supraglottic swallow
Voice therapy only
Airway protection strategies
A technique used to manage dysphagia by changing head and neck posture is what treatment approach:
The Effortful Swallow
The Mendelsohn maneuver
The chin tuck posture
The Masako maneuver
Poor mastication during the clinical exam MOST likely results from dysfunction of:
CN V (trigeminal)
CN X (vagus)
CN XII (hypoglossal)
CN IX (glossopharyngeal)
The suck–swallow–breathe (SSB) pattern typically emerges around:
After birth only
28 weeks gestation
32–34 weeks gestation
36–38 weeks gestation