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A 26 year old male comes to the clinic on concurrent visits with complaints of a dry, productive cough. Previous bacterial and viral testing did not yield a pathogen. An O&P evaluation is ordered, and eggs measuring approximately 100 µm long by 60 µm wide are found in a wet mount of the sputum (shown in the image below). Which organism is most likely present?

  Mr. Jones is a patient who underwent a total laryngectomy (no flaps) and bilateral neck dissections at an outside hospital and then had postoperative radiation tx and secondary TE puncture.  His treatment was completed about 1 year ago.  He is now establishing care at your facility.  When seen, he reports that he’s always had trouble with his indwelling voice prosthesis leaking after about 4-6 weeks.  He was frustrated with this and considering trying to have it removed.  He also complains that talking is difficult at times and he often has to go through 3-4 peristomal adhesives per day because he “blows the seal”.  His voice is somewhat tight and effortful, with a max TE phonation time of about 4-5 seconds. He does not initially complain of swallowing problems, but upon further questioning does admit that meats and breads are difficult to eat and he avoids them.  He has to drink a lot of liquid to wash his food down and does not like to go out to eat too often.  He has a lot of difficulty talking during and foe a while after eating a meal.  Occasionally, when he drinks liquids too fast, they come back up or might come through his nose.  1. What are some potential causes of this patient’s voice prosthesis difficulty? 2. What further testing would you want to complete and why?  3. How could this patient’s swallowing and voice prosthesis difficulty be related?  Explain.  4. What could be some potential interventions that might be helpful, based on further testing?    

Give a step-by-step description of how you would train a TL patient to apply an adhesive peristomal device. Be sure to include ALL THE STEPS.

List 2 things you learned from your studies/ readings or learned from this class or from the support groups or from the discussion panel that was not asked on quizzes or the final examination.

You have been seeing a patient every two weeks while this patient is undergoing radiation treatment for head and neck cancer.  The 4th week into her treatment, the patient has developed mucositis. What recommendations or treatment would you suggest to help this patient for this side effect? 

Please enter your personal Integrity Principle below.  Also please add your initials and today’s date to acknowledge the following: I will adhere to our Classroom Code of Conduct during this exam, which includes the following:  I will take the test alone without anyone’s help. I will not have my phone or another communication device with me during the test. I will not search for answers using any outside resources. I will not communicate regarding the test content with anyone prior to Thursday, March 18 at 8 pm. Remember, please enter your personal Integrity Principle and then initial and date to acknowledge your adherence to our Classroom Code of Conduct. Thank you and good luck!

Mr. Ray will be undergoing a total laryngectomy.  Dr. Cummings referred the pt to you for presurgical counseling.  You provide him with information about pros and cons of each available postsurgical mode of communication.  Please imagine that you are talking directly to the patient and use the exact words that you would say to him during your session to explain the benefits and drawbacks of each listed mode of communication.   1.  Esophageal speech:     2.  Artificial larynx:     3.  Tracheoesophageal speech:

Describe one anatomic or physiological problem a patient may have that would impair swallowing following a total laryngectomy.  What interventions could be beneficial for this problem?  

Lymphedema is accumulation of lymphatic fluid which contains excessive ____________________.

Mr. Smith had a T3N0M0 glottic cancer and underwent total laryngectomy with bilateral modified radical neck dissection 3 weeks ago.  He never had preoperative radiation and there is no plan for postoperative radiation.  He had a primary puncture during his surgery and currently has a 16 French catheter in his TEP which is being used for tubefeeding.  He just saw ENT and the surgeons did a swallowing test in the clinic and have cleared him to eat and drink, pending your approval.  The surgeons also have cleared him for removal of the catheter and placement of his first voice prosthesis.  He comes to your clinic after his ENT appointment with his wife. His neck and lower face appear mildly edematous but his incisions appear well-healed.  Both the patient and his wife seem anxious and are eager for him to begin to eat and talk.   1.  Explain the steps you would take in terms of assessing his swallowing ability.  How would you determine if it was safe for him to eat and drink? 2.  Explain the steps you would take in fitting him with his first prosthesis. (You do not need to be specific about which prosthesis you would select) 3.  Once you place the voice prosthesis, the patient is unable to achieve tracheoesophageal voicing with thumb occlusion of his stoma.  Why might this be occurring?  What steps would you take to troubleshoot during your clinic visit? 4.  How would you counsel the patient and wife if voicig could not be acheived during the visit?  What would you do or expect going forward? 5.  What other educational needs might the patient or family member have at this point?  What else do you want to teach or explain?