Dasguppta - Control Of Respiration

Question 1

The central chemoreceptors are located inside the brainstem on the other side of the BBB. They are sensitive to fluctuation of ____ in the brain interstitium.

Answer 1

CO2

Question 2

The peripheral chemoreceptors can be found in the carotid sinus. They respond to ?

Answer 2

Arterial [H]

Arterial pCO2 (only because of the effect it has on[H+])

Arterial pO2 (but only when very low, below 60mmHg)

Question 3

For a normal person, fluctuation in _____ is the main drive for respiration

Answer 3

CO2

Question 4

Chronic exposure to ____ can cause adaptation of central chemoreceptors

Answer 4

CO2

Question 5

Hypoxia _______ central chemoreceptors

Answer 5

Does not drive

Question 6

Central chemoreceptors can be stimulated by a very small increase in PaCO2, around ______ mmHg, and / or increases in H+ concentration in CSF

Answer 6

42-43mmHg

Normal range is 35-45mmHg

Question 7

Why is the overall buffering system in the CSF very slow, causing rapid increases in [H+] and making the receptors there very sensitive?

Answer 7

CSF lacks hemoglobin and carbonic anhydrase and has a relatively low bicarbonate and protein level.

Question 8

PaO2 about 60mmHg and lower leads to _________ of peripheral chemoreceptors

Answer 8

Activation

Question 9

The driving force for ventilation that comes from the aortic arch and carotid bodies is ?

Answer 9

Fluctuation in pO2

There is no adaptation for hypoxia

Question 10

Hypoxic stimulation of ventilation is exclusively mediated by __________

Answer 10

Peripheral chemoreceptors

Question 11

The most powerful stimulus known to influence the respiratory components is the ________.

Mediated solely by peripheral chemoreceptors

Answer 11

Concentration of [H+] ions

Question 12

There must be _______ hypoxia before pO2 causes any increase in ventilation

Answer 12

Moderately severe

Question 13

Hypoxic response of the carotid bodies is _________ _by increasing pCO2

Answer 13

Very strongly enhanced

Question 14

Does the response to hypoxia ever adapt?

Answer 14

No

Question 15

The neurons in the medulla have both inspiratory and expiratory activity, and this region of the medulla is referred to as the ?

Answer 15

Central pattern generator

Question 16

During exercise or patients of lung disease, accessory muscles (internal intercostal and abdominal muscles) are used for EXPIRATION, where is innervation for these muscles from ?

Answer 16

Nerves in the lumbar region and near the thoracic vertebrae

Question 17

The motor act of inhalation is mostly innervated by what?

Answer 17

Phrenic nerve innervation to the diaphragm.

Question 18

In the “respiratory center of the medulla” the intrinsic respiration is controlled by which 2 groups of neurons?

Answer 18

The dorsal respiratory groups

The ventral respiratory groups

Question 19

Receives inspiratory impulses from several different specialized monitoring systems throughout the body, including central chemoreceptors, peripheral chemoreceptors, stretch receptors, and higher brain centers. Send neural impulses every few seconds to the muscles of inspiration. Believed to be responsible for the basic rhythm of breathing. Trigger inspiration at rate of 12/15 breaths/min

Answer 19

Dorsal respiratory groups

Question 20

Contains both inspiratory and expiratory neurons

Control constituent muscles of upper airway, regulating diameter during breathing. Stimulates the muscles of the upper airway to expand in inspiration. Also controls muscles of expiration and the accessory mm. Of inspiration during stress and heavy exercise

Answer 20

The ventral respiratory group

Question 21

Located in pons

Normal respiration cut-off switch

Continually sends neural impulses to stimulate inspiratory neurons of DRG and VRG

Answer 21

Apneustic center

Question 22

Located in pons

Major function; prevent apneusis, enhance and fine tune the rhythmicity of breathing

Answer 22

Pneumotaxic centers

Question 23

An abnormal pattern of breathing characterized by deep, gasping inspiration with a pause at full inspiration followed by a brief, insufficient release

Answer 23

Apneustic respiration

Question 24

Central pattern generator inoperative

Insensitivity of chemoreceptors to O2, CO2 or pH

Respiratory drive only voluntary

Tracheostomy needed so they can plug into ventilator when they sleep because otherwise respiratory drive is gone when asleep

Answer 24

Congenital Central Hypoventilation Syndrome (CCHS)

Question 25

Drugs that depress CNS and alter respiratory control system in medulla. Cause respiratory depression and dampen the normal ventilatory response to increase of CO2

Answer 25

Alcohol

Opiates

Benzodiazepines

Barbiturates

Anesthetics

Question 26

Drugs that increase respiratory drive by stimulating the respiratory control center in the medulla

Answer 26

Cocaine

Amphetamine

Caffeine

Question 27

Fever _____ ventilation

Answer 27

Increases

Question 28

Mild hypothermia _____ ventilation

Answer 28

Increases

Due to stimulation of sympathetic nervous system as the body works to preserve heat

Also have shivering, tachycardia, and vasoconstriction

Question 29

Deep hypothermia ________ ventilation

Answer 29

Depresses

{probably through general depression of neural activity}

Question 30

Depression of CNS activity due to brain injury or drug overdose and _____ ventilation

Answer 30

Depress

Question 31

Painful stimuli can cause ______ in ventilation

Answer 31

An increase

Question 32

Panic can result in _

Answer 32

Hyperventilation

Question 33

10-30 seconds of apnea followed by gradual increase in volume and frequency of breathing until another period of apnea comes.

Found in patients of cardiac failure or brain damage

Answer 33

Cheyne-Stokes breathing

Question 34

What kind of illness is Cheyne-Stokes breathing associated with ?

Answer 34

Cardiac failure

Brain damage

Question 35

Rhythmic but deep respiration movements which alternate (at approximately regular intervals) with long respiratory pauses (from few seconds to half a minute)

Occurs in meningitis patients, disorders of cerebral circulation, and damage to the respiratory center from trauma, stroke and opioid use

Answer 35

Biot’s respiration

Question 36

What conditions are associated with Biot’s respiration?

Answer 36

Meningitis

Disorders of cerebral circulation.

Damage to the respiratory center from trauma, stroke, or opioid use

Question 37

Type of breathing; inspiratory process intact.
Upper airway obstructed bc too much fat around the pharynx; pharyngeal muscles do not contract properly.

Absence of airflow due to an occlusion in the upper airway that lasts at least 10 seconds in spite of continual effort to breathe.

Answer 37

Obstructive sleep apnea

Question 38

How are the types of sleep apnea different from Cheyne-Stokes respiration?

Answer 38

No hyperventilation and waning of ventilation

Question 39

Pattern of breathing characterized by a normal deep inspiratory cycle interchanged with complete cessation of breathing.

Typically caused by problems with how the brain controls breathing rather than an occlusion

Absence of airflow for at least 10 seconds

Answer 39

Central sleep apnea

Question 40

Hyperventilation, gasping, deep and labored respiration, usually seen in DKA, kidney failure, diabetic coma, or other states with high degree of acidossi

Answer 40

Kussmaul’s respiration

Question 41

What types of conditions are associated with Kussmaul’s respiration?

Answer 41

DKA

Diabetic Coma

Renal Failure

States characterized by high degree of acidosis

Question 42

Symptoms associated with ARDS:

Answer 42

Tachypnea, tachycardia, diahporesis, cyanosis, dyspnea, diffuse crackles ,+/- cough and cp,

(Onset of symptoms usually 6-72 hours after inciting event)

Question 43

Static compliance of the lung is determined by ?

Answer 43

PV slope at FRC

Question 44

Pathophysiology of ARDS:

Answer 44

Alveolar injury —> cytokine release

Recruit neutrophils to lungs (releases ROS and proteases)

Damage capillary endothelium (lymph drainage overwhelmed)

Damage alveolar epithelium (no more tight junctions)

Question 45

Ventilation = __

Answer 45

CO2

Question 46

Where are the apneustic center and pneumotaxic center located?

Answer 46

The pons