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Cardio AP > Unit 4/Chapter 11: Ventilation > Flashcards

Unit 4/Chapter 11: Ventilation Flashcards

1
Q

Where do neural impulses for ventilation originate?

A

Medulla oblongata

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2
Q

What happens with transection below medulla?

A

Ventilation ceases

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3
Q

What happens with transection above pons?

A

Rhythmic breathing

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4
Q

The heart lies where, behind the sternum?

A

Mediastinum

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5
Q

Which group contains respiratory neurons

A

Dorsal respiratory group (DRG)

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6
Q

Where do respiratory neurons in the DRG send impulses?

A

Phrenic and external intercostal motor neurons

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7
Q

Which nerves transmit lung sensory impulses to the DRG to modify the medulla’s basic breathing pattern?

A

Vagus X and glossopharyngeal IX

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8
Q

What are the 2 inspiratory neuron population of the DRG?

A
  1. Inhibited by deep lung inflation- inflation stops
  2. Excited by lung inflation-inflation continues
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9
Q

What are the 2 nuclei in the medulla where the VRG is located?

A

Nucleus ambiguous
Nucleus retro ambiguous

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10
Q

What do inspiratory neurons in the VRG innervate (supply organs with nerves)?

A

laryngeal and pharyngeal muscles via the vagus nerve
abduction of the vocal chords

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11
Q

Caudal expiratory stimulation of the VRG to _?

A

Internal intercostal and abdominal muscles

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12
Q

What provides the main stimulus for inspiration?

A

The DRG

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13
Q

What group contains both inspiratory and expiratory neurons?

A

Ventral Respiratory Group (VRG)

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14
Q

Rostral inspiratory stimulation of the VRG to_?

A

diaphragm and external intercostal muscles

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15
Q

What is the Botzinger complex?

A

Neurons that inhibit inspiratory impulses

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16
Q

Botzinger/prebotzinger complex may have a role in what?

A

rhythmic breathing pattern

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17
Q

2 major theories of rhythm generation

A

pacemaker hypothesis
network hypothesis

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18
Q

What is the inspiratory ramp signal?

A

gradual firing of impulses after expiration ends that get progressively stronger and cause a gradual inflation of the lung

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19
Q

What happens with the inspiratory ramp signal during exercise?

A

It becomes steeper and lungs fill more rapidly

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20
Q

What are the two Pontine Centers?

A

1.Apneustic center 2.Pneumotaxic center

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21
Q

What does the apneustic center do?

A

Sends signals to the DRG
prevents inspiratory neurons from being switched off

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22
Q

What is apneusis?

A

Prolonged inspiratory gasps interrupted by occasional expirations

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23
Q

What does the pneumotaxic center do?

A

Controls length of inspiration

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24
Q

What does a strong signal from the pneumotaxic center do?

A

short inspiratory time - increase RR

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25
Q

What does a weak signal from the pneumotaxic center do?

A

prolongs inspiratory time - increase tidal volume

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26
Q

What effect does the lack of pneumotaxic and stretch receptor neurons have on ventilation?

A

Causes long deep inspiratory gasps

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27
Q

What do pontine impulses do?

A

Fine-tune medullary rhythm

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28
Q

Hering-Breuer reflex is activated by what?

A

large tidal volumes of .8 - 1 L

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29
Q

Hering-Breuer reflex regulates rate and depth during what?

A

Exercise

30
Q

Hering-Breuer inflation reflex - low lung compliance with increased inspiratory effort leads to?

A

Faster breathing rate

31
Q

Hering - Breuer deflation reflex - what stimulates breathing?

A

Sudden lung collapse or irritant

32
Q

What is the pathway from the lung to the medulla called?

A

Vagus nerve

33
Q

What does the Head’s Paradoxical Reflex do?

A

Causes a rapid inspiration creating a gasp in infants and sighs in adults

34
Q

Irritant receptors in lungs are what?

A

rapidly adapting - stop firing after response to stimulus

35
Q

Vasovagal reflexes are found on both ______________ and ______________ neurons?

A

Sensory and motor

36
Q

Vasovagal reflexes are responsible for what?

A

bronchoconstriction, coughing, sneezing, tachypnea, glottic narrowing, bradycardia

37
Q

J-receptors (juxtapulmonary capillary receptors) are what?

A

C fibers in the lung parenchyma near the pulmonary capillaries

38
Q

J receptors are stimulated by

A

pneumonia, CHF, pulmonary edema

39
Q

J receptor stimulation causes

A
  • Rapid, shallow breathing
  • Sensation of dyspnea
  • Glottic narrowing (expiratory grunting)
40
Q

Peripheral Proprioceptors _?

A

Found in muscles, tendons, joints, and pain receptors
Movement stimulates hyperpnea

41
Q

Muscle spindles are?

A

Muscle stretch sensitive and located in diaphragm and intercostal muscles

42
Q

Which stimulates central chemoreceptors more quickly and elicits more increase in ventilation? Increase in PCO2 or H+?

A

Increase in PCO2 due to the blood brain barrier being impenetrable to H+. Hypoxemia becomes a more prominent stimulus for ventilation

43
Q

Central (medullary) chemoreceptors are stimulated by ______________, not by ____________ or ____________

A

H+ ions
CO2
O2

44
Q

What can cross the blood brain barrier easily, raising the H+ concentration of CSF?

A

CO2

45
Q

VA increases _____-_____ L/min for every _______mmHg increase in _____________

A

2-3
1
PaCO2

46
Q

What is the principal minute to minute stimulus for ventilation mediated through central chemoreceptors?

A

PaCO2

47
Q

What is the primary mediator of minute to minute breathing drive in humans?

A

PaCO2

48
Q

Even maximal hyperventilation cannot raise the PaO2 higher than what?

A

125 - 130 mmHg

49
Q

Arterial hypoxemia does not stimulate ventilation until PO2 reaches which level?

A

<60 mmHg

50
Q

The chronically high PaCO2 in a patient with COPD who has compensated respiratory acidosis does not stimulate central chemoreceptors - why?

A

pH is normal
HCO3- buffers H+

51
Q

Peripheral chemoreceptors are located

A

Carotid and aortic bodies

52
Q

peripheral chemoreceptors are sensitive to __________ directly and ___________ indirectly

A

H+
CO2

53
Q

peripheral chemoreceptors are responsible for ______-______% of ventilatory response to hypercapnia

A

20-30

54
Q

peripheral chemoreceptors respond ________x faster to H+ than central chemoreceptors and give a quick response to ___________ ____________

A

5
metabolic acidosis

55
Q

A sudden increase in CO2 results in what?

A

increase in H+ in CSF
increase in ventilation

56
Q

A gradual increase in CO2 results in

A

renal retention of HCO3-
normal pH

57
Q

severe COPD patients experience a ___________ increase in CO2 and ______________. What is the minute to minute breathing stimulus?

A

gradual
hypoxemia
hypoxemia

58
Q

What is oxygen induced hypercapnia?

A

acute increase in PaCO2 when O2 is given to chronically hypoxemic/hypercapnic patients with COPD

59
Q

What is the medullary response to acute increase in CO2 in chronic hypercapnia?

A

central chemoreceptors have less stimulation - H+ buffered in CSF
ventilatory response to CO2 depressed
buffer capacity increased because of HCO3 retention

60
Q

During exercise, CO2 production and O2 consumption may increase ____________x

A

20

61
Q

Stages of ventilatory response to exercise

A

onset
adjustment
steady state

62
Q

Gradual increase in breathing rate and volume followed by gradual decrease followed by apnea is known as what?

A

Cheyne - Stokes breathing

63
Q

Gradual increase in breathing rate followed by gradual decrease to apnea but volume remans the same is known as ?

A

Biots breathing

64
Q

prolonged gasping inspiration caused by pons damage known as?

A

apneustic breathing

65
Q

continuous deep breathing - caused by damage to the pons is?

A

central reflex hypernea

66
Q

continuous shallow breathing - caused by head trauma, brain hypoxia, narcotic suppression

A

central reflex hypopnea

67
Q

Increase in CO2 can do what to brain vessels?

A

increase cerebral blood flow

68
Q

To sustain cerebral blood flow, a cerebral perfusion pressure of _________mmHg must be maintained

A

60

69
Q

What do authors advaise against in traumatic brain injury patients

A

hyperventilation to a PACO2 of less than 30 mmHg

70
Q

What can hyperventilation of a TBI patient cause?

A

cerebral ischemia

71
Q

In a TBI patient, for every ______mmHg acute reduction in PaCO2 (between 20 - 60 mmHg) there is a _______% reduction in Cerebral Blood Flow.

A

1;3

Cardio AP (5 decks)

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