Disorders Of Respiratory Control

Front 1

Differentiate between obstructive apnea and central apnea.

Back 1

Obstructive apnea is the absence of oronasal airflow in the presence of continued respiratory effort lasting longer than two respiratory cycles

Central apnea is CESSATION of respiratory effort lasting at least two respiratory cycles

Front 2

Regarding respiratory physiology, there is central respiratory control, peripheral chemoreceptors, and other receptors. The central respiratory control is further subdivied into brain stem and cortex. What are the three main groups of neurons in the brain stem?

Back 2

DORSAL RESPIRATORY GROUP - generates inspiratory action potentials; receives input thru peripheral chemoreceptors via vagus and glossopharyngeal nerves

PNEUMOTAXIC CENTER: helps control rate and pattern of breathing; works by inhibiting dorsal respiratory group

VENTRAL RESPIRATORY GROUP: inspiration or expiration; responsible for abdominal expiratory movements during times of high levels of respiration

Front 3

Regarding respiratory physiology, there is central respiratory control, peripheral chemoreceptors, and other receptors. The central respiratory control is further subdivied into brain stem and cortex. Which of the three main groups of neurons is described?

generates inspiratory action potentials; receives input thru peripheral chemoreceptors via vagus and glossopharyngeal nerves

Back 3

DORSAL RESPIRATORY GROUP - generates inspiratory action potentials; receives input thru peripheral chemoreceptors via vagus and glossopharyngeal nerves


others are

PNEUMOTAXIC CENTER: helps control rate and pattern of breathing; works by inhibiting dorsal respiratory group

VENTRAL RESPIRATORY GROUP: inspiration or expiration; responsible for abdominal expiratory movements during times of high levels of respiration

Front 4

Regarding respiratory physiology, there is central respiratory control, peripheral chemoreceptors, and other receptors. The central respiratory control is further subdivied into brain stem and cortex. Which of the three main groups of neurons is described?

helps control rate and pattern of breathing; works by inhibiting one of the other main respiratory neuron groups

Back 4

PNEUMOTAXIC CENTER: helps control rate and pattern of breathing; works by inhibiting dorsal respiratory group

VENTRAL RESPIRATORY GROUP: inspiration or expiration; responsible for abdominal expiratory movements during times of high levels of respiration

DORSAL RESPIRATORY GROUP - generates inspiratory action potentials; receives input thru peripheral chemoreceptors via vagus and glossopharyngeal nerves

Front 5

Regarding respiratory physiology, there is central respiratory control, peripheral chemoreceptors, and other receptors. The central respiratory control is further subdivied into brain stem and cortex. Which of the three main groups of neurons is described?

inspiration or expiration; responsible for abdominal expiratory movements during times of high levels of respiration

Back 5

VENTRAL RESPIRATORY GROUP: inspiration or expiration; responsible for abdominal expiratory movements during times of high levels of respiration

DORSAL RESPIRATORY GROUP - generates inspiratory action potentials; receives input thru peripheral chemoreceptors via vagus and glossopharyngeal nerves

PNEUMOTAXIC CENTER: helps control rate and pattern of breathing; works by inhibiting dorsal respiratory group

Front 6

Regarding respiratory physiology, there is central respiratory control, peripheral chemoreceptors, and other receptors. The central respiratory control is further subdivied into brain stem and cortex. What are the three main groups of neurons in the brain stem and what do they do/control?

Back 6

DORSAL RESPIRATORY GROUP - generates inspiratory action potentials; receives input thru peripheral chemoreceptors via vagus and glossopharyngeal nerves

PNEUMOTAXIC CENTER: helps control rate and pattern of breathing; works by inhibiting dorsal respiratory group

VENTRAL RESPIRATORY GROUP: inspiration or expiration; responsible for abdominal expiratory movements during times of high levels of respiration

Front 7

True or False:
The most important factor in the central control of ventilation is the arterial pCO2.

Back 7

True

The central chemoreceptors situated near the ventral surface of the medulla stimulate breathing in response to changes in [H+] concentration in CSF.

Front 8

What is responsible for increases in respiratory rate in response to hypoxemia?
A. central respiratory chemoreceptors
B. J-receptors
C. peripheral respiratory chemoreceptors
D. Hering-Breuer receptors

Back 8

C. peripheral respiratory chemoreceptors - the carotid bodies and aortic bodies.

J-receptors are juxta-capillary receptors that respond to chemical changes in pulmonary circulation

Hering-Breuer inflation reflex - receptors in walls of bronchi and bronchioles; during overinflation, signal through vagus eventually sweitching off inspiratory ramp

Front 9

Name some factors leading to dysfunction of central control. (9)

Back 9

1. immaturity --> dysfunction of respiratory neurons
2. absences of respiratory function during sleep
3. metabolic dz
4. congenital abnormalities --> possible dysfunction in brainstem/medulla
5. toxic/drug exposures - like cocaine, opiods
6. chronic hypoxemia
7. seizures
8. infections (meningitis, RSV, pertussiss)
9. trauma (CNS bleeding)

Front 10

Name some factors leading to dysfunction of peripheral respiratory control. (4)

Back 10

1. lung dz
2. neuromuscular dz (muscular dystrophy, motor neuron dz, neuromuscular junction dz like mysethenia gravis)
3. upper airway dz / obstruction
4. GE reflux

Front 11

What is apnea of prematurity?

Back 11

Usually it occurs in preterm infants. Is essentially periodic breathing. Formally defined as a prolonged respiratory pause that is associated with bradycardia or cyanosis in the preterm infant with no other identifiable etiology. Is a diagnosis of exclusion.

Front 12

Which of the following statements is FALSE about apnea of prematurity?
A. Apnea of prematurity is essentially a diagnosis of exclusion
B. Apnea of prematurity is thought to at least partially be due to the immaturity of the central respiratory drive and brain stem
C. Apnea of prematurity is a risk factor that predisposes the infant to SIDS
D. Upregulation of inhibitory neurotransmitters like dopamine, endorphins and prostaglandins are thought to play a role in apnea of prematurity

Back 12

C. Apnea of prematurity is a risk factor that predisposes the infant to SIDS

DOES NOT PREDISPOSE INFANT TO SIDS!

Front 13

What are treatment options for apnea of prematurity?

Back 13

* tactile stimulation
* methylxanthines
* assisted ventilation /CAP
* home monitoring

Front 14

True or False:
To this day, pathologists are unable to distinguish between accidental or intentional suffocation and sudden infant death syndrome unless there are signs of physical violence.

Back 14

True

Front 15

True or False:
There are several pathognemonic characteristic autopsy findings in victims of SIDs.

Back 15

FALSE.

The characteristics are all nonspecific - intrathoracic petechiae, minor respiratory infection, astroglial proliferation, some abnormalities of the brainstem. Thus, to this day, pathologists are unable to distinguish between accidental or intentional suffocation and sudden infant death syndrome unless there are signs of physical violence.

Front 16

What is the definition of an ALTE episode?

Back 16

ALTE, or apparent life threatening episode is caused by a combo of apnea, color change, change in muscle tone choking or gagging.