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AP2 > 4/29 - Neural Breathing > Flashcards

4/29 - Neural Breathing Flashcards

Final (92 cards)

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1
Q

The pK of bicarb is ___. Why is it able to be the most effective buffer in the body?

A

6.1

It has help from other buffers in the body –> mainly proteins

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2
Q

We make adjustments for water vapors _____

A

once

ONCE ONLY

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2
Q

What is the only way you get the concentration of oxygen back to its original concentration upon expiring?

A

Dropping the temperature of the expired air –> this removed the heat/humidity

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3
Q

What is the concentration of inspired O2?

A

19.7%

150/760 =0.197

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4
Q

What is the concentration of expired deadspace when inspired 100% O2?

A

About 94%

713/760 =0.938

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5
Q

How much air is coming in and out of your lungs is related to ________. Please explain.

A

Strong cough: 2L able to move in/out of lungs

Muffled cough (as w worsening COPD): less than 2L being able to be moved

Quiet cough (End stage lung diseases): Cant get much air in/out

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6
Q

We breathe when we are unconscious UNLESS it’s related to an ______

A

OD

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7
Q

Control of breathing occurs in the ______ of the _______

A

Medulla

Brainstem

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8
Q

What are the 3 sections of the brainstem?

A
  1. Midbrain/mesencephalon: most superior
  2. Pons (olive shaped): middle
  3. Medulla: most inferior –> last portion before it turns into spinal cord
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9
Q

_______ is the last portion of the brain stem before turning into the spinal cord

A

Medulla

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10
Q

Peripheral chemoreceptors sense _______ (3). Which is most important?

A

-oxygen
-pH/protons
-PCO2
(honorable mention: BP)

Protons most important

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11
Q

There’s crosstalk between respiratory and ________ sensors

A

Cardiovascular

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12
Q

What are the types and locations of peripheral chemoreceptors & baroreceptors?

A

Baroreceptors locations (associated w stretch/pressure):
-Aortic arch
-carotid bifurcation

Chemoreceptors (associated wi chemical changes):
-Carotid (main one)
-Aortic (secondary)

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13
Q

Central chemoreceptors are located in the _______ and are most sensitive to _______. How is this achieved?

A

brainstem

protons

Brainstem is covered in meninges that has CSF under it –> Brainstem is bathed in CSF –> senses changes in pH/proton concentration in CSF

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14
Q

Changes in pH/proton concentration in CSF triggers ________. What type of receptors sense this?

A

Regulation of breathing

Central chemoreceptors in the medulla of the brain stem

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15
Q

Increased protons in CSF = ______ ventilation ______

A

Increased

Quickly

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16
Q

Nonvolatile acid cross the BBB _______ and volatile acids cross the BBB _______. What does this mean?

A

Harder (slower)
Easier (faster)

Longer for central chemoreceptors to be triggered by non-volatile acids since they don’t cross the BBB as well –> sensors in the periphery pick up on some of these acids (which is secondary to central)

Shorter for Central chemo receptors to be triggered by volatile acids/gases such as CO2 since it crosses BBB easier –> faster response

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17
Q

What is the role of the controllers and control system in the brainstem?

A

Monitors the information that the chemoreceptors/ baroreceptors sent –> make changes accordingly to breathing to adjust back to normal

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18
Q

Changes in ventilation during planned exercise occurs _________ during activity. What is this caused by?

A

Immediately

This is caused by higher order parts of the brain: cerebral cortex

Cerebral cortex is involved in planning & execution –> knows exactly how much to increase ventilation when you PLAN to do something –> tells brainstem to increase ventilation exactly what is needed to prevent blood gas changes

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19
Q

With exercise, what happens, if for whatever reason, your cerebral cortex is off-line or insufficient?

A

During exercise your peripheral and central chemo receptors will kick in to help prevent varying blood gases –> increase metabolism

(this is a secondary measure & unlikely if person is healthy –> if person is unhealthy most likely won’t be working out)

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20
Q

Once the information is sent to the controller system in the brainstem by the chemoreceptors, how do we fix imbalances? (3)

A

-kidneys
-fluid shifts
-buffers

They all work together in a negative feedback loop

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21
Q

______ has the strongest effect on ventilation. What is 2nd and 3rd?

A

1st: Protons/pH

2nd: CO2

3rd: O2

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22
Q

O2 deficit = PCO2 _____

A

Excess

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23
Q

O2 level decrease –> acids ______ –> protons _______. What does this cause?

A

Increase

Increase

Triggers chemoreceptors

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24
Peripheral chemoreceptors may not respond to changes in arterial PO2 until below _______
70 mmHg Note: Normal is 100 -- Thats a 30 drop which is alot -- it may take awhile to get to that level. **This will have a delayed response compared to the other factors protons & CO2** This why its considered the 3rd most important trigger in regulating ventilation
25
Changes in metabolism require an increase/decrease in ___________. What is the formula for this? (Hint these are the 2 elements to ventilation). What are the changes the system makes in order?
(minute) ventilation --------------------------- VE = RR x VT --------------------------- 1st: VT 2nd: RR
26
Why does Dr. S recommend adjust VT before RR on the vent? What is the exclusion to this?
Increasing RR 1st --> increased dead space ventilation --> **wasted ventilation** Exclusion: **R heart failure** -want to keep VT as low as possible (so you have to increase RR)
27
Adjusting VT 1st on the vent requires that you ________ inspiratory pressure by about ____
Increase 1 cm H20
28
VT is changed by stronger __________ coming from the brainstem. How does this work?
inspiratory signals Increases # of motor neurons connected to skeletal muscles (increased motor units) --> frequency of firing in the motor neurons increases --> **generate more force** when contracting diaphragm & external intercoastals --> allows for a deeper inhale by activating more muscles --> larger VT
29
The motor neurons associated with the respiratory system are ______. Describe them
A-alpha neuron fibers Large and fast -regulate VT
30
How is RR changed?
By shortening or increasing the amount of time between: the firing of inspiratory centers and expiratory centers, & the brief pause between breathing cycles
31
Chronic pain fibers are _________. Describe them.
unmeylinated C fibers Slow conduction
32
_______ fibers are for sharp pain. Describe them
A-delta Fast & myelinated
33
List fibers from largest to smallest
A-alpha A-beta A-delta C-fiber
34
_______ nerves are associated with motor & are difficult to block. Why? How does this relevant in a bundle of mixed neurons?
A-alpha Harder to block bc they are so large In a bundle of mixed neurons, If you block motor-- you probably blocked sensory as well bc the A-alpha associated w motor is difficult to block. The smaller fibers/neurons associated w pain would require a smaller dose.
35
VOLUNTARY conscious control of respirations comes from _________ in the _________ What is this do?
Motor cortex Frontal lobe (both higher orders of the brain) ------------------------- decide which set of muscles is going to recruit for breathing
36
What are the sensors in the lungs? Describe them (3)
Irritant receptors: -found in the lungs & airway (trachea) -cough stuff --> **innervated by vagus nerve (CNX)** --> info sent to brainstem Stretch sensors: -in lungs -shows how much lung expands during inhale -gives NS feedback --> stop inspiring Pain sensors: -Can disrupt normal breathing cycle
37
Irritant receptors in the lungs are innovated by _____ nerve
CNX Vagus nerve
38
What are the main muscles used quiet breathing?
Diaphragm -external intercostals
39
Internal intercostals deal with _______. What are additional accessory muscles for this?
Forced expiration ------------- Sternocleidomastoid -scalene -pec minor -abdominal muscle muscles
40
T/F: inspiratory and expiratory centers can fire at the same time
F
41
What area of the brain controls skeletal muscle coordination when we increase ventilation?
brainstem
42
If you lose ONE phrenic nerve you lose alot of the ________ muscle. What can step in to help?
Diaphragm (this is the main muscle for breathing so this is bad) Accessory muscles for breathing can assist -this is why your secondary muscles need to be strong
43
What happens when your diaphragm contract stronger? What does this allow for?
Body senses this -> activates accessory muscle groups Allows Forrest to inspire/expire at a faster rate
44
With normal breathing, exhaling is _______
Passive
45
What are the 2 areas on the medulla on the brainstem concerning respiration? What is this?
Dorsal respiratory group (**DRG** –back) Ventral respiratory group (**VRG** –front) --------------------- Group of neurons (nuclei): area of CNS that have lots of cell bodies where decision-making happens
46
The pons are ____ shaped and are _____ to the medulla
Olive Superior
47
Motor/respiratory function has crossover at the end of the ______ or the beginning of ________. This area is called _________. What else follows this pathway?
Medulla Spinal cord Decussation of Pyramids Phrenic nerve
48
Brainstem and respiratory muscle control are ________. What does this mean?
Contralateral ---------------- R side of brain stem controls L respiratory muscle muscles L side of brain stem controls R respiratory muscles
49
Describe Reciprocal Inhibition
Cross talk between the inspiratory & expiratory centers While one center is activated --> inhibits the other -This prevents activation at the same time
50
_________ is high up in the brainstem & is responsible for modulating activity of __________
Pontine respiratory group (PRG) Dorsal and ventral respiratory groups (DRG & VRG)
51
Caudal = _________
Tail (Lower, rear)
52
Rostral = __________
Beak (forward, front)
53
The ____________(2) nerves feed gas/sensory information from the peripheral chemoreceptors into the _____ to the ________. What else follows the same set up?
Vagus & glossopharyngeal Medulla Dorsal respiratory group (DRG) ----------------- Baroreceptors
54
Carotid bodies are associated w ________ nerve & aortic bodies are associated w _________ nerve
Glossopharyngeal nerve (CN IX) Vagus nerve (CN X)
55
The glossopharyngeal nerve into the medulla is ________ to the vagus nerve entry
Superior
56
Trigeminal nerve which is ______ feeds into the ____. Describe the nerve
CN V Pons -------------- Location: side face Covers sensory in majority of face -3 parts: ophthalmic, maxillary, mandibular -**big, fat nerve**
57
Slow pain signals terminate in ____________. What else is associated with this area?
Lower parts of the reticular formation ------------------ Control centers are located here: DRG & VRG
58
Where EXACTLY is the dorsal respiratory group (DRG)?
w/i the **nucleus tractus solitarius** --> which is in the lower part of the reticular formation --> on the medulla --> in the brain stem
59
What are the roles of the dorsal respiratory group (DRG)? (2)
1. **Send inspiratory signals** to motor neurons --> muscles 2. Send inhibitory signals to the VRG during inspiration to prevent expiration
60
The most important motor neuron that the DRG send a signal to is the _________
Phrenic nerve
61
______ (3) regulates inspiration.
**Dorsal respiratory group (DRG)** Pontine respiratory group (PRG) Ventura respiratory group (VRG)
62
What are the muscle groups controlled by the dorsal respiratory group (DRG)?
Inspiratory: -diaphragm -external intercostal -mid pec Expiratory: -abdominal -internal intercostal (needs editing)
63
What is the main thing that the DRG controls?
Inspiratory rate
64
The site of Respiratory Rhythmogenesis is _________ (2). Where is this?
Botzinger complex Pre-Botzinger complex ----------------- In the ventral respiratory group (VRG) ---> Lower reticular formation --> Medulla
65
Describe the purpose of Botzinger complex & Pre-Botzinger complex
**Controls respiratory rate** Feeds into DRG --> control the pace of firing or spacing between breaths
66
The VRG innerates the _________ muscles and prevents _______. What does this do? Describe this muscle
Pharyngeal constrictor Tightening --> (laryngospasm) -------------------- Keeps airway open & prevents obstruction of breathing -------------------- Skeletal muscles around the larynx -these **muscles assure we have an open upper airway**
67
The Pontine respiratory group (PRG) is ________ to the VRG/DRG, and it is at the bottom of the _________ and top of the _______
Superior Pons Medulla
68
The pontine respiratory group (PRG) gets information sent from ______(2) that's fed in from the ______. What happens after this?
Irritant receptors Stretch receptors pons Info sent to DRG --> PRG limits inspiration time to make sure it's not prolonged
69
What is the role of the Pontine respiratory group (PRG)?
**Limits inspiration time** -communicating with DRG
70
What happens if there's a lesion that blocks the path between the pons and the medulla?
blocks communication path between PRG & DRG PRG unable to tell DRG to stop inspiring --> severely prolonged inspiration & short expiration (apneustic breathing)
71
Apneustic breathing is defined as severely prolonged _______ & short ________. What is this known as?
Inspiration Expiration "death reflex"
72
Briefly describe normal CSF
-clear -little to no proteins -pH = 7.31-7.32 (lower than arterial blood)
73
Describe Bicarb in the CSF?
Produces its own bicarb and has its own buffering system (bicarb cannot cross BBB)
74
Levels of bicarb in CSF are managed by ______ cells & maintainence is managed by _______ cells
Helper (Ependymal cells) Gilal (Astrocytes)
75
Brain CO2 is _____ than arterial CO2. Why?
(Substantially) Higher -------------- brain produces CO₂ as a byproduct of high metabolic activity --> CO₂ builds up in brain tissue before diffusing into the blood (Down concentration gradient) Less proteins & bicarb not as good of a buffer in CSF
76
What is the PCO2 in healthy CSF?
50 mmHg
77
T/F: PCO2 has to be higher in CSF for any of it to be carried away in the blood
T This is the gradient thats created to take CO2 out of CSF
78
Why is the pH lower in CSF? Describe the buffering system in CSF
Less proteins --> Decreased buffering capacity Governed by gilal cells Bicarb doesnt work well here bc not alot of proteins to help it
79
Smooth muscle that control the __________ of cerebral blood vessels ________ when CO2 is increased. What does this do?
arteriolar tone Dilate ------------------ Increases brain blood flow --> helps wash out CO2 buildup
80
The Apneustic Center is at the bottom of the ______ & top of the _______. What else is in this same exact place? (Hint: its the same thing). What does lesioning of this area do?
pons medulla -------------- Pontine Respiratory Group (PRG) --------------- Prevents communication between pons & medulla --> Prevents communication between PRG & DRG/VRG --> Apneustic breathing
81
The actual name of a physical peripheral chemoreceptor is called a ______. What are both called?
Body ---------- Carotid bodies Aortic bodies
82
There are ______ aortic bodies sitting on top of the ________
3-5 aortic arch
83
There is ___ carotid _____ on each side of the neck. How many are there in total? Where exactly in the neck are they located?
1 body ---------------- 2 --------------- bifurcation of the **external** carotid
84
The aortic bodies monitor blood chemistry from the _______ & carotid bodies monitor blood going into the _______
L ventricle the brain
85
Decrease in pH or increase in PCO2 = _______ CO = ________ BP
Increased Increased
85
Another way to get rid of excess CO2, beside increased ventilation, is _________. What does this do?
Increase perfusion into lungs Increase capillaries recruitment --> increases surface area for gas exchange
86
Decreasing RR = _______ CO2 = ________ BP
Increased Increased
87
Increasing RR = _______ CO2 = ________ BP
Decreased Decreased
88
What cautions should we have with adjusting BP with RR?
Increasing RR to decrease BP --> Blows off CO2/protons Albumin is negative charged and usually bound to positively charged protons. When you blow off protons it frees off space from albumin --> Ca++ is positively charged and will then become bound to albumin --> Decreases ionized Ca++ This **affects the heart** because the heart needs calcium to contract.
89
Nonvolatile acids take _______ time to cross the BBB because they are a ______ compound. How long does it take for the brainstem to respond to them? What do they require to cross BBB?
More Charged ----------------- 3 minutes or less (According to Dr. S way less than 3 mins) ------------------- Transport protein
90
The ______ chemoreceptors are the most important
central

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