Small Group 4 Ventilation Control/ Sleep Flashcards Preview

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Flashcards in Small Group 4 Ventilation Control/ Sleep Deck (10):
1

Why do the lower, lateral costal margins show inward motion during inspiration in a COPD patient?

costal margins are pulled inwards by a flattened diaphragm

2

Why would leaning forward assist in breathing for a patient with severe COPD?

increased abdominal pressure at the end of exhalation causes the diaphragm to start from a more mechanically advantageous position

3

Does tobacco use effect sleep apnea?

yes

4

How do levels of chemical stimuli (PaCO2 and PaO2) fluctuate during periodic breathing?

during apnea PaCO2 increases and PaO2 decreases upon microarousal, PaCO2 decreases and PaO2 increases

an increased gain in ventilatory response in this situation causes the PaCO2 to fall below the apnea threshold

5

Neuromuscular disease would be expected to present with what changes in normal lung volumes?

low TLC, normal FRC, high RV, low ERV

additionally, patients with bilateral diaphragmatic paralysis typically describe supine dyspnea (no gravity to aid the diaphragm descent)

6

Why is paradoxical inward abdominal motion observed in cases of neuromuscular weakness?

diaphragm is pulled into the chest by negative intrathroacic pressure, when upright, gravity tends to counteract this process

7

How is definitive diagnosis of bilateral diaphragmatic paralysis made?

measurements of trans-diphragmatic pressure

8

Why is central apnea more common in patients with muscular dystrophy?

REM sleep normally inhibits the activity of skeletal muscles (except the diaphragm) which are particularly important in cases of bilateral diaphragmatic paralysis, to continue adequate ventilation

9

How would you differentiate a high PaCO2 caused by inspiratory drive v. muscle weakness?

inspiratory drive is measured by mouth occlusion pressure and mean inspiratory flow, if these are normal, muscle weakness should be considered for possible decrease in TV

10

What muscle is most important in maintaining an open upper airway and preventing apneas?

genioglossus