Which of the following is an abnormal pattern of breathing characterised by progressively deeper, and sometimes faster, breathing followed by a gradual decrease that results in apnea, then the cycle is repeated?

1. A

   Paradoxical respiration

2. B

   Cheyne-Stokes respiration

3. C

   Biot's respiration

4. D

   Kussmaul's respiration

Appeared in: DSSSB 12 August 2024

Explanation

• The question describes a classic 'crescendo-decrescendo' or 'waxing and waning' pattern of breathing.
• This pattern involves a gradual increase in the depth and rate of respirations, followed by a gradual decrease.
• The cycle culminates in a period of apnea (temporary cessation of breathing) before repeating.
• This specific cyclical pattern is the hallmark definition of Cheyne-Stokes respiration.
• It is often caused by conditions that affect the brain's respiratory control center, such as congestive heart failure, stroke, or traumatic brain injury.

Why Other Options Were Wrong

• Option A: Paradoxical respiration describes an abnormal movement of the chest wall, not a cyclical change in breathing rate and depth. The chest wall moves inward during inspiration and outward during expiration.
• Option C: Biot's respiration is characterized by irregular clusters of breaths followed by irregular periods of apnea. It lacks the gradual, predictable waxing and waning pattern of Cheyne-Stokes.
• Option D: Kussmaul's respiration is deep, rapid, and labored breathing that is regular and does not involve periods of apnea. It is a compensatory mechanism for metabolic acidosis.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Identification of abnormal respiratory patterns as background academic context rather than a clinical decision trigger.
• Recognizing abnormal breathing patterns is a critical nursing assessment skill. It can be an early indicator of serious underlying conditions.
• Observation of Cheyne-Stokes respiration should prompt the nurse to perform a focused neurological and cardiovascular assessment and report the finding to the physician, as it can signify conditions like heart failure, stroke, or increased intracranial pressure.
• What if? If the patient's breathing was deep, rapid, and had a fruity odor on their breath, the priority would shift to suspecting Diabetic Ketoacidosis (DKA) and checking blood glucose levels immediately, which is characteristic of Kussmaul's respiration, not Cheyne-Stokes.

How to Approach the Question

• First, carefully read the question stem and break down the description of the breathing pattern into key components: 1) 'progressively deeper, and sometimes faster' (waxing/crescendo), 2) 'gradual decrease' (waning/decrescendo), and 3) 'results in apnea'.
• Next, recall the definitions of the four abnormal breathing patterns provided in the options.
• Compare the key components from the stem with the definition of each option.
• Eliminate options that do not match. Kussmaul's has no apnea. Biot's is irregular, not a gradual cycle. Paradoxical is about chest movement.
• Select the option that perfectly matches the description of a cyclical waxing and waning pattern with apnea, which is Cheyne-Stokes respiration.

Concept Tested & Keywords

• Concept Tested: Identification of abnormal respiratory patterns
• Stem keywords: abnormal pattern of breathing, progressively deeper, faster, breathing, gradual decrease, apnea
• Lead-in keywords: Which of the following is
• Negative lead-in flag: false

Question ID

QnPnJt2F2gcCc6dmLcSyon

Copy ID

Reference Book

E6 Physiology Guyton 4SAE Part 2A p. 115-117