sinhlyhocykhoatap1

7/14/2019 sinhlyhocykhoatap1

1/90

TRNG I HC Y KHOA PHM NGC THCH

B MN SINH L HC

SINH L HC Y KHOATP I

CH BIN: PHM NH LU

NH XUT BN Y HC

2009

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BIN SON:

PHM NH LU

GS. TS. BS. Ch nhim B mn Sinh L Hc Sinh L Bnh Min Dch Hc,Trng i hc Y khoa Phm Ngc Thch.

THI HNG H

TS. BS. Ging vin chnh, Ph ch nhim B mn Sinh L Hc Sinh L Bnh Min Dch Hc, Trng i hc Y khoa Phm Ngc Thch.

L TH HNG TUYT

ThS. BS. Ging vin chnh, Ph ch nhim B mn Sinh L Hc Sinh L Bnh Min Dch Hc, Trng i hc Y khoa Phm Ngc Thch

PHAN NGC TIN

ThS. BS. Ging vin chnh, B mn Sinh L Hc Sinh L Bnh Min Dch Hc,Trng i hc Y khoa Phm Ngc Thch.

TRN KHIM HNG

ThS. BS. Ging vin chnh, B mn Sinh L Hc Sinh L Bnh Min Dch Hc,Trng i hc Y khoa Phm Ngc Thch.

BIN TP:

NGUYN DUY THCH

BS. Ging vin, B mn Sinh L Hc Sinh L Bnh Min Dch Hc, Trng ihc Y khoa Phm Ngc Thch.

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LI NI U

p ng vi nhu cu hc tp ca sinh vin cc lp nm th hai y khoa, cc lpchuyn tu v nhu cu v sch tham kho ca cc i tng sau v trn i hc, chng ti binson cun sch Sinh l hc Y khoa, theo mc tiu ca ngnh Y t v ph hp vi s gi qui nh.

Cun Sinh l hc Y khoa cha ng nhng kin thc c bn v cp nht v mn Sinhl hc i vi sinh vin y khoa. Ngoi ra, cc bc s sau v trn i hc cng c th tm thynhng kin thc b ch.

V ni dung nhiu, nn chng ti xut bn sch lm hai tp, tp I v tp II. Trong tp Ic 7 chng, mi chng li c mt s bi, chng ti c trnh by mc tiu mn hc, mctiu chng, v mc tiu ca tng bi. Cui mi bi c cc cu hi trc nghim, ngi ct nh gi kin thc ca mnh.

Mc d c nhiu c gng, nhng cun sch chc cng khng trnh khi nhngthiu st, chng ti mong nhn c s ng gp kin, nhn xt ca cc c gi.

Thng 2 nm 2009

Ch nhim

B mn Sinh L Hc - Sinh L Bnh - Min Dch Hc

GS.TS. BS. Phm nh Lu

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HNG DN S DNG SCH

Trong cun sch ny c 7 chng, mi chng c mt s bi, chng ti c trnh bymc tiu ca c chng v mc tiu ca tng bi. Cui mi bi c 10 cu hi trc nghim sinh vin t nh gi kin thc ca mnh. Cui sch c hng dn gi vic tr li cc cuhi trc nghim: xem trang no.

Do cch hc ca sinh vin l c k cc mc tiu chng v mc tiu ca tng bi, nm vng cc phn trng tm ca chng trnh, c k cc phn trong sch gio khoa.Sau khi hc xong hy tr li cc cu hi trc nghim kim tra kin thc, xem phn gi tr li cui sch.

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MC LC

MC TIU MN SINH L HC 7

CHNG I: I CNG V SINH L HC 8

Phm nh Lu

Bi m u 9

CHNG II: SINH L HC T BO 16

Phm nh Lu

i cng v t bo 17

1. Cu trc ca t bo 18

2. H thng chc nng ca t bo 283. S vn chuyn vt cht qua mng t bo 42

4. iu ha hat ng ca t bo 56

CHNG III: SINH L HC MU 65

Thi Hng Ha

i cng 66

5. Sinh l huyt tng 67

6. Sinh l hng cu 74

7. Sinh l bch cu 84

8. Sinh l tiu cu v qu trnh cm mu 101

9. Nhm mu 109

CHNG IV: SINH L TUN HAN 115

Phan Ngc Tin

i cng 11610. c im v gii phu m hc v hot ng in ca tim 117

11. Chc nng bm mu ca tim 131

12. iu ha hot dng tim 138

13. Sinh l h mch 144

14. iu ha hot ng mch 156

CHNG V: SINH L H HP 162

L Th Hng Tuyt

i cng 163

15. Thng kh phi 164

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16. S khuch tn oxy v carbonic qua mng ph nang mao mch 185

17. Chuyn ch kh oxy v carbonic trong mu 195

18. iu ha h hp 206

CHNG VI: SINH L TIU HA 213Trn Khim Hng

19. i cng v h tiu ha 214

20. S tng, trn thc n trong lng ng tiu ha 221

21. Chc nng tit ca ng tiu ha 230

22. Chc nng hp thu 244

23. Sinh l chc nng gan 251

CHNG VII: SINH L THN 259

Phm nh Lu

24. S lc tiu cu thn 260

25. S ti hp thu v bi tit ca ng thn 272

26. S ti hp thu v bi tit ng xa v ng gp Bi xut nc tiu 284

27. Chc nng iu ha ni mi ca thn 296

28. Chc nng ni tit ca thn Thm d chc nng thn 306

INDEX 320

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MC TIU MN SINH L HC

Sau khi hc xong chng trnh Sinh l hc, sinh vin Y phi c kh nng:

1. Trnh by y chc nng ca cc t bo, cc c quan v h thng c quan trong c thcon ngi bnh thng.

2. Gii thch c ch v s iu ha hot ng ca t bo, cc c quan v h c quan trong cth.

3. Phn tch c mi lin h cht ch v chc nng gia cc t bo, cc c quan v hthng cc c quan, coi c th l mt khi thng nht.

4. Nu ra c mi lin h gia c th v mi trng sng.

5. Lm c mt s xt nghim thng thng trong chn on lm sng, v lm c mts bi thc tp chng minh cho l thuyt.

6. Xc nh c tm quan trng ca Sinh l hc i vi nn y hc, cc ngnh khoa hckhc v i vi cuc sng:

- Nhn nh c Sinh l hc l mn hc c s cho mt s mn y hc c s khc vcc mn y hc lm sng.

- Vn dng Sinh l hc trong cc lnh vc khc nh: k hoch ha gia nh, sinh llao ng v th dc th thao, sinh l hc ng, sinh l hng hi, hng khng, giodc hc, tm l hc, trit hc vv

- p dng c kin thc Sinh l hc phc v nghin cu khoa hc v t oto.

- Bit cch gi gn sc khe cho c nhn v cho cng ng.

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MC TIU CHNG:

1. nh ngha c mc ch ca mn Sinh l hc, v nu c cc qui lut hot ng cac th ni chung v cc c quan, b my ni ring trong trng thi bnh thng.

2. Gii thch c ton b hot ng ca c th nh l mt khi thng nht v thng nhtvi mi trng sng.

3. Xc nh c vai tr v v tr ca mn Sinh l hc, l mn y hc c s rt quan trng ca

y hc v c s lin quan cht ch gia mn Sinh l hc vi cc mn khoa hc c bn, yhc c s v lm sng.

4. M t c lch s pht trin ca mn Sinh l hc qua ba thi k: thi k c xa, giaion khoa hc t nhin, v thi i sinh hc phn t.

5. Lit k c cc phng php nghin cu Sinh l hc, t quan st n thc nghim v kthp vi lm sng.

6. Trnh by c khi nim v c th sng v nhng c im ca s sng.

7. Phn tch c s iu ha chc nng ca c th ni chung v cc c quan, b my niring, v c s iu ha hai chiu, hay iu ha ngc.

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CHNG 1

I CNG V SINH L HC


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BI M U

1. NH NGHA VAI TR V V TR CA MN SINH L HC:1.1. nh ngha:

Sinh l hc l mn hc chuyn nghin cu v hot ng chc nng ca cc c quan,b my, v h thng c quan b my trong c th trong trng thi bnh thng, tm ra qui luthot ng chung ca c th, v ca ring tng c quan, b my, ng thi nghin cu s iuha hot ng chc nng ca cc c quan, b my.

Cc c quan b my trong c th u c s lin h cht ch vi nhau, v chu s iuhoa chung ca hai c ch: thn kinh v th dch, trong iu kin y, hot ng chc nng cami c quan b my u c tc ng n c quan b my khc, to nn mi lin h hai chiu,ngy nay c gi theo mt thut ng l c ch iu ha ngc (feed back mechanisms).

Sinh l hc coi ton b hot ng ca c th nh l mt khi thng nht v thng nhtvi mi trng sng, trn c s lm cho c th tn ti v pht trin, nu s thng nht y

b ph v, c th s lm vo trng thi bnh l.

1.2. Vai tr v v tr ca mn sinh l hc:- Sinh l hc l mt mn c s rt quan trng ca y hc, trong qu trnh phng bnh,

chn on v iu tr, ngi thy thuc phi nm vng nhng qui lut hot ng v c chhot ng ca c th ni chung, v cc c quan b my ni ring trong trng thi bnhthng, t mi xc nh c nhng ri lon hot ng chc nng ca c th trong trngthi bnh l. Do mc d sinh l hc c hnh thnh t nhiu th k, nhng n l mtngnh khoa hc vn ang pht trin, v lun gp phn gii p nhng vn m y hc t ra.

Ngc li, y hc li cung cp nhng ti liu thc t gp trong lm sng, to iu kin cho sinhl hc pht trin.

- Sinh l hc gp phn nghin cu v s pht trin dn s, hng dn sinh c khoch. K hoch ha gia nh l mt cng vic c tm quan trng c bit, v l quc sch

ca nc ta hin nay.- Sinh l hc l c s khoa hc cho vic chm sc sc khe nhn dn theo ng li

chm sc sc khe ban u ca ngnh y t.- Sinh l hc l mt ngnh ca sinh vt hc, n da trn kin thc ca cc ngnh khoa

hc c bn khc nh: ton, l, ha. Hu ht nhng vn m sinh l hc nghin cu l nhngvn c lin quan n l sinh, ha sinh, ha m hc, sinh vt hc phn t vv Trong btk mt qu trnh sng no u c lin quan n s chuyn ha vt cht v nng lng, nghal c lin quan n nhng qu trnh l ha.

- Sinh l hc c lin quan mt thit vi mt s cc mn c s khc nh m - phi hc vgii phu hc, v l cc mn hc hnh thi, v hot ng chc nng ca cc c quan bmy quyt nh hnh thi cu trc ca chng.

- Sinh l hc l khoa hc c s cho mt s mn hc khc trong y hc nh: Sinh l bnhhc, Dc l hc, Bnh hc lm sng v iu tr hc.

- Sinh l hc l c s cho cc ngnh khoa hc khc nh: y hc lao ng v th dc ththao, Sinh l hc ng, Sinh l hng hi hng khng, gio dc hc, tm l hc, trit hcvv

2. LCH S PHT TRIN MN SINH L HC:2.1. Thi c xa:

- Khi khoa hc t nhin cha pht trin, t thi k C Trung Hoa ngi ta vn dngthuyt m dng v 5 yu t ng hnh (kim, mc, thy, ha, th) gii thch cc hot

ng sinh l ca c th ngi v ng vt, cng nh s sng ni chung.

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Theo thuyt ny th sc khe ca ngi v ng vt ph thuc vo tnh trng cn bnggia hai lc m v dng v ng hnh y. Trong cc tng ph, th phi thuc kim, gan thucmc, thn thuc thy, tim thuc ha v lch thuc th.

- Thi k C Ai Cp v n : ra thuyt vt linh lun gii thch mi hot ngchc nng ca c th bng linh hn. C th hot ng c l nh c linh hn, linh hn cnhot ng th c th cn sng. Trt linh hn la 2 cht, tc l hn la khi xc.

- Trc cng nguyn 5 th k, mt thy thuc ngi Hy Lp l Hippocrate, c xem lng t ngh y, c xng Thuyt hot kh, thuyt ny cho rng hot kh trong phichuyn sang mu ri lu thng khp c th, lm c th hot ng. Tt th l cht.

- Galien th k th II chia hot kh thnh 3 phn: Linh kh trong no iu khin tm linh, k c Vt kh trong gan, mt chi phi dinh dng, mu Hot kh trong tim, mch chi phi s gan d, phn n

2.2. Giai on khoa hc t nhin:T th k XVI n XIX, kinh t cc nc Ty u pht trin, ch t bn ra i,

khoa hc t nhin c nhng tin b quan trng, to iu kin cho sinh l hc pht trin.- Michel Servet, mt ngi thy thuc Ty Ban Nha (1511-1553) tm thy tun hon

phi trn ngi trong khi m t thi, v b pht thiu trn dn ha.- Andr Vsale, mt thy thuc ngi B (1514-1564), tin hnh gii phu c th ngi,

thy r cu trc ca c th.- William Harvey, mt thy thuc ngi Anh (1578-1657) m t thi quan st thy ton

b tun hon mu trong c th. ng vit mt cun sch v tun hon, b pht phi t i.- Ren Descartes, mt nh ton hc v trit gia Php (1596-1650), nghin cu phn x,

cho rng phn x l mt hot ng ca linh kh, v a ra quan nim c hc ca s sng.- Marcello Malpighi, mt thy thuc ngi (1628-1694), dng knh hin vi soi thy

tun hon mao mch phi.- Boe de Sylvius (1614-1672) cho rng h hp v tiu ha l nhng hot ng men.- Antoine Laurent de Lavoisier, mt nh ha hc ngi Php (1743-1794) chng minh

rng h hp l mt qu trnh thiu t c tiu th oxy ( con chim v ngn nn trong chung,khi nn tt th chim cht).

- Luigi Galvani, thy thuc ngi (1737-1798) pht hin in sinh vt.- Franois Magendie, thy thuc ngi Php (1783-1855) pht hin xung thn kinh.- Flourens (1794-1864) ct i no chim b cu, con chim mt kh nng thch ng.- Th k XIX: Trong giai on ny khoa hc t nhin pht trin mnh, c 3 hc thuyt

tc ng ln ti s pht trin ca sinh l hc: nh lut bo tn nng lng: Lomonosov (1742-1786) Hc thuyt tin ha: Darwin (1809-1882) vit quyn ngun gc cc loi chn

lc t nhin (1859).

Hc thuyt t bo: Scheiden (1804-1881) tm ra t bo thc vt; Schwann(1810-1882) tm ra t bo ng vt, t bo thn kinh.- Dubois Reymond, ngi c (1818-1896); Karl Ludwig, ngi c (1816-1904);

Etienne Marey, ngi Php (1830-1904) sng ch nhiu dng c o c trong sinh l hc.- Bassov (1842), Heidenhein (1868) mo l r d dy thc nghim trng din trn ng

vt quan st chc nng tiu ha.- Claude Bernard (1813-1878), nh sinh l hc ln ngi Php, dng phu thut ngoi

khoa nghin cu thc nghim trn ng vt, v a ra quan nim hng nh ni mi, mCannon (1871-1945) gi l Homeostasis.

- Sherrington (1859-1947); Setchenov (1829-1905) c nhiu cng hin v sinh l hcthn kinh.

- Broca (1861) tm thy trung tm vn ng li ni v no.

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- u th k XX, nh sinh l hc ln ngi Nga Pavlov (1849-1936) nghin cu sinhl h thn kinh, lm nhiu th nghim trng din trn ch, chng minh hot ng thnkinh cao cp da trn phn x c iu kin, v a hot ng tm l vo lnh vc thcnghim. Pavlov chng minh rng c th hot ng nh l mt th thng nht v thng nhtvi mi trng sng.2.3. Thi i sinh hc phn t:

Trong giai on ny c nhng bc nhy vt v nghin cu sinh hc phn t, em limt cuc cch mng v kin thc v phng php nghin cu trong sinh l hc v y hc.- Watson, Cricks, Wilkins tm ra cu trc phn t ca nucleic acid, nhn c gii

Nobel 1962 v y hc v sinh l hc.- Jacob, Monod, Lwoff tm thy mRNA (RNA thng tin) ot gii Nobel nm 1965.- Nirenberg, Holley, Khorana tm thy m di truyn, v ot gii Nobel nm 1968.- Sutherland tm ra c ch tc dng ca hormone, v ot gii Nobel nm 1971.- Albert Claude, George Palade, Christian de Duve pht hin siu cu trc v chc nng

ca t bo, ot gii Nobel nm 1974.- Temin, Baltimore, Dulbecco, tm ra enzyme sao chp ngc (reverse transcriptase)

ot gii Nobel nm 1975.

- Khorana i su vo b n ca m di truyn v tng hp c gene nhn to (1977).- Arber, Nathans, Smith tm thy enzyme ct phn t DNA, ot gii Nobel nm 1978.- Dausset, Suell, Benaceraff tm ra khng nguyn HLA, ot gii Nobel nm 1980.- Jerue, Kohler, Milstein, tm ra nguyn tc v k thut to khng th n dng, ot

gii Nobel nm 1984.- Bishop, Varmus, tm ra cht sinh ung th oncogen, ot gii Nobel nm 1989.- Neher, Sakmann, pht hin knh ion, ot gii Nobel nm 1991.- Rodbell, Gilman tm ra protein G v vai tr ca cc protein ny trong s chuyn tn

hiu trong t bo; ot gii Nobel nm 1994.- Doherty v Zinkernagen pht hin tnh c hiu ca s bo v min dch trung gian t

bo, ot gii Nobel nm 1996.- Furchgott, Ignarro, Ferid Murad: nitric oxide nh l mt phn t tn hiu trong h tim

mch, ot gii Nobel nm 1998.- Carlsson, Greengard, Kandel: s chuyn tn hiu trong h thn kinh, ot gii Nobel

nm 2000.- Brenner, Robert Horvitz, Sulston: s iu ha gene ca s pht trin c quan v s

cht theo chng trnh ca t bo, ot gii Nobel nm 2002.- Lauterbur, Peter Mansfield: cng hng t, ot gii Nobel nm 2003.- Marshall, Robin Warren: Bacterium Helicobacter pylori, vai tr ca n trong bnh

vim lot d dy t trng, ot gii Nobel nm 2005.- Fire, Mello: s can thip ca RNA bt hot gene do RNA gy cn tr kp, ot gii

Nobel nm 2006. k nguyn sinh hc phn t, ngi ta i su nghin cu t bo mc phn t, lm sng t mi chc nng ca cc c quan trong c th, i su vo m di truyn, cu trc cagene, tng hp gene, tm ra nguyn nhn phn t ca mt s bnh bm sinh do sai m ditruyn. Nhng pht hin ca Pauling v Itano (1949) v s sai lc ca mt vi amino acidtrong cu trc ca huyt cu t, trong bnh hng cu hnh lim m u cho ngnh bnh l

phn t. Ngy nay ngi ta bit nhiu bnh thuc v bnh l phn t, do ri lon m ditruyn.

Lch s pht trin khoa hc sinh l hc cho ta thy khoa hc ny phi tri qua nhiugiai on t siu hnh, huyn b, ch quan n khoa hc t nhin v sinh hc phn t ngynay.

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Nn vn minh ni chung, nn cng nghip ni ring cng pht trin, h sinh thi cngbin i, loi ngi cng ng c trn hnh tinh, nhiu bnh tt mi pht sinh v ngy cnghonh hnh, y hc v sinh l hc phi ng ph vi nhiu vn mi, v d: AIDS, Ebola,Skaig. Hin nay ton th gii ang tp trung nghin cu phn t ca virus HIV, v h thngmin dch ca c th, tm ra cch gii quyt bnh ca th k l bnh AIDS.

Sinh l hc, mt khoa hc pht trin hng nghn nm nay, vn cn ang pht trin.

Hin nay c th ni, hng ngy, trn th gii u c nhng thng tin mi v sinh l hc, chonn ngi thy thuc cn cp nht nhng kin thc v sinh l hc v y hc.3. PHNG PHP NGHIN CU SINH L HC:

C nhiu phng php nghin cu sinh l hc3.1. Phng php quan st:

- Quan st bng cc gic quan: nhn ton trng; s nn cc c quan ni tng c nhgan, lch; g cc tng ph c v rng; nghe tim phi bng ng nghe; hi bit tnh trng.

- Quan st bng nhng my mc, dng c, phng tin, ha cht c bit nh: xtnghim mu, nc tiu, dch no ty, dch tit, phn vv3.2. Phng php thm d chc nng cc c quan, b my:

- Chc nng gan: th cc loi men gan

- Chc nng tun hon: o huyt p, in tim, siu m tim, chp mch- Chc nng thn: phng php Clearance, ng v phng x- Chc nng thn kinh: in no, chp ct lp- Chc nng h hp: o cc th tch v dung tch kh phi- Chc nng tiu ha: ni soi

3.3. Phng php thc nghim:p dng trn ng vt, to cc m hnh bng nhng th nghim cp din v trng

din, tng gim hot ng ca mt c quan, b my v theo di s p ng.3.4. Phng php ha min dch v ha m hc:

Dng cc k thut nh: cc th nghim min dch phng x (RIA), min dch men(ELISA) min dch hunh quang, vv Quan st i th bng phn tch, quan st vi th

bng knh hin vi quang hc, hay knh hin vi in t.3.5. Kt hp vi lm sng:

Vic kt hp vi lm sng l quan trng, v l ni din ra nhng hot ng chc nngca cc c quan v b my ca c th tnh trng khng bnh thng.

Nghin cu sinh l hc, chng ta lun phi tr li 3 cu hi:- Hin tng g xy ra- N din bin nh th no- Ti sao n xy ra v din bin nh vy, tc l tm ra c ch hot ng chc nng ca

cc c quan, b my.Quan st v phn tch hin tng phi da trn cc kin thc v khoa hc c bn v y

hc c s, khng c a ra cc gi thuyt ch quan.4. KHI NIM V C TH SNG V NHNG C IM CA S SNG:4.1. S sng l g?

Nm 1878 nh trit hc Eugels trong quyn sch chng During c nh ngha nhsau: S sng l mt phng thc tn ti ca cht Albumin, m cht ny lun thay i t lcc thnh phn ha hc cu to ra n.

Ngy nay ta gi Albumin l protein, hay cht m, bao gm cc nguyn t C, H, O, N,ngoi ra cn cc yu t vi lng nh: Fe, Zn, Mg, Ca, Na, K vv Eugels cn ni: uc s sng l c protein, ngc li u c protein cha phn gii l c s sng.

Cho n nay, ta mi ch bit c tri t l c s sng v ngi ta ang tm xem trongv tr c ni no khc c cht C, H, O, N khng nh c s sng nh chng ta khng.

4.2. Ngun gc s sng:

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Chng ta quan nim s sng xut hin do cc nguyn t C, H, O, N phn ng vinhau, di tc dng ca nhng yu t vt l trong bu kh quyn bao quanh a cu nh:

phng in, cc tia bc x mt tri, p sut kh quyn, nhit vv, to ra cht m.Nm 1953, hai nh khoa hc M l S.Miller v H.Urey cho phng mt dng in cc

mnh gia hai in cc t hai u mt ng thy tinh, trong c nhng cht kh m thnhphn ging nh kh quyn tri t. Sau khi phng in, trong ng xut hin mt s cht m.

Theo nh bc hc Oparine, th trong hng triu nm, cc nguyn t C, H, O, N trongkh quyn, di tc dng ca nhiu yu t vt l, kt hp li vi nhau thnh mt cht ths, m Oparine gi l Coacervat. Cht ny t chc li, thch nghi vi nhng iu kin ca mitrng chung quanh, dn dn tr thnh c th n bo, sau tin ln a bo. Trong qu trnhtin ha ny, cht sng to c cho mnh tnh cht chuyn ha, v t sinh sn theo mt

phng thc, m mi cho n nhng nm 60 ca th k XX, ngi ta mi bit c v gi lm di truyn.4.3. Nhng c im ca s sng:

Vt sng khc vi vt khng sng 4 c im sau y:4.3.1. Thay c, i mi:

Cn gi l chuyn ha, tc l lin tc thu nhp vt cht t bn ngoi vo qua b my

tiu ha, v bin i vt cht theo hai hng:- Bin vt cht thu nhp vo thnh ra cc thnh phn cu to ca c th, l qu trnh

ng ha.- Bin vt cht thu nhp vo thnh nng lng c th hot ng, l qu trnh d

ha.Hai qu trnh ny l hai mt i lp, nhng thng nht ca mt qu trnh chuyn ha,

chuyn ha ngng l c th cht. Qu trnh chuyn ha din ra trong t bo.4.3.2. Kh nng chu kch thch:

L kh nng p ng vi cc kch thch a dng ca mi trng bn ngoi v bntrong c th, nh cc kch thch vt l, ha hc, tm l x hi, nh sng lm co ng t, ncchanh lm chy nc bt, s hi lm tim p nhanh, mnh; hay cc kch thch thuc cc cch thn kinh v th dch trong c th 4.3.3. Kh nng sinh sn ging mnh:

L kh nng to ra c th mi ging mnh, hot ng sinh sn nm trong chngtrnh ca s sng, do m di truyn quyt nh nhm mc ch duy tr ni ging.4.3.4. Kh nng thch nghi:

L kh nng thay i mt phn cu trc, hay hot ng ca cc c quan, b my, thch nghi vi iu kin mi trng sng thay i, l c s c th tn ti v pht trin.4.4. Khi nim v iu ha chc nng:

C th sng l mt chnh th, m cc c quan, b my u c lin quan mt thit vinhau, nh hng qua li ln nhau, mi c quan trong c th hot ng theo mt qui lut ring

ca n, nhng ng thi phi tun theo mt qui lut hot ng chung ca ton c th.Trong mt mi trng sng lun lun thay i (ngoi mi), c th phi lun iuchnh hot ng ca cc c quan, b my v ton b c th, thch nghi vi mi trngsng, nhng ng thi phi bo m tnh hng nh ca mi trng bn trong c th (nimi), mt hin tng m Claude Bernard gi l Hng tnh ni mi nh: cc thnh phn cani mi, thn nhit, pH, p sut thm thu vv

C th hot ng thnh mt khi thng nht, v thng nht vi mi trng sng lnh vo s iu ha chc nng ca c th. C th iu ha chc nng bng hai phng thcl th dch v thn kinh. Hot ng ca hai h thng ny lun h tr ln nhau v b sung chonhau.

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iu ha bng th dch l do ni mi ph trch, bao gm mu, bch huyt, dch khe,dch no ty, dch cc c quan (dch mng tim, mng phi, mng bng, dch khp, nhn dch,nh dch vv). Trong ni mi, c nhng thnh phn quan trng gp phn iu ha cc cquan, b my nh: cc hormones, cc kh O 2 v CO2, cc cht in gii Na+, K+, Ca++, Mg++,vv

iu ha bng thn kinh l do h thn kinh trung ng v h thn kinh thc vt ph

trch, bao gm cc neurons v cc si trc thn kinh i n tng tn cc t bo. Cc neuronsthn kinh iu ha cc t bo thng qua mt s ha cht trung gian, gi l cc cht dn truynthn kinh (Neurotransmitters), cht dn truyn ph bin v in hnh l acetylcholine. Cn cct bo tip nhn cc cht dn truyn thn kinh bng cc th th (receptors).

Hot ng iu ha c tin hnh theo nguyn tc hai chiu, gi l c ch iu hangc, ngha l khi cc c quan, b my nhn cc tn hiu iu ha, n cng c nhng phnng ngc tr v cc c quan m pht tn hiu n n. l kh nng t iu chnh ca cth.5. KT LUN:

Sinh l hc l mt mn c s quan trng ca y hc. Nghin cu hot ng chc nngbnh thng ca c th, tm ra qui lut hot ng ca c th ni chung, v qui lut hot ng

ca tng c quan, b my ni ring l mt cng vic phc tp, i hi nhng kin thc tnghp ca cc ngnh khoa hc c bn, y hc c s v lm sng.

T nhiu th k nay, sinh l hc pht trin qua nhiu giai on, t giai on duy tm,thn b, n giai on thc nghim khoa hc, v cho n nay giai on sinh vt hc phn t,chng t sinh l hc c nhng bc tin di, v cn tip tc pht trin.

Mun nghin cu sinh l hc phi c phng php lun chnh xc, v c quan imduy vt bin chng. Lch s pht trin sinh l hc cng cho thy nhng quan nim duy tmthn b ch quan, bo th, my mc, tin vo nh mnh s km hm bc pht trin ca khoahc ni chung v sinh l hc ni ring.

Ngi thy thuc mun gii v chuyn mn phi cp nht nhng thng tin mi vsinh l hc v y hc, phi c phng php suy lun ng: tip nhn thng tin, chn lc x l,v s dng thng tin mt cch hiu qu nht.

tr thnh mt ngi thy thuc tt, phi trung thc vi ngi v vi mnh, philun lun hc tp, hc na v hc mi (Lenin), trau di kin thc phc v tt sc khenhn dn, lm vic theo lng tm ngh nghip, l y o v y c. Bc H dy chng tathy thuc nh m hin. Thy thuc dt nt, khng th nh m hin c, v khng ai cth trao tnh mng ca mnh cho mt thy thuc dt.

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MC TIU CHNG:

1. M t c cu trc ca t bo: cu trc ca mng t bo, cu trc ca bo tng v ccbo quan, cu trc ca nhn.

2. Trnh by c cc chc nng c bn ca t bo nh:Hot ng thng tin ca t bo.Tiu ha cht trong t bo.

S to nng lng t cc cht dinh dng.S tng hp v to thnh cc cu trc ca t bo.

3. Gii thch c cc hnh thc vn chuyn vt cht qua mng t bo: khuch tn th ngv vn chuyn tch cc.

4. Phn tch c cc h thng iu ha trong t bo.

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I CNG V T BO

C th con ngi c cu to t hng t t t bo, t bo l n v cu to v cng ln v chc nng ca c th. Nhng t bo chuyn chc kt li vi nhau thnh cc m, cc c

quan, h thng nh: h thng tun hon, h hp, tiu ha, tit niu, sinh dc, thn kinh, v.vV vy, mun hiu chc nng ca cc c quan trong c th, cn nm c chc nng ca tbo. Mi hot ng chc nng ca c th u c c s ti t bo, v cc ri lon chc nngcng c c s t bo.1. NHNG C TNH C BN CA T BO C TH NGI:

T bo c th ngi c kh nng bit ha v phn chia. i a s t bo u phnchia, sinh ra nhiu t bo con, kt li vi nhau thnh t chc hay m. Nhng c mt s t bo

pht trin theo mt th thc ring. Th d:- T lc phi cn trong bng m cho n tun l th tm, cc c quan sinh dc ca nam

v n ca phi u ging nhau. T tun l th tm tr i c qu trnh bit ha thnh nam hocn. C trng hp qu trnh bit ha ny khng xy ra, v tr sinh ra mang trong ngi hai

gii tnh.- T bo c vn khng phn chia, v ch tng trng theo chiu ngang v chiu dc.- T bo thn kinh cng khng phn chia, nhng mi khi b tn thng th pht trin

nhnh.- T bo tuyn gip thay i hnh th khi ngh v khi hot ng bi tit.- T bo bung trng ln lt bit ha trong mi chu k kinh nguyt, c mt trng

thnh thc c phng ra khi bung trng, ri vn chuyn theo ng dn trng vo tcung.

i b phn cc t bo c phn chia s pht trin ti ch thnh cc t chc c nh,nhng cng c mt s t bo sau khi thnh thc th c gii phng khi ni sn xut, nhcc t bo mu lu thng khp c th, ri cht, khng phn chia, v ty xng s tip tc sn

xut t bo mi.2. I CNG V CU TRC V CHC NNG CA T BO:

Trong qu trnh thch nghi vi mi trng sng, c th c nhiu c quan, b my khcnhau, lm nhng chc nng khc nhau. Do cc t bo trong c th rt a dng, c th chnh th rt khc nhau, nhng nhn chung mi t bo u c cu trc ging nhau: mi t boc mt mng bao quanh, gi l mng t bo, bao bc bo tng. Trong bo tng c nhiu

bo quan chuyn chc nh: chc nng sn xut cc sn phm ca t bo, chc nng tiu hacht, chc nng sn xut nng lng v.v

Trong bo tng c mt bo quan ln l nhn t bo, bao quanh nhn l mng nhn,bn trong l nhn tng, cha ng nhiu phn t ADN, l thnh phn c bn ca nhim scth, bo m chc nng di truyn, v nhiu phn t ARN, tp trung trong ht nhn.

Ngoi nhn t bo ra, trong bo tng cn c nhng bo quan khc nh hn nh: tyth to nng lng, lysosom chuyn chc tiu ha cht, v mt mng li ng ng, gi l

b Golgi, chuyn chc sn xut cc sn phm ca t bo.Tt c t bo cng nh cc bo quan u c mng bao bc, cu trc ca cc mng u

ging nhau.

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CU TRC CA T BO

MC TIU:1. M t c cu trc ca mng t bo.2. Trnh by c cc thnh phn ca bo tng v chc nng ca cc bo quan: li ni

bo v b Golgi, lysosom v ty th.3. Phn tch c cc thnh phn ca nhn: mng nhn, nhim sc th, ht nhn.

CU HI T LNG GI

1. Cu no sau y sai v c tnh c bn ca t bo:1. i a s t bo u phn chia sinh ra nhiu t bo con.2. T bo c vn khng phn chia, ch tng trng theo chiu ngang v chiu dc.3. T bo thn kinh mi khi b tn thng th phn chia v pht trin nhnh.

4. T bo tuyn gip c thay i hnh th khi nghi v khi bi tit.5. Hng cu lu hnh trong mu th khng sinh sn.

2. Cu no sau y sai v thnh phn cu trc ca mng t bo:A. Nc l thnh phn dch t bo, chim 70 85%B. C cc cht in gii nh K+, Na+, Ca++ C. Protein chim t 10 - 20% khi t bo.D. Cacbohydrat ng vai tr chnh v dinh dng t bo l chc nng cu trc.E. Lipit chim 2% ca khi t bo, quan trng nht l phospholipit v cholesterol.

3. Cu no sau y ng vi mng t bo:A. Gm hu ht l protein.B. mt s ion qua li c l nh cc knh ion.C. Khng thm i vi cc cht tan trong du m.D. Cho cc ion thm qua t do v khng cho protein i qua.E. Phn k nc ca phn t phospholipit hng ra mt ngoi ca mng t bo.

4. Cu no sau y sai v protein ca mng t bo:A. Protein ton b xuyn sut b dy ca mng v li ra ngoi mt on.B. Protein ton b cung cp cc knh cu trc, qua cc cht ha tan trong nc v cc

ion c th khuch tn qua mng.

C. Protein ngoi bin thng nm hu nh hon ton pha trong ca mng.D. Cc protein ngoi bin thng hot ng nh cc men hay nhng cht kim tra chcnng trong t bo.

E. Protein ton b c khi hot ng nh nhng protein mang, chng vn chuyn cc chttheo chiu khuch tn t nhin.

5. Cu no sau y sai v cacbohydrat mng:A. Cacbohydrat thng kt hp vi protein, gi l glycoprotein.B. Khong mt phn mi lipit mng l glycolipit.C. Phn t cacbohydrat gn vi li protein nh c gi l proteoglycan.D. Glycocalyx gn cc t bo vi nhau to thnh m.

E. Glycocalyx tham gia vo cc phn ng men.6. Cc t bo sau y u l t bo prokariot, ngoi tr:A. Hng cu.

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B. Vi sinh vt n bo.C. Vi khun.D. T bo nm.E. Siu vi.

7. Cu no sau y khng ng i vi nhim sc th:A. Cng c trong ty lp th.

B. Bao gm cc phn t ADN v ARN.C. Phn t ADN kt hp vi histon v mt s protein khc lm thnh nhim sc th giitnh.

D. Cn c gi l cht nhim sc.E. C s lng nh nhau tt c cc t bo trong c th, tr trng v tinh trng

8. Ni no sau y l v tr sinh tng hp protein:A. Nhn.B. Ht nhn.C. Li ni bo trn.D. Li ni bo c ht.

E. B Golgi.

9. Cu no sau y ng v mng t bo:A. Bao gm tan b l cc phn t protein.B. Khng thm i vi cc cht ha tan trong lipid.C. Cho php thm qua O2 v CO2.D. Cho thm cc cht in gii mt cch t do, nhng khng thm protein.E. C thnh phn n nh trong sut i sng ca t bo.

10. Cu no ng v protein ca t bo:A. c tng hp mng ni bo tng trn.B. c tng hp b Golgi.C. N c ha tan trong bo tng.D. c tm thy trong nhng ti vn chuyn nh, sn phm ca li ni bo.E. Nguyn liu tng hp protein l cc phn t peptide v cc amino acid.

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1.

H THNG CHC NNG CA T BO

MC TIU:1. Trnh by c cc hot ng thng tin ca t bo, bao gm nhn tin t knh thn kinh v

nhn tin t h thng th dch Khng nguyn tng hp t chc HLA nhn dng cc tbo.

2. M t c s tiu ha ca t bo vi chc nng ca cc lysosom.3. Gii thch c s tng hp cc cht v to thnh cc cu trc ca t bo do li ni bo

v b Golgi m nhn.4. Phn tch c s to nng 1ng t cc cht dinh dng vi vai tr ca ty th.

CU HI T LNG GI

1. Cu no sau y ng vi cht truyn tin th hai?

A.L nhng cht tng tc vi cht truyn tin th nht bn trong t bo.B.L nhng cht gn vi cht truyn tin th nht trn mng t bo.C.Gy p ng trung gian bn trong t bo, khi c tc ng ca cc hormon hay cht

dn truyn thn kinh khc.D.L nhng hormon do t bo bi tit, v c s kch thch ca hormon khc.E.L phn t ATP trong bo tng.

2. Cu no sau y ng vi khng nguyn tng hp t chc?A.Cn c gi l HLA.B.Bn cht l lipoprotein.

C.Ch c trn mng t bo bch cu.D.c biu l bi gen nm trong nhnh ngn ca nhim sc th X.E.Mt s ln ngi c khng nguyn tng hp t chc ging nhau.

3. Cu no sau y ng vi bnh t min?A.Din ra khi lympho T v B b bin i tnh cht v tiu dit cc m ca c th mnh.B.C th xy ra khi i thc bo thay i tnh cht, t tn cng t bo ca c th mnh.C.L bnh i tho ng khng ty thuc insulin.D.Do mt s t bo ca mt c quan b bin i v HLA ca mnh, b coi l mt m l

v b h lympho min dch tn cng.

E.L trng hp c th t c kh nng min dch i vi khng nguyn l.

4. Cu no sau y khng ng vi lysosom?A.L mt h thng tiu ha trong t bo.B.N cha cc men thy phn c kh nng phn hy cc hp cht hu c v v cC.Mng lysosom ngn men thy phn khng cho n tip xc vi cc cht khc trong

thnh phn ca t bo.D.T bo tiu cc cht qua hai qu trnh m bo v thc bo.E.Lysosom cn cha cc men lysozym, n phn gii mng vi khun, lysoferrin n gn

st v cc kim loi khc.

5. Cc cu sau y u ng vi lysosom, NGOI TR:A.Tt c cc sn phm tiu ha ca lysosom u c t bo s dng.

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B.Lysosom c to thnh bi b Golgi.C.Lysosom tiu ha c cc cu trc ca t bo b ph hy, cc vi khun, v cc

tiu phn thc n c a vo t bo.D.Trong lysosom c khong 40 men axit hydrolaz.E.Khi no b vim nhim, cc men c gii phng, chng s tiu cc cht ca t bo.

6. Cc cu sau y u ng vi li ni bo, NGOI TR:A.C loi sinh tng hp protein.B.C loi sinh tng hp lipit.C.C rt t t bo bi tit.D.C loi c nhiu ht ribosom.E.Khong bn trong ca li ni bo c lin h vi khong gia hai mng nhn.

7. Cu no sau y khng ng i vi ht ribosom?A.L mt thnh phn ca li ni bo c ht.B.C vai tr quan trng trong sinh tng hp protein.

C.Thnh phn gm mt hn hp axt ribonucleic v protein.D.Cc phn t protein c tng hp trong cu trc ca ribosom.E.Ribosom a phn t protein c tng hp vo trong bo tng ca t bo.

8. Cc cu sau y u ng vi b Golgi, NGOI TR:A.B Golgi cng c th sn xut mt s sn phm nh li ni bo.B.Cu to tng t nh li ni bo.C.Nm v mt pha ca t bo, gn nhn.D.Pht trin mnh cc t bo tuyn.E.C vai tr ng gi cc ht bi tit.

9. Cu no sau y khng ng vi ty lp th:A.L ni din ra chu k Krebs.B.L ni tp trung cc enzym ca chui h hp.C.Trong cht khun ca ty lp th c nhiu acetyl coenzym A.D.L ni din ra qu trnh ng phn ym kh.E.L ni sn xut nng lng di dng ATP.

10. Cu no sau y sai v th th (receptor) ca t bo:A.Cc hormone c bn cht ha hc l protein c tip nhn bi th th trn mng t

bo.B.Cc hormone c bn cht cu to bng lipid c tip nhn bi th th trong bo

tng.C.C ch tc dng ca cc hormone bn cht lipid l lm tng tng hp protein ca t

bo ch.D.Bn cht ca hormone tuyn gip l amino acid, nhn tyrosine, nn tc dng thng

qua cht truyn tin th hai.E.Hormone c gn vi th th bng dy ni ha tr.

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S VN CHUYN VT CHT QUA MNG T BO

MC TIU:1. Trnh by c cc hnh thc khuch tn qua mng t bo v cc yu t nh hng n

qu trnh khuch tn.2. M t v phn tch c cc hnh thc vn chuyn tch cc nguyn pht v vn chuyn

tch cc th pht .3. Gii thch c s vn chuyn lin tip qua hai mng ca t bo

CU HI T LNG GA

1. Mng t bo c tnh thm rt cao i vi nc v l do no sau y?A. Nc ha tan trong lp lipit ca mngB. Nc c vn chuyn qua mng bng c ch khuch tn c h trC. Nc l mt phn t nh, n c khuch tn n thun qua cc knh protein ca

mng

D. Nc c vn chuyn tch cc qua mngE. Nc c th bin hnh d dng

2. S khuch tn n thun v khuch tn c h tr ging nhau im no sau y?A. Cn cht mangB. i ngc bc thang nng C. Mc khuch tn tng ln mt cch cn xng vi nng cht khuch tnD. Cn th th (receptor) c hiuE. Hot ng khng cn nng lng ATP

3. Khuch tn c h tr v vn chuyn tch cc ging nhau im no sau y?A. Cn nng lng do ATP cung cpB. Cn enzym xc tcC. Cn protein mang vi receptorD. i ngc bc thang nng E. C th vn chuyn c cc cht in gii

4. Cu no sau y ng vi tnh trng phn cc ca mng t bo?A. Ty thuc tnh thm ca mng i vi ion K+

B. Ty thuc tnh thm ca mng i vi ion Na+

C. Tng ln khi men ATPase trong mng b c ch

D. L do bm Na

+

- K

+

E. Thay i rt nhiu nu nng Cl- dch ngoi bo tng

5. Vn chuyn tch cc th pht khc vn chuyn tch cc nguyn pht im no sau y?A. C c ch bo haB. Cn protein mangC. Cn receptor c hiuD. Khng ph thuc vo bc thang nng E. Ph thuc vo th nng ca Na+

6. p sut thm thu c tc dng no sau y?A. Chuyn dung mi qua mng bn thm ti vng c p sut thy tnh thp

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B. Chuyn dung mi qua mng bn thm t vng c cht ha tan vi nng cao sangvng c cht ha tan vi nng thp hn.

C. Chuyn dung mi qua mng bn thm t vng c cht ha tan vi nng thp sangvng c cht ha tan vi nng cao hn.

D. Chuyn cht ha tan qua mng bn thm t vng c cht ha tan vi nng cao sangvng c nng thp hn.

E. Chuyn cht ha tan qua mng bn thm t vng c cht ha tan vi nng thpsang vng c nng cao hn

7. Cc yu t sau y nh hng ti mc khuch tn, NGOI TR:A. Tc dng v bc thang in tchB. Tc dng v bc thang nng lngC. Tc dng v bc thang p sutD. Tc dng v bc thang nng E. Tc dng v tnh thm ca mng

Cu hi t 8 10:

- Nu v th nht ln hn v th hai, tr li ch L;- Nu hai v bng nhau, tr li ch B;- Nu v th nht nh hn v th hai, tr li ch N.

8. Nng ca ion H+ trong lysosom (L/B/N) nng ca ion H+ trong bo tng ca tbo.

9. S gp phn ca nng glucoz huyt tng cho thm thu tan phn ca huyt tng(L/B/N) s gp phn ca nng Na+ huyt tng cho thm thu tan phn ca huyttng.

10. Th tch huyt tng tnh c khi cht mu dng o c chch vo di da (L/B/N)th tch huyt tng tnh c khi cht mudng o c chch vo tnh mch.

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IU HA HOT NG CA T BO

MC TIU:1. Trnh by c s iu ha hot ng ha sinh trung t bo, vi 2 c ch c bn l iu

ha gen v iu ha enzym.2. Phn tch c s iu ha sinh sn ca t bo vi s sao m ADN, pht trin t bo v

mt s lng v kch thc.3. Nu c s bit ha t bo.4. M t c s t bin ca t bo dn n ung th, vi s ri lon v gen iu ha s

pht trin v gin phn t bo.

CU HI T LNG GI

1. Cu no sau y ng v 3 operon:A. Operom gm 3 gen cu trc v 3 enzym tng ngB. Operon gm cc gen cu trc v b iu khin c ch

C. Operon gm cc gen cu trc v b iu khin hot hoD. Operom gm 3 gen cu trc v cc b iu khinE. Protein c ch gn vo b iu khin thc y s gn ca men ARN polymeraz

2. Cc cu sau y ng vi operon, NGOI TR:A. Cc sn phm c t bo to ra gy iu ho ngc m tnh i vi operonB. Cc sn phm ca t bo c th to ra mt protein c ch gn b vi b iu khin

c ch, hoc to ra mt protein gn protein hot ho vi b iu khin c ch, do c ch s to ra sn phm

C. Cht hot ho lm t cu ni cu protein c ch vi b iu khin, gy ra qu trnhsao chp to ARN

D. S sao m gen trong operon s to ra ARN tng hp protein ca t boE. Khi protein iu ho gn vo b iu khin gy thu ht men ARN polymeraz, lm

hot ho operon

3. Cc c ch kim tra s sao chp bng operon sau y u ng, NGOI TR:A. Khi ADN cun li quanh mt protein l histon, l n c th hot ng to ra ARNB. Operon c kim tra bng mt gen iu ho, gen vy to nn protein iu hoC. Nhiu operon khc nhau c th c kim tra ng thi bng cng mt protein u

hoD. S kim tra c th xy ra cc giai on khc nhau ca s tng hp protein t bo

E. ADN c ng gi trong nhng n v cu trc c bit gi l nhim sc th4. cu no sau y sai i vi s hot ho enzym:

A. Mt s cht ho hc c to thnh trong t bo c tc dng c ch h enzym chiu to ra n

B. Cc enzym b bt hot c th hot ng tr li, khi n c hot ho bi mt s chtho hc

C. AMP vng l cht hot ho enzym phophorylaz phc hi phn t ATPD. Purin v pyrimidin cn cho s tng hp ADN v ARN, khi purin c to thnh

chng s c ch enzym xc tc s to ra chnh nE. Khi pymidirin c to thnh do purin hot ho enzym, s c ch enzym cn cho s

to thnh purin5. Tt c cc cu sau y u ng vi s sinh sn t bo, NGOI TR:

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A. S sinh sn t bo bt u bng s sao chp tt c ADN trong nhim sc th, s saochp ny ging ht s sao chp ARN

B. C 2 dy ADN trong mi mt nhim sc th u c sao chpC. Ton b dy ADN u c sao chp t u ny n u kiaD. Cc enzym chnh cho s sao chp l ADN polymerazE. Men ADN lipaz xz tc s gn cc nucleotit lin tip t phn t ny ti phn t kia

6. Cu no sau y sai v vn ung th:A. Ung th l do s t bin hay s hot ho bt thng ca genB. Cc t bo b t bin gen c kh nng sng km hn so vi t bo bnh thngC. Cc t bo b t bin gen khng cn chu s iu ho ngc ngn cn s pht trin

qu mc naD. Cc t bo ung th lun b ph hu bi h min dch ca c thE. Trong m ung th, thng nhiu oncogen khc nhau phi c hot ho ng thi

7. Cc cu sau y du ng vi s iu ho pht trin v sinh sn ca t bo, NGOI TR:A. C mt s t bo pht trin v sinh sn sut i nh cc t bo to mu ca tu xngB. Mt s t bo nh nrn v c vn khng sinh sn sut i, k c thi k bo thai

C. Mt s t bo ti sinh rt mnh nh t bo ganD. T bo tuyn, t chc di da, biu m rut cng c kh nng ti sinh caoE. S pht trin ca t bo c iu ho bngcc yu t pht trin

8. Nhng yu t sau y c kh nng gy t bin gen, NGOI TR:A. Mt s ho cht c trong thuc lB. S bc x nh tia X, tia gamma, tia cc tmC. Nhng tc nhn kch thch vt lD. Cc yu t di truynE. Vai tr ca vi khun

9. Cu no sai v c im ca t bo ung th:A. T bo ung th thng pht trin qu mcB. Cc t bo ung th thng dnh vi nhau v tri theo dng mu, nn to ra hin tng

di cnC. T bo ung th to ra yu t sinh mchD. T chc ung th cnh tranh cht dinh dng vi cc t bo bnh thngE. T bo ung th c kh nng sng km hn t bo bnh thng.

10. Cu no sai v s bit ha t bo:A. Bit ha t bo l s chuyn mt s t bo c bit thnh cc cu trc khc nhau ca

c th.B. Khi t bo tng sinh trong bo thai, c s thay i v c tnh chc nng v vt l, to

nn s bit ha.C. Mt s t bo bnh thng cng mang cc thng tin di truyn cn thit to nn

mt c th han chnhD. Bit ha l kt qu ca s c ch chn lc mt s gen ny v hat ha mt s gen

khcE. B gen iu ha to ra mt protein iu ha c ch vnh vin mt nhm gen chn lc.

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MC TIU CHNG:

1. Nu nhng chc nng chnh ca mu.2. Trnh by thnh phn v c, hu c v vai tr ca chng trong huyt tng.3. M t cu trc v chc nng ca cc t bo mu: hng cu, cc loi bch cu, tiu cu.4. Gii thch c ch cm mu tc thi v cm mu duy tr.5. Phn tch c ch ca qu trnh ng mu ni sinh v ngoi sinh.

6. Ni v cc nhm mu h ABO v Rhesus. Nguyn tc ca truyn mu theo h ABO.7. Lm mt s xt nghim thng thng v mu: m hng cu, bch cu, tiu cu; nhcng thc bch cu; nh lng Hemoglobin; nh sc bn hng cu; nh nhm mu;nh thi gian mu chy, mu ng... ng dng nhng xt nghim c bn trn vo thc tlm sng.

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CHNG 3

SINH L HC MU


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I CNG

Hng cu Tiu cu Bch cuTrong c th chng ta lun din ra nhng phn ng chuyn ha, cho nn vic cung

cp cc cht dinh dng v thi cc sn phm chuyn ha l cn thit. m bo chc nngtrn, mu ng mt vai tr rt quan trng.

Mu l mt cht lng, lu thng trong h tun hon, bo m mi lin h gia cc c

quan, b phn trong c th.1. CHC NNG CHUNG CA MU:1.1. Chc nng h hp:

Vn chuyn O2 t phi n cc t bo v ngc li, vn chuyn CO2 t m n phi.1.2. Chc nng dinh dng:

Cc cht nh acid amin, glucose, acid bo, cc cht in gii, cc vitamin v ncc cung cp t ng tiu ha vo mu, v c vn chuyn n m, nhm tng hp cc chtv cung cp nng lng cn thit cho hot ng sng ca t bo.1.3. Chc nng o thi:

Mu ly cc sn phm chuyn ha ca t bo, CO 2 ion H+ v NH3 t cc m chuynn thn, phi bi tit ra ngoi.

1.4. Chc nng bo v:Th hin qua cc qu trnh thc bo, qu trnh min dch.

1.5. Chc nng iu nhit:Mu lm nhim v vn chuyn nhit gi cho nhit ca c th ch thay i trong

phm vi hp. Mu vn chuyn nhit nh cc c tnh nh: t nhit ca nc, kh nng dnnhit cao.2. TNH CHT CA MU:

Mu l mt dch qunh, vi khi lng khong 1/13 trng lng c th, mu titrong h thng ng mch, mu xm trong h thng tnh mch.

T trng mu ton phn: 1045-1055, t trng mu ca nam cao hn n.Mu gm hai thnh phn: huyt tng chim khong 54% khi lng mu, t trng

huyt tng khong 1030, cn 45% l huyt cu gm hng cu, bch cu, tiu cu, y chnhl ch s Hct (hematocrit), t trng huyt cu 1100. qunh ca mu so vi nc: 4,5/1, qunh huyt tng 1,7/1 so vi nc. qunh ca mu thay i ph thuc vo nng

protein huyt tng v Hct.Ch s Hct thay i theo gii tnh. Nam: 42 - 46% N: 38 - 42 %. pH mu lun n nh : 7,35-7,45 trung bnh l 7,39. pH mu lun hng nh, l

nh vo h thng m ca mu, thn v phi.

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SINH L HUYT TNG

MC TIU:1. Vit ng, v phn tch c ion huyt tng.2. Trnh by chc nng ca cc cht in gii huyt tng.3. K cc thnh phn protein, lipid v carbohydrate huyt tng.4. Ni v chc nng ca protien, lipid v carbohydrate huyt tng.5. Phn bit s bt thng do thay i nng huyt tng ca cc cht trong lm sng.

CU HI T LNG GI

1. Cu no sau y ng vi bn cht ca mu?A. Cht dch protein ha tanB. Hn hp cc dch thC. M lin kt c bit

D. Hn hp cc loi t bo muE. Hp cht v c v hu c

2. T trng ca mu ph thuc vo yu t no sau y?A. S lng hng cuB. S lng bch cuC. S lng tiu cuD. Nng protein v s lng huyt cuE. Nng natri v clo

3. nht ca mu ph thuc vo yu t no sau y?A. Nng protein v s lng huyt cuB. Nng protein v nng cc cht in giiC. Nng cc yu t gy ng mu v s lng tiu cuD. Nng phospholipid v lipoproteinE. Nng NaCl v globulin

4. p sut thm thu ca mu ph thuc vo yu t no sau y?A. Nng NaCl v protein ha tanB. Nng NaCl v calciC. Nng clo v calci

D. Nng albumin v lipoprotein.E. Nng glucose.

5. Protid huyt tng c nhng chc nng sau y, NGOI TR :A. To p sut keo ca muB. Vn chuyn lipid trong muC. Bo v c thD. Vn chuyn oxyE. ng mu

pH ca mu ph thuc ch yu vo ion no sau y?

A. Na+

B. Cl-

C. K+

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D. HPO4 --

E. HCO3- v H+

Hematocrit l t l phn trm gia hai i lng no sau y?A. Tng th tch huyt cu v th tch mu ton phn

B. Tng th tch hng cu v th tch huyt tngC. Tng th tch huyt cu v th tch huyt tngD. Tng th tch huyt cu v th tch huyt thanhE. Tng th tch hng cu v th tch bch cu cng vi tiu cu

p sut keo ca mu c to nn bi cht no sau y?A. GlobulinB. AlbuminC. NaClD. LipoproteinE. Phospholipid

Cc lipoprotein huyt tng bao gm nhng cht sau y, NGOI TR:A. Alpha - lipoprotein (High Density Lipoprotein HDL)B. Tin beta lipoprotein (Very Low Sensity Lipoprotein VDL)C. Lipoprotein (Intermediate Density Lipoprotein IDL)D. Beta lipoprotein (Low Density Lipoprotein LDL)E. Caroten.

Hemoglobin ngi trng thnh bnh thng thuc loi no sau y?A. Hb AB. Hb CC. Hb ED. Hb FE. Hb S

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SINH L HNG CU

MC TIU:1. M t hnh th v cu trc ca hng cu.2. Trnh by chc nng ca hng cu.3. Ni v cc c quan v cc yu t tham gia to hng cu.4. Phn tch s thoi ha ca hemoglobin v nhng sn phm phn hy ca chng.

CU HI T LNG GI

1. Hng cu c vai tr min dch v c cc kh nng sau y, NGOI TR:A. Gi ly cc phc hp khng nguyn khng th b th to thun li cho thc boB. Bm vo cc lymplo T, gip s "giao np" cc khng nguyn cho t bo nyC. C cc hot ng enzyme b mtD. Cc IgE thng bm trn mng hng cu, gy phn ng vi khng nguyn

E. Cc khng nguyn trn mng hng cu c trng cho cc nhm mu.

2. Hemoglobin c chc nng m v l do no sau y?A. Tng tnh acid ca huyt tngB. pH t thay iC. pH tng caoD. pH gimE. Tng tnh kim ca huyt tng

3. Vitamin B12 kt hp vi yu t ni ti s c bo v khi s ph hu ca cc men nino sau y?A. TyB. GanC. RutD. LchE. D dy

4. Sau khi B12 c hp thu t b my tiu ha n s c d tr ni no sau y?A. Cc m trong c thB. TuC. Ty xng

D. GanE. Lch

5. St l mt cht quan trng trong s thnh lp hemoglobin, n c hp thu ch yu nino sau y?A. T trngB. Hng trngC. Hi trngD. Manh trngE. i trng

6. Cc cht cn thit cho s to hng cu bao gm cc cht sau y, NGOI TR:

A. Vitamin B12B. Acid folicC. Cht st

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D. Cholin v Thymidin.E. Cht ng.

7. Khi d tr mu lu trn mt thng yu t no sau y trong mu s thay i?A. Thnh phn proteinB. pHC. p sut thm thu

D. p sut keoE. nht

8. Cc khng th anti -A v anti- B t nhin c bn cht ha hc no sau y?A. Ig G.B. Ig A.C. Ig M.D. Ig DE. Ig E

9. Hng cu ngi bnh thng ly mu ngoi vi c hnh da lm hai mt thch hp vi kh

nng vn chuyn cht kh v nhng l do sau y, NGOI TR:A. Bin dng d dng xuyn qua mao mch vo t chcB. Lm tng tc khuch tn khC. Lm tng din tch tip xcD. Lm tng phn ly HbO2E. Tng din tch tip xc ca hng cu trong c th l 3000m2

10. Tc lng mu thay i ph thuc vo cc cht cu to mng t bo hng cu m chyu l cht no sau y?

A. PhospholipidB. GlycoproteinC. GlycolipidD. Acid sialicE. Cholesterol

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1. SINH L BCH CU

MC TIU:1. Nu c s lng v t l phn trm trung bnh ca cc loi bch cu trong mu (cng

thc bch cu), v ngha ca s thay i s lng bch cu trong lm sng.2. Xc nh ngun gc v chc nng ca i thc bo (macrophages).

3. Phn tch vai tr ca bch cu lympho trong qu trnh min dch bm sinh v min dchmc phi.

4. Trnh by chc nng ca t bo lympho B v lympho T.5. M t ngun gc v s bit ha ca cc dng bch cu.

CU HI T LNG GI

1. Bch cu c nhng c tnh sau y, NGOI TR:A. Xuyn mch

B. Chuyn ng bng chn giC. To p sut keoD. Ha ng ngE. Thc bo

2. Neutrophil tng trong trng hp no sau y?A. Tim cc protein l vo c th.B. Tim norepinephrineC. C th b nhim k sinh trngD. B chn thng tm lE. Dng thuc ACTH

3. Trong trng hp vim, cc loi t bo sau y u tng NGOI TR:A. NeutrophilB. MonocyteC. i thc boD. M boE. Basophil

4. Basophil cha cc loi ha cht sau y, NGOI TR:A. HeparinB. Histamine

C. PlasminogenD. SerotoninE. Bradykinin

5. Trong trng hp vim mn tnh t bo no sau y s tng?A. NeutrophilB. EosinophilC. Basophil.D. MonocyteE. Tiu cu

6. Cp t bo no sau y c lin quan n tnh trng d ng?A. Neutrophil v eosinophilB. Neutrophil v basophil

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C. Eosinophil v basophilD. Basophil v monocyteE. Eosinophil v lympho T

7. Khi c th b nhim k sinh trng t bo no sau y s tng?

A. NeutrophilB. EosinophilC. BasophilD. MonocyteE. Lymphocyte

8. Plasminogen c gii phng t bch cu no sau y?A. NeutrophilB. EosinophilC. BasophilD. Monocyte

E. Lymphocyte

9. Cc khng th ca lympho B tn cng trc tip vt xm ln bng cc cch sau y,NGOI TR:A. Ngng ktB. Kt taC. Trung haD. Tiu iE. Gy vim

10. Cc yu t sau y c gii phng khi khng nguyn phn ng vi khng th gn trn tbo gy v t bo, NGOI TR:A. HistamineB. Yu t c ch di tn bch cuC. Cht phn v ca phn ng chmD. Yu t ho ng ngE. Yu t gy phn ng phn v.

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SINH L TIU CU V QU TRNH CM MU

MC TIU:1. M t hnh dng v ngun gc ca tiu cu.2. Trnh by qu trnh cm mu v cc yu t tham gia.3. Phn tch cc cht chng ng trong c th v trong ng nghim.

CU HI T LNG GI

1 Tiu cu s khng kt dnh vi lp collagen c nu thiu cht no sau y?A. Yu t WillebrandB. PhospholipidC. ADPD. SerotoninE. Thromboplastin

2 Tiu cu gi vai tr quan trng trong giai on cm mu tc thi do tiu cu tit ra chtno sau y?A. HistamineB. BradykininC. AdrenalinD. PhospholipidE. Thromboplastin

3 S co tht mch mu khi thnh mch b tn thng c tc dng g trong cc tc dng sauy?A. Tng gii phng cc yu t gy ng muB. Gim bt lng mu b mtC. c ch tc dng cc cht chng ng muD. Tng s kt dnh tiu cuE. Hot ha cc yu t gy ng mu

4 Khi thnh mch b tn thng c s co tht mch mu l do qu trnh no sau y?A. Phn x thn kinhB. S co tht c ti chC. Kch thch h ph giao cmD. A v B ng

E. B v C ng5 Phn x thn kinh gy co mch khi b tn thng bt ngun t ni no sau y?

A. Phn da pha trn mch mu b tn thngB. Cc mch mu tn thngC. Cc m ln cn vng mch mu tn thngD. A v B ngE. B v C ng

6 iu kin gy co mch tt l thnh mch phi:A. Dy dn

B. Vng chcC. n hi ttD. A v B ng

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E. B v C ng7 Cc cht gip cho mch mu co tht mnh hn l cht no sau y?

A. ADPB. SerotoninC. AdrenalinD. A v B ng

E. B v C ng

8 S gia tng tnh bm dnh ca tiu cu vo thnh mch tn thng ph thuc vo yu tno sau y?A. ADPB. ATPC. Vitamin KD. T trng ca muE. nht ca mu

9 Cu no sau y KHNG NG i vi qu trnh thnh lp nt chn tiu cu?

A. Thnh mch b tn thng l ra lp m lin kt c collagenB. Tiu cu bm dnh vo lp collagenC. Tiu cu pht ng qu trnh ng muD. Tiu cu gii phng ADPE. ADP lm tng tnh bm dnh ca cc tiu cu, to nn nt chn tiu cu

10 Cc nt xut huyt xut hin nhiu trn c th l do nguyn nhn no sau y?A. S lng tiu cu gimB. Cht lng tiu cu gimC. Phospholipid tiu cu gimD. A v B ngE. B v C ng

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NHM MU

MC TIU:1. Trnh by nhm mu h ABO v ng dng trong truyn mu.2. Gii thch v nhm mu Rh, v nhng tai bin ngi khi c nhm mu Rh-.

CU HI T LNG GA

1. Tiu cu s khng kt dnh vi lp collagen c nu thiu cht no sau y?1. Yu t Willebrand2. Phospholipid3. ADP4. Serotonin5. Thromboplastin

2. S co tht mch mu khi thnh mch b tn thng c tc dng g trong cc tc dng sau

y?A. Tng gii phng cc yu t gy ng muB. Gim bt lng mu b mtC. c ch tc dng cc cht chng ng muD. Tng s kt dnh tiu cuE. Hot ha cc yu t gy ng mu

3. Khi thnh mch b tn thng c s co tht mch mu l do qu trnh no sau y?A. Phn x thn kinhB. S co tht c ti chC. Kch thch h ph giao cmD. A v B ngE. B v C ng

4. Phn x thn kinh gy co mch khi b tn thng bt ngun t ni no sau y?A. Phn da pha trn mch mu b tn thngB. Cc mch mu tn thngC. Cc m ln cn vng mch mu tn thngD. A v B ngE. B v C ng

5. Thi gian chy mu (TS) ko di trong cc trng hp sau y, NGOI TR:A. S lng tiu cu gimB. Cht lng tiu cu gimC. Thnh mch km vng chcD. Thnh mch gim kh nng n hiE. Thiu cc yu t ng mu

6. iu kin gy co mch tt l thnh mch phi:A. Dy dnB. Vng chcC. n hi tt

D. A v B ngE. B v C ng

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7. Tiu cu gi vai tr quan trng trong giai on cm mu tc thi do tiu cu tit ra chtno sau y?A. HistamineB. BradykininC. AdrenalinD. Phospholipid

E. Thromboplastin

8. Cc cht gip cho mch mu co tht mnh hn l cht no sau y?A. ADPB. SerotoninC. AdrenalinD. A v B ngE. B v C ng

9. Cc nt xut huyt xut hin nhiu trn c th l do nguyn nhn no sau y?A. S lng tiu cu gim

B. Cht lng tiu cu gimC. Phospholipid tiu cu gimD. A v B ngE. B v C ng

10. Vitamin K cn thit cho qu trnh tng hp yu t ng mu no sau y?A. Tt c cc yu t gy ng muB. ProthrombinC. FibrinogenD. ThromboplastinE. Yu t Hageman

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MC TIU CHNG:

1. M t c im gii phu, m hc v tnh cht sinh l ca tim.2. Gii thch hot ng in ca tim, cch ghi in tm v cc sng ca mt in tm

bnh thng.3. Trnh by chc nng bm mu ca tim v cc giai on ca chu chuyn tim.4. Phn tch cc c ch iu ha hot ng tim.5. nh ngha c huyt p v cc yu t nh hng n huyt p.6. Ni v chc nng ca mao mch, mch bch huyt, v cc yu t gip mu v tim.7. Hy nu nhng c ch iu ha mch v trung tm vn mch.

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I CNG

H tun hon l h thng vn chuyn mu trong c th, h tun hon mang cc chtdinh dng hp thu t h tiu ho n cc c quan trong c th, v mang oxy t phi n ccm. ng thi mu cng mang cc cht thi n c quan bi tit nh thn phi

Tim phi gm nh phi, nhn mu t hai tnh mch: ch trn v ch di, v tht phi,bm mu vo ng mch phi, mao mch phi. Ti mao mch phi c s trao i oxy v CO2gia mu v kh ph nang, sau mu theo tnh mch phi ra khi phi v nh tri, ri xungtht tri. l vng tun hon nh hay tun hon phi.

Tim tri gm nh tri v tht tri, bm mu n tt c cc m. Mu t tht tri i rang mch ch, cc ng mch ln, nh v mao mch. Ti mao mch, c s trao i chtgia mao mch v m. Sau mu t mao mch v h tnh mch ri v tim phi. l vngtun hon ln hay tun hon h thng.

Mu chy qua tim mt chiu nht nh do s sp xp cc van tim.p sut mu cao ng mch ch, gim dn ng mch ln, gim nhiu khi qua

cc ng mch nh. S iu ha co c vng ca cc ng mch nh cho php iu chnh

lu lng mu qua m, v gip iu ha huyt p ng mch. p sut mu gim dn n khiv tim.Ngoi ra cn h thng mch bch huyt, chuyn ch dch bch huyt n ng ngc ri

vo h tnh mch.

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C IM V GII PHU M HC V HOTNG IN CA TIM

MC TIU:

1. M t c im gii phu v m hc ca tim2. Trnh by tnh cht sinh l ca c tim3. Gii thch c hot ng in ca tim4. Ni v cch mc in cc ghi in tim5. Phn tch mt in tm bnh thng

CU HI T LNG GI

1. Nt xoang bnh thng l nt to nhp cho ton tim v l do no sau y?A. nh

B. To cc xung thn kinhC. Nhp xung cao hn cc ni khcD. Chu s kim sot ca h thn kinh thc vtE. Gn nt nh tht

2. V tr dn nhp bnh thng trong tim ngi l ni no sau y?A. Nt nh thtB. Nt xoangC. B BachmanD. Si Purkinje

E. B His

3. S lan truyn in th ng trong tim nhanh nht ni no sau y?A. Nt xoangB. Nt nh thtC. B HisD. Si PurkinjeE. C tht

4. in tm T hiu qu nht trong vic khm ph cc bt thng no sau y?

A. V tr ca tim trong lng ngcB. Dn truyn nh - thtC. Nhp timD. Co tht timE. Lu lng mu mch vnh

5. Thi gian bnh thng ca sng P trn tm in l bao nhiu?A. 0,08 - 0,11 giyB. 0,05 - 0,08 giyC. 0,08 - 0,12 giy

D. 0,06 - 0,11 giyE. 0,05 - 0,10 giy

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6. Khong cch P-R bnh thng c thi gian l bao nhiu?A. 0,12 - 0,20 giyB. 0,08 - 0,10 giyC. 0,06 - 0,10 giyD. 0,08 - 0,12 giyE. 0,10 - 0,20 giy

7. Sng ti cc ca tm tht c biu din bng sng no sau y trn in tm ?A. Sng PB. Sng QC. Sng TD. Sng SE. Sng R

8. Cu no sau y ng vi khong cch P-R trn tm in ?A. Thay i vi v tr ca in ccB. Khng c ngha sinh lC. Thng di khong 0,25 giyD. Lin quan n thi gian dn truyn t nh sang thtE. Khng cu no nu trn l ng

9. Phc b QRS c nghaA. Thi gian kh cc thtB. Thi gian ti cc thtC. A v B ngD. Tt c u sai

10. Sng P trn in tm c nghaA. Thi gian kh cc nhB. Thi gian ti cc nhC. A v B ngD. Tt c u sai

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CHC NNG BM MU CA TIM

MC TIU:1. M t cu trc t bo c tim v phc hp kch tch co c2. Trnh by v chu chuyn tim3. Phn tch cung lng tim, ch s tim v cng ca tim

CU HI T LNG GI

1. Yu t no sau y l ch s chnh ca tin ti?A. Th tch muB. p sut tnh mch trung tmC. p sut nn mao mch phiD. Th tch tht tri cui tm trng

E. p sut tht tri cui tm trng

2. Yu t no sau y l ch s chnh ca hu ti?A. p sut tht tri cui tm trngB. p sut ng mch ch trong lc van ng mch ch mC. p sut nn mao mch phiD. Tng khng lc ngoi binE. p sut mu ng mch trung bnh

3. Van ng mch ch ng lc bt u pha no ca chu k tim?A. Co ng th tchB. Bm mu nhanhC. Gia tm trngD. Gin ng th tchE. Mu v tht nhanh

4. Ting tim th hai xy ra trong thi k no sau y?A. Co ng trngB. Co ng trng (co ng th tch)C. Gin ng trngD. Gin ng trng

E. Khng cu no nu trn l ng5. ng van nh - tht c khi u bi qu trnh no sau y?

A. Co nh B. Co thtC. Co c ctD. Gin thtE. p sut mu trong tm tht cao hn trong tm nh

6. Hin tng no sau y xy ra sau ting tim th nht v trc ting tim th hai?A. Giai on tim bm mu

B. Sng P ca ECGC. Gin ng trngD. Thu nh

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E. Tim ht mu v

7. Khi ngh ngi, ngi n ng kho mnh, tim bm bao nhiu lt trong mt pht?A. 0,9B. 2 n 3C. 5 n 6

D. 8 n 10E. 15 n 20

8. Lng mu do tim bm ra trong mt nhp c th gim bi nguyn nhn no sau y?A. Tng co tht thtB. Tng nhp timC. Tng p sut tnh mch trung ngD. Gim tng khng lc ngoi binE. Gim p sut mu

9. Giai on bm mu ra ng mch ca k tm thu, p sut trong tht tri

A. Ln hn p sut trong ng mch chB. Bng p sut trong ng mch chC. Gp i p sut trong ng mch chD. 120mmHgE. 100mmHg

10. Ch s tim ca ngi trng thnh bnh thng khongA. 1 n 2 ltB. 2 n 3 ltC. 3 n 4 ltD. 5 n 6 ltE. 7 n 8 lt

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IU HA HOT NG TIM

MC TIU:1. Trnh by c ch thn kinh iu ha hot ng tim2. Ni v vai tr ca cc phn x v c ch th dch iu ho hot ng tim3. Phn tch qui lut Starling: s iu ha ngay ti tim

CU HI T LNG GI

1. Kch thch dy X s lm tng hot ng no sau y?A. Nhp timB. Sc co tht c timC. Dn truyn trong timD. Bi tit acetylcholineE. Bi tit norepinephrine

2. Cu no sau y din t ng nh hng ca h hp ln nhp tim?A. Nhp tim gim khi ht vo v tng khi th raB. Nhp tim tng khi ht vo v gim khi th raC. Nhp tim tng khi ht vo v tng khi th raD. Nhp tim gim khi ht vo v gim khi th raE. Khng cu no nu trn l ng

3. Khi vn ng, ch s no sau y s tng?A. Lu lng timB. Huyt p tm trngC. n hi ca tnh mchD. Khng lc ng mch phiE. Tng khng lc ngoi bin

4. ngi bnh thng, lng mu do tim bm ra trong mt nhp s tng trong iu kin nosau y?A. Tng kch thch giao cm n timB. Tng kch thch ph giao cm n timC. Gim co thtD. Gim th tch cui tm trngE. Phn x p th quan

5. Nng epinephrine trong mu tng gy hu qu no sau y?A. Gim lng mu trong mt nht bpB. Gim nhp timC. Tng cung lng timD. Gim co tht c timE. Gim dn truyn trong tim

6. Lng mu tim bm ra trong mt nhp c th tng do:A. Gim n hi thtB. Tng n hi tnh mch

C. Gim khng lc ngoi binD. Tng nhp timE. Gim co bp nh

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7. nht mu ty thuc vo yu t no sau y?A. Dung tch lng ng hng cuB. S lng t bo muC. Hnh dng t bo muD. Lng protein trong huyt tngE. Tt c cc cu trn u ng

8. Cu no sau y KHNG phi l yu t xc nh lu lng mu?A. sai bit p sutB. ng knh mch muC. pH ca muD. Tng khng lc ngoi binE. Sc n hi thnh ng mch

9. Thyroxin tng trong mu lm tng nhp tim l do:A. Do tng hot ng h giao cm

B. Do c ch hot ng h ph giao cm

C. Do lm tng chuyn ho t boD. Tt c u sai

10. Huyt p tng v nhp tim gim khi p ng vi:A. Tp luynB. Nhit c th tngC. trn caoD. p lc ni s tngE. Xut huyt

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SINH L H MCH

MC TIU:1. Trnh by v huyt p ng mch: cc loi, cc yu t nh hng n huyt p ng

mch.2. Phn tch v mch p.3. Ni v h mao mch:cu trc, chc nng ca mao mch.4. M t v mch bch huyt v vai tr ca mch bch huyt.5. Gii thch v huyt p tnh mch v cc yu t gip mu v tim.

CU HI T LNG GI

1. Yu t no sau y s lm gim p sut y (hiu p) ng mch?A. Gim sc n ng mchB. Gim sc n tnh mchC. Gim th tch mu

D. Tng p sut tnh mch trung ngE. Tng co tht c tim

2. Tt c cc yu t sau y u lm tng huyt p ng mch, NGOI TR:A. Cung lng tim tngB. Khng lc ngoi bin tngC. Tng th tch mu tngD. Sc n hi thnh mch tngE. nht mu tng

3. S trao i cc cht dinh dng v kh gia mu v m xy ra ti ni no sau y?A. ng mch chB. ng mchC. Tiu ng mchD. Mao mchE. Tnh mch

4. Tng thit din mch ln nht ni no sau y?A. ng mch lnB. Tiu ng mchC. Mao mch

D. Tnh mch nhE. Tnh mch ln

5. Bnh thng lng mu c phn b nhiu nht ni no sau yA. ng mchB. TimC. Mao mchD. H thng tnh mchE. Gan

6. H thng mao mch cha khong bao nhiu lng mu ca h tun hon

A. 10%B. 15%C. 5%

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D. 20%E. 25%7. c tnh no sau y ca ng mch gip n nh huyt p khi c thay i th tch trongng mch:A. Co tht cB. Nhiu c trn

C. C tnh n hiD. Nhiu si n hiE. Nhiu u tn cng thn kinh

8. Cu no sau y ng vi hin tng t iu ha do c mch?A. Khi p sut truyn vo mch tng mch co li v ngc liB. Khi p sut truyn vo mch tng, mch gin ra v ngc liC. Khi p sut truyn thay i, khng c phn ng thnh mchD. p ng mch l thuc vo t bo ni b thnh mchE. Khng cu no nu trn l ng

9. Tc truyn ca mch cao nht :A. ng mch chB. ng mch lnC. Tiu ng mchD. Tt c u bng nhau

10. n v p sut tnh mch trung tm:A. mmHgB. mm ncC. cm ncD. cm HgE. Cc cu trn u sai.

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IU HA HOT NG MCH

MC TIU:1. Gii thch c ch iu ha ti ch ca mch2. Trnh by trung tm vn mch v nhng xung ng thn kinh v trung tm vn mch.3. Phn tch c ch thn kinh thc vt v th dch iu ha h mch.

CU HI T LNG GI

1. Vng thn kinh no sau y c tham gia vo phn x vn mch?A. V noB. Vng di iC. Hnh noD. Ty sngE. Tt c cc cu trn u ng

2. Phn x p th quan c tc dng no sau y?A. Nhp tim tng, huyt p tngB. Nhp tim chm, gy gin mchC. Nhp tim chm, gy co mchD. Nhp tim khng thay i, lm huyt p tngE. Nhp tim tng, gy co mch

3. Ap lc mch tng khi:A. Tng nhp timB. Th tch mt nht bp gimC. n hi ng mch ch tngD. Hp ng mch chE. Huyt p ng mch trung bnh tng

4. Gim p sut trong xoang cnh s lm gim yu t no sau y?A. Nhp timB. Co tht c timC. Huyt pD. Kch thch trung tm c ch timE. Xung ng giao cm ra ngoi bin

5. Khi cc p th quan b gim kch thch, tt c cc yu t sau y s tng, NGOI TR:A. Cung lng timB. Nhp timC. Tng khng lc ngoi binD. Hot ng thn kinh giao cmE. Hot ng thn kinh ph giao cm

6. Mao mch bch huyt khc mao mch h thng:A. t thm hnB. Khng c lp t bo ni mcC. Khng c valve

D. Khng c h thn kinh trung ngE. Xp khi p lc m k tng

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7. Tng yu no sau y s lm co tiu ng mch h thng:A. Nitric oxideB. Angiotensin IIC. Atrial natriuretic peptideD. Beta () antagonist

E. Ion Hydrogen

8. Tnh thm mao mch thp nht :A. ThnB. LchC. GanD. NoE. Da

9. S phn b mu vo cc c quan khc nhau trong c th c iu ho do s iu chnhkhng lc ca:

A. ng mchB. Tiu ng mchC. C tht tin mao mchD. Tnh mch sau mao mchE. Tnh mch

10. Khi xoa cng th th p sut xoang cnh, s gy tng:A. Tng khng lc ngoi binB. p sut nh phiC. Trng lc tnh mchD. Co c thtE. Hot ng thn kinh X

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MC TIU CHNG:

1. M t c im gii phu v cu trc m hc ca c quan h hp.2. Trnh by hot ng c hc ca thng kh phi.3. Phn tch s khuch tn kh qua mng ph nang - mao mch.4. Gii thch s vn chuyn kh trong h hp.5. Hy din gii cc yu t iu ha h hp.

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I CNG

1. TM QUAN TRNG CA H HP:Mi t bo ca c th ng vt u cn xy t mi trng ngoi, nhm chuyn ha

cc cht carbohydrate, lipid, protein thnh nng lng v cu trc c th duy tr s sng.Sn phm sau d ha khng ch c nng lng, m cn c C02 v H20.Kh carbonic trong t bo gp nc s to ra acid carbonic (H 2C03). H2C03 l mt acid

yu d phn ly thnh H+ v HC03-, H+ s thi qua thn, cn C02, mt phn thi qua b my hhp, cn mt phn s thi qua thn.

Nc d ca c th s o thi qua thn vo nc tiu.Hot ng cung cp xy v thi kh carbonic ca c th l hot ng trao i kh do

b my h hp m nhim.2. NH NGHA CHC NNG CA H HP:

H hp l hot ngtrao ikh,gmcung cp 02 cn thit cho t bo, o thi khC02 ra ngoi c th duytrs n nhpHni mi.3. QU TRNH TRAO I KH:

Qu trnh trao i kh gia t bo ca c th vi mi trng ngoi thay i theo stin ha ca c th ng vt. i vi ng vt n bo, s trao i kh n gin ch qua mngt bo. ng vt a bo, s trao i kh thc hin phc tp, qua nhiu khu vc trung gian trckhi n t bo, ch yu l qua b my h hp v b my tun hon.

Qu trnh h hp gm cc hot ng chc nng sau: Thng kh ca phi Khuych tn kh qua mng ph nang - mao mch phi Vn chuyn kh ca mu t mao mch phi n mao mch quanh m. Trao i kh qua mng t bo S dng xy trong t bo.

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THNG KH PHI

MC TIU:1. M t gii phu sinh l v cu trc m hc ca c quan h hp.2. Gii thch vai tr ca lng ngc v cc c h hp trong s co gin phi.3. Phn tch tc dng ca cc p sut kh gip kh di chuyn ra, vo phi.4. Trnh by s n hi ca phi v mi quan h n hi ca phi vi lng ngc.5. Nu cc nghim php nh gi kh nng thng kh phi v ph nang.6. Xc nh chc nng ca ng dn kh.

CU HI T LNG GI

1. Cu trc m hc ng dn kh c tc dng:A. Thng kh

B. iu ha lu lng khC. Bo vD. Trao i khE. Khuch tn kh

2. Cu trc cy ph qun t h nhnh th 1 n 17 c tc dngA. Dn khB. Trao i khC. Gy s khng tr kh lu thngD. Bo vE. Khuch tn kh

3. Thng kh ph nang khi ht vo bnh thng l:A. Kiu mB. Kiu dngC. Ap sut kh ngoi ph nang thp hn trong ph nangD. Ap sut kh ngoi ph nang ln hn trong ph nangE. Lng ngc co y kh vo ph nang

4. Th tch lng ngc thay i:A. Theo chiu trn di

B. Theo chiu ngangC. Theo chiu trc sauD. Gip th tch phi thay iE. Do c h hp co gin

5. S th l:A. Hot ng ht voB. Hot ng th raC. Gip thng kh phiD. Mc th ph thuc kh nng n hi ca lng ngcE. Mc th ph thuc kh nng n hi ca ph nang

6. Vai tr c honh th hin trong hot ng h hp bnh thng l:A. khi ht vo c honh co

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B. Khi th ra c honh ginC. S co gin c honh lm th tch phi thay i 70%D. Th ra nh c honh nng lnE. Th ra nh c honh h xung

7. Chc nng mng phi:A. Lin kt phi vi thnh ngcB. Tham gia hot ng thng kh ca phiC. Hnh thnh khoang mng phiD. Mng phi co lm gim th tch phiE. Mng phi gin lm tng th tch phi

8. S thng kh ph nang ph thuc:A. S n hi ca thnh ngcB. Vai tr cc si n hi trong m k quanh ph nangC. Vai tr dch lt thnh b mt trong ph nangD. S co gin ph nang

E. Vai tr ca p sut n9. nh gi kh nng thng kh phi da vo:

A. Th tch kh lu thngB. Th tch kh d tr ht voC. Th tch kh d tr th raD. Th tch kh cnE. Dung tch sng

10. Kho st hi chng bnh l ca phi l:A. o th tch th ra nhanh mnh ti a trong 1 giyB. o dung tch sngC. Tnh t s TiffneauxD. o th tch cnE. o th tch ton phi

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S KHUCH TN XY V CARBONIC QUA MNGTRAO I PH NANG MAO MCH

MC TIU:

1. Trnh by s khuch tn ca kh qua mng trao i v qua dch gian bo, m v cc ccyu t nh hng.2. Phn tch s trao i kh v kt qu trao i kh ca phi.

CU HI T LNG GI

1. Cc yu t nh hng s khuch tn:A. Din khuch tnB. H s ha tanC. Hiu s phn p kh ti mng trao i

D. B dy mng trao iE. Kch thc phn t kh

2. Cu trc mng trao i c:A. 3 lpB. 4 lpC. 5 lpD. 6 lpE. 7 lp

3. Thc t b dy mng trao i gim c:

A. 1 lpB. 2 lpC. 3 lpD. Lp huyt tng gia hng cu v thnh mao mchE. Lp dch m k

4. c im kh th trong ng dn kh so vi kh quyn:A. Ging nhauB. Khc nhauC. Trong ng dn kh kh th c trn vi phn t ncD. Ap sut kh th ca ng dn kh l 713 mmHg

E. Phn p xy thay i theo phn p kh th

5. c im kh ph nang sau mi ln h hp KHNG NG l:A. c thay i ton bB. Ch thay i mt phn nhC. S lng kh c thay i trong ton b kh ph nang l 1/7D. S lng kh ton ph nang c thay i l 350mlE. S lng kh ton ph nang c thay i l 500ml

6. Tc dng s thay i kh ph nang t t sau mi ln h hp l:A. Hn ch s thay i sinh l t bo t ngtB. m bo hiu qu s lng kh c khuch tnC. Theo nhu cu cung cp xy cho mD. Trnh s C02 trong mu

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E. Duy tr s n nh ca ni m

7. Hiu qu s trao i kh tt ph thuc:A. C s xng hp thng kh ph nang tt v tun hon mao mch phi lu thngB. Ch cn phi thng kh tt

C. Ch cn tun hon mao mch lu thng ttD. T s V/Q = 0.8E. Tn s h hp

8. Khi c s bt xng gia thng kh ph nang v tun hon mao mch ph nang:A. Ni thng kh tt, tun hon km, tiu ph qun co liB. Ni tun hon mao mch tt,thng kh km, mao mch co liC. Trung tm h hp t iu chnhD. C hin tng tng shun sinh lE. C hin tng tng khong cht sinh l

9. Kt qu trao i kh phi mu ng mch c c im l:A. Cn 5% kh CarbonicB. Ch ton c kh xyC. Phn p xy ti a l 95 mmHg 97 mmHgD. Hiu qu s trao i kh din ra khong 0.25 giyE. S trao i kh xy ra trn ton b b mt din tch mng trao i

10. Kt qu trao i kh xy ca phi sau 16 ln h hp l:A. 250 mlB. 350 mlC. 400 mlD. 150mlE. 200ml

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CHUYN CH KH XY V CARBONIC TRONGMU

MC TIU:

1. Trnh by vai tr vn chuyn kh xy ca hmoglobin v giao xy cho m.2. M t ng cong gn nh xy ca hmoglobin. Nu ngha.3. Gii thch s vn chuyn kh carbonic t m n phi. Cho bit s n nh pH ca t bo

v mu.4. Phn tch cc yu t nh hng t l hmoglobin bo ha xy v nng kh carbonic

trong mu.

CU HI T LNG GI

1. Cc yu t nh hng lng xy ha tan:

A. H s ha tan ca xy trong dchB. Phn p xy trong muC. Lng hmoglobin trong muD. Trng lng phn tE. Nhit c th

2. c im xy dng ha tan trong mu:A. C s lng trong mu l 3%B. Khuch tn qua mng t bo d dngC. Nng cao trong mu d gy ng c xy mD. H s ha tan trong dch m ca 02 thp hn C02

E. Chn A,B, C

3. Oxy dng kt hp:A. C s lng l 97% nng xy mu ng mchB. Cht kt hp l hmoglobinC. S kt hp 02 vi Hb l lc gn kt gia cc phn tD. Cht khng khuch tn c qua mng t boE. Trong 100ml mu c 15 gam Hb cung cp c 20ml xy

4. S gn nh xy ca hmoglobin c m t bng:A. ng thng

B. ng cong parabonC. ng cong sigmoidD. Khng theo qui lutE. A, B,C,D sai

5. c im ng cong Backroft la:A. Vng phn p xy thp < 40mmHg ng cong dc ngB. Vng phn p xy cao > 40mmHg, ng cong i ln t tC. Phn p xy trn 100mmHg, ng cong nm ngangD. M t kh nng gn nh 02 ca HbE. M t mi quan h gia t l Hb02 vi s thay i Pa02 mu

6. ngha ng cong Backroft l:A. ng cong dc ng l ni Hb gn nh xy d dng khi Pa02 thay i nh

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B. ng cong dc t t l ni Hb gn nh xy kh khn d Pa02 thay i lnC. Hb nh xy d dng ni phn p 02 thp, m bo cung cp xy mD. Hb d gn 02 ni phn p 02 cao l m bo s n nh lng xy d tr trong muE. Nh c Hb, vic cung cp 02 cho m nhanh gp 100 ln

7. Cc yu t nh hng t l Hb-02, lm ng cong lch phi:

A. Thn nhit tngB. Nng C02 mu gimC. S vn ng c bp tngD. pH mu tngE. Dung tch hng cu tng

8. Kh C02 vn chuyn n phi cc dng:A. Kt hp vi HbB. Kt hp vi H20 to ra acid carbonicC. C02 t doD. C02 - protein

E. Chn A,B,C,D

9. ngha hiu qu Haldan l C02 t do c to ra t:A. HbC02 trong hng cuB. H2C03 muC. HbC02 ch chim 4% lng C02 c trong muD. Ch yu H2C03E. Ngun khc

10. Nng C02 mu nh hng:A. Nng Hb chuyn ch kh xyB. giao xy mC. thi C02 qua phiD. pH muE. nng H2C03 mu

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IU HA H HP

MC TIU:1. Trnh by hot ng ca cc trung tm h hp.2. M t vai tr ca cc vng cm ng ha hc i vi iu ha h hp.3. Phn tch tc dng cc yu t ha hc i vi iu ha h hp.4. Hy ni v cc yu t khng ha hc iu ha h hp.

CU HI T LNG GI

1. Trung tm iu khin ht vo nm phn trn cu no:A. ngB. sai

2. Trung tm h hp phn trn cu no tc dng c ch s ht vo:A. ngB. sai

3. Tc dng trung tm ngng th l gy ht vo di:A. ngB. sai

4. C02 kch thch trc tip t bo cm ng ha hc trung ng:A. ngB. sai

5. Yu t gy kch thch t bo cm ng ha hc ngoi vi:A. PC02B. Nng ion H+

C. P02D. auE. Nhit

6. Phn p kh carbonic tng cao trn. . . . . . mmHg gy c ch trung tm h hp

7. Tc dng ca trung tm nhn cm ha hc l. . . . . . . . .trung tm ht vo8. Phn x Hering Breuer:

A. Xut hin khi h hp bnh thngB. Lin quan n thn kinh thc vtC. Tc dng bo v ng h hpD. Tham gia iu ha thng kh phiE. Th th cm ng vng ngoi bin

9. Kch thch thn kinh X gy gim h hp:A. ng

B. sai

10. Thn nhit tng gy gim h hp:

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A. ngB. sai

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MC TIU CHNG:

1. Phn tch c hot ng c hc ca ng tiu ha.

2. Trnh by hot ng bi tit dch ca tuyn nc bt, d dy, rut non, tuyn ty v

gan.

3. Gii thch hot ng hp thu cc cht dinh dng, nc v mui khong rut non.

4. M t hot ng tiu ha v o thi cht cn b rut gi.

5. Nu c chc nng ca Gan bao gm chc nng tun hon, tit mt, chuyn ha, chng

c, chc nng d tr .

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SINH L TIU HA


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I CNG V H TIU HA

MC TIU:

1. M t c gii phu sinh l ca thnh ng tiu ha.2. Gii thch cc dng sng ca c trn.3. Trnh by h thn kinh ni ti v thn kinh thc vt ca h tiu ha.4. Nu c cc hormone kim sot qu trnh vn ng ca c trn.5. Phn tch tun hon mu ca h tiu ha.

1. VN NG:1.1. Gii phu sinh l ca thnh ng tiu ha:

Hnh 19.1. Hnh ct ngang rut

Hnh trn cho thy cc lp ca thnh ng tiu ha t ngoi vo trong. Chc nng vnng do cc lp c trn m nhim. Chc nng ca c trn ng tiu ha tng t nh hp

bo. Tc l cc si c trn c ng knh 2-10 m, chiu di 200-500 m v chng sp xpthnh b c khong 1000 si nm song song vi nhau. Trong cc b c cc si lin h vi

nhau thng qua cc khp ni (gap junction) cho php cc ion di chuyn vi tr khng thp tsi c ny sang si c ln cn. V th tn hiu c truyn rt nhanh, v phng din chcnng coi nh l hp bo.1.2. C ch in sinh l:

Gm 2 loi : sng chm v sng nhn.- Sng chm c ngun gc t cc t bo to nhp (pacemarker) gi l t bo k Cajal

nm trong lp c trn, to thng mng li c qu trnh kh cc, ti cc t ng theo chu kto thnh sng chm. Sng chm ny lan dc theo cc si c dc v i xung lp c vng bndi. Tuy nhin sng chm ny khng to nn in th hot ng v cng khng c s co ctrn v in th ca n di mc in th ngng.

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Hnh 19.2. in th mng ca c trn ng tiu ha

- Sng nhn: xy ra khi c cc kch thch t cc cht dn truyn thn kinh(acetylcholine), hormone trn nn kh cc ca sng chm s lm tng in th ca n vtqua mc ngng, cho php ion calcium qua cc knh i vo trong t bo. Kt qu hnh thnhs co c. S co c mnh hay yu ty thuc vo s lng cc gai hnh thnh trn nh sng

chm, trong khi tn s ca sng chm th khng i.- Tn s sng chm thay i ty theo phn no ca ng tiu ha: D dy, rut gi : 3 - 8 l/pht. Rut non : 10 - 20 l/pht.

2. H THNG THN KINH NI TI:Nm hon ton trong thnh rut, bt u t thc qun v kt thc hu mn. S lng

t bo thn kinh khong 100 triu. H thng thn kinh ny c 2 m ri: m ri ngoi cngnm gia lp c dc v lp c vng gi l m ri mc treo hay Auerbach, chc nng chnhl iu ha chc nng co bp ca rut dc theo chiu di ca ng tiu ha. Khi m ri nyc kch thch s dn n hu qu: (1) Tng trng lc c, (2) tng cng co c, (3) giatng tc truyn dn kch thch dc theo thnh rut lm tng nhu ng rut. m ri cn li

nm di nim mc, nn gi l m ri di nim hay Meissner c chc nng iu ha tit,lu lng mu cung cp cho ng tiu ha v qu trnh hp thu cc cht. S iu ha nych nh hng ln mt on ngn ca rut.2.1.H thng thn kinh ni ti thc hin chc nng thng qua cc cht dn truyn thnkinh nh: acetylcholine, norepinephrine, adenosine triphosphate, serotonin, dopamin,cholecystokinin, subtance P, vasoactive intestinal polypeptide, somatostatin, leu-enkephalin,met-enkephalin, bombesin. C nhiu cht vn cha r chc nng, tuy nhin in hnh lacetylcholine thng kch thch cc hot ng ca ng tiu ha, cn norepinephrine hunh c tc dng c ch.2.2.Mc d h thng thn kinh ni ti c th thc hin chc nng ca mnh, chng vn cs lin kt vi h thng thn kinh thc vt bn ngoi: thn kinh giao cm v ph giao cm.Thng qua y chc nng ca ng tiu ha c th b c ch hay tng cng mt cch ngk.

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Hnh 19.3. H thng thn kinh ni ti rut

Chc nng ng tiu ha c thay i cho ph hp nh cc phn x ng tiu

ha. Khi u l cc si thn kinh cm gic c u tn cng t bo biu m rut, thnh ngtiu ha b kch thch. Cc si ly tm mang tn hiu n 2 m ri thn kinh ni ti, cng nhty sng, thn no2.3. Hormone kim sot qu trnh vn ng:

Mt s hormone c vai tr trong vic iu ha hot ng c ng ng tiu ha,nhng chc nng ny yu hn cc chc nng tit cc cht.

Gastrin c tit bi cc t bo G vng hang v, tit khi c cc kch thch nh: s cnggin ca thnh d dy sau ba n, cc sn phm protein v gastrin releasing hormone ctit bi nim mc d dy khi c s kch thch ca thn kinh ph giao cm.

Cholecystokinin c tit bi cc t bo I nm nim mc t trng v hng trng khic s kch thch ca m, acid bo v monoglyceride c trong thc n. Hormone ny lm co

tht mnh ti mt, tng mt nhanh vo t trng. Cholecystokinin c tc dng c ch s co thtca d dy mt cch va phi, nhm m bo kh nng trung ho, tiu ha cht m ngtiu ha trn.

Secretin c tit bi t bo S nm trong nim mc t trng p ng vi dch acid vot trng t mn v. Secretin c tc dng va phi trn c ng ca ng tiu ha, ch yu thcy qu trnh tit bicarbonate gan v ty.

Gastric inhibitory peptide c tit bi nim mc phn u rut non, khi c kch thchca acid bo, m v amino acid c tc dng lm gim nh c ng ca d dy do lm gimi tc tng thc n ra khi d dy.3. TUN HON:

Mu cung cp cho h thng tiu ha l mt phn m rng hn ca h thng gi l tun

hon tng c trnh by trong hnh sau:

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Hnh 19.4. Tun han ni tng

Trong iu kin bnh thng lu lng mu chy qua cc vng ca h thng tiu hac mi lin quan trc tip vi cc hot ng ti vng . Chng hn trong qu trnh hp thucc cht dinh dng, lu lng mu qua nhung mao tng ln khong 8 ln. Tng t, hintng ny cng thy trong cc lp c trn khi hot ng c hc gia tng. V th sau ba ncc hot ng: c hc, ch tit, hp thu u gia tng nn lng mu ti cng gia tng sau

s gim dn cho n mc ngh khong 2-4 gi sau .C ch ca hin tng ny n nay vn cha r, tuy nhin c mt vi gii thch:Trc tin cc cht gin mch c phng thch t nim mc rut non trong qu trnh

tiu ha. Phn ln l peptide hormone nh cholecystokinin, vasoactive intestinal peptide,gastrin v secretin.

Mt vi tuyn ng tiu ha phng thch vo thnh rut 2 kinin: kallidin vbradykinin cng mt thi im m n tit cc cht vo lng rut . Cc kinin ny l cht gygin mch rt mnh v xy ra cng lc vi qu trnh tit dch tiu ha.

S gim nng oxygen trong thnh rut c th gia tng lng mu n khong t 50n 100%, v th hu qu ca vic gia tng chuyn ha rut lm gim nng oxygen tich li l nguyn nhn lm gin mch.

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CU HI T LNG GI

1. Cu no sau y ng vi sng chm?A. Khi s trong phn trn thc qun khi nutB. L nhng dao ng ca in th mng t bo c trnC. L nhng co tht c tc dng y thc n dc theo thnh rut.D. C tn s khong 20 ln/pht trong d dyE. L do acetylcholine kch thch trc tip t bo c trn

2. Sng chm l ngun gc ca in th hot ng:A.ngB. Sai

3.Tn s sng chm thay i ty vo s kch thch ca cc yu t: thn kinh, ni tit.A.ng.B.Sai.

4.Pht biu no sau y ng vi h thng thn kinh ni ti:A.Nm mc treo rut.B.Gm c hai m ri Auerbach v Meissner.C.m ri Auerbach c chc nng iu ha chc nng bi tit dch men tiu ha.D.Tt c u ng.E.Tt c u sai.

5.Vi h thng thn kinh ni ti rut c th thc hin trn vn cc chc nng ca mnh.A.ng.B.Sai.

6.H thng thn kinh thc vt c vai tr g i vi chc nng ca ng tiu ha.A.c ch.B.Kch thch.C.iu ha.E.Tt c u sai.

7.Mt s hormone nh: Gastrin, cholecystokinin, hon ton khng c tc dng trn ngtiu ha.

A.ng.B.Sai

8.Cholecystokinin c tit bi cc t bo C t trngA.ngB.Sai

9.Pht biu no ng: Sau nA. Lng mu n c quan tiu ha gia tng.B.Lng mu tng ch khi ta tng vn ng.C.Tt c u ng.D.Tt c u sai.

10.C ch ca s gia tng lng mu n c quan tiu ha:A.Cc cht gin mch c phng thch t rut non trong qu trnh tiu ha.B.Vai tr kallidin, bradikinin.

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C.Gim nng oxygen ti rut.D.Tt c u ng.E.Tt c u sai.

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1.

S TNG, TRN THC N TRONG LNG NG

TIU HA

MC TIU:1. M t cc ng tc nhai, cc giai on ca ng tc nut v hot ng ca c tht thc

qun d dy.2. Gii thch chc nng vn ng ca d dy vi cc sng nhu ng v vai tr ca cc

hormone.3. Phn tch cc sng nhu ng ca rut v cc yu t iu ha.4. Trnh by chc nng vn ng ca rut gi.

CU HI T LNG GI

1. Cu no sau y ng vi phc hp c ng?A.Ch xy ra gia cc ba nB.Do dy X iu khinC.Ch thy rut nonD.Xy ra mi 2 gi mt lnE.Khng b nh hng bi hormone tiu ha

2.Phc hp c ng c tt c nhng c tnh sau y, NGOI TR :A.Lin quan n s tng motilin trong huyt tngB. l nhng giai on tng hot ng co tht rt mnhC.Ch xy ra trong thi k gia cc ba nD.Ch xy ra rut nonE.Cn c h thn kinh rut iu khin s di chuyn

3.Cu no sau y ng vi tc thot thc n ra khi d dy?A.Nhanh hn khi nh trp lm cng thnh t trng nhiu hnB.Tng khi pH ca nh trp ra khi d dy gimC.Gim khi nh trp ra khi d dy cha nhiu lipidD.Tng khi c s bi tit ca cholecystokininE.Gim khi c s bi tit ca gastrin

4.Cht no sau y c ch s co bp ca d dy ?A.AcetylcholineB.GastrinC.SecretinD.HistamineE.Somatostatin

5.S tng thot thc n khi d dy chu nh hng ca tt c cc yu t sau y, NGOITR :

A.Carbohydrate trong d dyB.Bi tit gastrin

C.Cng thnh t trngD.Nng thm thu ca cht cha trong d dyE. axt ca nh trp khi vo t trng

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6.Nhu ng rut non c c tnh no sau y?A.Tng khi kch thch h giao cmB.Khng b nh hng bi h thn kinh rutC.Xy ra khi thnh rut b cngD.Nim mc rut non tng bi tit dch trc khi nhu ng xy ra

E.y thc n vi vn tc 10 cm/pht

7.Hot ng c hc ca rut non b kch thch bi tt c cc cht sau y, NGOI TR :A.CholecystokininB.SecretinC.GastrinD.InsulinE.Motilin

8.Van hi manh trng:chn cu saiA.Nhm ngn chn qu trnh tro ngc dch phn t hi trng.B.Van ny c th chu p lc 50-60 cm nc.C.Van ny hi nh su vo lng manh trngD.C tht hi manh trng ngay pha trc ca van hi manh trng.

9. Yu t no sau y c tc dng bo v chng li s tro ngc thc qun:A.C vng thc qun.B.Cu trc ging nh van on cui thc qun.C.S tng p lc trong bng mt mc gii hn no .D.Tt c u ng.

10.Chuyn ng phn on ca rut non c tn s ti thiu l 12 ln/phtA.ng.B.Sai.

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CHC NNG TIT CA NG TIU HA

MC TIU:1. Ni v s bi tit nc bt: cc loi tuyn, thnh phn, tc dng v iu ha bi tit nc bt.2. M t bi tit dch v: cc loi tuyn, thnh phn, tc dng v iu ha bi tit.3. Gii thch c ch to thnh HCl, vai tr tiu ha v iu ha bi tit HCl.4. Phn tch yu t hot ha, iu kin hot ng v tc dng ca men pepsin.5. Trnh by dch ty, dch mt v dch rut: thnh phn, tc dng v iu ha hot ng.

CU HI T LNG GI

1. Nc bt gm cc thnh phn sau y, NGOI TR :A. BicarbonateB. Kali

C. Clo (Cl-

)D. GlucoseE. Amylase

2.Cu no sau y ng vi amylase nc bt?A.c bi tit trong mt dung dch c thnh phn ion ging dch ngoi boB.Hot ng mnh nht trong khong pH t 1.3 - 4.0C.Ct ni peptide trong cc chui polypeptideD.Khi u s tiu ha ca acid bo trong mingE.c bi tit khi nng gastrin trong mu tng cao

3.S bi tit ca cht no sau y KHNG ph thuc vo secretin ?A.Nc btB.Dch rutC.PepsinD.Dch tyE.Mt

4.S bi tit HCl ca d dy c m t ng bng nhng cu di y, NGOI TR :A.C s dng CO2B.B c ch bi cc thuc khng histamineC.Cn c s chuyn ch ch ng ca H+

D.B kch thch bi acetylcholineE.Xy ra ti cc t bo chnh

5.Mt chc nng quan trng ca nim mc d dy l bi tit cht no sau y?A.CholecystokininB.EnterokinaseC.Yu t ni tiD.SecretinE.Trypsinogen

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6.T bo thnh bi tit cht no sau y?A.GastrinB.CholecystokininC.Yu t ni tiD.Secretin

E.Histamine7.Cc cu sau y u ng vi s bi tit ca tuyn ty ngoi tit, NGOI TR:A.Dch giu bicarbonate c bi tit bi t bo biu m ng dn di tc dng ca

secretinB.Men c bi tit bi t bo nang tuyn di tc dng ca cholecystokininC.Dch ty c bi tit trc khi thc n vo n rutD.Gastrin kch thch s bi tit menE.Epinephrine kch thch s bi tit bicarbonate

8.T bo ng dn ca ty tng bi tit cht no sau y?A.TrypsinB.NaHCO3C.LipaseD.BilirubinE.Amylase

9.Amylase nc bt l men tiu ha ca c cht no sau y?A.SucroseB.GlucoseC.MaltoseD.Tinh btE.Lactose

10.Cu no sau y ng vi s co tht ti mt ?A.B c ch bi ba n giu lipidB.B c ch bi s hin din ca amino acid trong t trngC.B kch thch bi atropineD.B kch thch bi cholecystokininE.Xy ra ng thi vi s co tht c vng Oddi

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CHC NNG HP THU

MC TIU:1. M t cu trc c trng ca nim mc rut to thun li cho s hp thu.2. Phn tch c ch hp thu cc cht: nc, cc cht in gii, protein, glucid v lipid rut non.3. Trnh by s hp thu cc cht rut gi.

CU HI LNG GI

1. Tt c nhng iu sau y u ng i vi dch ty bnh thng ca ngi, NGOI TR :A.pH kimB.Cha pepsinC.Trn 1000 ml c bi tit mi ngyD.Cc men tiu ha protein c bi tit di dng tin men

E.S bi tit b kch thch bi dy X

2.Sau khi c bi tit vo t trng trypsinogen c i thnh dng hot ng trypsin bi chtno sau y?

A.EnterokinaseB.ProcarboxypolypeptidaseC.Lipase tyD.Amylase tyE.pH kim

3.C quan no sau y c vai tr quan trng nht trong vic cung cp men tiu ha m?

A.Tuyn nc btB.D dyC.Ty tngD.GanE.Rut non

4.Cht no sau y c vai tr trong s iu ha bi tit enzyme ca tuyn ty ?A.SecretinB.HistamineC.CholecystokininD.GRP (Gastrin releasing peptide)

E.Motilin.5.S co ti mt c iu khin bi hormone no sau y?

A.EnterogastroneB.Cholecystokinin (CCK)C.GastrinD.SecretinE.Histamine

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6.Cu no sau y ng vi secretin?A.L mt enzyme ca t trngB.Lm tng s bi tit ca t bo thnhC.Kch thch ty bi tit ion bicarbonateD.L mt hormone ca tuyn tyE.Lm tng s thot thc n ra khi d dy

7.Mt KHNG cha cht no sau y?A.CholesterolB.Mui v cC.LecithinD.LipaseE.Bilirubin

8.Cu no sau y ng vi s co tht ti mt ?A.B c ch bi ba n giu lipidB.B c ch bi s hin din ca amino acid trong t trngC.B kch thch bi atropineD.B kch thch bi cholecystokininE.Xy ra ng thi vi s co tht c vng Oddi

9.Amylase nc bt l men tiu ha ca c cht no sau y?A.SucroseB.GlucoseC.MaltoseD.Tinh btE.Lactose

10.Cu no sau y ng vi carbohydrate trong thc n?A.Tiu ha ch yu ti d dy.B.Tiu ha ming pH 2.0.C.Ct thnh disaccharides do amylasD.Hp thu di dng duy nht l glucosE.Hp thu ch yu vo mch bch huyt.

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SINH L CHC NNG GAN

MC TIU:

1. M t cu trc c bn ca gan.2. Trnh by su chc nng quan trng ca gan bao gm:

Chc nng tun hon.Chc nng bo v vi h i thc bo ca gan.Chc nng chuyn ha: protein, glucid, lipid.Chc nng kh c.Chc nng bi tit mt.Chc nng d tr.

CU HI T LNG GI

1.Acid mt bao gm tt c cc cht sau y, NGOI TR :A.Acid cholicB.Acid chenodeoxycholicC.Acid deoxycholicD.Acid lithocholicE.Acid uric

2.Cu no sau y KHNG NG i vi mt?A.Cha mui mt v sc t mtB.C tc dng nh tng ha lipidC.c d tr ti ti mtD.S ti hp thu mui mt rut lm tng s bi tit mtE.Mui mt c to ra t hemoglobin

3.Cu no sau y ng vi mui mt:?A.c tng hp trong gan t cholesterolB.Khng c ti hp thu sau ba nC.L nhng cht kt hp ca acid mt vi acid glucuronicD.Nhim v ch yu l trung ha acid hydrochloric ca d dyE.L cht chuyn ch aminoacid trong rut

4.Mui mt c ngun gc t cht no sau y?A.HemoglobinB.GlycerolC.CholesterolD.Sc t mtE.Lecithin

5.Mui mt cn cho s hp thu cht no sau y?A.Vitamin AB.Protein

C.CarbohydrateD.Yu t ni tiE.Calcium

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6.Mui mt lm tng hp thu m l do kh nng thc hin nhng iu sau y, NGOITR :

A.Thnh lp micelleB.Gim sc cng b mt ca cc ht lipidC.Vn chuyn lipid n b bn chi nim mc rut.

D.Nh tng ha mE.Kch thch s tiu h tip theo ca lipid trong t bo biu m rut

7.Tt c cc cu sau u u ng vi cholecystokinin (CCK) NGOI TR :A.c phng thch khi m kch thch nim mc rut nonB.Tng s bi tit men ca tyC.Gy co c trn ti mtD.Lm co c vng Oddi

E.c ch s thot thc n khi d dy

8.Cc cu sau y u ng i vi s bi tit mt ca gan, NGOI TR:A.Mt c a xung t trng khi n do adrenalin gy co tht ti mt.B.S bi tit mt gip thi cholesterol.C.Si mt c hnh thnh l do s mt cn bng trong qu trnh c c mtD.Mt tham gia vo s tiu ha v hp thu lipidE.Nu b tc mt phn s nht mu

9.Nhng hot ng khc nhau ca h tiu ha lin quan trc tip n mt s loi t bo.Trong nhng kt hp sau y ci no KHNG ng ?

A.C ng - T bo c trn thc qunB.Bi tit - T bo biu m ti mtC.Tiu ha - T bo nang tuyn tyD.Hp thu - T bo biu m rut nonE.Bi tit - T bo ng dn tuyn nc bt

10.Khi tc ng dn mt s gy vng da. Triu chng vng da ny l do tng cht no sau ytrong huyt tng ?

A.BiliverdinB.Urobilin

C.BilirubinD.HemoglobinE.Stercobilin

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MC TIU CHNG:1. Nu c nhim v to nc tiu ca thn v hai chc nng chnh ca thn l bi xut

cc sn phm chuyn ha ca c th v gi hng nh ni mi.2. Trnh by c qu trnh lc tiu cu thn, v qu trnh ti hp thu v bi tit ng

thn.3. Xc nh c chc nng gi hng nh ni mi ca thn l kim tra nng cc cht

trong huyt tng, iu ha p sut thm thu dch ngoi bo, iu ha th tch mu vdch ngoi bo, iu ha pH ca dch c th.

4. Phn tch c chc nng ni tit ca thn l iu ha huyt p, kch thch sinh hngcu, v gp phn chuyn ha canxi v phosphat trong c th.

5. M t c cc vn sau y- Thm d chc nng thn bng thanh thi- Cc cht li niu v c ch tc dng- Thn nhn to- S bi xut nc tiu

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S LC TIU CU THN

MC TIU:1. M r c cu to ca nephron, mch mu thn kinh thn, phc hp cn tiu cu2. Trnh by c dng mu thn, cc p sut trong tun hon thn3. Phn tch c s lc tiu cu thn: mng lc, dch lc, ng lc hc, cc yu t nh

hng, v s iu ha mc lc

CU HI T LNG GI

1. Cu trc t bo no sau y KHNG NG i vi nephron?A. T bo biu m ca cu thn l nhng t bo c chn bm vo mng yB. T bo biu m ng gn c b bn chi to bi cc vi nhung maoC. T bo biu m on dy ca quai Henle c b bn chu th s, c ch ni cht gia

cc t boD. T bo biu m ng xa c v bn chi v nhiu ty lp th nh ng gnE. C khong 250 ng gp ln nc tiu vo b thn

2. phn bit t bo biu m ca ng gn v t bo biu m ca ng xa, ngi ta da voc im cu trc no sau y?

A. ng xa c mng y dy hnB. ng gn c mng y dy hnC. ng gn c b bn chi rng hnD. ng gn to thnh phc hp cnh cu thnE. ng xa c t ch ni cht gia cc t bo hn

3. Cu no sau y KHNG NG i vi v tr ca cc nephronA. Cu thn, ng gn v ng xa nm trong vng v thnB. a s nephron nm hon ton trong vng vC. 1 s nephron nm vng cn tyD. 1 s quai Henle thc su vo vng tyE. 1 s t nephron nm vng ty

4. H mch mu ca nephron bao gm cc phn sau y, NGOI TR:A. Tiu ng mch vo cu thnB. Li mao mch dinh dng trong cu thn

C. Tiu ng mch raD. Li mao mch quanh ngE. Quai mao mch thng vasa recta

5. p sut mu trong mao mch cu thn cao, thun li

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