Sinh Ly Benh - Full

8/6/2019 Sinh Ly Benh - Full

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Cu 1: trnh by ngnhn v biu hin ca nhim toan chuyn ho. Cho vd-nhim acid: l tnh trng cc acid thm nhp vo huyt tng (t tb hoc t ngoi mi) hoc tnh trng hu b mt cc mui kim, lm cho pH c xu hng jm xung-nhim acid chuyn ho l s tch lu (.) mu cc acid hoc s mt nhiu mui kim-nguyn nhn: do nhim acid ni sinh hoc t ngoi mi (thuc, truyn dch) hoc do ko o thi c acid hnhiu mui kim+nhim acid chuyn ho sinh l:., (.) lng nng: do c 1 fn glucid chuyn ho ym kh -> acid lactic tm thi tng (.) mu., (.) cn i s huy ng m c th lm gan a vo mu 40g acid thuc th cetonic+nhim acid chuyn ho bnh l:.,gp (.) cc bnh c chuyn ho ym kh: bnh tim mch, bnh h hp lm c th thiu O2.,tiu ng do tu: m b chuyn ho mnh nhng ko vo c vng Krebs m bin thnh th cetonic gy nhnng.,cc bnh lm mt kim: l d tu, l d mt,suy thn trng din, c bit mt nhiu kim (.) tiu chyln cc dch tiu ho cha mui kim., bnh thn: vim cu thn cp, vim ng thn cp, suy thn lm c th ko o thi c acid.,c th nhim toan do a acid vo c th (thuc, dch cha bnh) vd dch truyn c nhiu acid citric-biu hin:+th nhanh, kh th +bun nn, nn ma (p thi acid)

+dch v tng tit, tng toan+ri lon chuyn ho+nhim c thn kinh, hn mCu 2: trnh by ngnhn v biu hin ca nhim toan h hp.vd-nhim toan h hp: acid cacbonic ng lm t s 1/20 ca h m bicacbonat c xu hng tng ln-ngnhn:+nhim acid h hp sinh l:., (.) gic ng: trung tm h hp km nhy cm vi CO2 -> b tch li v hi tng (.) mu., (.) lng nng: CO2 to ra vt qu kh nng o thi+nhim acid hi bnh l:., (.) gy m su, ng c thuc m, thuc ng: trung tm h hp b c ch., cc bnh tun hon: lm km vn chuyn mu n fi vd: suy tim ton b, suy tim fi., cc bnh gy tng kh cn ca fi : do cn tr s khuch tn ca CO2 t mu ra vd: x fi, lao x, suy tim tri,hen., cc bnh ca g dn kh: lm cn tr s lu thng ca ko kh th: vim f qun, d vt, ph thanh qun, ngt (f fi cp, bch hu)., vim fi thu: ng bnh c im au ko dm th mnh, vim xut tit lm thu fi ng c, p vim lxquanh f n km thng kh.,vim f qun tr em: vim ri rc fi v cc f qun, hn ch s trao i kh, p vim lan c sang gy xut tit, co tht f qun v km n hi f nang, p st to nhiu CO2-biu hin: +kh th +trung tm h hp b kthch+tm ti

Cu 6: Nu v ptch quy lut vtr ca p tnh (.) bnh sinh-Tnh p ca c th l tp hp cc 2 p ca c th trc cc kthch ni chung v trc bnh nguyn ni ring. Tnh pnhau c th lm qtrnh bnh sinh mi c th v mi nhm khng jng nhau a li cc kqu # nhau (tt, nh)-Trc tng ca 1 kthch no (gy bnh hoc ko gy bnh) c th p ng li = 1 hay nhiu p:+S p ng c th = loi p chung cho nhiu loi: ng t co li khi nh sng cng chiu vo vtng glucose mu khi au n+Loi p ring cho cc c th (.) 1 loi, ring cho tng c th: ng khi b stress th tng nhp tim, c ng tng mhi hp lo lng, c ng th tng rt t+Nu c th c chung 1 p trc kthch ng ta xp h thnh nhm v thnh ku p: nhm ng j, nhm ng tr+a s p mang m du vt di truyn v tnh bm sinh nhng cng c nhiu p hthnh (.) i sng f thti, ji, yu t tkinh - ni tit, mi trg, thi titCu 3: nu cc t/c c bn trong kn K/hc v bnh, vd-Bnh c t/c 1 cn bng mi km bn vng:+S hng nh ni mi l kqu ca 1 cn bng sinh l ja 2 qtrnh: qtrnh tn to v qtrnh tiu hu. Vd: gluhuyt l kqu ca s cn bng ja tiu v to glucoza


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+Khi 1 yu t v bnh xm nhp vo trong c th, c th c nhng p bo v, p ny to ra trng thi ccn bng ny k ko di v thng bin i theo hng hoc hi fc trong trng thi cn bng ban u (khhoc cn bng tin trin theo hng bt li cho c th vt qu knng bo v ca cth -> t vong. Vd: bng-Bnh hn ch knng thch nghi ca c th+Cth lun tm cch thch nghi vi ngoi cnh bng nhiu c ch nhm duy tr s hng nh ni mi. Khi ngoi mi thay i mnh m n mc lm thay i ni mi th c th vn cn knng thch nghi song b h+Vd: khi st knng iu ho thn nhit vn cn, ng bnh ra lnh vn c p tng to nhit vo nng vn thnhng p k mnh m nh khi khe. knng iu ho ng huyt ca ng b x gan hn ch-Bnh hn ch knng lng:+Bnh gy s tn thng, lch lc ri lon ctrc, cnng t mc pt, tb, m, c quan, ton c th -> jm kthm ch nhiu bnh li di chng lm mt knng lng+Vd: khi st bnhn mt mi -> jm hot ngBnh bi lit lm mt knng lngv vy thc hin fng chm fng bnh l chnh v trong iu tr fi ch n bo tn nht l nhng c qnng c lquan n lngCu 4:Trby cc kn Khc v bnh nguyn. Vd-Kn K/hc v bnh nguyn l quan nim c da trn duy vt bin chng, t c mqh ng n ja ngnhngy bnh v p dng c quy lut nhn qu. bnh nguyn gm nguyn nhn v kin-Mqh ngnhn k: ngnhn l quyt nh, l yu t khch quan:

+Bnh k t sinh ra m fi do ngnhn no c th c tm ra hoc cha c tm ra+Ngnhn khi tng ln c th trong k nht nh s gy bnh v quyt nh tnh c hiu ca bnh. Trongtrng hp bnh ny biu hin k jng bnh # do chng c nhng ngnhn khc nhau. Vd: bnh lao do trc kcn bnh a chy do vk t+Ngnhn ch ft huy c tdng ca n trong nhng k nht nh ca c th v mi trng. vd lao phi do trlao gy ra song thng xy ra ngi suy yu sc chng jm, hon cnh sinh hot kh khn.+k h tr v to thun li cho ngnhn nhng k ko th gy bnh nu thiu ngnhn. Vd 1 ng d n ung tlng nng nhc cng k th mc bnh nu ko nhim vk lao+C ngnhn i hi nhiu k mi ft huy tdng nhng c nhng ngnhn i hi t k. thm ch c ngnhn dnh k cn k j gy bnh, vd da tht tip xc vi nhit rt cao hu nh gy bnh bng-S hon i:+Ngnhn trong trng hp ny c th l k trong trng hp khc: n ung thiu thn l ngnhn ca suy dnhng trong nhiu trng hp l k ca bnh lao+k trong trng hp ny c th l ngnhn trong trng hp khc: lnh l k cho virus ng mi hng cm, lnh li gy ra nhim lnh-Ngnhn - hu qu:+Mi hu qu u fi c ngnhn no vd bnh bi lit l do virus+C ngnhn cha hn c hu qu do thiu k hoc do th tng v s p tt ca c th. Vd c th c m thch nghi+1 ngnhn c th gy nhiu hu qu tu thuc vo k. Vd: vk lao c th gy nhng bnh khc nhau: rutsng, mng no+Cc ngnhn khc nhau c th gy cng 1 hu qu. Vd: bnh l c th do 2 ngnhn hon ton khc nhau gamip v do vk Shigella

-P ca cth:+Cng 1 ngnhn mi c th khc nhau gy hu qu khc nhau. Vd: d ng+Tnh p c th tng t nhau c cng ng thm ch c dn tc. vd: F n Chu Fi him khi b bnh lxng. Ng Chu Phi him khi b su rng+C nhng p c bit r, vd tnh trng MD ca c th: ng mc hoc tim chng 1 bnh nhim khmc bnh na+Tnh p trc 1 yu t gy bnh nu t nhiu c tnh h thng v tnh di truyn th c gi l tng, vd : tntng d xut huyt nim mc+Da vo cht lng v mu sc hcu: thng da vo ch s lng Hb trung bnh hcu (MCH):.,Thiu mu nhc sc: MCH< 27 pg.,Thiu mu u sc: MCH> 35 pg.,Thiu mu ng sc: MCH = 27-35 pgVd: thiu mu nhc sc do thiu Fe, thiu mu u sc do thiu VTM B12 v acid folic+Da vo ngnhn v c ch bnh sinh:.,Thiu mu do chy mu ( cp v mn tnh): thng nhc sc. vd: chn thng v tng.,Thiu mu do tan mu (ngnhn ti hcu hay huyt tng): thng ng sc. vd st rt.,Thiu mu do jm sinh mu (do thiu nguyn liu, do cnng tu km) vd: suy tu, thiu Fe, suy dinh dn


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Cu 7: Th no l p thc ngo (.) y hc, cho vd-P2 thc ngo l p2 bt chc nh tht, chun m hnh thc t vo thc ngo. l p2 xut ft t s qst cc htng bnh lsau dng nhng hiu bit c cminh t trc ct ngha chng, cui cng dng 1 hoc nhiu thc ngo cminhs ng sai ca j thuyt-P2 thc ngo c 3 bc: qst htng bnh l, c ch bnh sinh, thc ngo cminh r rng-vd: gy m hnh sc = cch to ra chn thng ch+dng v p mnh ltc vo mt (.) i sau ca ch n khi HA jm 60mmHg qst ton trng:., con ch: sc c 2 g:-sc cng: HA tng-sc nhc: HA jm., mch: nhanh, nh, h hp nhanh, nngCc ch tiu c xu hng thay i, ko u+Chn thng gy dp nt ti ch -> sinh ra cht c.., chn thng gy RL tkinh, gy au n qu mc., Cht c sinh ra t t chc ko fi l ngnhn ch yu gy ra sc m n ch 1 fn gy ra sc hoc g no+Sc chn thng do RL tkinh v au n qu mc

Cu 5: (c s cui) Trby knim v bnh sinh v vng xon bnh l (.) bnh sinh. Vd c th-Bnh sinh l qtrnh din bin ca 1 bnh t khi bt u n khi kt thc.Vd: bnh vim cu thn cp: xhin sau 1 nhim trng do nhng lin cu dung huyt nhm A typ 12.., fc hp KN-KT t nhim trng tin ft n lng ng cu thn vi s kt hp ca b th gy 1 lotn thng t chc ti ch thn. fc hp ny gn vi cc ctrc ca cu thn to fc hp c tnh KN kthsinh KT chng li chnh t chc ca mnh., mt # s lng ng fc hp MD trn ni mc cu thn gy p thm nhim bi cc Bcu t mu hoc tblkt -> tn thng tng sinh.,Hqu: thay i cu thn lm jm cnng lc ca cu thn ko theo nhng thay i cnng ca ng thn niu, v niu.Vim cu thn cp c th:+suy thn cp vi ur huyt cao -> t vong+vim cu thn mn+khi bnh-vng xon bnh l: (.) qtrnh bnh sinh nhng ngnhn ban u c th gy ra nhng hu qu nht nh, nhi ny li l nhng ngnhn ca nhiu ri lon mi v nhng ri lon mi c th gy nhng hu qu # nh bnh ko ngng tin trin v ngy 1 nng. bit nhng khu sau li tng tr li khu trc hthnh vng xonVd (s

Cu19: nu cc t.cht c bn ca s lo ha v yu t chi phi tui th+t/c c bn ca s lo ha- l quy lut tt yu v ng vi tt c cc loi

-thay i c bn ca c th gi so vi tr(ngoi hnh, chc nng, kha nng mc bnh)c tnh quy lut cho-T/K khng ng th v khng ng tc trong s lo ha:khc nhau cp d loi, chng, c th v c qu-qu trnh lo ha khc gia cc loi v khc nhau v tui th ti atc tng t l t vong theo tg, khc nhau gia cc loi c tnh quy lut*cc yu t chi phi tui th:+tui th lin quan n gen-quan st thng k cho thy tui th khc nhau gia cc loi, chng, dng h, gia nh=>do gen chi phi-qua lai 2 dng sc vt c tui th cao v thp=>dng tui th TB+tui th lin quan n mi trng, k sng: quan st loi ng c tui th TB tng theo LS pht trin XH

Cu 12: trby 1 s hiu bit c bn v cc hot cht trung jan (.) vim-Cc hot cht trung jan xut ft t tn thng tin ft v th ft-Bn cht l cht chuyn ho trung jan glucid, lipid, protein c hot tnh sinh hc cao-Gm:+Cc acid amin hot mch


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+Cc dn xut acid bo, leucotrien gy au v hp dn BC+Cc men ca lysosom gy hu hoi t chc: collagen+Cc kinin, bradykinin+Cc lymphokin: TL-1: hot ho tb, TL-2: tng sinh tb, TL-3: tng tu xng

Cu 11: nu v s thc bo (.) vim:-Thc bo l htng BC bt j v tiu ho cc i tng thc bo (VK, mnh tb b fn hu)-cc tp tham ja: TB, lympho bo, tb ni m-Cc gon:+Ho hng ng -> thu ht BC ti vim: ti vim BC c hot ho lm cho knng thc bo tng ln r hnh thi chng ln hn cc thc bo bthng cha nhiu ty th, lp th, lysosome, giu li golgi, ribosom

sinh ho chng cha nhiu protein, ATP, glycogen+BC bm dnh v xuyn mch: BC tip cn i tng thc bo, bao quanh chng, sau lysosome tin tigphng cc cht fn hu i tng thc bo+Thc bo: khi b thc bo cth xy ra 5 knng:.,N b tiu dit nh vtr ca lysosom.,N k b tiu dit m tn ti lu (.) tb nh bi than (.) tb fi, cht hemosiderin gan (.) bnh x gan nhim.,N k b tiu hu v c th theo thc bo i ni # gy vim mi.,N c th b nh ra m TB k cht.,N lm cht thc bo: lao, lin cu khun

+tr ng nhn gy vim hn l tr triu chng vim

Cu 15: Trby bn cht, nggc ca cc cht gy st v c ch gy st-Bn cht. ngun gc:+Cht gy st ngoi sinh: loi a t ngoi vo c th: vk, virus, nm, kst

+Loi ni sinh: do sfm hu hoi m ca c th: xut huyt ni, hoi t t chc+ Mui: tim mui vo di da hay bp tht u gy st+Thuc: 1 s thuc c tdng kthch sinh nhit: thyroxin-C ch: cht gy st ngoi sinh t ngoi vo c th thng c nggc vk, kthch i thc bo sinh ra cht sinh, cht gy st ni sinh tng ln vng di i thng qua Prostaglandin E2 tng ln th th ca n lm thay iim t iu ho nhit cao hn bthng, ngha l trung tm p vi nhit 370c l b nhim lnh v iu chnhnhit c th theo hng tng sn nhit, jm thi nhit

Cu 16: nu cc hu qu v RLCH trong st-Chuyn ho nlng: do nhu cu tng thn nhit nn CH nlng tng kh r. nhit tng 10c -> CH tng 3-5%


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-Chuyn ho glucid: l nlng ch yu sdng gon u ca st. nlng d tr trong gan: glycogen -> gluglucid jm -> cn kit. c th tng to glucid t protid -> khi st cn truyn ng glucose-Chuyn ho lipid: lun b huy ng trong st, nht l khi lng glucid bt u cn kit, lm lipid mu tngxhin th xeton-Chuyn ho protid: do nhim c, nhim trng, i n. Tng to KT, b th, BC lm cho huy ng protid tng ln-Nhu cu sinh t: do tng CH nn nhu cu sinh t B1, C tng rt mnh-CH mui nc v thng bng kim toan:CH mui nc thay i theo din bin ca st:+G u: CH mui nc hi tng+G 2: aldosterol, ADH tng -> j nc v mui thn v tuyn m hi -> da kh, lng nc tiu jm -> thy+G 3: ADH, aldosterol c gphng khi tuyn m hi -> v m hi, lng nc tiu tng ln -> thn nhit tr

Cu 18: cho bit ngha ca p st v thi x tr khi gp trg hp bn st-Thi x tr:+Duy tr p bo v t nhin ca c th, k h nhit v nguyn nu st k t ra nguy him v gy hu qu ldin bin v tin lng bnh+Jp c th chu ng c cc hu qu xu ca st v khc fc hu qu hn l ct cn: b nc, tr tim, b

+Can thip h st nu c hu qu ln, qu sc chu ng ca c th+Tm ngnhn x tr ngCu20: nu s thay i c bn trong qu trnh lo ha*thay i mc ton thn-ngoi hnh: dng dp, c ch-th lc: gim st, km chu ng, km thch nghi trc han cnh khng thun li-d mc bnh, t vong*thay i mc c quan.+thn kinh:gim s lng TB TK, tch t sc t Lypofuchsin-cht c trng ca qu trnh lo ha, gim scht dn truyn trung gian=>tng ngungx v gim tc phn x do km dn truyn-gim sm xut Catecholamin=> gim kh nng hng phn-s thay i chc nng vng di i din ra chm+h ni tit:thay i nng nhiu hooc mn trong mu v gim mc nhy cm ca c quan ch=> gimiu ha nhit-gim hot ng ca tuyn sinh dc-tuyn thng thn gim mc cm ng vi s kch thch ca vng di i v c tuyn yn-suy gim chc nng tuyn gip=>nh hng ti thn nhit-di lon hot ng ca tuyn ty-tuyn c lien tc gim kch thc v chc nng+h MD-KT trong mu: gim hiu gi KT t nhin, gim p ng to KT vi KN ngoi lai, tng sm xut t KT-p ng MD TB gim phn ng da, gim phn bo(blast ha), gim sm xut IL-2, gim hot tnh v s ltrong h tr sm xut KT, gim SXIL-3, gim sm xut TH1, gim s lng v ch nng TCD4

+M khi gim cc glycoprotein, proteoglycan cu trc nn cc si n hi, tng Collagen-xng cng b x, gim lng ng canxi+cc c quan khc:-tun hon:HA tng, tim v mch x ha, gim mt mao mch, km p ng vnhy cm vi s iu hTKT v TV-phi:pht trin m x, nhu m km n hi-thn:c c nc tiu km, s lng gim, gim t trng-to mu gim-tiu ha:gim tit dchCu21:trnh by s thay i mc phn t trong qu trnh lo ha.--qu trnh lo ha s ko theo s tch ly cc phn t ch gp o tui tr trong tnh trng bnh l: lipofusin troloi TB hoc hemosiderin trong TB h lien vng hoc dng tinh bt hu ht ng gi trn 80 tui, b ba cnhim dng tinh bt (amyloit): no, tim, o ty,-cc pt collagen tr nn tr ,km ha tan,d b co do nhit, o ln cu trc v gn glycosyl-tch ly nhiu enzyme mt c hiu,k cn h, nhng ng ch nht l bin i trong AND &ARN+AND gn cht hn vi histon v KL,d b phn on, nhu NST c cto sai lc+cc enzyme chu trch nhim phc hi cc tn thng ca AND cng gim hot tnh


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CU 22nu nhng thng c v bnh ng gi-gi lm gim cnng cc c quan->hn ch knng thch ng v phc hi, d a n ri lon cn bng n cho bnh tt xhin-bnh ng gi c th l bnh nh t tui tr nay ptrin mnh c th gi-c th coi bnh ng gi l bnh pht sinh do tui, bt ngun t s thay i Tb, cquan, h thng trong qtrnha n tnh trng km bo v=>t l t vong tng-din bin bnh khng in hnh, d bt ng -bnh c trng chon ng gi thng gp:ung th, tim mch, HA, tiu g, long xng-qu trnh lo ha c vai tr ca ngoi cnh v di truyn

Cu 30:T.by n, n.nhn, hu qu ca tc rutn: Tc rut l tnh trng 1 on rut mt lu thng khin fa trn b cng jn do t.n & cht dch tr. N.nhn:C hc: tht rut, xon rut,lng rut, tc do bi giun, thot v bn.Chc fn: lit rut, cng f giao cm.Hu qu: khc nhau tu tng v tr tc cao hay thp.Tc cao: mt nc do nn c bit l khi tc mn v gy nn nhiu, mt acid --> nhim kim.Tc t trng: nn ra dch rut, mt kim--> nhim acid.Tc thp: tnh trng nhim c nng hn mt nc.

Cu 31:P.tch n.nhn & c ch ri lon hp thu ti rut & ngoi rut:Hp thu l c.nng quan trng ca rut cng l ca ton b h tiu ho --> kh nng hp thu ni l c.nng chrut & hi chng km hp thu c coi l tnh trng thiu nng tiu ho. N.nhn & c ch:Ti rut:+ Nhim khun gy vim rut mn tnh, k c RL VK ch & s c mt ca KST.+ Nhim c tiu ho: cht c trc tip ln NM ng tiu ho: ru, cc thuc ty, thuc cha lao...+ Gim tit enzym tiu ho: cc cht c ni trn lm teo NM tiu ho, c ch tit enzym tiu ho.+ Gim din hp thu: ct 1 on rut, RL tun hon ti rut. Ngoi rut:+Bnh d dy: vim,lot,v toan,ung th... tc ng trc tip hay gin tip .hng xu n co bp & titrut.+ Suy gan: gy thiu mui mt hp thu lipid.+ Suy ty: thiu 1 ngun enzym quan trng.+ 1 s bnh ni tit: suy cn gip, suy thng thn a n gim canxi huyt gy tng co bp rut.

Cu 33:Nu n.nhn,c ch bnh sinh, biu hin sinh hc ca vim ng thn cp N.nhn: do nhim c.+ Cc cht c ho hc & thuc: thu ngn,ch,asen,bismut.+ Cht c bt ngun t hu t chc & TB nh do fu thut, chn thng,bng,truyn mu nhm loi...+ Cc cht c bt ngun t VK.C ch bnh sinh: l 1 q.trnh c ch cc men chuyn ha ca TB thn gy ra nhng h hi v sinh ho. 1

td ln nhng men ca thn c th to thnh nhng kt hp bn vng lm cho nhng men ny mt hot tnRL c.nng & tn thng thc th thn.+ Thn c c im d tn thng hn cc t chc # l v n l t chc c n` mu qua nht.Biu hin: thiu niu hoc v niu.+ Nhng triu chng cp tnh ch xut hin nhng ngy u.+ Sau dn n hn m km theo s tng ur & cc gc nit # (.) huyt tng.+ S nhim toan & nhim c kali l n.nhn ch yu lm bnh nng & dn n t vong nu k c iu tr

Cu 34:T.by c ch bnh sinh & cc biu hin ca hi chng thn h.C ch bnh sinh: s jn rng cc l lc cu thn khin protein thot ra --> hin tng mt protein,nng (.) huyt tng gim xung m ch n & s sx ca gan k b p c --> tn thng cu thn.+ Lng dch lc t cu thn sang ng thn b.thg do vy k c s ng cht o thi (.) c th, k f do tthm thu m f do p lc keo (.) mu -->c.nng ng thn b.thg.+ Lng ng thn x.hin tr m.+ Kh nng ti hp thu m gim.+ C tn thng mng lc cu thn.Biu hin: protein niu cao, protein mu gim, f ton thn, RL chuyn ho m.


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Cu 39:Nu k.nim v suy thn cp,g.thch c ch nhng thay ic bn (.) mu do suy thn cp.Suy thn cp: l hu qu ca n` bnh thn # nhau (.) thn k thc hin c y c.nng ca n: trc ht biu hin = s ng (.) c th cc cht cn b & cht tha #. Lm jm nhanh chng c.nng thn y btnh trng nguy him.C ch nhng thay i c bn (.) mudo suy thn cp.+ Tb` fng to, lm tc ng thn.+ Tb` hoi t bong ra lm lp ng thn,n' tiu chy trc tip vo mu em theo cht o thi.+ S tr cp din n` sn fm c:H+,hp cht nit( hi chng ure huyt cp din)+ cc cht c hot tnh ca vim gp' vo mu.

Cu 40:T.by c ch bnh sinh ca hn m thn. Nu cc biu hin chnh ca suy thn mn.Hn m thn l g.on cui cng ca bnh thn. S tng ure (.) mu chng t c n` sn fm c (.) c ththi.+ cc sn fm c:indol,phenol,amoniac... thm vo mu. Nhng cht ny b.thg vo mu s c gan thi thi qua fn. Nhng (.) bnh thn do cc cht c k c x l, loi thi,tch li & gy c.+ n' tiu vi tp`:acid citric,acid oxalic...k c o thi li lm tng tnh trng nhim c c th.

. No b chn p bi f n cng vi tnh trng f n chung: nhc u, co jt,ng g.. c ch TK do TK b nhim c: l m, l ln,kh th.

. Jm ion Ca2+ mu do kt hp vi photphat k c o thi: co jt,nn,a lng.Cc biu hin chnh ca suy thn mn:+ RL n' tiu: thiu niu,(.) n' tiu c protein,tb.tr niu.+ RL mu: ure huyt tng & nhim acid.+ Ph: xy ra trn ton thn.+ HA cao.

Cu 38:T.by c ch nhng biu hin ton thn ca bnh thn ( f,tng HA) Nhng biu hin ton thn:-Ph:+ vim cu thn cp: s ng mui Natri ko theo j n' li c th. N.nhn j natri:. Tn thng cu thn--> Na+ tc lc (.) khi ng thn ti hp thu b.thng.. Tng tit aldosterol th ft.+ Hi chng thn h: do mt protein qua n' tiu--> jm protein mu--> jm p lc keo-->f.Tng HA: tn thng cu thn,ng thn u lm jm dng muqua thn( thiu mu cc b)--> TB` cnh tng tit renin--> tng HA.P.bit f do vim cu thn cp & hi chng thn h v bn cht.Vim cu thn cp: jm c.nng lc ca cu thn.Thn h: c.nng j protein ca cu thn b suy jm + hin tng nhim m tb`ng thn.

Cu 43:T.by cc b.hin ca RLCH glucid, RLCH mui n' khi gan b bnh.Biu hin ca RL chuyn ho Glucid:+ Gim k.nng chuyn ho g` mi hp thu t ng tiu ho,g` tha thnh glycogen d tr.+ Jm k.nng d tr glycogen nn bnh nhn d b h g` mu xa ba n.+ Tng cc sn fm chuyn ho trung jan ca glucid: lactic,acid pyruvic. V gan thiu nng nn k s dng B1 hnh thnh coenzym photpho ho a nhng sn fm trn vo vng Krebs.RL chuyn ho mui-n':


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+ Gan sx fn ln protein huyt tng,protein huyt tng c td j n' (.) lng mch. Protein huyt tng jthot ra ngoi mch mu--> trng thi f thng.+ Trng hp x gan c tng p lc TM ca lm cho p lc thu tnh tng--> n' b y ra ngoi lng mch-hn.+ Gan l c quan duy nht f hu ADH, (.) suy gan ADH b j li lm jm lng n' tiu-->f nng thm. Acng b j li-->j mui-->j n'.Mc d gan ng vai tr "th yu" (.) chuyn ho mui-n' nhng n` khi suynng cng s hnh thnh bng n' cn thy thiu niu, kht,h HA.

Cu 44: Cc hnh thc kh c ca gan & cc b.hin khi RL chc fn chng c.Cc hnh thc kh c ca gan:+ C.nng chng c ca gan c thc hin = 2 fng thc: c nh & thi tr.+ Do tb` nhu m gan & tb` ca t chc lin vng m nhim, cc p.ng ho hc ch do cc tb` nhu m gan nhim.Biu hin khi RL chc fn chng c:+Gim fn hu 1 s hormon:. Kch t sinh dc: suy gan c cc triu chng: teo tinh hon,jn mch,mt kch dc tnh.. Kch t v thng thn: mui, n'-->thiu niu--> f & bng n'.. ADH hormon chng li niu ca tuyn yn k b f hu--> thiu niu,f bg n'c+ GIm k.nng c nh cht mu: cht mu lu hnh (.) mu n` (.) 1 t.gian nht nh,gan cn jm k.nng ckhi b suy( sinh KT trung ho c t & chng li VK).

+ Gim k.nng chuyn cht c thnh cht k c hoc km c = p.ng ho hc:. Oxy ho: phenylbutazon, hexobarbbital.. Kh oxy: chloramphenicol.. thu fn: fethidin. Acetyl ho: sunphonamit.. lin hp: bilirubin t do,amoniac,acid benzoic.

Cu 45:T.by n vng da.Nu n.nhn & c im ca vng da do n.nhn trc gan & sau gan.n vng da: l tnh trng bnh l xy ra khi sc t mt (.) mu cao hn b.thg` & ngm vo da & nim mc.Vng da trc gan: l vng da do tng dung huyt nn Hb c chuyn thnh bilirubin t do qua n`.+ N.nhn: nhim khun (lin cu khun dung huyt,xon khun),KST(st rt),nhim c(phenyl hydrazin,dinitro phenol...) & do truyn nhm nhm mu.+ c im:. bilirubin t do tng cao (.) mu.nhng k c (.) n' tiu v bilirubin t do k tan (.) n'.. Gan b.thg` nn tng cng k.nng kt hp--> bilirubin kt hp tng,urobilinogen & stercobilinogen tng,fmu.Vng da sau gan( vng da do tc mt): mt k xung rut c & vo mu gy vng da,fn trng,n' tiu vng.Cca mt:cholesterol, acid mt tng do mt.+N.nhn: do c hc(si ng mt,giun chui ng mt,u u tu,hch to chn p g` dn mt),vim so,dy cTKTV gy co tht c oddi.+ c im: vng da m,fn trng,n' tiu vng; cholesterol,acid mt & bilirubin kt hp tng.


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Cu 46:T.by cc biu hin v xt No ca suy gan trng din.

Cu 47:T.by n.nhn & cc biu hin xt No ca suy gan cp. N.nhn:+ Nhim c: tt c cc n.nhn lm gan b nhim c nng: phospho,thuc m...+ Nhim khun nng,vim gan do virus.Biu hin:+ Lm sng: Bnh nhn c nhng du hiu nng ngay t u,hnh thnh rt y & nhanh tu theo mc gan: nn,du hiu TK (mt l, ng g, mt ng,ni ln,hnh vi k b.thg`, co jt,hn m),xut huyt di da

rut, ri st tng ln.+ Xt No mu:gluce jm,cholesterol este ho jm n`,amoniac tng cao.Gii fu bnh :nhu m gan b hoi t ton b hoc kiu mi gm,hoi t c cu ni nht l hoi t vngtiu thu.+ tin trin ca bnh: bnh nhn cht ngay sau 5-6 ngy nu suy gan th ti cp vi RL (.) c th nh ctnghim trn sc vt. Nhng thc th ng` bnh cnh fc tp hn n`,tu thuc vo tc nhn tn thng gan no m .hng n cc c quan #: thn,tiu ho lm cho din bin & tin lng bnh # nhau.

Cu 48:T.by biu hin & c ch bnh sinh ca hn m gan.Biu hin hn m gan do suy gan bt u t nhng RLTK: chn tay run ry,p.x tng, thc jm st,m mlp bp,co jt cui cng l hn m.C ch:+ Tng NH3 (.) mu: NH3 c s.xut 7-8g/24h t 2 ngun:ni sinh(kh nhm amin) & ngoi sinh(VK g` ru NH3 (.) mu rt thp(0,02-0,18mg/100ml)nh gan-c quan duy nht chuyn n thnh ure k c: NH3 + NHCO2--> (NH2)2CO + H2O. (.) bnh l x gan NH3 tng ln 0,3mg/100nl & (.) hn m gan 0,54mg/100ml & bit tng cao bnh nhn c RL tiu ho do VK g` rut lm tng NH3 ngoi sinh.+ Tng cc cht dn truyn TK gi: cc cht dn truyn TK gi l cc dn xut bt thg` ca cc cht dndo qu trnh B-hydroxyl ho bi 1 enzym k c hiu ti t chc TK.. Nu s tch lu cc cht dn truyn TK j no--> hi chng tm thn kinh: mt thc,chn tay run l. Nu s tch ngoi vi--> jm trng lc c tiu M,hnh thnh mch tc ngoi vi,jm mu ni tng-gan thn.+ Glucose mu jm,f t chc no,cc sn fm c t ng tiu ho k c gan c nh & thi tr,tnh trng sth.

Cu 49: nu v pitch cc c ch ph. mi loi cho 1 vd-tng p lc thu tnh: nc b y ra khi lng mch nhiu hn lng nc tr v do p lc thm thu keo caC ny c vtr qtrng: ph do tim fi (ph ton than, vng thp), suy tim tri (ph phi), chn p tnh mctc, c thai), ph y mt (cao HA)-gim p lc thm thu keo huyt tng (80% do albumin chi fi): nc c ko ra lng mch nhiu hn nc trthng gp: suy dinh dng, suy gan, x gan, thn h nhim m -tng tnh thm mch: protein thot qua vch mao mch ra jan bo lm p lc thm thu keo 2 bn t trit tnhau do p lc thu tnh t do y nc ra. thng gp: ph do d ng: xhin cc cht gy tng thm thnhcn trng t, (.) vim, (.) f phi-ph do tc bch huyt: tng tnh thm mch gy ph chm chp. thng gp: ph do jun ch, vim bchdi, tc ng bch huyt-ph do tng p lc thm thu: do cc ion quyt nh, c quan ch yu o thi in ji l thn vi s thamaldosterol. thng gp ph do vim thn-mt ca m: lm cho ph xhin sm hay mun, r rt hay ko.vd: ph phi: t chc phi l t chc lnmao mch dy c, thnh mch mng


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Cu 57: k ra 1 s ngnhn gy bnh v nu 3 ri lon c trng ca bnh bcu, hu qu-Ngnhn: do virus, tia x, ho cht ( nhm gy ankin ho), di truyn (yu t tng trng ni sinh hoc ngo-2:+Qu sn: sinh sn mt iu ho, vi s lng ln v k b cc tc nhn iu chnh lm cho ji hn li, xm ln vo tu xng vo hch ngoi vi, vo lch+Lon sn: t chc sinh bch cu da, gan, lch, s k bit ho ca bcu. Nhn to, bt mu kim, dng non+D sn: tb tng gon cui cng nhng k in hnh v c trng cho m sinh ra n m mang nhng nt c#-Hu qu:+Bcu b tung vo mu ngoi vi nhng fn ln l bcu non cha hon chnh lm d b nhim tr+Huyt cu jm sinh gy thiu mu+Jm tiu cu gy xut huyt

Cu 54: Nu v jthch c ch 1 s chung thng c (.) thiu mu do tan mu(S )

-Thng kh: a khng kh t mi trng vo n (.) f nang v ngc li+Ri lon thng kh khi c s thay i p lc, t l ja cc cht (.) lng f nang cng nh th tch kh th qh hp+Cc yu t chi fi:.,Do ko kh th bn ngoi.,B my h hp: ng dn kh trn, di.,Lng ngc: g vo ct sng, gy xng sn.,Tkinh- c: vim c h hp, lit c +Kqu: th nhanh, kh th, nhp th di ra, tm ti nu suy h hpCu 60: K tn cc ngnhn gy ri lon thng kh do thay i ko kh th v c ch,-Bnh ln cao: khi c s thay i p lc ko kh bn ngoi:+C ch: p sut ko kh cng ln cao cng thp, p sut ring fn O2 v CO2 u jm dn (% cc kh k i), jm psut ring fn O2 v O2 (.) f nang+2: c O2 v CO2 (.) mu u jm, bnh cng nng khi cng ln cao, nu c vn ng th lc i km lm rchuyn ho (nhim toan) do sfm chuyn ho ym kh tng ji phng acid lactic-Ngt: do thay i t l % cc cht kh (.) tfn kh th hoc do b ngt, tc b my h hp+C ch: p sut O2 v CO2 qu cao (.) mu gy i O2+: th nhanh, su cho ti khi trung tm h hp b nng cao CO2 lm cho t lit-i O2 do CO: thay i t l % cc cht kh (.) thnh fn kh th

+C ch cnh tranh ca CO v O2 chim Hb lm ko vn chuyn O2-Bnh chung ln: l t su di nc a ln mt nc qu nhanh lm p lc (.) chung jm t ngttan (.) huyt tng s tr li dng kh lm tc mch trn lan (.) ton thn

Cu 63 Trnh by k/n v suy h hp. Nu ng.nhn, biu hin, cch xc nh _Suy h hp l tnh trng chc nng ca h h hp ngoi ko m bo dc yu cu cung cpO2 v o thi CO 2 =cho c th

_Ng.nhn+H hp chu k: l kiu th bt thng, lp i lp li c chu k. VD:kiu th cheyne stolesko di40-60s: th su, th nng, ngng tp thi ri lp li.,tjan mu ln no tng i chm lm trung tm h hp ko phn ng tc thi vi s thayi p sut CO2 v O2 mu m chm chp lch pha., Do s iu ho ngc m tnh tng ln vng kim sot nhp th ngha l s thay dinh CO2, O2 mu lm thay i ln hn v thng kh so vi ngi bnh thng+Tm ti: l tnh trng Hb kh tnh mch(30%) lm da, nim mc, vng ju mao mch dac mu tm nh mu tnh mch. Tm ti l do tr kh CO2 m ko phi do thiu O2. xuthin trog trng hp i O2 hoc bnh a HC, tr tun hon a phng


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+kh th: do tc nghn g h hp( hen, nghn) hoc cm jc c vt nng ngc ln _Biu hin: th gng sc, c s co rt cc c h hp...VCjm, FEV1 jm, RV tng, Tiffeneau jm _Cch xc nh: tin hnh nghim php thm d h hp: o th tch kh lu thng. Dungtch sng =V kh lu thng+ V dung tch ht vo+ V dung tch th ra

Cu64:trnh by cc g RLTK ca chn thng s no

Trong chn thng s no c 4gd:-g 1:sau chn thng c ch lan rng ton v no v di v,ty chn thng m mc v thi gian nhau-g 2: qtrnh c ch chung gim i v hng phn 1 s b phn biu hin bi p 1 s kthch tng, ri lon gia v no v di v c RLTKTV: tit m hi-g 3: nu chn thng k nng cc ri lon mt dn v phc hi h TK theo trnh t ngc li:mt trc thisau.vd:px c k t nhin phc hi sm hn px c k nhn to-g 4: ti ni tn thng ln so kthch vo ni tn thng c th l ngun gc ca cc cn ng kinh sau

CU 65:k tn cc ng/nhn gy RLTK.vai tr ca cc yt TK nh hng ti bnh l TK *cc ng/nhn gy RLTK +ng/nhn bn ngoi:-cc yt vt l:nhit ,phng x,dng in-yt c hc:-yt ha hc:nghin ru,thuc ng,thuc m,-vi sinh vt:nhim khun,lao,bch hu,un vn-virus: bi lit,di-tinh thn:chn thng tm l cp v mn:lo lng,bun phin+ng/nhn bn trong:-thiu oxi no-RL tun hon cc b ti no:x cng mch no,tc mch,u no-RL ni tit v chuyn ha-di truyn: AO

-bnh l MD:bnh t min*vai tr ca cc yt TK nh hng ti bnh l TK ch yu l nhng chn thng tm l cp v mn+lo lng, bun phin tc ng ln h thng tn hiu th nht+px c k: xy dng cm gic nhn thc tc ng ln h thng tn hiu th 2+2 h ny c qh mt thit,qua li vi nhau-h 1:tnh cm t pht lun kim sot h 2 l l tr


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-h 2 km hm h 1 mt cch ng mc+khi 1 trong 2 h km=>RLTm thn-h 1:mnh =>hay xhin bnh histeri-h 2:mnh=>mt mi, n o sngh nhiu nhng xa ri thc t

CU66:tby qlut tng mn cm khi mt TK -c vn v dy TK vn ng ti c vn hnh thnh 1 v vn ng m qtrng l 1 tm vn ng

-khi 1day Tk vn ng ti 1cquan b ct =>rt nhy cm vi acetylcholine v s tng mn cm cng thy mc d k ging c vn-c trn teo khi mt TK nhng p ng cng tng vi acetylcholine v adrenalin-tb cng nh cc si TKc th b cc yt gy bnh lm tn thng=> tb thoi ha v ra v thc bo tiu i,tso hnh thnh v c th ph hy tb v t chc TK khc*qtrnh ph hy ty theo nron:-nron ngoi vi:vn ng=>lit c;cm gic=>mt cgic; tit dch=>ngng; vn mch=>mch k co+nron trung tm:do c lquan vi nhiu nron khc to thnh h thng tng tc ln nhau:c 1cnng chnhth h hip ng or i khng vi nhiu cnng khc-tn thng nron trung tm c 2RL: +RL cnng chnh m Tk ph trch b mt i+RL biu hin gii c chd nhng cnng m trc y b phn tn thng km hm

CU67:pitch qlut tng tnh t ng c bn ca cc nron Tk khi tn thng 1noron trung ng c 2 hin tng:+mt cnng do noron chu trch nhim+gii km hm cc cnng di-trong qtrnh tin ha ca sinh vt,TK ptr t thp ti cao,ctrc tng di hnh thnh trc,ctrc tng trn hthnsau.mi ctrc nh vy c th h t ng v ng gp vo h chungca cp thp phi chu s iu ha h ccao.\


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Cu 68: N cm gic au, p.tich 1 s n.nhn gy auau: l 1 triu chng c bn ca qu trnh bn l ni ln ri lon chc nng v tn thg t chc. Nu au thqu th bn than n cng hay l ng.nhn ca nhiu ri lon khc nhau l thn kinh N.nhn gy au:Cm gic au path sinh do nhng tc nhn phi hoi mnh kch thch ln mt on tkinh (cc th quan), gylung xung ng dn truyn qua tu ln no, qua i th ti v no gy nn cm gic kh chu y.Cm gic au c dn truyn bi 2 loi tkinh:+ loi c g knh to, c v myelin (loi A), c tc dn truyn nhanh (cm gic au tc th)+ loi c g knh nh ko c myelin (loi C) vi tc chm -> cm gic au m nhiu ng.nhn # nhau gy au nh tip xc, nhit . cm gic au ti vim l cc cht ho hc # nhau tmt on tkinh cm hic # nhau l Histamin bradykinin , prostaglandin chng gy au vi nhng liu rnh 10-6 10-8 mg.1931 Van Enlle v Gaddum pht hin ra cht P (Pain) l mt cht dn truyn cm gic au t da n c qu

T. C s cn bng iu ho ca cht P vi cht endorphin ca h thg vin, h khu no, no giaCu70:tby c ch bnh sinh ca x va M:-x va m l tnh trng vch mch dy ln do lng ng cholesterol v lp o trong gy tn thng thoi dng=>lng ng Ca2+=>vim lot,si,huyt khi v hp long mch,gim tnh n hi thnh mch-c ch;ch yu do RL chuyn ha lipoprotein m trong Lp c cholesterol ton phn,cholesterol esteha,photpholipit,triglicerid+da vo trng lng phn t:VLDL,IDL,LDL, HDL+trong LDL:gy x va mchHDL:tng chuyn ha cholesterolLDL:tng ln do 2 c ch:khu phn n tha cht ny, n mc vt nhu cu ti a ca cc tb v s o thi theo g mt khng xu(2)cc tb thiu th th tip nhn cholesterol thng do di truyn+ngoi ra cn c nhiu yu t thun li cho s xhin v tng x va M:thiu VTM C, thiu Thyrosin, gitnh h enzyme heparin-lipase, cc stress,tng tit adrenalin v gim ng huyt ko di, bnh HA cao

Cu 69: Phn loi v phn tch cc th au bnh l:Cc th au bnh l chia thnh cc loi: au su, au c, tng cm gic au, au ni tngau su:s # bit gia au bn ngoi v au su kh khu tr, thg kt hp vi m hi, nn v thay i HAthc nghim gy au su = cch tim nc mui u trg vo di ct mc hay dy chng. Khi au th gy co th

x cc c xung quanh mu km nui dng gy au trong c au li gy co tht mnh hnvng xon bnh l b) au c:Cc c thiu mu nh co ko di thg gy au, khi lu lng mu cung cp tr li th cm gic au cng h Ng ta cho rng khi thiu mu th cc cht Kinin c hnh thnh v gy auLewis cho yu t P hnh thnh khi c co v c mu o thi i, ch khi no mu ko lu thg th mi tch lauc) tng cm gic au:Mt s trg hp bnh l, tnh nhy cm vi au thay i, l tng cm gic au.+ C th l tin pht nh thy vng xung huyt ng mch xung quanh vim, ch cn kh s vo khu vthy au d di. Do vng xung huyt c yu t kho hc c tnh cht tiu m v phng thch cc Kinin g+ th pht sau mt chn thg, ti y ngng au tng v lan c ra 1 vng xung quanhd) au ni tng: Ni tng bnh thg ko gy cm gic au hoc ch cho mt vi cm gic m h nh tc, kh chu do mt s rng b cng ra (d dy, bang quang)Trong ni tng c rt nhiu cm th quan i vi p lc, ho cht, nhng rt t i vi nhit , vi au. vn c nhng th quan vi au trong ni tng khi lm cng cc tng rng


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N.nhn gy au ni tng gin: cng tng rng, co ko cc mc treo, tn thg thanh mc (mng phi, mng b

Cu 73: Nu cch phn loi suy tim:V lm sang: c th chia ra:+ theo mc suy*) 1: tim vn p ng c mi nhu cu cp mu tr nhu cu ti a mc trc suy; II, III v cuiIV nu tim ko cp c lg mu ti thiu theo nhu cu c th+ theo din bin.*) suy cp: t ngt v din bin nhanh, tim ko kp hon thnh cc bin php thch nghi.*) suy mn: dn dn v ko di. tim c thi gian hnh thnh y cc c ch thch nghi-V b tr:+) tim tri: lc cn ln i tun hon, qu ti th tch do mu hoc tht tri qu nhiu+) tim pahi: suy do lc cn phi, do qu ti th tch, do l thng i-tiu tun hon-V chuyn ho:+ Suy tim do gim sn xut nng lg: do thiu oxy trong tbo c tim+ Suy tim do km d tr nng lg do ri lon cn bng K +, Na+ trong tbo c tim v ton thn, nhim acid ti tim dochuyn ho ym kh+ Suy tim do ko s dng c nng lg, do bin i cu trc actin-myosin v ATP-A trong c timV c ch SLB:+ Suy tim do qu ti: do lg mu v tim nhiu hay lc cn qu ln+ Suy tim do bnh l bn thn tim v mch+Suy tim do bnh l ngoi tim mch.*) Suy tim do qu ti th tch, lg mu v tim qu ln.*) Suy tim do qu ti p lc: lc cn tng

Cu 74: Nhng thay i ch tiu hot g ca tim khi tm suyGim cung lg v lu lg: do sc co bp ca tim gimtng th tch mu:*) Tim suy-> tim co bp yu -> ko y mu ra khi tim ht -> li TM -> mu qua thn t -> c/nng lc th-> nc v in gii -> th tch maus tng.*) do thiu mu -> kch thc tu xg -> sx ErythropoietinGim tc chy mu do tim co b yuthay i HA: suy tim -> HA gim v lu lg mu gim, sc co mbp gim, sc cn ngoi vi cng gim, do gv thiu O2 -> HA M gim nhng HA TM tng do tim bp yu mu chy chm -> mu TMCng v hiu sut cu tim gim: do cng sut tim gim lm cho tim phi p nhanh hn, tiu th o2 nhiusut ca tim gim. Bn cnh bin php tng nhp v s dng O2 ghn ch nn tim d suy

Cu 75: Cc yu t nguy c gy x va Mcc yu t nguy c:Thiu Vit C, thyroxin lm chm thoi ho cholesterol+ Gim hot tnh h enzyme hepin lipase tui gi v do di ruyn


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+ Stress lm tng huy g m, tg m huyt ko di.+ tg tit Adrenalin v gim g huyt ko di u lm tg m huyt+ Bnh cao HA.+ tn thg vch mch+ Ni c tc ngc ca HA cao: Cung M ch, ch ng ba m, thnh sau M chc, v tr t di dg ca M+ tg g huyt v T+ bo ph bnh l+ t vn g th lc+ n nhiu m, c bit l m g vt, cc thc n nhiu cholesterol2) Hu qu:+ Mch km bn,+ Lng g mch hp li+ hnh thnh huyt khi ti ni x va+ mch khng

Cu 77:Nu cc bin chng v gii thch c ch hu qu ca vic tng huyt p+bin chng ca HA:-suy tim-x va M-cc bin chng tim no khc

-gim th lc+gii thch:-bin chng tim:tht tri s dn dn ph i do phi thng p lc cao ca ca h Msuy tim tri vi cc hu quca n( h van M ch c nng, lon nhp tim, thiu mu no,thiu mu mch vnh, suy tim phi, ph phsuytim ton b-cao HA to diu kin cho x va pht trin Mv mch, gy xut huyt nhi mu v cc tai bn cp tnh kh-gim th lc do ph n v xut huyt vng mc

Cu 78:nu nh ngha v cc ri lon trong sc:+N:sc l hi chng suy mach cp tinh do nhiu nguyn nhn khc nhau, l tnh trng ri lon su sc vdng hc v chuyn ho, c trng bng suy xp chc nng tun hon khin cc c quan sinh tn ko c cnui dng+c ri lon xy ra trong sc:-huyt g hc: mt nc nhiu, mt muh HA-chuyn ho: ng c ,sc phn v-sc do tim: bnh l tim: vim c tim,bnh van tim ; ngoi mng mch-gim khi lng tun hon: mt mu, mt nc,gim sc co bp ca tim-thiu oxy t chc tim p nhanh, kh th -t.kinh: hn m, au n

Cu 76: Phn loi tng HA, n.nhn, c ch ca tng HAHA bnh thg:+ HA tm thu: 100-139; 140-150: tg HA ti hn; >150: tg HA th s+ HA tm trg: 60-89; 90-94: tg HA ti hn; >95: tg HA thc sPhn loi: Cao HA c chia lm 2 loi+ Nguyn pht: cha r n.nhn, v cn: 90-95%+ Th pht: xc nh c n.nhn. 5% Ng.nhn, c ch ca tng HA+ Cao HA th pht(5-10%)*/X cng M hay x va M:lm gim kh nng n hi ca thnh mch v lm tng sc cn ngoi vi*/thiu mu thn: thiu ovy tc ng ln b my cn cu thntit vo mu rennin tc dng vo angiotensinogen

angiotensin I angiotensin II gy tng HA = cch lm co mch ng thi kch thch thng thn tit aldosgi NA+ gi nctng HA*/Ni tit-u tu thng thn,u ca m a crom: nng catecholamine tng cao trong mu-hi chngconn: thng do u lm tng tit aldosteron nguyn pht Na+ trong c th v nhim kim chuyn ho-hi chng cushing;tng tit glucocorticoid v mineralocorticoidgi Na++/cao HA nguyn pht(90-95%)


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.-tng cung lng tim:lng Na+da vo c th cao hn lng thi ra. h thng rennin-angiotensin,vai tr ca i vi giao cm lm tng catecholaminetng sc co bp ca tim-tng sc cn ca mch ngoi vi: h thng reninangiotnin v h thn kiunh giao cm,thay i mng ngo bo,ph i thnh mch,tc nhn t ni mi,tnh khng insulin v nng insulin huyt

Cu 79: phn bit sc, ngt, tru mach v nguyn nhn, biu hin, c ch1/Sc: */nguyn nhn:-chn thng-mt mu, mt nc-phn v-bng-nhim khun*) biu hin-ri lon vi tun hon: xut huyt, ng mu ni mch lan to-thiu oxy c bit tim v no-RLCH: nhim c, nhim toan, cht t bo*)c ch: sc gin mch mu nhiu mao mchgim khi lng tun hon gy h huyt p, thiu oxy tchc chuyn ho ym khnhim toan, nhim c , cht t bo.2) Ngt: tnh trng bnh l do mt tri gic t ngt trong thi gian ngn*) Ng.nhn: hng phn dy 10, ri lon dn truyn nh tht, lon nhp nhanh*) Biu hin: +) mt tri gic trong thi gian ngn, phn ln t hi phc+) chong vng, xy xm mt my, v m hi, au ngc.+ Bun nn, mt ti nht, ng t gin, th chm*) C ch: do mu ln no t, lm thiu O2 t ngt, mt tri gic.3) Tru mch: *) n.nhn:+ trung tam vn mch b c ch do nhim c, nhim khun v do cc sn phm chuyn ho ym kh+ thay i t th t ngt+ chc tho bng qu nhanh, nhiu*) biu hin: h HA t ngt, c th xung 0

+ tim co bp rng du hiu thiu O2 nghim trng: xy xm mt my, ti mt*) C ch: gin t ngt h tiu m, c bit h tnh mch khi c ch b tr chua kp c tc dng


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Cu 80: trnh by k/n v u nng ni tit v hu qu ca nmt tuyn ni tit u nng l khi tuyn tng cng hot ng v tit ra 1 lng ni tit t ln hn bnc th ko iu chnh cnguyn nhn: ti tuyn v ngoi tuyn-hu qu:+ vi chnh bn than tuyn: t chc tuyn ph i tng sinh to thnh cc u bu,chuyn ho ca t chc rV d: u nng tuyn gip+ vi c quan ch: tng hormonetng hot ng. v d: u nng tuyn tutng tit insulingim nghuyt ; u nng tuyn giptng tit thyroxin tng chuyn ho c bn+ vi tuyn ln cn c nh hng nu lien quan. V d: u nng tuyn v thng thntng titcatecholamine tun yn gim tit ACTHgim hot ng ca tuyn yntuyn thng thn bn lnh b teo

Cu 81:phn bit u nng ti tuyn hay ngoi tuyn cho v d c th v 1 tuyn chn on u nng ngoi cc triu chng lm sang cn da vo cc nghim php thm d, trong nghing c p dng phn bit u nng ti tuyn hay ngoi tuynnguyn l chung: dung 1 tc ng km hm tuyn nh thm d v quan st phn ng ca chng+ u nng ti tuyn:hot ng ca nhu m ko chu s iu ho bnh thng nath nghim (-) cho bit lnghormon ko thay i,duy tr mc cao+ u nng ngoi tuyn: nghim php ng (+) ngha l gim hot ng nu km hm liV d: trc 1 bnh nhn u nng tuyn thng thn phn bit u nng ngoi tuyn hay ti tuyn ta ltm cch ct t s kch thch t tuyn yn bng cch u vo c th 1 lng ln hormone thng thn (lohp) ri theo di :+ nu thng thn vn tit hormone loi t nhinu nng ti tuyn+ nu gim titu nng ngoi tuyn tc u nng tuyn ynCu 82:trnh by v thiu nng ni tit v hu qu ca nthiu nng ni tit l khi tuyn ko tit hoc tit ko lng hormon cn thit cho c th hot ng bnh hu qu:+ tuyn ko hot ng th teo i, t chc x pht trin. v d:thiu nng tuyn thng thn+ c quan dch: gy thay i nht nh c hiu ca bnh cnh lm sang*/nu c quan ch l 1 tuyn th tuyn s teo i. V d: gim kch dc ttuyn sinh dc thiu nngb phnsinh dc km pht trin


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*/nu c quan ch l 1 cht c lng nht nh trong c thmt cn bng cht . V d: glucose huyt tng nthiu insulin, canxi huyt tng nu thiu nng tuyn cn gipCu 88: T.by 2 c bn v cu trc & c.nng ca tb` BC trung tinh,BC i kim,BC i toan,tiu cu (.)MD:Tb` B.cu trung tnh:+ Cu trc: trn b mt tb`c cc th th vi cc Ig(KT),b th--> c vai tr l.kt KN li thc hin c.nthc bo.+ C.nng:. Tiu thc bo c bit cc vim.. Tit ra 1 s yu t ho tan c td iu ho hot ng ca 1 s tb` # ti vim ni KN xm nhp.Tb` B.cu i kim:+ Cu trc: b mt c cc th th dnh cho KT IgE, khi c sn xut ra IgE c gn ngay trn b mt tb` nyi tb` hoc f v tb`,to ra cc cht c hot tnh sinh hc (.) tb`:histamin--> gy fn v,d ng.+ C.nng:. C vai tr quan trng (.) fn v & d ng.. Tit ra 1 s yu t ho ng ng Bcu i toan--> iu ho tc ng MD.Tb` Bcu i toan:+ Cu trc: tng bo c cc ht c hiu a acid cha cc enzym: histaminaza,arylsulfataza.+ C.nng:. iu ho hot ng ca Bcu i kim.

. C kh nng thc bo & gy c i vi u trng ca 1 s KST.Tiu cu:+ Cu trc: l nhng khi bo tng nh.+ C.nng: c n` KT & b th nn n tham ja vo q.trnh ng mu & MD:. Gn b th.. Gn KT (.) q.trnh MD.Cu 105: tr.by cc k/nim v: MD bnh l,qu mn,suy gim MD& bnh t MD?-MD bnh l l nhng tnh trng bnh l do hu qu c a tn thg cu trc & rlon c chhot ng c a h MDMD bnh l nghin cu nhng kha cnh khng bnh thng c a h thng MD-Suy gm MD: tn thng cu trc hay ri lon c ch hot ng c a 1 hay nhiu cu thnhno trong h thng MD;do vy p ng yu ko t yu cu gy hu qu bnh l-Qa mn: L tnh trng bnh l do tng mn cm c hiu ca c th vi cc KN # nhau" l nhng tn thng,rlon c/nng cc c quan do P ca p ng MD c hiu hnhthnh trog c th vi KN"-Bnh t MD: l nhng tnh trang bnh l do p ng MD chng li cc thnh phn bnthn (t KN), gy ra cc tn thng t chc,ri lon c/nng c quanCu 92: Trnh by c ch chng KST v cc bin fp n trnh MD ca chng-c ch:+bo v ko c hiu:KST sau khi xm nhp vo c th theo g da, nim mc, g mu: jun ch, st rt chnfi:., b th hot ho: cc KN KST xut hin l tc nhn hot ho b th theo con g cnh tranh -> li ji KST hp tn cng mng., thc bo: TB c th n cc KST nhng c ch ny l rt yu+c ch bo v c hiu:., p ng MD dch th: tng sx IgE c hiu v tng bch cu i toan, 1 s Ig # c kh nng hot ho b thho KST tng thc bo, TB khi c hot ho cng c kh nng trc tip nut v tiu dit KST, mt s Kcc u ht, ptrin cc t chc x ., MD t bo: TCD4 v cc xitokin ng gp vo vic y li bnh nhng cng c th lm bnh trm trngTCD8 c vai tr bo v (.) st rt-s n trnh cc c ch MD ca KST:+1 s KST tm ch lp ngay bn (.) tb: plasmodium, Toxoplasma,+KST n mnh (.) 1 v bc: amp, jun xon

+KST ngu trang bi 1 lp v bc protein ca c th ch+thay i KN b mt: thay i KN tng gon, thay i lien tc+KST lm jm MDCu 94: k tn v cc hng ro MD t nhin,ptch c dim cu to & c chbv hng ro vt l+Cc hng ro MD t nhin:


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-Hng ro vt l: da,nim mc-Hng ro ho hc: cc ho cht c mt da,nim mc,huyt thanh,dch tit-Hng ro t bo-Hng ro th cht-Vim ko c hiu+c im cu to ca hng ro vt l:

_Da: gm rt nhiu lp tbo.trog lp tbo cng sng ho,lun lun c bong ra & imiNim mc: tuy ch c 1 lp tbo,ngoi tnh n hi nh da,n cn c ph bi 1lp cht nhydo nhng tuyn di nim mc tit ra+C ch bv:-Da: do c im cto c a mnh m da to ra 1 hng ro vl ht sc vng chc vis xm nhp c a VK.Nhng khi da b tn thng rt d c nhim trng .iu chng t vaitr qtrng c a hng ro ny-Nim mc: do cc tbo tuyn di nim mc tit ra c cht nhy,to nn 1 hng ro bvlm cho vt l & cc VK ko bm thng vo c tbo,m s bm ny l kin tin quyt chochg xnhp su hn.+1 s nim mc(mt,ming,ng tit niu) thng xuyn c ra sch bi tit long(ncmt,nc bt,nc tiu)+1s nim mc # bit l nim mc g h hp,li c cc vi nhung mao lun rung ng,ctdng cn li bi mang theo VK & cc vt l,ko cho chng vo f nang & y dn chng rakhi f qun cng px ho & ht hiVi c im cto & vtr c amnh,hng ro vl c coi l tuyn fng ng u tin

Cu 95: Nu tphn tja,cto & c ch bv c a hng ro ho hc+Thnh fn:

Trn da nh c cc cht tit nh acid lactic,acid bo ca m hi & tuyn m di da m cc VK ko tn ti c lu-Ti nim mc cht nhy che ch b mt tbo khi b enzym neuramindase c aVRt tc

ng-Cht nhy ca cc tuyn nh nc mt,nc bt,nc mi,sa...c nhiu lyosom,1loi enymmuranidase c tdng trn v c a 1 s VK.nhng tphn # c a huyt thanh nh bth,protein,fn ng C A,inteferon+Cu to:-Da % nim mc l hng ro u tin ngn cch c th vi mi trng ngoi,c tdng cn trc hc.Ngoi ra,cc hng ro ny cn c tng cng yt ho hc.2 hng ro ny fi hp vinhau to ra 1 tuyn fng ng vng chc u tin-Nhng 1 khi KN vt qua c hng ro da & nim mc th s gp fi hng ro ho hc ngaybn trong c th, l huyt thanh+C ch bv:c ch s ft trin,lan trn & tiu dit VSV-Ngn cn s tc ng c a cc d vt & VSV ln da & nim mc+vtr: qtrng tu theo VSV

Cu 96: Nu tphn tham ja & cc c im c/nng chung c ahng ro tbo+tphn tja: fong f,a dng,loi trc tip tja tiu dit & cc tbo hiu ng-Trc tip: N.E,M,K,NK... dit ngoi tbo & thc bo bn trong-Hiu ng: ni m,tiu cu B,mt,si,biu b,tkinh,mch mu+c im c/nng chung:-C c/nng tiu dit VSV gy bnh,vi tu loi c cch tiu dit # nhau:thc bo,ditngoi,tbo hiu ng-Thc bo vi 3 gon: g gn,g nut,g tiu ho c a cc tbo thc bo+i thc bo: bt ngun t tu xng,fn ho thnh mono bo mu & di tn ti cc mthnh h thng vng ni m+Tiu thc bo: l cc BCu a nhn trung tnh c a mu-Dit ngooi: vi cc tbo nhim khun.Tbo NK l bin th c a lympho bo,nhng ko ck/nng tiu dit cht c (perorin) hu tbo


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-Tbo hiu ng: tng sinh tbo,tng gi bcu ti vim,lm hot ho vim v iu ho,sacha tn thng.

_Kt lun:Nh hng ro tbo bv c th khi nhng tc nhn VSV,tbo u,tbo chaVR,tham ja P vim,bv hu hiu hn

Cu 97: phn loi cc c ch c a hng ro tbotu tng loi tbo m c nhng cch bv c th theo nhng c ch ring

_thc bo: l c ch qtrng nht+vi cc tbo thc bo: bao gm tiu thc bo v i thc bo+qtrnh thc bo bao gm cc gon sau:-gon gn: .cc VSV khi gp tbo thc bo s dnh vo mng tbo nh cc receptor bmt # nhau.cc receptor ny c th l nhng pt trc tip ca thc bo nh cht MBP haycc adhesin hoc thng qua nhng tphn c a b th nh C3,C5 bi cc C3R,C5R sau khinhng cht ny bm trc ln i tng thc bo (VK).S kin i tng thc bo gn voreceptor s khi ng s chuyn thng tin vo bn trong gy nn qtrnh nut v tiu-goan nut: mng tbo b lm vo,cht nguyn sinh s to cc chn gi bao ly VSV,ring kn li to thnh hc "thc bo" (phagosom)-gon tiu: cc ht lysosom tin n gn cc hc thc bo (phagosom),xy ra htng homng,mng lysosom nhp vo cng mng phagosom (gi l phagolysosom).cc cht c troglysosom s vo trog hc tbo tiu dit i tng thc bo.trog cc phagolysosom,VSVs b tiu dit nh 1 lot cc phng tin nh: pH acid,enzym thu phn,polypeptit ditkhun,superoxyt (sn fm c a s bng n xy ho ni tbo

_Dit ngoi: i vi tbo NK +tbo NK l 1 bin th c a lysosom bo,nhng c k/nng tiu dit ko c hiu vi cc tbou,tbo c VR, bng cch p st,tit cht c (peroxyt) hu tbo

_tbo hiu ng: lm hot ho vim,tng sinh tbo,tng gi bch cu ti vim,iu ho,sacha tn thng

Kt lun: Nh vy hng ro tbo ng vtr rt qtrng MD t nhinCu 98: ptch mi qh c a cc yt bo v trog MD t nhin: hng ro hohc,tbo,th cht trog bo v c th-Cc cht ho trong c th c trog da (acid lactic,acid bo c a tuyn m hi & tuyn m d-i da);ti nim mc (cht nhy,dch tit);trog huyt thanh (b th,interferon); c tdng cch s pht trin,lan trn & tiu dit VK -Ngoi ra,cc cht ho hc cn c trog 1s tbo,cht ho hc trog lysosome,perforin trogtbo NK;cc cht c trog hc thc bo,histamin,inteleukin-1,interferon c a i thc bo+Cc cht trog lysosome c tdng tiu ho i tng thc bo+perforin c tit bi tbo NK c tdng dit ko c hiu tbo u,tbo c VR+Ngoi ra,1 s cht trog phagolysosom khi gii fng khi tbo c th lm tng p vimcp,tng tnh thm thnh mch,tng gi bch cu ti vim-Bch cu cn gii fng cht st ni sinh lm tng thc bo,gii fng histamin c tdng hotho b th,kthch chuyn ho mng tbo-i thc bo tit interleukin-1 v interferon l nhng cytokin c tdng khuych i p tich & ton thn-Nh vy,cc cht ho hc v tbo c a hng ro ho hc & hng ro tbo cng hp tc vinhau;cc cht ho hc lm tng qtrnh vim,tng tbo u,tbo c VR.gup bv c th quaMD t nhin-Hng ro th cht l tng hp tt c cc c im hnh thi & c/nng c a c th trc ytxm nhp;lm cho c th ny,loi ny nhy cm hoc t,nhiu khng vi s xm nhpca 1 loi VSV no .trog ,hng ro ho hc & hng ro tbo cng ng gp 1 fntrong hng ro th cht.-S kt hp ca 3 hng ro trn c tdng bv c th tt hn.Ngoi ra,qtrnh MD tnhin cn khi ng MD thu cCu 99: ptch mi qh c a cc yt bv t nhin (thc bo,b th) vi bv chiu-Tbo thc bo c c/nng trnh din KN cho cc tbo min dch #.nu hin tng thc bo


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l 1 fn ca MD ko c hiu th ng thi n cng l bc khi u c a MD chiu.trog MD c hiu,i thc bo c c/nng nhn din bng x l & trnh din KN.Vnhng thng tin v KN s c truyn cho cc lympho bo c tr ti nhng hch gn khu vcKN xm nhp;cc sn phm ging ho sau thc bo c a KN li c da ra ngoi mng kt hpgia phn t MCH 2 trnh din sphm vi cc tbo c thm quyn min dch#.Nhng lympho bo tham gia MD ln u;nhng lympho c mn cm( c tipxc vi KN) s sn xut ra KTh chng li KN ;c th l KT dch th hoc KT tbo+Khj P vim c hiu xy ra,khi KN-KT u di dng ho tan th s hnh thnh fc hpMD.fc hp ny s c cc i thc bo(TB) n qua tng tc gi KT & b th vi cc receptordc hiu trn b mt TB.TB cn dn nhng t chc & tbo cht+1 s lymphokin c tdng tp trung & hot ho cc TB,thu ht bch cu n nhn & anhn,tng cng ti vim-Khi P KN-KT xy ra,s hot ho b th,lm tan Tbo KN (VK,KST,nm,Tbo ghp...);tng c-ng kt dnh,tng qtrnh thc bo,tng p vim;C3a,C5a c tdng gy co c trn thnhmch,c tdng tng tnh thm thnh mch;C5a cn hp dn & tp trung bch cu anhn,trung tnh ti vim+C3b cn bm trn 1 s nhm lympho T & B,hot ho chngNgoi ra,s hot ho cn c th xy ra theo con ng cnh;KN c th t hot ho b th-S hot ho b th gip cho mu nhanh chng thi fc hp MD.theo con dng c inngn cn fc hp MD ln ln v kch thc.theo con ng th 2 gip fc hp MD d ho tan,khlng ng nn t gy hqu bnh lCu 103: k tn cc yt b th,th t tham gia hot ho c a chng 2 con ngc in *Cc yt b th:-tphn:+ theo con ng c in: C1q,C1r,C1s,C2,C3,C4,C5,C6,C7,C8,C9.+theo con ng thay fin: B,D,P, cc yt iu ho-Nng cc cht trog huyt tng 0,025-1,4mg/ml*Th t tham gia hot h c a chng:-Con ng c in:+Xy ra sau khi KN kt hp vi KT IgM,IgG1,IgG2,IgG3+Vi m hnh thc nghim u tin nghin cu hot ho b th ng c in: gm KN l

HC cu- vit tt E: ErythrocyteKT chng HC cu vt tt A: anti bodyKhi kt hp vi KN;fn Fc ca KT IgM & IgG thay i cu hnh,lm bc l 1 v tr m C1q cth gn vo;m mn cho qtrnh hot ho+Sau l s hot ho C1C1 gm 3 tphn: C1q,C1r,C1s-C1q gm 6 tiu n v,c cu hnh # nh 1 b hoa sen 6 chic m cung l 6 chuipeptid xon nhau 3 chui mt,tn cng C, ni gn vo Fc.Khi gn vo KT,chng c th kthp t nht 2 pt Ig l iu kin P tip tc,nu cc pt Ig qu xa nhau th hot hoCA ko xy ra.Vi IgM lun xy ra s hot ho b th.Tip ,C1r,C1s s gn vo C1q. 2PT C1r & 2 pt C1s s lin kt vi nhau thnh nhm,gn vo cung c a C1q thnh phc hpC1qrs,vi s c mt c a Can xiEA + C1q EAC1qEAC1q + C1rC1s EAC1qrs( vit tt EAC1s)-Tip theo l s hot ho C4 & C2:EAC1s + C4 EAC1,4bCu 106: Tr.by c ch bnh sinh c a qu mn tp 1,K tn & m t biu hinbnh l lm sng tiu biu cho qu mn tp 1?-Qa mn tp 1: tn gi phn v trn sc vt,bnh d ng c c a di truyn( ngi)-C ch bnh sinh:.Giai on mn cm: KN( bt k, t nhin) mn cm,kch thch c th sinh KT IgE lm hotho Mast, BC i kim do c IgE-Receptor.Gon phn v : KN +KT(IgE) hot ho Mast,Basophil hot cht trung gian(histamin,serotonin,leucotrien,NAF,EAF,PAF) tc ng ln Receptors (mch mu,ctrn,no) triu chng: co c trn, gin mch;tng tnh thm mch,tng tit).G.on gii mn cm: sau phn v xy ra,a KN c hiu vo ko xy ra phn v naKN trc kt hp ht vi IgE c nh-Cc biu hin lm sng:


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.Ton thn: Sc phn v ( do thuc,huyt thanh,sa): tt HA nhanh,co tht c trn ( khth,a vi,nga ton thn,ht hong,au u e do t vong nu ko cu cha kpthi,ng cch.Biu hin khu tr cc c quan: +Hen ph qun+Vim mi d ng+Vim da d ng (eczema)+My ay+Ph Quincke+Vim kt mc mi

Cu 109: M t biu hin c trng,c ch & nu 1 s vd lm sng c a qu mntp 4?Qa mn tp 4: qu mn chm.xut hin sau 12h k t khi KN vo c th ln 21.Biu hin lm sng:-P Mantoux: da,sn cng,phng,c th lot-P bong mnh ght-Vim da do tip xc-H/C Lyell-Stevenson-P to u ht trog bnh fong,lao-Vim da do tip xc( eczema): da ,dy,nga,c mn li ti,phng d v

2.c ch: _giai on mm cm: KN vo da, phi lympho T mm cm( hot ho) _giai an qu mm: KN vo ln 2 phn ng vi T mm cm titlymphokines( MIF,MAF,IFN...) vim c hiu kiu mun, u ht do thm nhim t.bo nnhn, tn thng t chc khu tr3. v d:

_qu mm kiu Tubeculin: to nn nhng nt sn cng, sng , c th lot _qu mm do txc: c th mm cm vi 1 KN, sau c dp tip xc vi KN quada, th ti ni tip xc s xut hin nt chm, da dy ln rt nga, b mt c nhngmn phng nh li ti, d v, to c hi cho nhim khun th pht, KN gy bnh

Cu 107: Tr.by c ch bnh sinh c

a qu mn tp 2.-Qa mn tp 2:bnh l c tbo ph thuc KT-C ch bnh sinh:.G.on mn cm: KN tbo mu,hapten(thuc) KT(IgG,IgM).G.on qu mn: KN + KT CA(c in) tan tbo KN nh HC,BC,tiu cu C3a,C5a tng tnh thm mch,hot ho kinin,gin mch HAh,sc,vim,thc bo.-Biu hin lm sng:+tai bin do truyn nhm nhm mu h: ABO: cn tan mu cp,c th sc,v niu-Vng da tan mu tr s sinh do # bit Rh gia m & con (m Rh-,con Rh+)-Thiu mu tan mu,gim BC do thuc;do t min dch-Bong mnh ghp ti cp,bnh nhc c,bnh thn c t KT chng mng c bn-Thc nghim in hnh l th nghim truyn mu # loi: Sc xut hin y khi ctruen 20-30ml mu # loi(th,ln,ngi ) cho ch.Huyt tng d sm,hematocrit gim do tanhng cu.C thot huyt tng,gim bch cu c bit l BC trung tnh & i toan,mu trnn kh ng, hot tnh b th gim r

Cu 108: Tr.by c ch bnh sinh c a qu mn tp 3.?-QM tp 3: bnh do fc hp MD(PHMD)-C ch bnh sinh:.G.on mn cm: hinh thnh KT (IgG,IgM,IgA vn t).G.on QM: KN + KT = PHMD lu hnh lng ng cc c quan hot ho C A ti ch vim dc hiu thc bo tng tinh thm mch,ten thng ni mc & c quan-Biu hin lm sng:+Bnh huyt thanh: st,ni hch,au khp,protein niu:sau tim huyt thanh iu tr 1-vi tun+Vim cu thn,thp tim sau nhim trng+Vim mch mu d ng+Vim thn,mch mu do thuc


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+Tn thng da trog bnh phong+Vim khp dng thp,lupus ban

_ v d:+Bnh huyt thanh: c triu trng st, pht ban, vim cc khp, protein niu, sau khi timhuyt thanh iu tr 1 n vi tun. do khi huyt thanh vo c th ln th 2 lm b thv khng th tt thp phc hp min dch tng ln, s li ko b th, bch cu, tiu cugy vim+vim cu thn, vim tim sau nhim trng: khi vim thn: st, au lng, nc tiu c protein,bch cu, tr, dn dn ph do i t. nu din bin cp thn to, cng, sng, xut huyt, vith thy KN lin cu, KT' chng lin cuCu 110: nu 1 s bnh l tiu biu i km vi suy jm MD bm sinh, nu c im c trng v MD hchng _Thiu nng MD dng T: bnh l tiu biu l hi chng Di George+Hi chng Di George hay jm sn tuyn c lm cho dng lympho T ko th trng thnh v bit ho c ns lng v chc nng lympho T mu ngoi vi, hch bch huyt v lch.Nhng s lng lympho B,glob b mt mu ngoi vi li tng cao v vy tr b jm MD t bo, d b vsv k sinh ni bo: nm candidalbicans...+Ngoi ra cn hi chng thiu IL-12R, hi chng tng IgM cng dn n suy jm MD t bo do cc vi rt,khun k sinh ni bo _Thiu nng MD dng B: d b nhim cc vi khun sinh m( ph cu, lin cu...) xy ra b my h hp

xoang mng no, nhim 1 s vi rt( bi lit) KST ng rut( Giardia)+Tiu biu l bnh Bruton: bnh di truyn theo th ln nhim sc th X do vy ch xut hin con trai. Dho c lympho B nn jm lympho B trong mu, hch, c th ko pht hin c, jm nng Ig huyt thanh, MDth, d nhim VK ngoi bo c bit h thng h hp, cc hch bch huyt ko c tng bo v trung t+ngoi ra cn b thiu nng Isotyp globulin MD chn lc. Thiu nng IgA, IgM, IgG u ko bit ho c lym _Thiu nng MD phc hp: c B v T+Dn n bnh SGMD phi hp nng, c trng bi cc ri lon qu trnh cc lympho B, T. nng n lySGMD+Hi chng Wiskott-Aldrich: c im lm sng ni bt l eczema, hay chy mu, jm tiu cu, thng ttrc 10 tui+Hi chng Ataxia telangiectasia: Tht iu gin mch , c trng bi dng i bt bnh thng, d dng mch m _Thiu nng MD ko c hiu:jm b th gy cc bnh Lupus ban , vim cu thn, nhim VK sinh m+Jm kh nng thc bo: u ht mn tnh+jm kt dnh bch cu: thng biu hin= tng t nhim khun 1 nm ti i ti li+Hi chng JobCu 111: Trnh by k/n v suy jm MD (SGMD) mc phi v nu cc ng.nhn1.Khi nim: thiu nng MD mc phi hay th pht, rt phc tp l hu qu ca nhiu qu trnh bnh l ndng...nhim khun, K, sau iu tr thuc c ch MD... ng ch l cc bnh thiu nng MD do cc t bo cthm quyn MD b nhim khun, c bit l cc vi rt gy SGMD ngi2.Cc ng.nhn SGMD mc phi: _Do nhim vi rt HIV: VR HIV l ARN virus c men sao chp ngc, k sinh trong t bo lympho T h tr, bo( nhng t bo c CD4 trn mng t bo l th th HIV xm nhp)+sau khi xm nhp t bo ch, n nhn ln ri chui ra khi t bo, ph hu t bo TCD4

+Do jm st nng s lng v chc nng ca CD4, tin trin trong nhiu nm( 8 n 10 nm). V Th liu ho h tr cc MD t bo v MD dch th, sau l chuyn sang giai on AIDS v cht _Do suy dinh dng:+ng.nhn: do thiu n c v cht lng v s lng, do bnh l ng tiu ho, nhim khun, jm kh nng tnghp, tng tiu th bnh gan, thn, st, K, bnh mn tnh hoc mt ra ngoi qua l d+c im: thiu cht dinh dng lm cho cc c quan, m, t bo chu trch nhm v MD s b suy jmlng, cht lng+tuyn c v hch bch huyt b suy thoi, teo nh+ jm r s lng v chc nng lympho bo T, jm MD, jm phn ng qu mn chm+s lng lympho jm mu ngoi vi, i thc bo v bch cu ht jm kh nng thc bo+hm lng b th ton phn jm r rt, cc thnh phn bo tng cng jm, nhiu nht l C3+MD dch th t nh hng, s lng lympho B+ hm lng cc globulin MD t thay i3. Cc nguyn nhn #: do tn thng h MD bi ho cht, thuc, tia x. c tnh ho h lympho.Nhim khunKST,nm, n bo,vi rt( si,HIV) _do thiu nguyn liu tn to,thiu n, suy dinh dng, bng _do thuc c ch MD: thiopurin, corticoid, huyt thanh chng lympho boCu 112: Phn tch nhng c trng ca suy gim MD(SGMD) do nhim HIV-AIDS?


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Tbo T chng li cc t KN cng gp nhiu bnh t min.Chng hot ng ring r hoc kt hp vi Kk ra 1 s vd sau :Vim teo d dy (a n thiu m do thiu vtamin B12 )Vim gan mn t min.Vim tuyn gip Hashimoto.Vim no t min thc nghm, v tinh trng thc nghim .....4.C ch khuych i:S khuyn i cc tn thng trog bnh t min cng tng t nh trog qu mn.Tn thng nguyn ft fc hp MD hay tbo T t P c th c m rng bng vai t b th,cc enzym hu hoi ca bch cu a lymphokin.Ngi ta thy IL-1,IL-6 v TNF c tdng gy tn thng rt mnh trog vim a khp dng thCu 115: Trnh by cu trc & c/nng ca phn t TCR trog p ng mn dch tbo (MD TB )?Cu trc:TCR- T cell receptor l phn t c c/nng nhn bit KN 1 cch c hiu trn b mt cc tbo TCu trc l phn t glycoprotein c 2 chui polypeptid & hoc & Trng lng phn t 40 000 - 50 000D , gn vi CD3 thnh fc hpCu trc kiu tng t cc chui ca vng Ig : vng C & vng V+phn hng nh C c u tn l - COOH,+ phn thay i V c u tn cng l -NH2.Vng V lin quan n tnh c hiu ca TCR khi gn vi KN, fn CDR1,CDR2,CDR3 ( complement determinant region )C vng xuyn mng ngn

2.Chc nng: Nhn bit KN trn b mt tbo trnh din KN, lin quan n tnh c hiu ca TCR & KN , & trn tbo con loi tr KNT ng ng lien kt to ra tn hiu hot ho tbo, iu ho c/nng MDCu 116: M t cc c im cu to v chc nng ca mt s loi t bo lympho T tham ja vo MD tDi nhm cc t bo trc tip thc hin chc nng MD t bo _TDTH : l phn nhnh ca T cng c CD4 trong cu trc+TDTH vi CD4 cng c kh nng nhn bit KN ngoi lai,do MCH(II) gii thiu+TDTH c hot ho sn xut ra cc lymphokin ring,c tdng ch yu l thu ht i thc bo (TB) ti.Chl tbo hiu ng trc tip loi tr KN.-Cc lymphokine ch yu ca TDTH l:+MIF: yu t c ch TB.do TB tp trung dy c ti vim+MAF: yu r hot ho TB lm TB hot ho mnh-Do vy vm c TTDH to ra xy ra chm,tin trin mn tnh,tp trung dy c lympho bo, TB,rt t Bcu anhn.Cch to vim ny c hiu qu loi tr cc VK ni bo-TDTH c k/nng gy qu mn chm khi vim ti hch _Tc ( lympho gy c tbo) c phn t CD8+C k/nng nhn bit KN ni sinh do c pt CD8 c th gn kt c hiu vi phn t MHC(I),do vy Tc ckin tip cn vi mnh KN do MHC I trnh ra b mt tbo+Chng li cc tbo c mang KN ni sinh tc l hnh thnh t trog ni bo.Tbo nhim VR,1s VK, n bo c KNgia nhp ni bo hoc chng li cc tbo b K ho.Ngoi ra, n cng chng c cc tbo ghp d gen2.Di nhm iu ho MD _Th c CD4 trog cu trc c c/nng iu ho & chi fi MD

+ Nhn bit KN ngoi sinh do c phn t CD4 c th gn c hiu vi phn t MHC II.Do vy T h c icn vi mnh KN do MHC II ra b mt tbo (TB)+T h chi fi ton b cc hot ng hiu ng, tc l hot ng ca cc tbo MD k c chc nng trc tip loi trvd nh s sn xut KTh ( ca tbo B),vai tr gy c ca Tc & vtr gy vim ca TDHT..Do nh Thtit ra cc interleukin thch hp cho s sn sinh mc ca cc tbo hiu ng,gip cho chng hot ho loi tr KN+S hot ho Th s c kim sot nh chnh cc sn phm & hu qu tbo hiu ng _Ts c CD8 trog tuyt i i s trng hp c c/nng kim sot MD+ c ch loi tr KN khi P ny t ra qu mnh+Ngoi ra,n cn km hm sut i nhng qun th(dng) Th "t P" tc l nhng Th c k/nng chng lichnh c th ch.Nh vy c th ko mc nhiu bnh t min-Th c : CD4,CD2,CD3.CD5.CD7-Tc c: CD8,CD2,CD3,CD5.CD7Cu 117:k tn,nu bn cht & c/nng ca 1 s phn t lymphokin? _k tn: lymphokin bao gm cc interleukin( IL) v MTF(yu t c ch di tn i thc bo) , MAF(yu t i thc bo), MF( yu t gay cc dng lympho bo, NIF( yu t c ch di tn bch cu ht trung tnh), CSkch thch t bo gc thnh dng v n bo), TNF,( yu t hoi t), IFN(c ch tc dng ca virus), v


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interleukin(IL) nh IL-1,; IL-2,3,4,5,...c tc dng hot ha & pht trin nhiu qun th t bo _bn cht: lymphokin l nhng cht tit ra t T hot ho c bn cht l cc peptid trng lng phn t thnng cao, tc dng hp, ngn hn+c ch thng qua receptor, thay i C' ho ni bo _chc nng: kch thch bit ho tng sinh t bo MD: IL-1, IL-2, IL-4, GF+gy vim, ho hng ng thc bo: IL-1, MIF, NIF, MAF, IFN, CF+gy t bo: TNF, lymphotoxin,+tham ja iu ho MD: IF, RF

Cu 119: Lit k cc yu t tham ja kim sot v iu ho MD v phn tch vai tr iu ho MD ca Ktham ja iu ho v kim sot MD c cc yu t nh KN, KT, t bo(Th, Ts), mng li idiodyp-khng idiocytokin. Bn cch yu t di truyn, TK- ni tit cng ng gp 1 phn vo qu trnh iu ho v kim sMDPhn tch vai tr iu ho MD ca KN _Cc KN l l cc tn hiu u tin gy hot ho t bo lympho. Bn cht KN c nh hng n loi cng ca p ng xy ra _cc KN # nhau v cu trc ho hc kch thch cc loi p ng khc nhau+cc KN polysarcarid v lypit ko gy c MD t bo+cc KN protein gy c MD dch th v t bo _Liu lng KN tip xc c nh hng n cng p ng vi KN . Cc liu rt ln hay khi tim n

liu KN nh thng gy c ch _MD i vi 1 KN nht nh thay i tu ng vo ca KN . Khi a theo ng di da thng lMD, khi a theo ng tim & ng ung thng ko p ng l do dung th ca t bo T, B hay do kchcc Ts c hiu _Cng sn xut cc KT jm khi nng KN jm. Khi mn cm, cc t bo c hiu KN tng, cc thay cc KT s loi b KN sau p ng jm dn v tt c khi cc KN b loi b hon ton sn sng phvi cc nhim khun mi. Nu mt c ch ny c th s trn ngp cc clon t bo MD c hiu hay snchng

Cu122: MD ch ng bng vaccine & MD th ng: cc loi,phm vi, sng dng?1.MD ch ng:Gm: vaccine cht,vaccine sng gim c lc,vaccine di v,vaccine ti t hp DNA-Phm vi ng dng: p dung cho mi i tng c nguy c mc 1 bnh no m cha c MD chng1.MD th ng: -Gm:+Huyt thanh # loi.vd: khng huyt thanh chng c rn+ Huyt thanh cng loi: n gi hoc a gi.vd: -globulin MD+ Kth n dng-Phm vi ng dng:+suy gim MD bm sinh+ Nhim khun nng : bch hu,un vn+ nhim vi rt: vim gan,vim no, cm

+ ng th+ bnh t MD

Cu 120: Trnh by c ch v vai tr iu ho MD ca yu t KT v tb1.yu t KT _vai tr: cc KT c sn xut khi c kch thch KN c kh nng c ch cc p ng sinh KT tip theo vi c _C ch : + Thanh lc KN: hin tng thc bo cc phc hp MD, KT trung ho KN, nn loi b c kch tng cho MD+KT phong b cc epitop KN, ko cho cc epitop tip cc vi sIg trn t bo B, ko hot ho c t bo B+cc KT khi gn vi th th Fc trn t bo B s c ch trc tip s hot ho ca t bo B+cc KT c th cm ng 1 mng li idiotip-antiidiotip trong iu ho MD2.Mng li idiotip-antiidiotip trong iu ho MD _ chng 1KN c th sinh ra KT( 1) (idiotip). Nhng KT( 1) li c vng cc k thay i, l vi c th. DKT( 2) chng li, KT( 2) l KT antiidiotip. Vai tr KT antiidiotip c th hoc tng cng hoc c ch M _c ch: do antiidiotip c th gn c hiu vi cc idiotip trn t bo MD. Khi nng anti idiotip tng catc dng c ch MD, dp tt MD


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Ts( T c ch) c ch qu trnh MD khi MD y . Ngoi ra Ts cn c ch MD vi cc t Kc s tip cc vi cc t bo lympho non trong qu trnh bit ho _c ch: do t bo cm ng c ch khi g s hot ho ca Ts. Do ThCD4+. Ts ko c cm ng khi ticc liu KN ln hay cc hapten a vo ko c ph cht hay bng ng tnh mch+ Ts c CD8+ c th gn vi KN dng nguyn u khi thiu APC v thiu MHC. Do n c th c ch c khi MD xy ra cha y ( c th cha xy ra)+tc dng c ch thng qua ncht tit ca n( yu t c ch). Yu t c ch ko c tnh c hiu KN, l chot ho, tranh ginh phc hp KN- phn t MHC trn cc APC ca cc t bo T #Th c vai tr cm ng c ch (Ts), h tr MD chi phi ton b cc hot ng hiu ng ( tc hot ngMD) _c ch: Th c th tit ra cc interleukin thch hp, trc ht l IL2, IL4,IL6, gip cho s sinh sn nh m bo hiu ng, gip chng hot ho mc loi tr KN. Th s c kim sot( km hm hoc tng cngcc sn phm v hu qu ca t bo hiu ng: KT, TNFCu121: Khi nim tr liu MD cc phng thc chnh ca tr liu MD & mc ch ca cc phng thc 1.K/nim: Tr liu MD l cc bin fp can thip ca y t hc da trn hiu bit ca MD hc p dng vo phng & cha bnh cho ngi, vt nui.2.Cc phng thc: 4 phng thc:-MD ch ng: a KN ko gy bnh vo c th t trc gy ra trog c th sng 1 ch ng ca h tnhm ch ng ngn chn,tiu dit VSV gy bnh xm nhp sau -MD th ng: a vo c th ngi mc bnh nhim trng nng hoc suy gim MD m cha c MD ch

no 1 loi ch phm huyt thanh t ngi hoc ng vt cha KTh dc hiu a gi hoc n gi c v tc khc khi cn cha khi hay mang li s thuyn gim 1 bnh ang ptrin (vim gan cp,bch hu c phng 1 bnh ang chuyn thnh dch ( cm,vim no)Kch thch, iu ha MD: b sung cc yu t sinh hc,t nhin, nhn to, tham gia trong chui iu ha D( cht iu bin MD) lm tng hoc gim ng thi tng cng cc hot ng chung ca h MDVD: BCG, cht cm ng NF, cytokine-c ch MD: km hm s hinh thnh MD iu ha ca c th bng cch tdng hn ch yu t tham gia Vd: corticoid c ch trc tip cc tbo lumpho, ngn cn thoai ha interleukin 2 l cht tng cng hot NK & lympho Tc.Gim bch cu toan tnh,,tng bch cu trung tnh,gim mt ht cc tbo kim & gim bmuCu 123: Cc phng thc tr liu MD bng cht KTH MD : ngun gc, bn cht.tdng,phm vi, ng dngun gc:+t VK: vd: Biostin t klebsiella, BCG, ni c t ca VK nh LPS+T tuyn c: vd: hocmn tuyn c,thymopentin+ Cht ti t hp do cng ngh gen: vd cc chtcm ng interferon, cytokin ti t hp Ngoi ra chng c th c chit sut t nm,tho mc ,ngun gc ni sinh-Bn cht: peptid,protein,polysacharid-Tc dng:+Tng sc khng MD ko iu ha+Tng hiu qu bv ca vaccine+ Kth MD: tng tng tc gia lumpho & i thc bo, Kth sn xut IL-1,TNF, tng tng hp interferonnng ca NK ,tng tng hp Kth c/nng i thc bo-Phm vi ng dng:

+bnh nhim trng mn tnh dai dng+ bnh t MD,bnh c suy gim MD ( nh VR, suy dinh dng )+ng thCu 124: Cc bin php c ch MD: ngun gc,bn cht,phm vi ng dung,tdng-ngun gc: phong ph, c tng hp trog hay ngoi c thvd:+ tuyn v thng thn > cortisol+ thuc c ch MD : aziathioprrin,methotrat-Bn cht: l cc cht ha hc,sinh hc,tia x,chit xut t thc vt-Tdung:+ gim c/nng ca i thc bo,gim sxut IL-1,TNF+c ch cc lympho,ngn cn tng hp interleukin-2 cht lm tng hot ng ca NK & lympho Tc+ gim bch cu toan tinh,gim b th+ c ch phn bo phm vi ng dng:+ chng vim: vd: thuc seroid= bnh tc min+ ghp tng+ ng thCu 125: khi nim ghp v cc P thi ghp:


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1, K/N: ghp m v c quan l 1 can thip sinh hc, nhn to, iu tr tm thi or lu di cho cc trn hpnhn b mt chc nng ca m, c quan no 2, phn loai: 4 loi:-ghp cng gen:mnh ghp c trao i gia 2 c th ging nhau hon ton vdi truyn.vd: 2anh em sinh trng or cc c th v cng dng thun khit.-ghp khc gen cung loi:n ghp c trao i, gia 2 c th cng lao nhng khc nhau v di truyn-ghp khc lao:m ghp c trao i gia 2 c th thuc 2 loi khc nhau-ghp t thn m ghp t v tr ny ghp ln v tr khc trong cng 1 c th vd: ly da ni lnh ghp vo n3,cc P thai ghp:c 3 lao P thi ghp tnh theo tg t lc ghp n lc c bh thi b-P ti cp: xut hin sau vi pht dn vi ngy sau ghp do c th c sn KT chng li KN ca c th cghp tim, thn ca ng nh mu AB chon g nhm mu O.Trong P ti cp , cc TB ni mac mch mu m ghp b cc KT v b th ph hy gy tn thng smtrng, lan rng, tc mch lan rng trong mnh ghp-P cp xut hin cui tun th 1 sau ghp nhng ko ko di n vi tun ngay c bnh nhn c dc ch MD mnh,tn thng ch yu l TB ni mc mch mu do c 2 c ch dch th v TB. vd trung gian TB gy t thng thn ghp biu hin bngP st, i t,suy thn,c th suy yu.-P mn tnh: xut hin sau nhiu thng,thng kt hp vi s gim dn c/nng ca m ghp.Vd: ghphin chnh ca P mn tnh l protein niu,cao huyt p, xt nghim m hc thy ni mc mch mu tncc ng mch nh.Cu 126: Nu bng chng v vai tr ca cc PMD trong thi b m gp?

Tin hnh ghp da trn chut bnh thng thy bong mnh ghp ra sm hn nhng ln ghp sau.cho thyc th ngy cng mnh hnTnh iu ha ca m ghp quyt nh hin tng bong mnh ghp sm: chut A -> chut B ( 1) -> 7 ngychut A-> chut B -> < 7 ngyTruyn th ng k/nng bong mnh ghp sm bng cch truyn huyt thanh ( hoc lympho) ca c th nhiu ln cho c th mi cng dng thun chng th vn xy ra hin tng thi b m ghp. _ vic thi b m ghp do tbo lympho thc hin nn hin tng bong mnh ghp c c ch MD c hiu-KN c trog mnh ghp quyt nh thi gian thi b m ghp c gi l KN ghp- ngi h thng KN l HLA ( k/nng ha hp t chc) thuc KN ha hp m MHC. Cc KN trog hHLA chia thnh 2 lp I & II+lp I : c mt trn hu ht cc tbo c nhn hot ng nh 1 v nhn dng, quyt nh tnh c hiu trogcng bi cc Tc gy c tbo nhim VR, tbo ng th, tbo alen # loi+Lp II: ch c cc tbo MD: lympho B, tbo tuyn c, tbo ni mc & lympho T hot ha -> khi ng m ghp chng tc ch, kch thch tng sinh cc lympho T # gen cng loiCu 127: C ch MD trog thi b m ghp?P thi b m ghp xy ra bi h MD ca c th nhn,xy ra sm hay mun ph thuc:+ Mc ko ph hp KN HLA ca c th cho & c th nhn+ C th ngi nhn c mn cm trc vi KN ph hp t chc ca c th cho hay ko+ Mc MD ca c th nhnVi c/nng l tbo MD, tbo ni mc m ghp tp trung cc tbo MD ca ngi nhn vo mnh ghp & triKN cho chng nhn din.Trn tbo ni mc c cc protein dnh c hiu trc ht l nhm selectin c k/nng bm dnh cc bch cuchng di chuyn chm li, tng thi gian tip xc gia cc bch cu ca c th nhn vi tbo nim mc c

ghp.Tip theo l cc protein dnh thuc gia nh Ig,tng cng bm dnh gia cc tbo nim mc & bch ccho tbo MD dnh vo tbo nim mc bn vng.Mt # cc cytokine ( IL-1,IL-2,IL-8,TNF,.) lm tng tnh thm gip tbo MD d dng di chuyn qua thnhvo lp di ni m _ tbo i thc bo, tbo dendrritic, tbo ni mc ca mnh ghp c k/nng gii thiu KN cho lympho T cnhn lm tng sinh lympho T.kt qu: gy nn MD ca coe th nhn m hu qu l cc tbo Tc & KT mn cm vi KN ca m ghng vo tbo ni mc nh 1 tbo ch gy ra s tn thng mch mu trong qu trnh thi ghp ti cp, cCu 128: Nu 1 s bin php nhm hn ch,ngn cn thi b m ghp; KN: +Mc ch: tm m ghp ph hp hn+ KN ABO gia ngi cho 7 ngi nhn l bc c bn ngn cn P thi ghp ti cp+ KN HLA: s ph hp KN HAL-B c ngha quan trng trog vic ghp thnh cng.nh tp m: dung huyt thanh ca ngi c truyn mu nhiu ln hoc ph n c thai nhiu ln nhcc KN ghp ngi v trog huyt thanh ca nhng ngi ny c nhiu KT chng li cc KN ghp # nhau sn xut c cc KT n clon, c tiu chun ha , dung nh tp mPht hin tnh trng mn cm sn: pht hin KT chng KN ghp c sn trong c th ngi nhn bng cthanh ca ngi nhn cho P vi lympho bo ca 1 panel bch cu c y KN ph hp m.Xc nh


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KT & xc nh KN c hiu vi KT. ng thi cho huyt thanh ca ngi nhn P vi lympho bo cacho d tuyn.-Truyn mu ton b: truyn mu trc khi ghp ci thin c tnh trng sng ca m ghp.Dng thuc c ch MD hu nh ton b ngi nhn ghp c dung thuc c ch MD trc khi ghp:azathicyclosporine A,steroid,methotrexatngoi bin chng gy c ch MD lan ta cc thuc c ch phn bo ny cn rt c vi ty xng, rut ndng ht sc cn thn.-P m ghp chng vt ch.Khi c th nhn b suy gim MD th cc tbo MD mnh ghp s mn cm vi KN ph hp t chc lp Ith nhn sinh MD chng c th nhnvd: ghp ty xng ngi bnh thng vo c th suy gim MD ( do phng x, dung thuc c ch MDKth trc khi ghp ko pht hin s ko ph hp tip xc gia c th cho & c th nhn. -> vic nh gi P ghp chng tc ch c tm quan trng trong tin lng & chn phng php iu tr thch hpCu 129:trnh by bng chng v MD chng ung th.-th nghim1: ghp U chut.mn cm chut = nhng mnh SarcomaA nh ly t chut b Sarcoma cho 1 con chut khc trong dngchng sau khi khi U ptrin 1 thi gian ng ta loi b khi U v ghp li mnh SarcomaA vo chut -> thmnh ghp.Thay SarcomaA bng Sarcoma B-> khng c hin tng thi loi. nh vy chut c MD vi loi TB Umc loi U na.

Th nghim 2:Tim cho chut TB K b bt hot bi ha cht or tia x sau tim TB K cng loi th K ko pht trin tim TB K cho chut ko c gy MD th K ko ptrin c-> c th tc ch c MD c hiu chng K.KN K khc KN khc. nu thay mn cm chut vi cc Sarcoma nh, TB K b bt hot = t chc BThnko co kh nng ngn cn K ptrin-TN 3: K do ha cht.Gy MD cho 3 nhm chut = TB K bt hot do ha cht MC1 .sau :+ nhm 1 c ghp li tbo K cng loi -. K ko ptrin+ nhm 2 c ghp li tbo K do MC2 -.> K ptrin+ nhm 3 ghp li tbo K do VR -> K ptrinMi K gy bi ha cht c KN c hiu ringTN4: K do VR: 3 nhm chut c gy MD vi SV 40 bt hot sau nhm 1,2 c ghp li K do SV40 -> ptrin,nhm 3 c ghp li K do MuLV -> K ptrin _Vy chut c gy MD vi SV40 c k/nng chng li K do SV40 nhng li b K do MuLVMt # c nhiu im lin quan gia K & MD ngiMt s K t thoi lui: chorio epithelioma, melanoma, & neuroloma-Ko c globulin -> lymphoma ptrin-lymphosacoma thng xut hin trog thiu mu dung huyt t minKo th gy K thc nghim ngi bng VR song c mi lien h gia nhm VR Herpes vi 1 s K ng- Pht hin c 1 s KN K ngi nh KN K phi thai;AEP c trog K gan,CEA trog K i trng,KN trog K KN trog melanoma-TN nui cy tbo hn hp xc nh KN trog iu kin ng gen & d genCu 130;Nu KN K: tn gi, TN chng minh

-KN K bn cht l cc protein c rt t hoc ko c tbo bnh thng m do t bin gen mt k/nng iu hhp protein & ptrin tbo.VD: protein P53 c 3 loi KNKN ghp c hiu ung th TSTAs c pht hin bng cch ghp cc mnh K gm cc protein ca cc tbo Kl & trnh dinKN trong phn t MCH.Phc hp TSTAs-MHC l ch th th ca tbo lympho T & Kth tip cn.Tnhha ca KN ph thuc vo t chc m K ptrin ch ko ph thuc vo loi ha cht gy K -KN c hiu t chc TSAs c mt trn tbo bnh thng & c dc tnh ring cho tng loi t chc K xuchc no thng biu hin KN dc hiu ca t chc -TSAs l 1 thnh phn ca tbo bnh thng ko kch thch MD chng K trog lm sang c s dng nh ch cho MD tr liu lm du n tm ngun gc xut pht ca t chc K KN K phi thai c sn xut 1 cch bnh thng ca tbo phi thai m ko c sn xut hoc ch c sn xut lng rt t nn c th kh c th pht hin c.KN ny ti xut hin do mt k/nng kim ch cc gen chu nhim sn xut KN phi thai cc tbo c tnh ca c th trng thnh-KN phi thai ko chng tc ch CEA, AFP+AFP c sn xut bnh thng trc tin ti non hong sau l ni b & gan phi thai. ngi ln proteii thnh albulin & ch cn 1 lng rt nh AFP tng cao bnh nhn K gan, K tbo mm,K ty


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-CEA l prtein ca mng b g lycozyl ha cao.CEA b ly giaq dch ngoi tbaog & tng cao trog vimty,gt,vim ty 3 thng u & gia thai k trog dich nhy ca vim trang ca ngi ln,sa m CEA cao trog huyt thanh,bnh nhn K trc trngCu 131: cc loi MD chng K: bn cht,vai tr?C 2 loi MD trog K l MD c hiu & ko dc hiu1.MD ko dc hiu : +bn cht l qu trnh ly gii tbo K 1 cch t nhin m ko cn mn cm trc. cn c KT & KN dc hiu+ vtr:tbo NK: c k/nng loi b tbo K ghp,loi b ghp ty & ngn cn di cn.ngoi ra cn c s dng trong vay mn-i thc bo :hot ha & ly gii mnh cc tbo bnh thng & cc tbo K bch cu i toan trog K:thc bo & tiu dit cc tbao K theo c ch c tdng ca b th & ph thuc vo Ktn thng t chc K UMD c hiu:-MD dch th: t c vtr trog iu tr K MD tbo: ph thuc ch yu vo lympho T & cc KN glycoprotein b mt ca cc tbo #.tbo Th sn xutlymphokin rt cn cho vic b sung & hot ha i thc bo,tbo NK.Vtr ca Tc: Tc mu ngoi vi ngi b carcinoma & melanoma c k/nng ly gii tbo K MHC : cc protein MHC hin din trn b mt tbo K. l mc tiu tbo lympho T nhn bit KN & dit Cu 132: Cc bin php n trnh ca t chc K thot khi s kim sot ca h thng MD?

-1 s K c tnh sinh MD yu,chng ko biu l cc MHC cn thit cho vic gn & trnh din KN c l -> h thng MD ca c th ko nhn bit c & ko MDgim iu ha ca MHC trn tbo K nn ko hnh thnh c phc hp KN-KT kch thch MD tc ch dungKN K.Lc mi hoc tbo K trinh din cc KN dng dung np c cho h thng MDHin tng ln qua vi 1 lng KN qu t n ni m c th ko nhn din c ko kthch MD.Khi MD ca c th pht hin c th khi u ptrin qu ln1 s tbo K t bin ko biu hin cc protein c k/nng sinh MD c bit l cc protein tr nn c tnh lm m cc clon Lympho Tc c th nhn bit c -> K ptrin & di cncc phn t KTh gn vi KN trn b mt tbo K ta thnh kin kt lm bt ng protein mng,KN s tpcc tbo chm vo trong mng tbo.Kth ca lien kt ny mt k/nng hot ha b th-> tbo K s ko b ly gKN di khi khi u n kt hp vi KTh to phc hp KN-KT phong b lm mt c/nng iu ha ca tKN c hiu K KN b mt ca tbo K c th ln trnh h thng MD do cc phn t glycocalyx gm acid sialic chamucplysacarid to nn mng che KNCc sn phm ca K hoc cc tc nhn vt l,ha hc nhim trng gy chuyn dng c tnh tbo -> suy githng MDCu 133: trnh by yu t c bn tham gia kim sot v iu ho MD1/vai tr ca dung th trong kim sot MD-c ch: khi liu lng KN qu ln tiu dit c c cc t bo lympho B,T v c cc t bo khcc ch ko p ngna m chp nhn n v chung sng vi nKN gy ra s tr ko cn cm ng ca dng t bocc KN bn thn cng gy ra dung th MD do cc clon Tc v Th t phn ng vi KN bn thn

2/vai tr ca KN: - ph thuc bn cht ca KN ; -ph thuc liu lng ca KN-ph thuc vo ng vo ca KN; -ph thuc vo cng sx KT3/vai tr ca t bo;-Ts: c ch qu trnh p ng MD khi MD y -Th:tham gia vo qu trnh iu ho hot ho cc TB MD ( Tc, TTDH, v lympho ba B ) c bit l qu trnh iuho hot ho lympho B4/vai tr ca KTiu ho (-) tnh nguc ca KT: KT khi sx ra c kh nng c ch sinh KT tip theo i vi chnh KN yc ch: + thanh lc KN = hin tng thc bo+ KT phong b cc epitop ca KN+KT khi gn vi th th Fc trn t bo B s c ch trc tip hot ho ca tb B+mi KT sinh ra c th sinh ra KT chng li KT y ( c ch )5/vai tr ca cytokine: c th tng cng hay c ch MD6/vai tr ca yu t TK,di truyn, ni tit-yu t di truyn:1 vi gen a/h n chung thong qua chc nng ca TB do chng c nh hng n ks l v trnh din KN ca TBa/h n qu trnh p ng MD-cc hormon ni tit v cc yu t TK cng nh hng n qu trnh MD


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+ 1 s hormon c tc dng c ch MD: androgen, estrogen, progesterol, glucocorticoid+ 1 s hormon c tc dng tng cng p ng MD: GH,thyroxin v insulin+ cc c quan MD c cc TK t ng v cm gic nn hot ng ca tk a/h n qu trnh sinh MDCu 134: trnh by c ch kim sot v iu ho MD bi cc lympho T h tr 1/c ch hot ho lympho T h tr:-CD4 v TCR (ca Th ) tip xc vi phn t MHC ( II) v KN (ca TB ) l tn hiu th nht, cn TB tit ratc ng ln Th l tn hiu th 2 cn v Th tr thnh hot ho2/c ch kim sot v iu ho MD-S hot ho Th th hin hin tng kick thick ca cht tit IL-2, IL-4 hay IL-6 tc ng ln lot t botrc ht l tc ng ln bn thn Th ri Tc,TDTH,B+ Th mi c hot ho tit IL-2 tc ng li ln chnh n, t hot ho v chuyn t vai tr nhn bit Ktr iu ho chi phi MD+ Th hot ho h gii phng IL-2 t/ ln Tc. TDTH l diu kin chng hon thnh chc nng nhn bitchuyn sang c/n hiu ngt bo hot ho h tr lympho B bng cch tit ra IL-4 gip cho 1 qun th B s sinh KT chng li KN mnhn bit. cc tm im mn ca nang lympho xut hin, m mn cho giai on tng sinh.tip Th sx ILqun th B ny bit hoCu 135: trnh by c ch kim sot v iu ho MD bi cc lympho T c ch ( Ts)-cc t bo khi ng s hot ho ca Ts gi l Tb cm ng c ch. l cc t bo c phenotip ca t bh viCD4+

-Ts thng c cm ng khi p ng vi cc liu KN ln hay vi cc hapten a vo ko c ph cht hayng tnh mch. Ts thng nhn bit cc KN khi thiu cc phn t MHC ca ATC-S tng sinh v bit ho ca Ts ph thuc vo cc Th CD4+-tc dng c ch ca Ts thong qua cht tit ca n gi l cc yu t c chyu t c ch ko c tnh c hiu KN nhng c th c cng Kn idiotip vi bn thn tb T, cho nn c tc girng,yu t c ch l cc TCR hot ho ( bi tit ra dng ho tan) tranh ginh phc hp KN-pt MHCAPC ca cc TB T khc-Ts c nhiu nhm nh c phenotip v chc nng khc nhauTs CD8+W- : ch cc Ts ko bm dnh vo lectin WTs CD8+W+ :ch cc Ts bm dnh vo lectin WTs CD8+ W-:c kh nng c ch cc t bo B mnhTsCD8+W+:ko c ch c p ng to KT ca t bo B m chng li tc dng c ch Ts CD8+ W- Nh vy tong nhm Ts ngoi cc tb c chc nng c ch cn c cc tb chn li s c ch to s cn bng Ni chung, s diu ho v kim sot DMd ca Ts thong qua qu trnh c ch MD, c ch phn ng loi tTh pht ng) nu p ny t ra qu mnh ng thi n cn km hm sut i nhng Th t phn ng tc h c timnng chng li cc KN ca chnh c th chCu 136:trnh by mt s th nghim rt ra nhn nh v vai tr kim sot v iu ho MD ca KN-th nghim 1:+ cc VK c v bc thng c cc KN polisaccarid v p ng MD chng VK ny c i sng ngn+ cc KN protein gy c MD dch th v t bo gp trong 1 s vi khun v a s virut.chng cn gy cko di. Do 1 s c th c tim vacxin ch ng chng nhng virut vn cn khng trong nhiu nmthng l c i Nh vy cc KN khc nhau v cu trc ho hc kch thch cc p ng khc nhau

-th nghim 2:+ khi tim liu rt ln hay tim nhc li cc liu KN nh thng gy c ch+cc liu lng ln KN polysaccarid hay protein c cc nhm quyt nh ging nhau c xu hng gy dungTB B c hiu KN, c ch s sx KT Nh vy liu lng KN c nh hng n cng p ng ca KN -th nghim 3:+ tim KN vo c th = ng di da thng l sinh MD,KN a = ng tim hay ng ung thngng do c s cm ng s dung th ca tb B hay T.hay do kch thch cc TS c hiu Nh vy MD i vi 1 KN nht nh thay i tu ng vo ca KN -th nghim 4:+ khi mn cm, cc t bo c hiu KN pht trin, cc t bo MD hay cc KT s loi b KN v sau pdn v tt i khi Kn b loi b hon ton sn sang i ph vi cc Kn mi Nh vy cng sn xut KT gim khi [ KN] gim-th nghim khc: thanh lc KN = tim 1 lng KT tha trong thi gian c p ng MD s lm gim vic tKT v gim s lng cc t bo tit KTCu 137: Th nghim rt ra nhn nh v vai tr kim sotv iu ho MD ca KTTh nghim v iu ho ngc m tnh ca KT


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Nu tim cho sc vt 1 lg KT c hiu ngay trc khi mn cm vi KN hay trog thoi gian xy ra p ngth s sn xut KT b gim. l hin tg iu ho ngc m tnhca KT, KT c th iu ho c MD dich th*)c ch: + thanh lc KN = htg thc bo cc phc hp MD: KT trung ho KN, loi tr KN, nn loi n c kkhi g cho md+ KT fong b cc epitop KN, kocho cc epitop tip cn vi sIg trn tbo B, ko hot ha c tbo B+ Cc KT khi gn vi th th Fc/TB B s c ch trc tip s hot ho ca tb B+ Cc KT c th cm ng 1 mng li idiotip antidiotip trong iu ho MD2) cc Kt c th cm ng 1 mng li idiotip antidioptip iu ho md dch th v tboTh nghim: KN c mn cm cho sc vt th nht c KT chng li KN : ng ta em tinh khit KT nys l KT1 (tc idiotip 1). Sau ng ta em tim Id1 cho sc vt T2 c KT2 (tc idiotip 2). Ng ta em tinhId2 mn cm cho sc vt T3 v c tip tc nh th.Kt qu thy rng Kt2 (tc idiotip 2) chnh l Antin Id1: n nhn bit Id1 c mt trn KT 1 nhng ng tnhn bit c Id1 c mt trn KT3 (chnh l Anti id2 tc Id3). KT4 c t/c ging KT2 nhng ch c 1 phca KT3 (Antin Id2) l kt hp vi KN u tin. N th 1 Id c nhiu p/ cho vi nhiu nhm quyt ca KN c th khi ng cc tbo B c hiu # nhau, nn thg c 1 mng li idiotip chung hay idiotip gy /ho MD cho n khi nng KN hay KT gim dn ri tr v nh lc cha mn cm. ngha l dp tSau khi KN b loi tr mng li idiotip c th cho php md chy ko trong 1 thi gian duy tr qun thnh. Cc tbo Th mn cm trc tip vi cc Id chung trn cc Tbo nh # nhau & c hiu vi KN nht cng md th ft.

Cu 138 - 141: Nu cc chng c v vai tr /ho md ca hthng Tk - ni titT/dng ca hormone trn tbo MDcc tbmd c receptor vi nhiu loi hormon. Do hormon c th tc dng i vi md:+ cc glucocorticoid, androgen, oesterogen, progesterol c ch md.+ GH, thyroxin v insulin c tc dng tng cng mdKhi ct b tuyn thg thn ca con vt hay b stress u lien quan n s bin i cc tbo tit KT. Cc bc nhiu # bit trog cc gii # nhau.Cc c quan md c cc dy tkinh t ng v cm gic. Khi ct tkinh giao cm ca tr s sinh bng 6hydroxydopamin hoc ct b tkinh lch ca tr - a tr s tng cng md.Dng bo c lien quan vi tk v gii phu. cc yu t tng trng tkinh gy mt ht dng bo. Cc chsomatosstatin, VIP h tiu ho c ch s tng sinh lympho mng Payer, c ch prolactin s c ch hoT. Cyclosporin A c ch chn lc c tbo Th, c Receptor chung vi prolactin trn tbo t2) tc ng ca h md trn h tk ntSau thch thc vi KN, khi KT t nh cao, nng glucococticoid cao s c ch md. IL-1 kick thctnghp cc glucococticoid thong qua trc tuyn yn - thng thn. Trong vng lnh vt thg c tg tc giatbo, vim v cc yu t tng trg tkinh, IL-1 cng gy tng yu t tng trng tkinh on tkinh hng to. IlN gy st thong qua cc trung tm iu nhit.Cc tg tc gia h md v tk nt di theo cc mch knh+ mch 1: lquan n s tng hp c glucococticoid di a/hg ca IL-1, glucococticoid l c ch ngc tr lIL-2mch 2: lquan n hcmon, receptor vi hocmon (ccoi nh idiotip); vi anti hocmon v vi anti idiotip (receptor). mch ny c th lquan n c ch bn sinh ca bn t min v chng trc tip cc Receptor v(chng receptor vi axetylcholine trong bn nhc c l 1 vd)

Cu 142: cc cch phn loi KNPhn loi theo mi tng quan di truyn gia KN v c th nhn KNKN khc loi (xenoantigen):KN ng loi nhng d gen (alloantigen):T KN (autoantigen): Ngoi ra, sinh hc pt cn phn them vo nhm ny mt loi KN na: l KN idiotyp.VD: KN ng loi nhng d gen: in hnh cho loi KN ny l: h thng cc KN bch cu (HLA: Human LAntigen) b) phn loi theo bn cht ho hc:Kn l Glucid: vd: tnh c hiu KN ca c vk: t cu, ph cu, lin cu, KN ca cc nhm mu do cquyt nhKN l Lipid: vd: cht cardiolipin ly t tim b c dung lm KN pht hin Kt chng giang maiKN l acid nucleic: vd: trong cc bnh t min nh bnh lupus ban h thng, vim a khp dng thpKT khng nhn (khng DNA) trog muKn l Protein: l loi KN ph bin nht trong t nhin v v c tnh Kn cao. Vd: cht vasopressinKn tng hp, ti t hp, siu KN. Vd: pt enterotoxin, pro A G ca lin cuc) phn loi theo p ng MD (theo ngun gc)


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lympho bo T gim r rt v s lng v cht lng, gim p ng MD qua trung gian t bo, gim cc pqu mn chm vi candida, PPD k/n tit lymphokin ca cc lympho bo gim. thi gian thi loi mnh gen di hn so vi bnh thng-s lng lympho bo B, hm lung cc globulin MD. t thay i. gim k/n sx KT ca cc lympho bo khmn cma s cc trng hp suy dinh dng c s lng lympho bo B bnh thng, Ig bnh thng hay tng. Cc trnghp ny c nhim khun km theohm lng b th ton phn gim r rt, cc thnh phn b th u gim ( tr C4) gim nhiu nht l C3 vi vacxin: khi dc tim chng vacxin phng bnh, cc tr suy dinh dng phn ng rt khc nhau v cnguy him cho tr. k/n to KT cng nh hiu gi KT ca tr suy dinh dng thp hn nhiu so vi tr bncng la tuiCu 71: nh ngha suy tim, ri lon chuyn ho tbo c tim khi suy tim:N: Suy tim l tnh trng qu tim ko m bo c nhu cu cp mu cho c th (qua cc ch s v lu lngca suy tim sm mun cng lan ti mch, dn ti suy tun hon chung.Ri lon chuyn ho: cc n.nhn suy tim cui cng dn n RLCH trong t bo c tim+ thiu oxy tim khin qu trnh oxy ho to nng lg b thu hp. tim ko ng lg co bp+ thiu oxy v 1 s ng.nhn khc dn n Ca++ ko vo c tbo c tim ng khi g h enzym ATPase d thiu ng lg co c.+ gim tc chy mu+ thay i HA: Suy tim -> HA gim, lu lg mu gim, sc co bp gim, sc cn ngoi vi cng gim. do gi

v thiu oxy -> HA M gim nhng HA TM tng do tim bp yu mu chy chm -> mu TM+ Cng v hi sut ca tim gimCu 72: cc nguyn nhn gy suy tim hay gp:C 2 nhm ln: do mch vnh v khng do mch vnhKhng do mch vnh:Tim b qu ti ko di, qu ti v th tch (bnh van tim, st cao); qu ti v p lc (cao HA, hp van Mu a n thiu oxyBnh l ca tim: c tim b vim, nhim khun, nhim c, ng c K +, Ca++, 1 s thuc c i vi tim, vi khun, t vi khun, (cm, thg hn..) thiu vit B1Do mch (gim khi lng tun hon chung, chy mu, tru mch) Ng.nhn ngoi tim: bnh l ca gan, thn, ni tit2) Do mch vnh: hp, tc, co tht:, nhi mu c tim.Tt c cc ng.nhn lm ri lon chuyn ho trong tbo c tim. Tbo c tim thiu nng lg hot ng u dti

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