电大病理生理学期末复习考试小抄.doc

临床医学 病理生理学（50分）4一、名词解释1代酸 :细胞外液H增加和Hco3丢失而引起血浆中的Hco3浓度减少而致PH下降。2.代碱:细胞外液碱增多或H丢失而引起以血浆Hco3增多而致的PH增高。3.呼酸：CO2排除障碍或吸入过多引起以血浆PCo2升高导致PH下降。4呼碱:肺通气过度引起血浆中的碳酸浓度原发性减少，而致PH升高。5.水中毒： 血Na下降，血清Na浓度<130mmol/L,血浆渗透压<280mmol/L，但钠总量正常或增多，患者水潴留使液体量明显增多，故称为水中毒。 6.血液性缺氧（樱桃红）：血红蛋白数量不足或性质发生改变，以至血红蛋白含量降低或Hb结合的O不易释放。7.低动力性缺氧（循环性缺氧）：组织学流量减少引起的组织供氧不足，主要是由于全身和局部循环障碍。8.组织缺氧：在组织供氧正常的情况下，因组织细胞不能有效的利用氧而导致的缺氧。（玫瑰红）9.低张性缺氧（乏氧性缺氧）：以动脉氧分压降低为基本特征的缺氧。（青紫色）10.受体：能接收化学信号的细胞膜或细胞内蛋白为受体。分为膜受体和细胞内受体。11.G蛋白耦联受体：（七次跨膜受体）：配体包括激素、神经递质、神经肽、趋化因子、PG、光、气味等，在细胞代谢和组织器官的功能调控中发挥重要的作用。12.呼吸爆发（氧爆发）：再灌注期间重新获得氧，激活的中性粒细胞耗氧显著增加，产生大量的氧自由基。13.肺性脑病：由呼吸衰竭引起的脑功能障碍，由于酸中毒和缺氧对脑血管和脑细胞的作用。14.肝性脑病：继发于肝功能紊乱的一系列的严重的神经精神综合症。具有人格改变、智利减弱、意识障碍等特征。15.水通道蛋白（AQP）：是一组构成水通道和水通透有关的的细胞膜转运蛋白，广泛存在于动植物、微生物界。 16.细胞信号转导系统：能接收信号的特定受体、受体后的信号转导通路以及其作用的靶蛋白组成，具有调节细胞的增值、分化、代谢；适应、防御、凋亡等作用。17.凋亡：体内外因素刺激细胞内的预存死亡程序而导致的细胞死亡过程，是程序性细胞死亡的形式之一。18.缺血-再灌注损伤：在缺血的基础上恢复血流后组织损伤反而加重，甚至发生不可逆损伤现象。 19.钙超载：各种原因引起的细胞内钙含量异常增多的并导致细胞结构损伤和功能代谢障碍的现象。20.心衰：在各种致病因素的作用下，心脏的舒缩功能发生障碍，使心排出量绝对或相对减少，不能满足组织代谢需求的病理生理过程。21.凋亡小体：细胞凋亡时，胞膜皱缩内陷，分裂包裹胞浆或核碎片形成的泡状小体，是凋亡细胞特征性的形态学改变。二、简答1.高钾的原因？（1）钾摄入过多（2）排出减少：肾衰，盐皮质激素缺乏。（3）细胞内的钾向细胞外转运：见于酸中毒、糖尿病等。（4）假性高钾血症2.用体温调定点学说解释发热机制？发热激活物-机体-激活产EP细胞-EP-作用于体温调节中枢-中枢发热介质释放-调定点上移-发热体温升高。3.自由基概念、损伤作用（1）自由基：外层轨道上有单个不配对电子的原子、原子团、分子的总称。其中。氧自由基：由氧诱发的自由基称为氧自由基。（2）自由基可与各种细胞成分发生反应，造成细胞结构损伤和功能障碍。主要包括：膜脂质过氧化增强；蛋白质功能抑制；核酸及染色体破坏。4.经肾失钾引起低血钾的原因？（1）长期大量使用排钾利尿剂（2）盐皮质激素使用过多（3）各种肾疾患（4）肾小管性酸中毒（5）镁缺失5.钙超载引起缺血-再灌注损伤发生的机制？（1）促进氧自由的生成（2）加重酸中毒（3）破坏细胞膜（4）线粒体功能障碍（5）激活多种酶的活性6.凋亡的形态、生化变化？（1）形态变化：微绒毛消失；胞膜空泡化；体积缩小固缩；出芽；染色质边集；出现凋亡小体。（2）生化变化：内源性核酸内切酶激活，caspases激活、DNA片段化段裂。7. 急性肾功能衰竭（ARF）多尿期机制？（1）GFR回升至正常（2）新生肾小管上皮浓缩功能下降（3）肾小管阻塞解除（4）少尿期蓄积大量的尿素经肾小球滤出产生渗透性利尿。8. 慢性肾衰竭（CRE）多尿期机制？（1）原尿流速过快：肾血液集中在健存的肾单位，GFR增高，厡尿生成增多，流经肾小管的流速过快，肾小管来不及重吸收。（2）渗透性利尿：健存的肾单位滤出的溶质代偿性增高，产生渗透性利尿。（3）尿浓缩功能降低：肾小管髓袢减少，易受损，由于Cl主动吸收减少，使髓质高渗环境形成障碍。9.低钾、高钾引起骨骼肌松弛异同？（1）低钾血症：细胞内外K浓度差增大，静息电位膜负值增大,发生超极化阻滞，由于膜电位和阈电位距离大，使除极化障碍；（2）高血钾时：静息膜电位负值急剧变小，接近阈电位，发生除极化组织，快钠通道关闭。10.缺血-再灌注损伤引起自由基增多的机制？ （1）黄嘌呤氧化酶增多（2）中性粒细胞聚集和激活（3）线粒体功能受损（4）儿茶酚胺增多和氧化11.低钾、高钾引起心肌兴奋机制？低钾：心肌细胞膜对K的通透性降低，Em绝对值减少，Em-Et间距离缩短，心肌兴奋性增高。兴奋性增高；自律性增高；传导性降低；收缩性先升高再降低。高钾：（1）兴奋性改变：急性轻度高钾血症：兴奋性高；急性严重高钾血症：兴奋性降低；慢性高钾血症：变化不明显。（2）自律性降低（3）传导性降低（4）收缩性减弱12.氰化物中毒引起血氧变化的特点？（导致组织性缺氧）缺氧类型PaO2A血氧容量ASO2A血氧含量A-V脉差低张性缺氧N或N血液性缺氧N或NN循环性缺氧NNNN组织性缺氧NNNN13.BCL-2抗凋亡的机制？（1）直接抗氧化（2）抑制线立体释放促凋亡蛋白质（3）抑制促凋亡性调节蛋白（4）抑制凋亡蛋白酶的激活（5）维持细胞钙稳态14.急性肾功能衰竭，肾血流量减少的机制？（1）肾灌注压下降，低于50-70mmHg（2）肾血管收缩（3）肾血管内皮细胞肿胀（4）肾血管内凝血三、论述1.氨中毒引起神经功能障碍机制？(1).氨使脑内的神经递质发生该变当脑内的氨增多可使脑内兴奋性递质减少；抑制性神经递质增多，导致中枢神经系统障碍。(2).干扰脑细胞能量代谢。氨主要干扰脑组织葡萄糖生物氧化的正常运行。(3).氨影响神经细胞质膜的作用：干扰神经细胞膜的Na+ - K+ - ATP酶的活性影响C内外Na+ 、K+分布，可使线粒体内膜的膜通透转换口开放，跨膜电位下降或消失，产生能量代谢障碍。2.缺血-再灌注损伤引起钙超载的机制？1. Na+ /Ca+交换异常（1）细胞内高Na+对Na+ /Ca+交换蛋白的直接激活（2）细胞内高H+对Na+ /Ca+交换蛋白的间接激活（3）蛋白激酶C对Na+ /Ca+交换蛋白的间接激活2.生物膜损伤（1）细胞膜损伤（2）肌浆网膜损伤（3）线粒体膜损伤3.心功能不全的病因、诱因？一、.病因（1）心肌舒缩功能障碍：心肌损害：心肌炎、心肌病。 代谢异常：缺血，缺氧。（2）心脏负荷过重容量负荷过重左室容量负荷过重，二尖瓣、主动脉瓣关闭不全，右心室容量负荷过重见于三尖瓣、肺动脉瓣关闭不全。动-静脉瘘等可引起左右心室容量都增加压力负荷过重左室压力负荷过重见于高血压、主动脉狭窄，右室压力负荷过重见于肺动脉高压，肺源性心脏病等。二、诱因 ： 感染；水电解质和酸碱平衡紊乱；心律失常；妊娠和分娩。4.Caspase定义、分类、功能（1）.定义：天冬氨酸特异半胱氨酸蛋白酶，是细胞凋亡的执行者（2）分类：共分为2类，启动型Caspase和效应型Caspase（3）.功能：灭活凋亡抑制蛋白 、直接作用于细胞结构并使之解体、分解与细胞骨架构成相关的蛋白瓦解核结构5.假性神经递质与肝性脑病概念：苯乙醇胺和羟苯乙醇胺在化学结构上与正常的神经递质（去甲肾上腺素和DA）相似可同样被神经末梢摄取、贮存、释放。但不能完成真性神经递质的功能，称为假性神经递质。 假性神经递质在脑内堆积竞争取代正常递质，被神经末梢摄取、贮存、释放、但信息传递功能不如正常递质，使网状结构上行激动S及黑质纹状体通路等功能失常，导致大脑功能紊乱，从而发生昏迷。6.死亡受体介导凋亡的通路机制？ （1）由胞外的TNF超家族的死亡配体引发（2）死亡配体和相关细胞表面死亡受体结合，使受体三聚化并活化。（3）通过死亡域（DD）募集衔接蛋白TRADD或FADD（4）衔接蛋白通过死亡效应域与procaspase-8形成死亡又到信号复合物（5）procaspase-8诱发自我剪接并活化，释放到胞浆并启动P-8联级反应，激活下游的caspase-367.导致细胞凋亡（6）活化的Caspase-8能激活Bcl-2家族的促凋亡因子Bid诱导Cyto-C释放进入胞浆，进而把死亡受体通路和线粒体通路联系起来。7.线粒体介导的凋亡？(1)线粒体通路由死亡受体非依赖的凋亡诱导信号启动，各种凋亡信号作用于线粒体。（2）细胞色素C在dATP存在的情况下，结合并活化凋亡蛋白酶激活因子，进一步与P=9结合形成凋亡复合体，导致P-9激活，通过级联反应激活下的caspese促使细胞凋亡。（3）AIF通过促进线粒体释放细胞色素C而增强凋亡信号，并快速激活核酸内切酶；（4）Smac/Diablo可以通过阻断凋亡抑制蛋白的作用，参与细胞凋亡的调控。8.G蛋白介导通路？（1）Gs-AC-Camp-PKA （2）Gi-AC-Camp（3）Gq-PLCB-双信使DAG TP3（4）G蛋白其他磷酸酯酶途径PLA2（花生四烯酸、前列腺素、白三烯）PLD（磷脂酸）（5）PI-3K-PKB（6）离子通道途径四、填空题1.假性神经递质：苯乙醇胺、羟苯乙醇胺2.休克发病环节：血容量减少、血管床容积增大、心排出量减少。中心环节：组织灌注量减少3.凋亡的过程：诱导期、效应期、降解期4.等容量性低钠血症的机制：ADH分泌异常综合征5.达到心肌梗死的程度：心肌损伤面积达到23%6.肝性脑病时：芳香族氨基酸增加7.肾衰竭的分期：少尿期、多尿、恢复期8.“酸碱平衡紊乱”的相关的计算问题Visa-free policy brings Chengdu biz, tourism boost. Making national headlines several times, Chengdu's 72-hour visa-free policy has attracted wide attention from both Chinese and foreign experts and businessmen since it took effect on Sept 1 last year. The program permits citizens from 51 countries and regions including the United States, Australia, Canada and Japan who have valid visas and flight tickets to a third country to spend three days in the city. The capital of Sichuan province is the first city in the western region of China to offer foreign tourists a three-day visa and the fourth nationwide to adopt the policy following Shanghai, Beijing and Guangzhou. Li Zhiyong, deputy dean of the tourism institute at Sichuan University, said the move "contributes to a large increase in the number of overseas tourists and raises the city's level of internationalization". "The policy will also bring direct economic revenue," Li said. "Chengdu has many cultural legacies and is also a paradise for panda lovers with the world's largest breeding and research center. Three days are long enough for foreign visitors to visit those iconic tourist spots," he noted. The city is home to the remains of the Jin sha civilization that dates back more than 3,000 years as well as the Qing cheng Mountains and the Du jiang yan irrigation system. Qing cheng has long been recognized as the birthplace of Taoism, China's ancient indigenous religion, while Du jiang yan is considered to be the oldest functioning water-control project in the world. Chengdu ranked third in tourist facilities, management and services among 60 Chinese cities in a customer satisfaction survey released last year. But, Li added that efforts are still needed to develop more tourism products, improve English services and provide accurate translation of traffic signs and scenic billboards. Zhao Yun, chairwoman of British Chamber of Commerce Southwest China, told China Daily that his colleagues found the policy very convenient. "A British client once flew here and stayed for just one day to check her ordered goods," she said. Zhao was born in Shanxi province, but she has lived in Chengdu for more than 10 years. "My life was like a running race moving from place to place. I also lived in Beijing and Shanghai before," she said. "But Chengdu is a place that you never want to leave once settling down. It is now my second hometown," she said. If the environment is further improved, the city will attract more people to visit and live, with the 72-hour visa-free policy and compelling conditions in transportation, culture, climate and cuisine, he said. Foreigners also gave positive feedback on the policy. A spokesman from Dell Inc said the company has a global hub of operation in Chengdu, so the three-day visa "has an immediate and positive influence on the company's business development". Rudy Buttignol, president of the public broadcasting company in British Columbia, Canada, said his work requires frequent travel to Chengdu and the policy "makes the trips easier". Data from the city's public security bureau shows some 100 foreign visitors enjoyed the 72-hour policy by the end of March, most of them from the United States, the United Kingdom and Germany. Chengdu also reported robust growth in its overall tourist industry last year. Official statistics show that it received some 150 million tourists last year, an increase of 28 percent from 2012. Around 1.7 million came from abroad, an increase of 12 percent. Total revenue from tourism surpassed 133 billion yuan ($21.7billion). During his visit to Kazakhstan in September, Chinese President Xi Jinping proposed that China and Central Asia join hands to build a Silk Road economic belt to boost cooperation. The idea has been widely echoed in Central Asian countries, becoming an encouraging blueprint for Chinese areas along the Silk Road that has linked Asia and Europe for more than 2,000 years. In the next three weeks, China Daily reporters will travel through the belt in China and in Kazakhstan, Uzbekistan and Turkey. They will show the progress and expectations of the countries, businesses and peoples on the route. Shaanxi - the start of the ancient Silk Road - has positioned itself as the new starting point for the development of the Silk Road Economic Belt, which will strengthen China's cooperation with Central Asian countries, a senior official said. Shaanxi Governor Lou Qinjian said the province is fresh, rich and unique, as it was when it anchored one end of the ancient Silk Road. "It is the best option for accommodating industrial transfers from East China or the world at large," he said on Wednesday in Xi'an.Lou held a joint interview with 27 media, including China Daily, the first in a series of interviews entitled Chinese Media Along the Silk Road. The interviews will be in Shaanxi and Gansu provinces and the Xinjiang Uygur autonomous region, as well as Kazakhstan, Uzbekistan and Turkey.The media group held the first interview on Wednesday morning in Xi'an, the starting point of the ancient Silk Road, a trade channel established more than 2,000 years ago linking China, Central Asia and Europe.