BO Y TE VU KHOA HOC VA DAO TAO CIAIPHAU - SINH LY SACHDUNGCHOCACTRJONGTRUNGHOCYTE BO Y TE VU KHOA HOC VA DAO TAO GIAI PHAU - SIM I LY SACH DUNG CHO CAC TRUONG TRUNG HOC Y TE MA SO: T.10.W1, T.30.W1 NHA XUAT BAN Y HOC H A N O I -2 0 C H i D A O B IE N S O A N VU KHOA HOC VA OAO TAO, B0 Y i t ' NHUTNG N G I/O I BIE N S O A N P h a n g ia i p h a u TS N G U Y EN VAN HUY P h a n s i n h ly TS L£ BA THUC T H A M G IA TO CHLfC B A N T H A O THS PHI' VAN THAM VA BAN TH U KY HDTDSGK VA TLDH © Ban quyen thuoc Bo Y te (Vu khoa hoc va Oao tao) LCft G ldl THIEU ThUc hien Nghi dinh 43/2000/ND-CP 30/8/2000 cua Chm h phu quy dinh chi tiet va hudng dan trien khai luat Giao due, Bo Y te da phe duyet va ban h anh cac chUdng trin h khung cho giao due trung hoc chuyen nghiep nhom nganh siic khoe Bo Y te to chutc bien soan bo tai lieu day - hoc cac mon cd sc! va chuyen mon theo chUdng trin h mdi nhfim ttfng budc xay dung bo sach chuan cong tac dao tao trung hoc nganh y te Cuon Giai p h a u - S in k ly dUdc cac giang vien co kinh nghiem cong tac dao tao n h a n lUc y te bien soan dUa tren chUdng trinh giao due cua nganh Dieu dUdng da khoa, Ho sinh he trung hoc Tai lieu chia lam phan: Giai phau hoc va Sinh ly hoc, moi phan co cac chUdng/muc vdi so" tiet hoc dUa tren quy dinh cua chUdng trinh Moi chUdng/muc deu cau true gom: muc tieu, noi dung va tu lUdng gia Day la tai lieu tot, lam cd sci bien soan giao trinh day - hoc phu hdp vdi cac doi tUdng dao tao trUdng Trung hoc va Cao dang y te Nam 2005, cuon sach da dUdc Hoi dong chuyen mon tham dinh sach giao khoa va tai lieu day - hoc cua Bo Y te tham dinh, lam tai lieu day - hoc cua cac trUdng T rung hoc nganh y te giai doan hien Vu Khoa hoc va Dao tao, Bo Y te xin chan th a n h cam dn TS Nguyen Van Huy, TrUdng Dai hoc Y Ha Noi (bien soan phan Giai p h l u hoc) va TS Le Ba Thuc, T rung hoc y te Benh vien Bach Mai (bien soan phan Sinh ly hoc) da tich cUc tham gia hoan th a n h tai lieu Sach xuat ban lan dau chac chan nhieu khiem khuyet, chung toi mong n han dUdc y kien dong gop cua cac thay, co giao va dong nghiep de cuon sach cang hoan thien VU KHOA HOC VA DAO TAO BO Y TE MUC LUC ■ ■ Ldi gidi thieu Phan GIAI PHAU HOC Chuong Gi6i thieu mon giai phau hoc ngi/di Chuong He xUdng 11 Chuong He khdp 48 Chuong He cd 71 Chuong He tim mach 112 Chuong He ho hap 139 Chuong He tieu hoa 157 Chuong He tiet nieu 185 Chuong Cac he sinh due 196 Chuong 10 He than kinh 211 Chuong 11 Cac giac quan 248 Phan SINH LY HOC Chuong Sinh ly dai cifdng 261 263 Gidi thieu mon sinh ly hoc 263 Dai ci/dng ve cd the song 263 Dai ci/dng ve te bao 266 Dich ngoai bao, dich noi bao va hang ti'nh noi moi 270 Sinh ly hoc chuyen hoa nSng lUdng 273 Sinh ly dieu hoa than nhiet 279 Chuong Sinh ly mau 284 Sinh ly hoc hong cau 285 Sinh ly bach cau 289 Sinh 292 hoc tieu cau Chuong Sinh ly tuan hoan Sinh ly tim 297 Sinh ly tuan hoan dong mach 304 Sinh ly tuan hoan tTnh mach 307 Sinh ly tuan hoan mao mach 309 Chuong Sinh ly ho hap 315 Chuong Sinh ly tieu hoa 328 Chuong Sinh ly tiet nieu 340 Chuong Sinh ly noi tiet 347 Sinh ly vung di/6i doi 347 Sinh ly tuyen yen 348 Sinh ly tuyen giap 351 Sinh ly tuyen can giap 353 Sinh ly tuyen thUdng than 354 Sinh ly tuyen noi tiet 356 Chuong Sinh ly sinh san 362 Sinh ly sinh san nuf 362 Sinh ly sinh san nam 370 Chuong Sinh ly than kinh 378 Chifc nang cam giac cua he than kinh 383 C hu t nang van dong cua he than kinh 386 Vai tro van dong cua tieu nao 390 Chifc nang van dong cua vo nao 391 Sinh ly he than kinh thi/c vat 393 ChiTc nang cap cao cua he than kinh 394 Chuyen hoa cua nao 396 Tai lieu tham khao 297 402 Phan GIAI PHAU HOC Cac dirdng lien he cua tieu nao Tat ca cac dUdng cam giac di len vo nao deu cho thong tin den tieu nao, cac thong tin cua vo nao cam giac va van dong deu co dudng diia den tieu nao Tuf tieu nao co dudng lien h§ vdi nhan dd, nhan tien dinh, vd nao va tieu nao doi ben Churc nang djnh khu Tieu nao gom: nguyen tieu nao la phan p h at trien sdm n h a t theo bac thang tien hoa cua dong vat, tieu nao co, tieu nao mdi chi cd d nhiing dong vat cao cap Cac phan khac cd chiic nang khac nhau: Nguyen tieu nao: Cac thong tin cam giac tii cac vung CO the, cam giac ve vi tri khong cua dau dUdc dua ve nguyen tieu nao, cho phep nhan biet vi tri khong gian cua tiing phan cO the dac biet la vi tri cua dau khong gian, tii dd tieu nao dieu hoa trUOng luc co de giQ thang bang cho cd the Tieu nao co: Cac thong tin cam giac dac biet la cac thong tin ve trUdng liic cd cua cac phan cd the den tieu nao co Tieu nao co cd tac dung chu yeu la lam giam trUdng liic cd, la tru n g tam cua phan xa giQ th an g b in g va phan xa chinh the Tieu nao mdi: Cac thong tin tU vd nao va cac thong tin cam giac va giac quan den tieu nao mdi Tieu nao mdi cd tac dung chu yeu la tang trUOng luc cO, dieu hoa phoi hop dong tac phUc tap, lam cho cac dong tac chinh xac Chi phoi van ng cua tieu nao Tieu nao chi phoi van dong cung ben Tac dong len neuron van dong cua Tac dong len nao vung cam giac va vung van dong Cac roi loan lam sang ton th ifd n g tieu nao Khi ton thudng tieu nao thudng thay roi loan thang bing, the hien b in g di lao dao, dau lac lu, lay mat Cac roi loan dieu hoa trUdng liic cd la dong tac sai tam, sai hudng, va run Ton thudng tieu nao gay cac rdi loan ntia cd the cung ben vdi ben ton thUdng CHLfC NANG VAN DONG CClA VO NAO ■ ■ Vo nao van dong n i m trudc ran h tru n g tam, chi phoi cac van dong cd y thtic va dieu hoa phoi hdp cac dong tac (xem hinh 9.6) I.V u n g van dong so cap (vung theo Brodman) Chi phoi van dong cd y thtic, chi phoi ntia ngUdi doi ben Ban chi phoi van dong Ion ngUdc P han cd the cti dong phtic tap vung dai dien ldn 391 2.Vung ti n van dong (vung theo Brodman) Chi phoi cti dong nhom cd, hinh chieu cd the giong vung Cung vung van dong sd cap chi phoi nhieu nhom cO Vting tien van dong cting vdi cac nh an nen, doi thi va vting van dong sd cap chi phoi phan ldn cac cti dong phtic tap 3.Vung van dong bo sung (vung theo Brodman) Phoi hdp vdi vting tien van dong tao tu the khac nh au cua cac phan cd the Mot so vung van dong dac biet Vung Broca n im triidc vung van dong sO cap phoi hdp vung gay dong tac ho hap, cti dong day than h am, cti dong cua mieng va ludi luc noi N im ben ban c iu trai vdi ngiidi thuan tay phai Ton thUOng gay khong noi diidc (vung van dong cua ldi noi) Vung Wernick la vting nhan thtic cua ldi noi, ton thUOng khong hieu ldi noi, khong noi dUdc nam d hoi nep cong thuy thai dudng Cac d ifdng van dong xua t phat tir vo nao 5.1 Bd vd tu y (bd thap) Tti vo nao di xuong den h a n h nao 9/10 bat cheo sang ben doi dien (bo thap cheo) den tiep ndi vdi neuron van dong d sting triidc song 1/10 so' sdi lai di thang xudng (bd thap thang) b i t cheo den ben doi dien tiep noi vdi neuron van dong d sting trUdc Ton thUdng vd nao van dong gay liet d ntia ngudi ben doi dien Vung tien vanl ong Vung van dong sdclp Vung cif dong" kheo leo ban tay / Quay dau Hinh ti/ (vung Broca) Hinh 9.6 Cac vung van dong cua vo nao 392 SINH L * HE■ THAN KINH THl/C VAT ■ ■ He than kinh thuc vat co chtic nang: chi phoi va dieu hoa hoat dong cua cac tang Cac tang la da day - ruot, dudng dan va phoi, tim, than, v.v Dac diem cau tao churc nang He th an kinh thUc vat bao gom: he th an kinh giao cam va he th an kinh giao cam Hoat dong cua he th an kinh thuc vat tren cd sd cung phan xa (hinh 9.7) C u n g p h a n xa th u c v a t gom nOron, nOron cam giac di tti t a n g ve t r u n g tam , tti t r u n g ta m di d e n t a n g gom ndron: n e u r o n th ti n h a t di tti t r u n g ta m r a den h a c h th u c v a t dUdc goi la sdi tru d c h a ch , n e u ro n th ti h a i di tti h a c h th u c v a t den ta n g goi la sdi s a u ch Trung tam he giao cam d sting ben chat xam L1-TL3 va cung 2-4 He giao cam trung tam d hanh nao cho cac day giao cam di theo day th an kinh so III,VII, IX, X Hach thuc vat cua he giao cam gan trun g tam, xa tang; hach thuc vat he giao cam gan tang xa trung tam Hach mj Cd the mi (mat) Cd (hat dong tif Tuyen le Tuyen rhQi Hach dudi ham Tuyen dudi ham Hach mat Tuyen mang tai Tim - Da day Mon vi ( Dai trdng Ruot non Jan hoi-manh trang ' Tam giac He giao cam Cd thit hau mon Bang quang - - Cd detrusor ~ " - Tam giac He giao cam Hinh 9.7 Sd chi phoi cua he than kinh thi/c vat Hau het cac tang deu duoc chi phoi bdi hai he than kinh giao cam va giao cam 393 Tac dung cua he than kinh thirc vat len cac tang Cd quan He giao cam He giao cam Tim T3ng hoat dong Giam hoat dong Difdng dan Gian Co Da day-ruot Gian Co Dong tif Gian Co Bang quang Gian Co Chat truyen dat than kinh cua sdi sau hach giao cam la noradrenalin; sdi sau hach giao cam la acetylcholin Dieu hoa hoat dong he than kinh th irc vat Vung difdi doi difdc xem la trun g tam cao cap cua he th an kinh thiic vat, vung trUdc la trung tam cao cap cau he giao cam, vung sau la trung tam cua he giao cam Nhieu hoat dong nao anh hUdng den he th an kinh thiic vat; d tran g thai xuc cam lam thay doi nhip tim, nhip thd, co gian mach,v.v Hormon tuyen giap lam tang hoat dong he giao cam CHttC NANG CAP CAO C ilA H i THAN KINH Nhiing chiic nang cao cap cua he th an kinh thifdng de cap den qua trinh: nhan thiic, tu duy, ngon ngut, tri nhd, xuc cam,v.v nhiing qua trin h dien chu yeu d vo nao Cau tru e churc nang cua vo nao Phan hoat dong chiic nang cua vo nao chu yeu la mot ldp nOron day tif den mm, phu toan bo vo nao Toan bo vo nao co khoang 100 ty ndron, chia lam ldp Moi vung cua vo nao deu cd lien he m at thiet vdi cac cau true dudi vo, dac biet vdi doi thi Moi vung cua vd nao cd lien he hai chieu vdi mot phan tUdng iing cua doi thi Moi dudng dan truyen cam giac trudc den vd nao deu di qua doi thi Tren vd nao cd nhiing vung chuyen biet: vung cam giac th an the la vung tiep nhan va phan tich thong tin cam giac - giac quan (con goi la cac vung sd cap; vung cap I), cac vung van dong Ngoai ra, tren vd nao cd cac vung lien hdp thii cap cap II, cap III va cao hon nQa Nguyen ly hoat dong cua nao Cac thong tin tif moi trudng hay moi trUOng cO the, dUdc tiep nh an bdi cd quan tiep nhan cam giac cua he th an kinh He th a n kinh phan tich, tich hdp 394 cac thong tin roi dua quyet dinh d i n den mot dap iing thich hpp de dam bao sU ton tai va phat trien cua cd the Moi quan he gitia cam giac va van dong lam cho cd the la mot khoi thong n hat va moi ca the co tinh cach rieng nhd y thtic, tri nhd, ban nang va tri thong minh Phan xa co dieu kien (dieu kien hoa) Dudi tac dong cua kich thich cua moi trUdng, he th an kinh hinh mot moi quan he mdi gitia hoan canh cua moi trUdng va hanh vi cua cd the Do la sU hinh phan xa co dieu kien hay dieu kien hoa Khac vdi cac phan xa khong dieu kien, dieu kien hoa (phan xa co dieu kien) dupe hinh th an h ddi song, mang tm h ca the va khong ben vting, khong phu thuoc vao tac n han kich thich va bo phan nhan cam Nhd co loai phan xa ma cd the thich nghi vdi dieu kien song luon thay doi Hien ngUdi ta chia dieu kien hoa dieu kien hoa typ I va dieu kien hoa typ II 3.1 Dieu kien hoa typ I (phan xa kieu Pavlov) Phan xa co dieu kien cua Pavlov da dUdc de cap den d nhieu tai lieu, phan xa co dieu kien: bat den gay bai tiet nUdc bot Nhu vay kich thich cua moi trUdng, doi tUdng dap ting lai kich thich Co the thay dieu kien hoa dupe hinh ddi song, nhung doi tUdng khong kiem soat kich thich, hanh dong la kich thich tao ra, dap ting cua doi tUdng la thu dong theo hoan canh chti khong phai la y cua doi tUdng 3.2 Dieu kien hoa typ II (phan xa kieu Skinner) Thi nghiem cua Skinner, cho mot chim bo cau vao mot hpp(hop Skinner) Trong hop co mot can gat, neu chim mo vao can gat thi lam md lay va co hat thoc rdi Luc dau, chim mo ngau nhien, d i n dan chim hoc dUdc la phai md vao mot cho n h a t dinh thi se co thoc va xac dinh dUdc cho phai md vao de co thoc an Trong thi nghiem nay, kich thich dudng tinh (dUdc thoc rdi) la he qua cua hanh vi (md tru n g dich) Su khac cd ban cf day vdi phan xa kieu Pavlov la chim bo cau chu dong, han h dong de lam thoc rdi Bdi vay phan xa kieu Skinner dUdc goi la dieu kien hoa hanh dong Phan xa kieu Skinner dUdc ting dung nhieu nghien ctiu tam ly, tam sinh ly, dUdc ly hoc lam sang Cd che cua dieu kien hoa dang dupe nghien ctiu tti mtic neuron cho den mtic phan tti, tti mtic bo phan den mtic td chtic-chtic nang cua ca he thong T ri nhd Tri nhci la kh a nang ltiu giti va tai hien lai thong tin da tiep n h a n trticic Ve phudng dien Sinh ly hoc, tri nhd la dau vet lai cua qua trin h th an kinh 395 tren mot mach ndron sau kich thich va dap iing xay va co kha nang tai hien lai (trong y nghi hoac la lap lai h anh dong trudc da co) nhiing dieu kien nh at dinh Phan loai tri nhd, co nhieu cach phan loai nhii: tri nh6 diidng tinh va am tinh v.v Cach hay diidc dung n h a t la phan loai tri nhd theo thdi gian ton tai tri nhd, bao gom: th an h tri nhd tiic thdi, vi du nhd mot so' dien thoai vai phut; tri nhd n g in han, loai liiu giii nhd dUdc vai p hut den hang t u l n sau m at di hoac trd than h tri nhd dai han; tri nhd dai han, loai liiu giii nhd co den suot ddi Giiia cac loai tri nhd co sii chuyen hoa lan Chinh vi vay tri nhd la cd sd cua tri thiic, kinh nghiem Den cd che cua tri nhd chua diidc biet ro Cd tac gia cho r i n g dd la mach neuron doi lai (tri nhd tiic thdi); cd tac gia cho r i n g nhiing bien doi ly-hoa d vung synap (tri nhd ngan ha-i); cd tac gia cho la bien doi cau true synap (tri nhd dai han) Moi phan cua he th an kinh deu cd tham gia vao qua trin h nhd, nhUng dac biet la cac cau true sau: hoi hai ma, thuy thai dudng (hoi Wernicke, hanh nhan): lUu giii cac thong tin mdi doi thi: lUu giii cac thong tin cu CHUYEN HOA CGA NAO Chiic nang cua ndron la p h at va d i n truyen dien the hoat dong, sii p hat sinh dien the hoat dong la ddng md cac kenh ion, de lap lai nong ion giiia va ngoai ndron la nhd vao hoat dong cua cac bdm ion, vay nang liidng tieu hao la t ldn Chuyen hoa cua neuron va chuyen hoa cua nao Trong dieu kien nghi ngdi, chuyen hoa cua nao chiem khoang 15% chuyen hoa toan than mac du nao chi nang b in g 2% liidng cd the Nhu vay, chuyen hoa cua nao ca luc nghi ngdi cung hdn chuyen hoa chung cua cd the tdi 7,5 lan Chuyen hoa cua nao xay chu yeu d cac neuron, nang liidng chuyen hoa chu yeu dUdc neuron dung vao viec bdm n a tri va canxi ngoai te bao va bdm kali va clo vao ben Cii moi lan neuron truy en di mot dien the hoat dong thi cd sii van chuyen cac ion qua m ang va lai doi hdi phai cd nang liidng de tai lap nong ion ve miic binh thudng Khi nao hoat dong r a t m anh thi chuyen hoa cua neuron cd the tang len nhieu lan Nhu cau oxy cua nao Nhieu mo cua cd the cd the chiu diing tinh tran g thieu oxy nhieu phut, tham chi tdi niia gid, khoang thdi gian ay, mo lay nang liidng tCr cac qua trin h chuyen hoa yem (phan giai khong hoan toan mot liidng ldn glucose va 396 glycogen, khong can ket hdp vdi oxy) Md nao khong cd kha nang du trti oxy, lai khong cd kha nang chuyen hoa hiem Dd la miic chuyen hoa r a t cao cua cac neuron, ddi hdi cung cap t nhieu nang liidng Mot ly ntia la liidng glycogen va liidng oxy du trO md nao t it, vi vay hoat tinh cua neuron phu thuoc hoan toan vao su cung cap oxy tU m au vao luc dd Do vay, chi can m au khong len nao hay thieu oxy mau tti den 10 giay cung cd the gay bat tinh Vai tro cua glucose doi vdi cung cap nang luong cho nao Trong dieu kien binh thudng, hau het nang lUdng can cho hoat dong cua neuron la tti glucose m au cung cap Giong nhu doi vdi oxy, glucose cung mau mang tdi va r a t it dUdc chuyen glycogen de du trti d nao Su van chuyen glucose qua mang de vao neuron khong phu thuoc vao insulin benh n h a n bi dai thao dudng nang, lUdng insulin hau nhu bang khong thi glucose van vao dUdc neuron mot cach de dang nen hoat dong tam th an cua benh nhan v in khong bi roi loan Trong trudng hdp glucose huyet bi thap; ca d nhting benh n han m&c dai thao dudng bi tiem qua lieu insulin khien glucose huyet bi giam xuong t thap thi insulin lam cho glucose dUdc chuyen nhanh vao cac loai te bao khac khong phai la neuron Luc nay, lUdng glucose cung cap cho neuron khong du dan den roi loan hoat dong tri oc, roi loan tam t h i n tam ly va cd gay hon me T if Ll/ONG GIA A DONG/SAI Churc nang cua noron A Ndron cd chtic nang p hat va dan truyen xung dong B Ndron chi p h at xung dong chiu kich thich tti mdi trudng ngoai C Ndron cd ngUdng kich thich cao D Ndron cd kha nang dap ting vdi cac kich thich cd ta n so' cao Churc nang cam giac cua he than kinh A Cho t a n h a n b ie t dUdc sti v a t v a h ie n tUdng B Cam giac khong cd tin h dac hieu C Vd nao la ndi phan tich, tong hdp cho ta cam giac D Cam giac cd tinh he thong Cam giac thi giac A Vung 17 d vd nao cho ta nhin thay vat B Ton thUdng vung 18 khong nhin thay v at 397 C Ndi tiep nhan kich thich anh sang la vong mac D He tho ng t h a u k in h cua m i t co tac d u n g dieu hoa lUdng a n h s a n g vao m i t Cam giac xuc giac A Tac nhan kich thich la: va cham, rung dong, ap su at B Vo nao vung thai dudng cho biet cam giac xuc giac C Cam giac xuc giac d vo nao chi phoi ntia ngUdi doi ben D Vung nao co cam giac tinh vi thi vung dai dien d vo nao ldn Churc nang tu y song A D in truyen cam giac va van dong, la trun g tam cua phan xa B La trung tam cua cac phan xa co dieu kien C La trun g tam cua nhieu phan xa thuc vat D Chat xam la trung tam cua phan xa, chat t r i n g la cac bo sdi th an kinh Hien tu o n g choang tu y A Mat van dong cam giac d dudi ndi ton thudng B Huyet ap giam, mach cham C Het thdi gian choang m at van dong cd tinh tU dong D Het choang gay liet mem Vai tro cua than nao doi vdi van dong A Nhan dd d c a u n ao cd ta c d u n g la m g ia m trU dng lUc cd B Nhan tien dinh cd tac dung lam tang trUdng luc cd C Nhom nhan ludi d cau nao cd tac dung tic che truyen xudng D Nhom nhan liidi d han h nao cd tac dung tang cUdng truyen len Churc nang cua nao tru n g gian A Ddi thi la trun g tam diidi vd cua cam giac B Ddi thi la tram dting cua moi cam giac va giac quan C Vung dudi doi trudc la tru n g tam chong lanh D Vung dudi doi sau la trung tam chong nong Churc nang cua tieu nao A Tieu nao nhan cam giac ntia ngtidi doi ben B Tieu nao mdi dieu hoa phoi hdp cac dong tac phtic tap 398 C Tieu nao chi phoi mia ngiidi doi ben D Ton thudng tieu nao roi loan dieu hoa trUdng liic cd 10 Vai tro cua vo nao A Chi phoi cac van dong co y thiic B Chi phoi van dong khong co y thiic C Vung van dong sd cap la vung D Vung van dong bd sung la vung 11 Tac dung cua he than kinh th i/c vat len cac tang A He giao cam lam tang hoat dong cac cd quan B He giao cam lam giam hoat dong C He giao cam lam gian da day - ruot D He giao cam lam gian dudng d i n B CHON CAU TRA LOI DUNG NHAT 12 Cac dac diem d in tru yen dien the hoat dong sau day la cua soi true, trir A Theo qui lu at “ta t hoac khong” B Dan truyen theo chieu C Dan truyen d sdi co myelin nh anh hdn sdi khong co myelin D Trong mot bo sdi than kinh xung diidc dan truyen tii sdi sang sdi khac E Xung dong chi dUdc dan truyen tren sdi true nguyen ven ve cau true va chiic nang 13 Cac dac diem dan tru yen dien the' hoat dong qua synap la A D in truyen theo mot chieu tii mang triidc den m ang sau synap B Co h ie n tUdng moi s y n a p C Co h ie n tUdng c h a m s y n a p D Ca A va B E Ca A, B va C 14 Cam giac than bao gom A Cam giac sau co y thiic va khong co y thiic B Cam giac dau C Cam giac nong lanh 399 D C a A va B E Ca A, B va C 15 Cam giac th in h giac A Tai nhan diidc cam cac tan so am > 20.000Hz B Tin hieu am den mot ben tai diidc truyen ve mot ben vo nao C Ton thudng vung 44 va 42 thi bi diec D Ton thudng vung 22 khong nghe dUdc 16 Hanh nao la tru n g tam cua cac phan xa sau, tr if A Phan xa dieu hoa ho hap B Phan xa dieu hoa tim mach C Phan xa tieu hoa D Phan xa cang cd 17 Churc nang cua doi thj A Trung tam cua moi cam giac B Trung tam cua cam giac dau C Tram dting cua moi cam giac va giac quan D Ca A va C E Ca B va C 18 Churc nang cua vung W ernike A Nhan thCfc cua ldi noi B Chi phoi dong tac phat am C Ton thudng khong noi diidc D Ca A va B E Ca A va C 19 Moi ban cau tieu nao co churc nang A Nhan cam giac va chi phoi van dong cua ntia ngUdi cung ben B Nhan cam giac va chi phoi van dong ntia ngUdi doi ben C Nhan cam giac doi ben, chi phoi van dong ntia ngUdi cung ben D Nhan cam giac cung ben, chi phoi van dong ntia ngiidi doi ben 400 20 Phan vung churc ndng cua tieu nao A Tieu nao cd co tac dung lam tang trUdng luc cd B Tieu nao m6i lam tang triidng luc cd C Nguyen tieu nao tham gia giti thang b in g D Ca A, B va C DAP AN: 1A:D IB: S 1C:S ID: D 2A: D 2B: S 2C:D 2D: D 3A: D 3B: S 3C:D 3D: S 4A: D 4B: S 4C:D 4D: D 5A: D 5B: S 5C:D 5D: S 6A: D 6B: D 6C:S 6D: S 7A: S 7B: D 7C:S 7D: S 8A: S 8B: D 8C:S 8D: S 9A: S 9B: D 9C:S 9D: D 10A:D 10B:S 10C:S 10D:D 11A:S 11B:S 10C:D 11D:S 12: D 13:E 14: E 15: D 16: D 17: E 18: E 19:D 20: C 401 TAI LIEU THAM KHAO ■ Bo mon Sinh ly hoc Sinh ly hoc Tap I Nha xuat ban Y hoc, 2000 Bo mon Sinh ly hoc Sinh ly hoc Tap II Nha xuat ban Y hoc, 2000 Bo Y te Cac gia tri sinh hoc ngUdi Viet Nam binh thudng thap ky 90- the ky XX Nha xuat ban Y hoc, 2003 Guyton and Hall Texbook of medical physiology W.B Sauder company, 2000 Federative Committee on Anatomical Terminology : International Anatomical Terminology Thieme S tu ttg a rt - New York, 1998 Tortora G J ; Grabowski S R : Principles of Anatomy and Physiology John Wiley & Sons, INC, 2000 Kathleen J W : Anatomy and Physiology in H ealth and Illness Churchill Livingstone, 1988 402 \ a' •) NHA XUAT BAN Y HOC GIAI PHAU SINH LY (S a c h d iin g c h o c d c tr u & n g tr u n g h o c y te ) Chju trach nh iem x u a t ban HOANG TRONG QUANG Bien tap: BS NGUYEN TH| HANG SCra ban in: NGUYEN TH| HANG Trinh bay bia: CHU HUNG Ky thuat vi tinh: TRAN THANH TU In 1000 cuon, kho 19 x 27cm tai Xi/dng in Nha xuat ban Y hoc So dang ky ke hoach xuat ban: 22 - 2007/CXB/98 - 151/YH In xong va nop luu chieu quy III nam 2007 [...]... (H.2.22) D a u tre n cd mom khuyu va mom vet vay q u a n h khuyet rong roc K h u y e t ro n g roc k h dp vdi ro n g roc xUdng c a n h ta y con m om k h u y u va m om v e t la p vao cac ho" c u n g te n d d a u dudi xUdng c a n h ta y k h i c a n g ta y gap v a ruoi T r e n m a t n g o ai mom v e t cd khuyet quay tiep kh d p vdi v a n h k hd p c u a chom xUdng quay T h a n x itd n g gian cd h in h la n g... h a i xiidng cua ciing tay, deu la xUdng dai co m ot t h a n n a m giiia h a i dau Khi b a n ta y d t u th e giai ph&u, c h u n g n&m song song vdi n h a u va xiidng q u a y n a m ngoai xUdng tru H ai xUdng n a y tiep khdp vdi xUdng c an h ta y ta i khdp k h u y u , vdi cac xUdng cd ta y ta i khdp cd ta y va vdi n h a u ta i cac khdp q u a y t r u g an va xa 5.4.1 XtfOng quay (ra d iu s) (H.2.22) D... s thiic sU A* ~ O tu y ( m e d u lla ry cavity) la k h o a n g ro n g b e n tr o n g t h a n xUdng d a i c h iia tuy vang (yellow bone m a rro w ) T h a n h o tu y dUdc lot b a n g noi cot mac (e n d o s te u m ) T u y v a n g chiia n h ie u te bao md 12 I 1.2.2 Dac diem cau tao rieng cua mdi loai xi/ong (Hi2.2) Xiidng dai 6 t h a n xiicfng (d ia p h y sis), ldp xiidng dac d a y d giiia v a m o ng... tay va cac m om tr e n loi c a u ta o nen: m om tren loi cau trong va m om tren loi cau ngoai Loi c au xUdng c a n h ta y la te n goi c h u n g cua h a i m a t khdp: chom nho xiicfng canh tay ft ngoai tiep k h d p vdi xUdng qu ay , rong roc xiicfng canh tay 6 tro n g tiep k hd p vdi xUdng tru be Hinh 2.21 Xirong canh tay ben phai, nhin tir triidc (A) va sau (B) 33 5.4 Xirong quay va xuong tru D ay... a to m y ) la n g a n h k h o a hoc n g h ie n ctfu c au tru e cd th e ngUdi T u y th uo c vao phUdng tie n q u a n s a t, giai p h a u hoc dUdc ch ia t h a n h h a i p h a n mon: g id i p h a u dai the (gross a n a to m y h a y m acroscopic ariatomy)^ n g h ie n ctiu cac c a u tr u e co th e q u a n s a t b a n g m a t thUOng va g id i p h a u vi the (m icroscopic a n a to m y h a y histology) n g... co ta y , co c h an ), s u n dUdc t h a y t h e d a n chi b a n g m o t t r u n g t a m cot h o a n g u y e n p h a t XUdng cot so n g v a xUdng d a i c u a chi dUdc h in h t h a n h tii n h ie u t r u n g ta m cot h o a gom: t r u n g t a m cot h o a n g u y e n p h a t (chlnh) ta o r a t h a n xUdng va cac trung tam cot hod th ii p h a t (s e c o n d a ry o ssific a tio n c e n tre ) h a y cac trung. .. a y t r u g an va xa 5.4.1 XtfOng quay (ra d iu s) (H.2.22) D a u tr e n xUdng q u a y n h d h dn d a u dudi va dUdc goi la chom xiidng q u a y ; chom bao gom m o t vanh khdp d x u n g q u a n h tiep k h d p vdi k h u y e t q u a y xUdng t r u va m ot hom khdp d m a t tr e n tiep k hd p vdi chom con xUdng c a n h tay C hom noi vdi t h a n q u a m ot co t h a t hep T h a n x itd n g g a n co h in h... quay D a u d itd i la m ot khoi to d e t co h a i m a t khdp: m at khdp co tay h u d n g x u o n g dudi tiep kh d p vdi cac xUdng cd ta y h a n g tre n ; va khuyet tru h iidn g vao tr o n g tie p k hd p vdi v a n h k hd p c u a chom xUdng tru M om xUdng n a m d ndi t h a p n h a t c u a m a t ngoai (sd th a y dUdc dudi da) la mom tram quay 5.4.2 Xuong tru (ulna) (H.2.22) D a u tre n cd mom khuyu va... n co 32 xiidng: 1 xiidng vai, 1 xiidng don, 1 xiidng c a n h ta y , 2 xiidng cfing ta y (xiidng q u a y va xUdng tru ) va 27 xiidng b a n ta y (gom 8 xUdng cd ta y , 5 xiidng dot b a n ta y v a 14 xUdng d o t n g o n tay) T ro n g cac xiidng k e tre n , xiidng don va xiidng vai ta o n e n d a i c h i tr e n (s h o u ld e r g irdle) h a y d a i n g i/c (p e c to ra l girdle) g&n cac xUdng c u a obi t... a y n g a m m uo i calci b ie n t h a n h xUdng; d ie m ta o xUdng b a n d l u n a y la trung tam cot hod nguyen p h a t (p r im a r y o ssifica tio n c e n tre ) K h i t r u n g t a m cot h o a n a y p h a t t r i e n ro n g r a tdi dudi m a n g n goai xUdng, xUdng dUdc tie p tu c dUdc s in h r a bdi m a n g ng oai xUdng S u to r a ve dUdng k in h c u a xUdng s u n la do m a n g n g o a i xUdng xay ... Sinh ly noi tiet 347 Sinh ly vung di/6i doi 347 Sinh ly tuyen yen 348 Sinh ly tuyen giap 351 Sinh ly tuyen can giap 353 Sinh ly tuyen thUdng than 354 Sinh ly tuyen noi tiet 356 Chuong Sinh ly sinh. .. Sinh ly hoc chuyen hoa nSng lUdng 273 Sinh ly dieu hoa than nhiet 279 Chuong Sinh ly mau 284 Sinh ly hoc hong cau 285 Sinh ly bach cau 289 Sinh 292 hoc tieu cau Chuong Sinh ly tuan hoan Sinh ly. .. Sinh ly tuan hoan dong mach 304 Sinh ly tuan hoan tTnh mach 307 Sinh ly tuan hoan mao mach 309 Chuong Sinh ly ho hap 315 Chuong Sinh ly tieu hoa 328 Chuong Sinh ly tiet nieu 340 Chuong Sinh ly