医学题库-2012级各论1题.docVIP

2012级各论1回忆题。 本帖来自cc98 HYPERLINK /dispbbs.asp?boardID=241ID=4399563 /dispbbs.asp?boardID=241ID=4399563 翻译：肺泡华法林等长收缩Budesonide(布地缩松)限制性通气低动力缺氧CO2max1.简述颗粒细胞血生成中形态学发生的变化2.案例题：A 63-year-old man suddenly felt a crushing pain beneath his sternum. He became weak and began to sweat profusely. He called his physician, who advised him to go to the hospital immediately by ambulance. The tests made at the hospital confirmed his physicians belief that the patient had suffered a heart attack; that is, a major coronary artery had suddenly become occluded.1. When a coronary artery is occluded, the K+ concentration rises in the interstitial fluid of the ischemic region (i.e., the region deprived of its blood supply) of the ventricular myocardium. What effect does the elevated K+ concentration in the interstitial fluid have on the resting membrane potential of the myocardial cells in the ischemic zone?2. What effect does the change in resting membrane potential have on the propagation of the cardiac impulse? Why?Answer：1. As the K+ concentration rises in the interstitial fluid of the ischemic zone, the ratio of the intracellular K+ concentration ([K+]i) to the extracellular K+ concentration ([K+]o) would decrease. The myocardial cell membranes at rest (phase 4) are much more permeable to K+ than to any other relevant ion. Hence, the resting membrane potential is very close to that estimated by the Nernst equation for K+, As the [K+]i/K[+]o ratio diminishes, the resting membrane potential becomes less negative, as predicted by the Nernst equation.2. The fast Na+ channels in the myocardial cell membranes are voltage sensitive. As the resting membrane potential of myocardial cells becomes progressively less negative (i.e., partially depolarized), more and more of the fast Na+ channels in those cells become inactivated because of their voltage dependency. Hence, when the wave of excitation reaches the partially depolarized cells, a diminished number of fast Na+ channels