סיכומי רפואה פנימית

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CLL 00061 ) %03 ( ,CLL . CLL .ALL 4 : %03 Immunophenotyping 19, 20CD B. 5CD ,T /CLL. DD , . , . -. , . ' , , ) , (. ), , ,B, (, ' , AIH/ITP . CLL, , , , . , , , , , . , , . , . , ' ' ) (. ALL . Myeloid stem cell disease .MDS myelodisplastic syndrome .MPD myeloproliferative disease /. ,CML, PV .ET .AML , . ! BCRABL . AML ) APL .(ATRA all trans retinoic acid ALL . . AML ) ( , 1

maintainence .

, . ' ) (. ,(MGUS (monoclonal gammopathy of uncertain significance )%01 08( ) (. , . . .myeloma kidney , , . MM IgM . MM Spinal cord compression Ig , o ) ( o . o RBC ) ,DNA (. . , . /, .MM %08 o / %89 . o %2 - ,non secretory serum o .free light chain , . . ' 2 . , , , ..., , . " ' .VAD maintanance / . )(, )(. ,TANDEM .

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) , , (, .Velcade 747-537 , . . , . ,MI, CVA . , , . , . .DVT, PE , , / . , . RBC . .antiplatelet , . -. , . . . : - , PE/ . o - ) , DVT o (. , : ,NO )" (2COX .ADPase , , .vWF .tissue factor , ADP ) 2A " (1COX . . , 4PF 4 .((platelet factor . , . ) GP2b3a ( " ) vWF RGD .(KGD , . ) AKA 3, SERPIN serine protease (inhibitor .X ) ,PA Plasminogen activators PAI ,PA inhibitors (, ) - 2(. , --tissue PA (PA ,(fibrin specific ) (. PA systemic lytic state , . 1COX, 2COX. , ) %1, 04 2 05 1( . . 523-57 , . 061 . , )

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(, , . . . .ADP )( , . , /,UAP CVA . 57 , " . 009-003 , . ) / ,(CVA ) (. , . ,cAMP . , cAMP" . CVA ,TIA . ) ( . ) .. , , (. GP2b3a . , . KGD . RGD . .ACS ,MI .UAP ,IV . " . ) (. -: , " ) X" o (, " ) (. 1:1. ,TFPI .tissue factor , . , .ACS ,IV ) 08-07 /, 81-21 (. ,ACS . 0005 *3-2 ,SC . ) ( ) 4PF (, .acute phase " , . " , " . " ) aPTT , , 3-2(, " X ), (. , . 00053 , %52 . aPTT , X. ) , 1 / 001 (, ,HIT ) (, . ) HIT heparin induced thrombocytopenia 4PF (. , ) 000001 ( / ) ( . ELIZA /4PF ) (. /, K ,INR . HIT C C . 4

/ ,LMWH . , X o ) 4-2 (. . 2-1 , SC )" 0006 (. ), (ACS 052 //. . , ) (, . IV . , ) 05(, , , ) (. . ) , /, (, ) HIT , -(, ) , (. , X o ) (. , . .ACS SC , 5.2 , 5.7 ) " (. . ) , , (. : o , . SC ,IV . .aPTT . ,IV . ,aPTT ) INR (. , . . " . .aPTT ,HIT .ACS . ) ,II 01,9,7(, - S- .C K ) ,(VKOR . ) ,(X . ,GI . . 5 " . ) PT , (, ) INR, 3-2, (. INR 5.3-5.2 . 3-2 , . ) INR 1 K INR 9, 01 K IV ,FFP INR(, ) S ,C (, 21-6 ) , , (. , VKOR , ) , (. APLA 3-2 ) INR (, 5 bridging" . PA :systemic lytic state o . 5.1 , .IV , . . .MI , .. ) (. 5

acylated plasminogen streptokinase activator complex o . ,IV . ) ( . . . o . PA , . / .rtPA recombinant tisuue type plasminogen activator o " ) (DD-E ,X , . , MI 57 -6 ) (. 001 ,IV . .rtPA ,DDE . o IV. ) , (. .rtPA E, T . o .

, , , , o ,IHD, , )(, )(, NSAIDs o , , , , , o . o , o - Omeprazole o o 21 B , , , , o , , o , , , ) Crohns, UC o (, / , , 21 ,B, . o o ,G6PD, sickle cell anemia .., , , ) ( o .. o ) ( , ), ( o ,palmar erythema, clubbing, spider angiomatas. . o Cheilosis/ Koilonychia . o Virchov o , / . o PR, , , o 21 !!!B , , ,ataxia , , , .

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: 03 ,HB 7, MCV 72, PLT 500, WBC 4000, IR - 054 ) TIDC, 1. 052-051(. . . . , TIBC, . 001 .HB 7, MCV 120, WBC 2000, PLT. 2. /12B , MCV ) 011(, . LDH .ineffective erythropoesis , . 0005 HB 9, MCV 100, PLT 200, WBC 3. . 001 HB 8, MCV 78, PLT 180, WBC 5000, IR 25, TIBC 4. RA . /. . /. - Fe, Ferritin, Transferrin, RDW, RBC, MCV - Fe/N, Ferritin, Transferrin : , ), 12B'(. . . ) (. . , ) (, , . DD 12B . MCV ) 011(, MCV 021. . LDH .ineffective erythropoesis , . 12B . . :12B 21 B, . , ... Pernicious anemia . , , ... . MDS , . . %4-2. ) ,%HCT patient/HCT normal)*Reticulocytes . , " 3-5.1. , ,LDH ) ,heme RBC (, ) - , 7

, , ,PD6G , , PNH , .(RBC , . , ) , (, .sickle ) (. , . , ,G6PD , , ,PNH. G6PD - ,X . . ,AZT HAART DD . . / , , NSAID , , IBD , ' GI. , '. ,PO .IV , . .

: , , , / ' , , / , , ,HIV , ,. , , , , ), ...(. , , , /. , , , , .

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: , , , , , //GI' : . ) !( , . ) (, . . : : , , , .CSF 3 . , , , , , CRP/ESR ), ,babesiosis(. LP .CT CT/MRI - : . , , , ) myonecrosis, necrotizing fasciitis (. ; protein C'.

, " . , . DD', . CMV. " .PCR ,PCP. . )( , . . MAC . ,False Negative ) .(anergy CNS. DD . , . 05 ,4CD . , ) DD, , ( , , ,EBV, CMV, HIV ) (, ).(DKA 9

EBV, CMV IgM+IgG , , . IRIS immune reconstitution inflammatory syndrome - , - . , , )" ( . HAART . . o . .MRSA/MSSA o )(, / )(. MRSA. . ,IIIb. o ) (, - )/, .(HAP ) ( ,G )(. o ESBL extended spectrum lactamase o , E. ) ( , . ) KPC (. ESBL. o ) (, o / )(, . . ., . . ) (, , . / , +. , -, . IIIb IIIa . IV + . / .IV. II )(, . IIIa/. , , . . IIIb, . .IV cefipime , . .IV . ) , " (, ) (, . ) .(B , , , , .

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ESBL / o ESBL , , , ,UTI . PO .IV TARIVID CIPRO/XIN .TAVANIC , ) (. . , . . . /. . .HP : , ).(RF, GN , . IV PO, , , .

: - : 1. : ,TB, , , ),CMV, EBV 1. ,(HIV, ), ( : , , , , 2. . ),( ).(HCC, RCC, CRC 2. - ) (SLE ) ( 3. - ... 4. Central fever , / .CSF 5. , . , . ' : ) ( . 1. . 2. . ) , , , '...( ) , 3. , ' / , (. / , . 4. , , ) , , ( . ) , , ( , ) (, )(, ) , '...(, ), , (, ) (. 11

: : - ) CBC(, ) , , ( - 1. .CRP ) - (ZN ) 2. (, . ), (EBV, CMV, HIV ), ( 3. ,CXR, . . 4. , )(. 5. 6. 7. : .ANA, pANCA, cANCA, RF 8. .Still's 9. : CRC 01. US 11. CT , , ) RCC / , ( 21. 31. 41. , . 51. . , MRI/CT, US, , . FUO . 3.83 3 , 3 /3 . " , " 4 . FUO , . . . o 2. . o . . o / . . , ,UTI . o , 005. . , . o . HIV . o

)( ) (. , , . , ) (, , . . , . upper respiratory . ) (, ". . . . . 21

, . . . . ! o DIC o , acute phase o . , )%07-05 (. 01-7 . IgM IgG .IgA . !

-6 )3 (/ )6 (. . -6 , -3 . , -6 . . , , , , o , , , , ) (. , , , , o . , , , , o ) ( . , , o o ) ( ' ) o ( o : ) CBC - ,(WBC . :LP , ,immunocompromised - CNS o ) papilledema ( CT ICP . LP - LP CT . o - CSF : 081 mmH2O o -PMN 001 . . o 40mg/dL o 54 .mg/dL o ) %08 ( ) o %06(. 31

06 . : - CT - CT - LP o LP . cephalosporin ) III( vancomycin .IV Dexamethasone 02 o . Vancomycin - CNS )-(. - ICP , ) " o ( -.manitol . .penicillin G - rifampin . ,shock >systolic BP o 80mmHg < .30ml/hr MO o . DD o / . o . o Brain abscess o Encephalitis upper motor neurons o , . o sub arachnoid ,LP o o o . . , )( -5 . , . . 5 , , , , , . . RMSF - Rocky mountain spotted fever " , . ) tick (. , . , ) ( . .., , , ) ,CSF , (, ) GI (. " . ) (, . . . / )(. . Mediterranean spotted fever/Israeli spotted fever . " . . , ) 41

(, . , , , . , . Q fever " . , ) ( ,10IL . " ,