★血小板上昇

★血小板上昇
定義　50万以上
Reactive thrombocytosis→サイトカインで。症候性
　Infection ― 31 percent
Infection plus postsurgical status ― 27 percent
Postsurgical status ― 16 percent Malignancy ― 9 percent
Postsplenectomy state ― 9 percent
Acute blood loss or iron deficiency ― 8 percent

と
Autonomous thrombocytosis；, polycythemia vera (PV), primary myelofibrosis (PMF), and chronic myelogenous leukemia (CML).
100万以上で考慮
Infection ― 31 percent
Postsplenectomy or hyposplenism ― 19 percent
Malignancy ― 14 percent
Trauma ― 14 percent
Inflammation (noninfectious) ― 9 percent
Blood loss ― 6 percent
Rebound thrombocytosis ― 3 percent
Uncertain cause ― 4 percent

essential thrombocythemia (ET)

Patients with inflammatory or infectious conditions are likely to have neutrophilic leukocytosis. The presence of increased numbers of neutrophilic band forms and/or metamyelocytes (ie, a "left shift"), along with neutrophilic vacuolization, toxic granulation, and Döhle bodies, is suggestive of infection

★四肢筋肉のこわばり
・Malignancy　；paraneoplstic syndrome
・Polymyositis；CK↑
・Bursitis;筋肉痛、腱膜炎
・RA
・Vasculitis
側頭動脈炎
　　PMR
　　PN　・・・
・RS３PE症候群；remitting seronegative symmetrical synovitis with pitting edema
・Hypothyroidism
・IE
・Fibromyalgia　50才以下圧痛点がある　ESR正常HCT正常
　

★血尿の鑑別診断　
肉眼的血尿
顕微鏡的血尿

見逃してはいけない疾患
acute glomerulonephritis
1次 溶連菌感染症後糸球体腎炎、
IgA腎症、
Goodpasture症候群、

2次 SLE,
強皮症
Wegener肉芽腫
顕微鏡的多発性血管炎
亜急性感染性心内膜炎

急性進行性糸球体腎炎
急性腎盂腎炎（尿路閉塞を伴うもの）
溶血性尿毒症症候群
悪性腫瘍
横紋筋融解症
腹部大動脈瘤破裂


その他
尿路悪性腫瘍
　腎細胞癌
　膀胱癌
　前立腺癌
　前立腺肥大
　尿路結石
　多発嚢胞腎
　乳頭壊死

膝痛の鑑別

意識障害

CT LP、AND EEG HIM

Cerebrovascular accident(braintein ischemia, bleeding)
Tauma

Low BP
Psychiatric

Anoxia, hypoxia
Neoplasma
Drug/toxins/withdrawal

Epilepsy
Elevated BP
Glucose↓

Hemorrhage/bleedinf/ICH
Infection
Metabolic/endocrine

Loss of conciousness

VAGAL SYNCOPE

Volume loss/bleeding
Aortic dissection
Glucose↓
Autonomic dysfunction(shy-drager)
Low cardiac output (AR/AS.HOCM)

Seizure
Your mama's coming(anxiety,psychogenic)
Neoplasma
CVA/SAH/TIA/CI
Orthstatic hypotention
Pulumonary embolism
Elevated BP

頭痛

Cant stop head pains

Clustar/migraine
Arteritis
Neuralgia(trigeminal)
Tention headach

Sinus thrombosis
Trauma　(post-concussion）
Osteoarthritis/muscosketal　？？
Post-LP

Hydroceohalus
Elevated BP
Aneurysm・SAH
Drug(steroid,,opitite,oral cntraceptive)

Pseudotumor
Arteriovenous malformation
Infection
Neoplasma
Sinusitis/ototis/mastoiditis

Seizure

BITE TONGUE

Bleeding/hemorrhage
Infection
Trauma
Ethanol/drug/toxin

Tumor
Oxygen luck/ischemic/hypoxia
Noncompliance(Subtherapietic meds)
Glucose lack /hyperglycemia,hypoglycemia
Uremia/metabolic
Eclampsia

STROKE

DO SAVE THEM BRAINS

Dissection/dysplasia(fibromasucular)
Oral Contraceptives

Sinus thrombosis
Atherothrombosis
Vsculitis (collagen disease)
Embolism(include paradoxical,IE)

Trauma/herniation
Hematologic/hypercoagulable
（AT-Ⅲ低下⇒ネフローゼ患者に多い。ヘパリンが効かない）
(proteinS欠損、AT-Ⅲ欠損）
Exogenous toxin(コカイン）
Migirane

Bleed/AVM/aneurysm
Radiation
Angiography
Infection(Neurosyphilis,meningitis)
Neoplasma
Symatic hypotention

小児の発熱

Emergncy disease
1髄膜炎
2脳炎
3敗血症

見逃せない疾患
momepub
1pneumonia
2UTI
3otitis media
4enteritis
5bronchiolitis
6mucocutaneous lymph node syndrome
7measles

commmon disease
cold syndrome
ウィルス感染
熱中症

腹痛 解剖学的に