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24.Timo Jama, Article ID: ebm00341 (017.003) 2005 Duodecim Medical Publications
Ltd
1. EBM Guidelines, 29.9.2004, www.ebm-guidelines.com
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approaches. Annals of Pharmacotherapy 1999;33:61-72
3. Markus Frkkil, Article ID: ebm00743 (036.065) 2005 Duodecim Medical Publications Ltd
2. 3
3. 2007
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0.Editors Article ID: ebm00172 (008.002) 2005 Duodecim Medical Publications Ltd
2. 2
3. 2006
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(HSURC). Health Services Utilization and Research Commission (HSURC).Research
Paper No. 2. 1997
2. The Health Technology Assessment Database, Database no.: HTA-988939. In: The
Cochrane Library, Issue 1, 2001. Oxford: Update Software
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Editors Article ID: ebm00113 (006.060) 2005 Duodecim Medical Publications Ltd
EBM Guidelines, 14.10.2001, www.ebm-guidelines.com
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3. 2007
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2. 4
3. 2007

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Publications Ltd
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Article ID: ebm00213 (009.021) 2005 Duodecim Medical
1. EBM Gidelines, 17.6.2004, www.ebm-guidelines.com

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Ltd
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3. 2008
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2. 2
3. 2006
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).
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.
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().
.
ADH arginin vasopresin.
,
(24-A).
(-D).
. Hwang P, Auclair B, Beechinor D, Diment M, Einarson TR. Efficacy of pentosan polysulphate

in the treatment of interstitial cystitis: a meta-analysis. Urology 1997;50:39-43
3. Leo Niskanen Article ID: ebm00223 (010.001) 2005 Duodecim Medical Publications Ltd
1. EBM Guidelines, 16.6.2004, www.ebm.guidelines.com
2. 4
3. 2008
4.
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. Editors Article ID: ebm00233 (010.004) 2005 Duodecim Medical Publications Ltd
25

2. 2
3. 2006
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120-125 mmol/l.
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:
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;

.
. Miller M, etc. Apparent idiopathic hyponatremia in an ambulatory geriatric population. J

Am Geriatr Soc 1996;44:404-8
2. Arieff Al. Management of hyponatremia. BMJ 1993;307:305-8
2. 4
3. 2007
779
780
(
)
.
PTH ( ?).
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.
.
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mmol/l ).
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(4 mg 28 50 ml 0.9%
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. Ritva Kauppinen-Mkelin Article ID: ebm00502 (024.021) 2005 Duodecim Medical

Publications Ltd
2. 4
3. 2008
783
784
Takayasu
Polyarteritis nodosa
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.
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, (ANCA).
Arteritis temporalis;
Takayasu arteritis.
nodoza.
poliangiitis.
.
Churg-Strauss.
.
Henoch-Schnlein.
.
.
.
.
.
(Arteritis temporalis)
TAKAYASU
. .
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. CRP.
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.
POLYARTERITIS NODOSA
.
: , , .
.
, ,
, . : ,
.
70%.
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, , , .
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.
. IgA C3
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, .
.
: , .
: ,
, , .
: , , , , , ,
.
, , 4.
, .
.
, ,
, .
.
.
.
. Rao J, Weinberger M, Oddone E, Allen N, Landman P, Feussner JR. The role of

antineutrophil cytoplasmic antibody (c-ANCA) testing in the diagnosis of Wegener
granulomatosis: a literature review and meta-analysis. Ann Intern Med 1995;123:925-932
787
788
3. Tom Pettersson and Markku Ellonen, Article ID: ebm00449 (021.044) 2005 Duodecim
Medical Publications Ltd
2. 3
3. 2007
(
) . , , ,
VII.
VII 2 ,
5-7 . , , (warfarin31).
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2 .

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.
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.
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. (warfarin).
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.
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.
.
( 3).
( , ,
) , . (warfarin),
.
792
3. INR.
INR
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,
. ( , ).
, (warfarin) 4 INR < 1.5 .
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.
OAT (warfarin) :
. INR .
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3. , warfarin 1-5
.
,
() .
,
FXa-35, 0.3-0.7
-FXa i.e./ml.
(warfarin) INR-. (warfarin) :
5 INR > 4
3-4 INR = 3 - 4
2 INR = 2 - 3
4. INR .
35 .
1.9., 0.5-1.0 mg ( 1).

, ,
.
,
5-7 .
5. , ,
,
.
,
!
, .
, (warfarin)
, . (warfarin) . , (warfarin) .
(30%) INR ( ).
,
(warfarin) . .
(warfarin).
.

. (warfarin) .
5
(warfarin). .
, , , .
( ,
),
.

: : 1 mg, 1 ..
8 .
.
(-C).

(-A).
793
794
. Routledge PA, Davies DM, Bell SM et al. Predicting a patients warfarin requirements.
Lancet 1977;2:854-5
2. Koudstaal P. Anticoagulants for preventing stroke in patients with nonrheumatic atrial
fibrillation and a history of stroke or transient ischaemic attacks. The Cochrane Database
of Systematic Reviews, Cochrane Library number: CD000185. In: The Cochrane Library,
Issue 2, 2002. Oxford: Update Software. Updated frequently.
3. EAFT Study Group. Secondary prevention in nonrheumatic atrial fibrillation after transient
ischaemic attack or minor stroke. Lancet 1993;342:1255-1262
4. Koudstaal P. Anticoagulants versus antiplatelet therapy for preventing stroke in patients
with nonrheumatic atrial fibrillation and a history of stroke or transient ischaemic attacks.
5. Lip GYH, Gibbs CR. Anticoagulation for heart failure in sinus rhythm. The Cochrane
Database of Systematic Reviews, Cochrane Library number: CD003336. In: The
Cochrane Library, Issue 2, 2002. Oxford: Update Software. Updated frequently
6. Liu M, Counsell, Sanderlock P. Anticoagulants for preventing recurrence following
ischaemic stroke or transient ischaemic attack. The Cochrane Database of Systematic
Reviews, Cochrane Library number: CD000248. In: The Cochrane Library, Issue 2,
2002. Oxford: Update Software. Updated frequently.
7. Chatellier G, Colombet I, Degoulet P. An overview of the effect of computer-assisted
management of anticoagulant therapy on the quality of anticoagulation. International
Journal of Medical Informatics 1998;49: 311-320.
9. Sandercock P, Mielke O, Liu M, Counsell C. Anticoagulants for preventing recurrence
following presumed non-cardioembolic ischaemic stroke or transient ischaemic attack.
Cochrane Database Syst Rev. 2004;(2):CD000248.
1. EBM-Guidelines, www.ebm-guidelines.com 14.9.2004
2. 2-5
3. 2008
: .
( ).

.

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.
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, , .
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ACTH-.

( ).
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(<10 );
10-20 mg/ ;
>20 mg .

>1.500 400 .
, (). 5 mg /, 5 mg
.
(8) :
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.
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,

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798
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+
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1-2
100 mg .., 50-100 mg 6-8

.

, , 50 /,

. , ,
.
. Sharek PJ, Bergman DA. Beclomethasone for asthma in children: effects on linear
growth. The Cochrane Database of Systematic Reviews, Cochrane Library number:
CD001282. In: The Cochrane Library, Issue 2, 2002. Oxford: Update Software. Updated
frequently
2. Davies H, Olson L, Gibson P. Methotrexate as a steroid sparing agent in adult asthma.
799

1. EBM-Guidelines, 17.1.2005 www.ebm-guidelines.com,
2. 2
3. 2007- .
1. ( 1) .
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: 20mg/kg//3 x 10
otitis media
1. Amoxicilin
500-750mg x 2 x 5-7
2. Doxycicline
150mg x 1 x 5-7
100mg x 2/1 100mg x1x5-7.
3. Amoxicilin clavulanate
750mg x 2 x 5-7
4. Cefaclor
500mgx2x7
5. Azythromycin
500mg, 250mg x 1 x 4
6. Roxythromycin
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800
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. FDA Consumer magazine,Volume 35, Number 3 May-June 2001

2. Physicians Desk Reference 57th ed. Montvale, NJ: Thomson PDR; 2004: 3539.
3. Briggs GG, Freeman RK, Yaffe SJ, Drugs in Pregnancy and Lactation 6th edition,
Baltimore, MD: Williams & Wilkins,2002.
1. FDA Consumer magazine,Volume 35, Number 3, May-June 2001
2. 2
3. 2006
814
Nepoznata anamneza
Poznata anamneza
-trauma
-epilepsija
- dijabetes
-intoksikacija
Nepoznata anamneza
Klini~ka egzaminacij
Bez nevrolo{ki znaci
So nevrolo{ki znaci
Preku egzaminacija
Primarno intrakranijalna pri~ina

nevroradiologija (KTM ili MR)
- mozo~en udar
- intrakranijalna hemoragija
- mozo~en tumor
Meningizmus
(lumbalna punkcija)
-SAH
-meningitis
Korisni laboratriski testovi

Krvna slika: anemija, infekcii
Glikemija:hipoglikemija,
dijabeti~na koma
Natrium, kalium
CRP: infekcii
Etanol: alkoholna
intoksikacija
Amonium:hepati~na koma
Kreatinin, urea: uremija
Pulsna oksimetrija: hipooksija,
metabolna acidoza kaj
intoksijacija so metanol
EKG: aritmii
Algoritam 1: Bolen so izgubena svest
815
1
Algoritam za dijagnoza
x Odreduvawe na tipot na glavobolkata
x Zemawe na detalna anamneza i odreduvawe na funkcionalnoto zasegawe
x Odreduvawe na pri~ini koi se zagri ùva~ki
x Razmisluvawe za naru{uvawa so sekundarna glavobolka
x Upatuvawe na specijalist
2
Algoritam za tretman na
glavobolka
x Kategorizacija i
odbirawe na tretman
vrz osnova na te ìnata
i funkcionalnoto
zasegawe
x Razmisluvawe za
specijalen tretman
(vklu~uvaj}i DHE) za
status glavobolka
x Edukacija na pacientot
i modifikacii na
stilot na ìveewe
3
Algoritam za tenziska
glavobolka
x Odreduvawe na
dijagnozata
x Akuten tretman
x Za{titen tretman
x Edukacija na pacientot
i modifikacija na
stilot na ìveewe
4
Algoritam za Cluster
glavobolka
x Odreduvawe na
dijagnozata
x Akuten tretman
x Preventiven
tretman
x Edukacija na
pacientot i
modifikacija na
stilot na ` iveewe
5
Dali e pacientka ?
da
6
Algoritam za
migrena
asocirana so
menstruacija
10
7
Algoritam za
migrena vo
perimenopauza /
menopauza
8
Algoritam za migrena od upotreba na
kontraceptivi so estrogen
Razmisluvawe za kontraceptivi so
estrogeni
9
Algoritam za
profilaksa na
migrena
1
M igrenata e naj~esto
sretnuvana glavobolka vo
primarnata zdravstvena
za{tita
A-zabele` uvawe
D-diskusija
Algoritam 2.
Dijagnoza i tretman na glavobolkata (glaven algoritam)
816
Algoritam 3. Dijagnoza i tretman na glavobolka

10
Pacientot se oplakuva
glavobolka
AD
11
Kriti~ni prvi ~ekori:
Detalna istorija
Fokusiran fizikalen pregled
Fokusiran nevrolo{ki pregled
AD
12
Pri~ini za zagriùvawe?
ne
ne
da
14
Zadovoluva
kriteriumi za
primarna
glavobolka
AD
15
Glavobolka
poinakva od
primarnata
Nadvor od ova
upatstvo
13
Razmisluvaj za naru{uvawe so
sekundarna glavobolka
A
21
Indikacija za
specijalisti~ki
konsultacii?
A
da
ne
24
Upatuvawe na
specijalist za
glavobolka
ne
22
Pravewe
dijagnosti~ka lista
ako e potrebno
AD
16
Ocena na tipot na primarna
glavobolka
Zao~nuvawe na edukacija na
pacientot i sreduvawe na
stilot na ìvotot
AD
da
23
Naodi konzistentni so
sekundarna glavobolka
A
ne
25
Potvrdena dijagnoza
na primarna
glavobolka
26
Odreduvawe
na
sekundarna
glavobolka
Nadvor od
ova upaystvo
da
17
Migrena (Vidi algoritam
za migrena)
18
Tenziona glavobolka
(vidi algoritam)
19
Cluster
(Vidi algoritam)
20
Drugi tipovi, nadvor
od ova upatstvo
817

, ,

, ,
, ,
?
Algoritam 4. Poka~en serumski bilirubin.

Kratenki: AF-alkalna fosfataza, ALT-alanin aminotransferaza, AST-aspartat
aminotransferaza, AMA-antimitohondrijalni antitela, ERCP-endoskopska
retrogradna holangiopankreatografija, MRCP-magnetna rezonanca
holangiopankreatografija
818
( 2030 )
, grading/staging
5. .
: - ,
819
Poka~eni ALT i AST <5 pati nad normalata

Anamneza i fizikalen pregled*
Prekin so hepatotoksi~ni lekovi
Povtorete ja laboratorijata ako se
somnevate za gre{ka
Crnodrobni testovi, protrombinsko vreme, albumin, kompletna krvna

slika so Tr, serologija za hepatitis A, B i C**, Fe, TIBC, feritin
Negativna serologija, asimptomatski
pacient bez crnodrobna dekompenzacija
Pozitivna serologija - evaluacija

negativna serologija
Razmislete za ultrazvuk, ANA, antimaznomuskulni antitela,
ceruloplazmin, 1-antitripsin
N
e
g
a
t
i
v
n
a
s
e
r
o
l
o
g
i
j
a
abnormalni rezultati
Crnodrobna biopsija
Pozitivna hepatitis
A IgM serologija
Pozitivna hepatitis
B ili C infekcija
Promeni vo na~inot na ìvot
Prekin so alkohol
Prekin na hepatotoksi~ni lekovi
Namaluvawe na teìna
Kontrola za dijabetes
Klini~ko i laboratorisko sledewe
Klini~ko
podobruvawe,
normalizacija na
crnodrobnite
testovi za <6 meseci
6 meseci
Povtorete laboratorija
normalna
Opservacija
Perzistentna
abnormalnost na
crnodrobnite
testovi >6 meseci
abnormalna
Crnodrobna biopsija
***Opservacija
Ultrazvuk i serolo{ka evaluacija:
ANA, anti-maznomuskulni antitela,
ceruloplazmin, 1-antitripsin,
antiglijadinski i antiendomiijalni
antitela
Saturacija na Fe >50%, poka~en feritin

Prekin na zemawe èlezo i alkohol,
serumsko èlezo na gladno
Crnodrobna biopsija
6.
. * 1
,
** HAV-IgM, HBsAg, anti HBc IgM, anti
HCV (HCV-RNA) ***
HCV ,
ALT
Kontrolni crnodrobni
testovi i analizi na Fe
Bez dodatoci na
èlezo
abnormalni
nedijagnosti~ki
Perzistentna ALT elevacija,
poka~eni analizi za Fe
Crnodrobna biopsija
flebotomija
P
o
z
i
t
i
v
n
a
s
e
r
o
l
o
g
i
j
a
HFE test
A
b
n
o
r
m
a
l
n
o
s
t
i
dijagnosti~ki n
a
Flebotomija
F
e
Abnormalni ALT ili AST

Evaluacija za ciroza
820
, ,
GT 5
, ,
Algoritam 7. Poka~ena serumska alkalna fosfataza.

Kratenki: AF-alkalna fosfataza, ALT-alanin aminotransferaza, AST-aspartat
aminotransferaza, AMA-antimitohondrijalni antitela, ERCP-endoskopska
retrogradna holangiopankreatografija, MRCP-magnetna rezonanca
holangiopankreatografija.
823
1.
2.
3.
4.
5.
6.
824
7. Impetigo contagiosa
8. Herpes simplex labialis
9.
10. Urticaria
11. Pityriasis rosea Gibert
12. Pityriasis rosea Gibert
825
13.
14. Tinea corporis
15.
16.
17.
18.
826
19. Dermatitis herpetiformis Dhuring
20. Syndroma Gianotti-Crosti
21.
22. Lichen planus
23.

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Febris e causa ignota ( )

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1. EBM Guidelines, 1.5.2001, www.ebm-guidelines.com

NaCl (20-40 mg ..).

NaCl (3%=513 mmol/l) 0.05 ml/kg/min

. Miller M, etc. Apparent idiopathic hyponatremia in an ambulatory geriatric population. J

2.65 mmol/l ( 1.3

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1. INR > 1.2, 5 mg INR

32 INR = International Normalized Ration

1.9., 0.5-1.0 mg ( 1).

100 mg .., 50-100 mg 6-8

The Cochrane Database of Systematic Reviews, Cochrane Library number: CD000391.

160 mg x 2 x 5 300mg x 1x5

. FDA Consumer magazine,Volume 35, Number 3 May-June 2001

Bez nevrolo{ki znaci

Primarno intrakranijalna pri~ina

Korisni laboratriski testovi

Algoritam 1: Bolen so izgubena svest

Algoritam 3. Dijagnoza i tretman na glavobolka

Algoritam 4. Poka~en serumski bilirubin.

Poka~eni ALT i AST <5 pati nad normalata

Crnodrobni testovi, protrombinsko vreme, albumin, kompletna krvna

Pozitivna serologija - evaluacija

Klini~ko i laboratorisko sledewe

Saturacija na Fe >50%, poka~en feritin

Abnormalni ALT ili AST

Algoritam 7. Poka~ena serumska alkalna fosfataza.

8. Herpes simplex labialis

11. Pityriasis rosea Gibert

12. Pityriasis rosea Gibert

14. Tinea corporis

19. Dermatitis herpetiformis Dhuring

20. Syndroma Gianotti-Crosti

22. Lichen planus

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