{"id":7159,"date":"2020-12-25T10:00:35","date_gmt":"2020-12-25T01:00:35","guid":{"rendered":"https:\/\/wp.meccari.jp\/?p=7159"},"modified":"2023-12-27T09:38:15","modified_gmt":"2023-12-27T00:38:15","slug":"menu_22","status":"publish","type":"post","link":"https:\/\/wp.meccari.jp\/eigocafe\/menu_22\/","title":{"rendered":"Menu 22\u3000\u5faa\u74b0\u5668\u306e\u8eab\u4f53\u8a3a\u5bdf\u306b\u95a2\u3059\u308b\u82f1\u8a9e\u8868\u73fe"},"content":{"rendered":"\"\"\r\n

\u3053\u3093\u306b\u3061\u306f\u3002\u300c\u533b\u5b66\u82f1\u8a9e\u30ab\u30d5\u30a7<\/strong><\/span>\u300d\u306b\u3088\u3046\u3053\u305d\uff01<\/span><\/p>\r\n

\u3053\u3053\u306f\u300c\u30b3\u30fc\u30d2\u30fc1\u676f\u5206\u300d\u306e\u6642\u9593\u3067\u3001\u533b\u5b66\u82f1\u8a9e\u306b\u307e\u3064\u308f\u308b\u8a71\u3092\u6c17\u8efd\u306b\u697d\u3057\u3093\u3067\u3044\u305f\u3060\u304f\u30b3\u30fc\u30ca\u30fc\u3067\u3059\u3002<\/span><\/p>\r\n

\u672c\u65e5\u306e\u30c6\u30fc\u30de\u306f\u300c\u5faa\u74b0\u5668\u306e\u8eab\u4f53\u8a3a\u5bdf\u306b\u95a2\u3059\u308b\u82f1\u8a9e\u8868\u73fe<\/strong><\/span>\u300d\u3002<\/span><\/p>\r\n\r\n

\u4e16\u754c\u533b\u5b66\u6559\u80b2\u9023\u76df\uff08WFME\uff09\u306e\u56fd\u969b\u57fa\u6e96\u306b\u6cbf\u3063\u3066\u5404\u533b\u5b66\u90e8\u306e\u533b\u5b66\u6559\u80b2\u5206\u91ce\u5225\u8a55\u4fa1\u304c\u9032\u3080\u4e2d\u3001\u300c\u82f1\u8a9e\u3067\u3082\u5ba2\u89b3\u7684\u81e8\u5e8a\u80fd\u529b\u8a66\u9a13<\/strong>\uff08OSCE<\/strong>\uff09\u3092\u5b9f\u65bd\u3059\u308b<\/strong>\u300d\u3068\u3044\u3046\u533b\u5b66\u90e8\u304c\u5897\u3048\u3066\u304d\u3066\u3044\u307e\u3059\u3002\u3057\u304b\u3057\u82f1\u8a9e\u3067\u8eab\u4f53\u8a3a\u5bdf\u3092\u884c\u3046\u5834\u5408\u306b\u306f\u3001\u82f1\u8a9e\u570f\u3067\u306e\u8eab\u4f53\u8a3a\u5bdf\u306e\u9806\u5e8f\u3084\u7279\u6709\u306e\u82f1\u8a9e\u8868\u73fe\u306a\u3069\u3092\u6b63\u3057\u304f\u7406\u89e3\u3059\u308b\u3053\u3068\u304c\u5fc5\u8981\u3067\u3059\u3002<\/span><\/p>\r\n\r\n

\u305d\u3053\u3067\u4eca\u6708\u306f\u3001\u5faa\u74b0\u5668\u306e\u8eab\u4f53\u8a3a\u5bdf\u306b\u95a2\u3059\u308b\u82f1\u8a9e\u8868\u73fe<\/strong> \u3092\u3054\u7d39\u4ecb\u3057\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u82f1\u8a9e\u570f\u306e\u8eab\u4f53\u8a3a\u5bdf\u306f\u300c\u8996\u8a3a\u300d\u2192\u300c\u89e6\u8a3a\u300d\u2192\u300c\u6253\u8a3a\u300d\u2192\u300c\u8074\u8a3a\u300d\u306e\u9806\u5e8f\u304c\u57fa\u672c<\/strong><\/span>
\r\n\r\n\u300c\u8eab\u4f53\u8a3a\u5bdf\u300d\u306f\u82f1\u8a9e\u3067 physical examination<\/strong>\/exam<\/strong><\/span> \u3068\u8a00\u3044\u307e\u3059\u3002\u300c\u691c\u67fb<\/strong>\u300d\u306e\u82f1\u8a9e\u8868\u73fe\u3092 examination \u3068\u601d\u3063\u3066\u3044\u308b\u5b66\u751f\u3055\u3093\u3082\u3044\u308b\u3088\u3046\u3067\u3059\u304c\u3001\u75c7\u4f8b\u5831\u544a\u306a\u3069\u3067\u4f7f\u308f\u308c\u308b examination\/exam \u306f physical examination \u3092\u610f\u5473\u3057\u3001\u8840\u6db2\u691c\u67fb\u3084\u753b\u50cf\u691c\u67fb\u306a\u3069\u306e\u300c\u691c\u67fb<\/strong>\u300d\u306f workup<\/strong> \u3084 investigation<\/strong> \u306a\u3069\u3068\u533a\u5225\u3057\u3066\u8868\u73fe\u3057\u307e\u3059\u3002\u65e5\u672c\u3067\u306e\u300c\u5065\u5eb7\u8a3a\u65ad\u300d checkup \u306f workup\/investigation \u304c\u4e2d\u5fc3\u3068\u306a\u308a\u307e\u3059\u304c\u3001\u82f1\u8a9e\u570f\u3067\u306f\u982d\u306e\u5148\u304b\u3089\u3064\u307e\u5148\u307e\u3067\u4e01\u5be7\u306b\u884c\u3046 physical exam \u304c\u4e2d\u5fc3\u3068\u306a\u308a\u307e\u3059\u306e\u3067\u3001\u300c\u6700\u5f8c\u306b\u53d7\u3051\u305f\u5065\u5eb7\u8a3a\u65ad<\/strong>\u306f\u3044\u3064\u3067\u3059\u304b\uff1f\u300d\u306f\u3001 \u201cWhen was your last checkup?\u201d \u306e\u4ed6\u306b \u201cWhen was your last physical<\/strong>?\u201d \u3068\u3082\u8868\u73fe\u3055\u308c\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u3053\u306e physical exam \u306f\u300c\u75c5\u6b74\u8074\u53d6\u30fb\u533b\u7642\u9762\u63a5\u300dhistory taking\/medical interview \u306e\u5f8c\u306b\u884c\u308f\u308c\u308b\u3053\u3068\u304c\u4e00\u822c\u7684\u3067\u3059\u306e\u3067\u3001\u59cb\u3081\u308b\u524d\u306b\u306f \u201cI\u2019ve finished taking your medical history. I would now like to examine you.<\/strong>\u201d \u3068\u3044\u3046 transition<\/strong> \u3092\u4f1d\u3048\u3001 \u201cWould that be all right with you?<\/strong><\/span>\u201d \u3068\u5c0b\u306d\u3066\u60a3\u8005\u3055\u3093\u306e\u300c\u540c\u610f<\/strong>\u300d consent<\/span><\/strong> \u3092\u5f97\u308b\u3088\u3046\u306b\u3057\u307e\u3057\u3087\u3046\u3002\u307e\u305f \u201cBefore we begin, I will wash my hands.<\/strong>\u201d \u3068\u8a00\u3063\u3066\u624b\u3092\u6d17\u3046\u3053\u3068\u3082\u5fd8\u308c\u305a\u306b\u3002<\/span><\/p>\r\n\r\n

\u65e5\u672c\u306e OSCE \u306e\u624b\u9806\u306b\u6163\u308c\u3066\u3044\u308b\u65b9\u304c\u6238\u60d1\u3046\u3053\u3068\u306e\u4e00\u3064\u306b\u3001 physical exam \u306e\u9806\u5e8f<\/strong>\u304c\u3042\u308a\u307e\u3059\u3002\u82f1\u8a9e\u570f\u3067\u306f\u4e0b\u8a18\u306e\u9806\u5e8f\u3067\u884c\u3046\u3053\u3068\u304c\u4e00\u822c\u7684\u3067\u3059\u3002<\/span><\/p>\r\n\r\n

\u30001. General inspection (+mini-mental state examination)
\r\n\u30002. Vital signs
\r\n\u30003. Hand exam
\r\n\u30004. Head, eyes, ears, nose, and throat (HEENT) exam
\r\n\u30005. Neck exam
\r\n\u30006. Chest (cardiovascular + pulmonary exams) exam
\r\n\u30007. Abdominal exam
\r\n\u30008. Neurological exam
\r\n\u30009. Extremities
\r\n\u300010. Skin<\/span><\/p>\r\n\r\n

\r\n\u3064\u307e\u308a\u5168\u8eab\u89b3\u5bdf\u3068Vital signs \u3092\u78ba\u8a8d\u3057\u305f\u5f8c\u3001\u624b\u306e\u8a3a\u5bdf\u304b\u3089\u59cb\u3081<\/strong>\u3001\u305d\u306e\u5f8c\u306f\u982d\u304b\u3089\u8db3\u306b\u5411\u3051\u3066\u8a3a\u5bdf\u3092\u9032\u3081\u3066\u3044\u304f\u306e\u3067\u3059\u3002\r\n\u307e\u305f\u82f1\u8a9e\u570f\u3067\u306f\u8a3a\u5bdf\u3059\u308b\u90e8\u4f4d\u306b\u95a2\u308f\u3089\u305a\u3001\u300c\u8996\u8a3a<\/strong>\u300dinspection<\/strong><\/span> \u2192\u300c\u89e6\u8a3a<\/strong>\u300dpalpation<\/strong><\/span> \u2192\u300c\u6253\u8a3a<\/strong>\u300dpercussion<\/strong><\/span> \u2192\u300c\u8074\u8a3a<\/strong>\u300dauscultation<\/strong><\/span> \u306e\u9806\u5e8f\u3067\u884c\u3046\u3053\u3068\u304c\u4e00\u822c\u7684\u3067\u3059\u3002\u3053\u308c\u3082\u65e5\u672c\u306e OSCE \u306e\u624b\u9806\u306b\u6163\u308c\u3066\u3044\u308b\u3068\u6238\u60d1\u3046\u70b9\u306e\u4e00\u3064\u3067\u3059\u306e\u3067\u6ce8\u610f\u3057\u3066\u304f\u3060\u3055\u3044\u306d\u3002<\/span><\/p>\r\n\r\n

\u201cPatient is in acute distress.\u201d \u3063\u3066\u3069\u3046\u3044\u3046\u610f\u5473\uff1f<\/strong><\/span>
\r\n\u521d\u3081\u306e general inspection<\/strong><\/span> \u3067\u3059\u304c\u3001\u300c\u5165\u9662\u60a3\u8005\u300dinpatient \u306e\u5834\u5408\u306b\u306f\u300c\u30d9\u30c3\u30c9\u306e\u7aef\u304b\u3089<\/strong>\u300d from the end of the bed<\/strong><\/span> \u884c\u3046 general inspection of the patient from the end of the bed<\/strong> \u3068\u547c\u3070\u308c\u308b\u5168\u8eab\u89b3\u5bdf\u304b\u3089\u59cb\u3081\u308b\u3053\u3068\u304c\u4e00\u822c\u7684\u3067\u3059\u3002\u3053\u3053\u3067\u306f\u5168\u4f53\u7684\u306a\u5370\u8c61\u304c\u91cd\u8981\u3067\u3001\u60a3\u8005\u3055\u3093\u304c\u300c\u4eca\u3059\u3050\u51e6\u7f6e\u3092\u5fc5\u8981\u3068\u3059\u308b\u307b\u3069\u82e6\u3057\u3093\u3067\u3044\u308b<\/strong>\u300d\u3068\u5224\u65ad\u3059\u308c\u3070\u3001 \u201cThe patient is in acute distress.<\/span><\/strong>\u201d \u3068\u8868\u73fe\u3057\u307e\u3059\u3002\u3053\u306e distress<\/strong> \u306f\u300c\u82e6\u3057\u3044\u72b6\u614b<\/strong>\u300d\u3068\u3044\u3046\u30a4\u30e1\u30fc\u30b8\u306e\u8868\u73fe\u3067\u3001\u300c\u305d\u308c\u306f\u8f9b\u3044\u3067\u3059\u306d\u300d \u201cThis must be distressing.<\/strong>\u201d \u306e\u3088\u3046\u306b\u3082\u4f7f\u308f\u308c\u307e\u3059\u3002\u305d\u3057\u3066\u300c\u4eca\u3059\u3050\u51e6\u7f6e\u3092\u5fc5\u8981\u3068\u3059\u308b\u307b\u3069\u3067\u306f\u306a\u3044<\/strong>\u300d\u3068\u5224\u65ad\u3059\u308c\u3070\u3001 \u201cThe patient is in no acute distress<\/span>.<\/strong>\u201d \u3068\u8868\u73fe\u3057\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u300c\u898b\u5f53\u8b58\u969c\u5bb3<\/strong>\u300ddisorientation<\/strong> \u3092\u7591\u3046\u5834\u5408\u306b\u306f mini-mental state examination<\/strong> (MMSE<\/strong>) \u3092\u884c\u3046\u5fc5\u8981\u304c\u3042\u308a\u307e\u3059\u304c\u3001\u300c\u898b\u5f53\u8b58<\/strong>\u300dorientation<\/strong><\/span> \u3092\u78ba\u8a8d\u3059\u308b\u306b\u306f \u201cI would like to ask you some questions to test your orientation.<\/strong>\u201d \u3068\u8a00\u3063\u3066\u304b\u3089\u3001who\/when\/where\/why \u306e4\u3064\u306e\u9805\u76ee\u3092\u4e0b\u8a18\u306e\u3088\u3046\u306b\u5c0b\u306d\u307e\u3059\u3002
\r\n\u3000\u2022\u3000Who<\/strong>: \u201cCould you tell me your name?\u201d
\r\n\u3000\u2022\u3000When<\/strong>: \u201cDo you know the date today?\u201d
\r\n\u3000\u2022\u3000Where<\/strong>: \u201cDo you know where you are now?\u201d
\r\n\u3000\u2022\u3000Why<\/strong>: \u201cCould you tell me why you are here today?\u201d<\/span><\/p>\r\n\r\n

\r\n\u6b21\u306b\u300c\u30d0\u30a4\u30bf\u30eb\u30b5\u30a4\u30f3<\/strong>\u300dvital signs<\/strong><\/span> \u3092\u78ba\u8a8d\u3057\u307e\u3059\u3002\u3053\u306e vital signs \u306b\u95a2\u3059\u308b\u82f1\u8a9e\u8868\u73fe\u306f\u3053\u3061\u3089<\/a><\/span>\u306b\u307e\u3068\u3081\u3066\u3042\u308a\u307e\u3059\u306e\u3067\u78ba\u8a8d\u3057\u3066\u304a\u3044\u3066\u304f\u3060\u3055\u3044\u3002<\/span><\/p>\r\n\r\n

koilonychia\u3063\u3066\u4f55\u306e\u6240\u898b\uff1f<\/strong><\/span>
\r\nvital signs \u3092\u78ba\u8a8d\u3057\u305f\u3089\u3001\u201cI\u2019m going to take a look at your hands and fingers.<\/strong>\u201d \u3068\u8a00\u3063\u3066 hand exam \u3092\u59cb\u3081\u307e\u3059\u3002\u300c\u624b\u306e\u8996\u8a3a<\/strong>\u300dhand inspection<\/strong> \u3067\u306f\u69d8\u3005\u306a\u300c\u5146\u5019<\/strong>\u300d signs<\/strong> \u306b\u6ce8\u610f\u304c\u5fc5\u8981\u3067\u3059\u304c\u3001\u300c\u5faa\u74b0\u5668\u300dcardiovascular system \u306b\u7740\u76ee\u3059\u308b\u306a\u3089\u3070\u3001\u4e0b\u8a18\u306e\u3082\u306e\u304c\u7279\u306b\u91cd\u8981\u3067\u3059\u3002
\r\n\u3000\u2022\u3000clubbing<\/span><\/strong>: \u300c\u3070\u3061\u6307<\/strong>\u300d\u306e\u3053\u3068\u3002\u6307\u5148\u304c\u300c\u68cd\u68d2\u300d club \u306e\u5148\u7aef\u306e\u3088\u3046\u306b\u306a\u308b\u3053\u3068\u304b\u3089\u3053\u3046\u547c\u3070\u308c\u307e\u3059\u3002\u300c\u6162\u6027\u306e\u4f4e\u9178\u7d20\u8840\u75c7<\/strong>\u300d chronic hypoxemia<\/strong> \u306e sign \u3067\u3059 \u3002\u8a3a\u5bdf\u306e\u969b\u306b\u306f \u201cCould you bring your two fingernails together like this for me?\u201d \u3068\u8a00\u3063\u3066\u3001\u81ea\u5206\u306e\u4eba\u5dee\u3057\u6307\u306e\u722a\u3092\u5408\u308f\u305b\u3066\u60a3\u8005\u3055\u3093\u306b\u793a\u3059\u3068\u3088\u3044\u3067\u3057\u3087\u3046\u3002
\r\n\u3000\u2022\u3000cyanosis<\/span><\/strong>: \u76ae\u819a\u306e\u8272\u304c\u9752\u767d\u304f\u306a\u308b\u300c\u30c1\u30a2\u30ce\u30fc\u30bc<\/strong>\u300d\u306e\u3053\u3068\u3067\u3001\u300c\u30b5\u30a3\u30a2\u30ce<\/strong>\u30fc\u30b7\u30b9\u300d\u306e\u3088\u3046\u306b\u767a\u97f3\u3057\u307e\u3059\u3002\uff08\u30d7\u30ea\u30f3\u30bf\u30fc\u306e\u30a4\u30f3\u30af\u3067\u304a\u99b4\u67d3\u307f\u306e\u3088\u3046\u306b cyan\uff08\u300c\u30b5\u30a3\u30a2\u30f3\u300d\u306e\u3088\u3046\u306b\u767a\u97f3\uff09 \u306f\u300c\u9752\u300d\u3092\u610f\u5473\u3057\u307e\u3059\u3002\uff09\u3053\u306e cyanosis \u306f\u300c\u672b\u68a2\u306e\u5faa\u74b0\u4e0d\u5168<\/strong>\u300d poor peripheral circulation<\/strong> \u306esign\u3068\u306a\u308a\u307e\u3059\u3002
\r\n\u3000\u2022\u3000edema<\/span><\/strong>: \u300c\u6d6e\u816b<\/strong>\u300d\u306e\u533b\u5b66\u82f1\u8a9e\u3067\u3001\u4e00\u822c\u82f1\u8a9e\u3067\u306f swelling<\/strong>\uff08\u540d\u8a5e\uff09\u3084swollen<\/strong>\uff08\u5f62\u5bb9\u8a5e\uff09\u306a\u3069\u304c\u4f7f\u308f\u308c\u307e\u3059\u3002
\r\n\u3000\u2022\u3000koilonychia<\/span><\/strong>: \u300c\u3055\u3058\u72b6\u722a<\/strong>\u300dspoon nail<\/strong> \u306e\u533b\u5b66\u82f1\u8a9e\u3067\u3059\u3002koilo- \u306f hollow\uff08\u7aaa\u3093\u3067\u3044\u308b\uff09\u3001-nychia \u306f nail\uff08\u722a\uff09\u3092\u610f\u5473\u3057\u307e\u3059\u3002\u7686\u3055\u3093\u3054\u5b58\u77e5\u306e\u3088\u3046\u306b\u300c\u9244\u6b20\u4e4f\u6027\u8ca7\u8840<\/strong>\u300diron deficiency anemia<\/strong> \u306e sign \u3067\u3059\u3002<\/span><\/p>\r\n\r\n

\u6b21\u306b\u300c\u624b\u306e\u89e6\u8a3a<\/strong>\u300dhand palpation<\/strong><\/span> \u3067\u3059\u304c\u3001cardiovascular system \u3067\u306f capillary refill time<\/strong> (CRT<\/strong>)<\/span> \u3092\u78ba\u8a8d\u3059\u308b\u3053\u3068\u304c\u91cd\u8981\u3067\u3059\u3002\u3053\u308c\u306f\u300c\u722a\u3092\u5727\u8feb\u3057\u3066\u722a\u5e8a\u306e\u6bdb\u7d30\u8840\u7ba1\u306b\u5145\u6e80\u3057\u3066\u3044\u308b\u8840\u6db2\u3092\u5727\u8feb\u3059\u308b\u3053\u3068\u3067\u9000\u8272\u3055\u305b\u3001\u6307\u3092\u96e2\u3057\u3066\u304b\u3089\u518d\u3073\u6bdb\u7d30\u8840\u7ba1\u306b\u8840\u6db2\u304c\u5145\u6e80\u3059\u308b\u3053\u3068\u3067\u722a\u5e8a\u306e\u8272\u304c\u5143\u306e\u30d4\u30f3\u30af\u8272\u306b\u623b\u308b\u307e\u3067\u306e\u6642\u9593<\/strong>\u300d\u306e\u3053\u3068\u3067\u3001\u6b63\u5e38\u3067\u3042\u308c\u30702\u79d2\u4ee5\u5185<\/strong>\u3067\u5143\u306e\u30d4\u30f3\u30af\u8272\u306b\u623b\u308a\u3001poor peripheral circulation<\/strong> \u304c\u3042\u308c\u3070\u5143\u306e\u8272\u306b\u623b\u308b\u306e\u306b3\u79d2\u4ee5\u4e0a\u304b\u304b\u308a\u307e\u3059\u3002\u82f1\u8a9e\u3067\u306f \u201cI\u2019m going to squeeze<\/span> your finger gently.<\/strong>\u201d \u3068\u8a00\u3063\u3066\u6307\u5148\u3092\u5727\u8feb\u3057\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u307e\u305f\u300c\u6a48\u9aa8\u52d5\u8108\u306e\u8108<\/strong>\u300d radial pulse<\/strong><\/span> \u3092\u89e6\u8a3a\u3057\u3066\u3001\u5de6\u53f3\u5dee\u306a\u3069\u304c\u306a\u3044\u304b\u78ba\u8a8d\u3059\u308b\u3053\u3068\u3082\u91cd\u8981\u3067\u3059\u3002\u5f8c\u8ff0\u3059\u308b\u300c\u5f01\u819c\u75c7<\/strong>\u300dvalve disorders<\/strong> \u306e\u4e2d\u3067\u3082\u300c\u5927\u52d5\u8108\u5f01\u72ed\u7a84\u75c7<\/strong>\u300daortic stenosis<\/strong> (AS<\/strong>)<\/span> \u3067\u306f weak pulse with a delayed peak<\/strong> \u304c\u7279\u5fb4\u7684\u3067\u3001\u82f1\u8a9e\u570f\u3067\u306f\u4eca\u3067\u3082 \u201cpulsus parvus et tardus<\/strong>\u201d \u3068\u3044\u3046\u53e4\u5178\u7684\u306a\u8868\u73fe\u304c\u4f7f\u308f\u308c\u3066\u3044\u307e\u3059\u3002\u307e\u305f\u300c\u5927\u52d5\u8108\u5f01\u9589\u9396\u4e0d\u5168\u75c7<\/strong>\u300daortic regurgitation<\/strong> (AR<\/strong>)<\/span> \u3067\u306f\u3001\u8108\u5727\u304c\u5897\u5927\u3059\u308b hyperdynamic pulse<\/strong> \u304c\u7279\u5fb4\u7684\u3067\u3059\u3002\u3053\u306e hyperdynamic pulse \u304c\u300c\u9838\u52d5\u8108<\/strong>\u300d carotid artery<\/strong> \u3067\u898b\u3089\u308c\u308c\u3070 Corrigan\u2019s pulse<\/strong><\/span> \u3068\u547c\u3070\u308c\u3001\u300c\u6a48\u9aa8\u52d5\u8108<\/strong>\u300d radial artery<\/strong> \u3084\u300c\u5c3a\u9aa8\u52d5\u8108<\/strong>\u300dulnar artery<\/strong> \u3067\u898b\u3089\u308c\u308c\u3070 Watson\u2019s water hammer pulse<\/strong><\/span> \u3068\u547c\u3070\u308c\u307e\u3059\u3002\u3053\u306e\u4ed6\u306b\u3082 AR \u306b\u306f\u722a\u5e8a\u306e\u6bdb\u7d30\u8840\u7ba1\u306e\u62cd\u52d5\u3067\u3042\u308b Quincke\u2019s pulse<\/strong><\/span> \u3084\u3001\u982d\u90e8\u304c\u4e0a\u4e0b\u306b\u52d5\u304f head bobbing<\/strong><\/span> (De Musset\u2019s sign<\/strong><\/span>) \u306a\u3069\u6570\u591a\u304f\u306e signs \u304c\u8a8d\u3081\u3089\u308c\u307e\u3059\u3002\u3053\u308c\u3089AR\u306e signs \u306b\u8208\u5473\u306e\u3042\u308b\u65b9\u306f\u3053\u3061\u3089\u306e\u30b5\u30a4\u30c8<\/span><\/a><\/span>\u3067\u8a73\u3057\u304f\u3054\u78ba\u8a8d\u304f\u3060\u3055\u3044\u3002<\/span><\/p>\r\n\r\n

thrills \u3068 heaves \u3063\u3066\u4f55\u306e\u3053\u3068\uff1f<\/strong><\/span>
\r\n\u6b21\u306f\u300c\u981a\u90e8\u306e\u8996\u8a3a<\/strong>\u300d neck inspection\u00a0<\/span><\/strong><\/span>\u3067\u3059\u3002
\r\n\u5faa\u74b0\u5668\u306e\u8a3a\u5bdf\u3067\u306f\u300c\u53f3\u5fc3\u4e0d\u5168<\/strong>\u300d right heart failure<\/strong> \u306e\u6240\u898b\u3067\u3042\u308b\u300c\u9838\u9759\u8108\u6012\u5f35<\/strong>\u300djugular venous distension<\/strong> (JVD<\/strong>)<\/span> \u304c\u91cd\u8981\u306b\u306a\u308a\u307e\u3059\u3002\u82f1\u8a9e\u570f\u3067\u8eab\u4f53\u8a3a\u5bdf\u3092\u3059\u308b\u969b\u306b\u306f\u300c\u60a3\u8005\u3055\u3093\u306e\u53f3\u5074\u300d\u304b\u3089\u8a3a\u5bdf\u3092\u3059\u308b\u3053\u3068\u304c\u4e00\u822c\u7684\u3067\u3059\u306e\u3067\u3001\u201cCould you sit on the examination table, please? Now could you turn to your left side<\/strong> for me, please?\u201d \u3068\u8a00\u3063\u3066\u53f3\u5074\u306e\u9838\u9759\u8108\u306e\u6012\u5f35\u3092\u78ba\u8a8d\u3057\u307e\u3057\u3087\u3046\u3002<\/span><\/p>\r\n\r\n

\u305d\u306e\u6b21\u306f\u300c\u80f8\u90e8\u306e\u89e6\u8a3a<\/strong>\u300dchest palpation<\/strong><\/span> \u3068\u306a\u308a\u307e\u3059\u3002
\r\n\u3053\u3053\u3067\u306f aortic\/pulmonary\/tricuspid\/mitral valve \u306e\u4e0a\u306b\u3001 \u201cI\u2019m going to place my hand on your chest.\u201d \u3068\u8a00\u3063\u3066\u624b\u3092\u5f53\u3066\u3001 thrills<\/strong> \u3068 heaves<\/strong> \u306e\u6709\u7121\u3092\u78ba\u8a8d\u3057\u307e\u3059\u3002
\r\n\u65e5\u672c\u8a9e\u3067\u3082\u300c\u30b9\u30ea\u30eb\u6e80\u70b9\u300d\u306e\u3088\u3046\u306b\u4f7f\u3046 thrills<\/strong><\/span> \u3067\u3059\u304c\u3001\u3053\u308c\u306f\u300c\u80f8\u58c1\u306b\u624b\u3092\u89e6\u308c\u3066\u611f\u3058\u308b\u304f\u3089\u3044\u5f37\u3044\u5fc3\u96d1\u97f3<\/strong>\u300d\u3092\u6307\u3057\u307e\u3059\u3002\u3053\u308c\u306b\u5bfe\u3057\u3066 heaves<\/strong><\/span> \u3068\u306f\u300c\u80f8\u58c1\u306b\u624b\u3092\u89e6\u308c\u3066\u611f\u3058\u308b\u304f\u3089\u3044\u5f37\u3044\u5fc3\u62cd\u52d5<\/strong>\u300d\u306e\u3053\u3068\u3067\u3001\u300c\u5fc3\u80a5\u5927<\/strong>\u300dcardiomegaly<\/strong><\/span> \u3092\u793a\u5506\u3059\u308b sign \u3068\u306a\u308a\u307e\u3059\u3002\u3053\u306e\u4ed6\u306b\u3082 cardiomegaly \u306e\u5834\u5408\u306b\u306f\u300c\u5fc3\u5c16\u62cd\u52d5\u90e8<\/strong>\u300dpoint of maximum impulse<\/strong> (PMI<\/strong>)<\/span> \u304c\u5916\u5074\u306b\u504f\u4f4d\u3059\u308b displaced PMI<\/strong><\/span> \u306a\u3069\u306e sign \u304c\u8a8d\u3081\u3089\u308c\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u82f1\u8a9e\u3067S3\u3068S4\u306f\u3069\u306e\u3088\u3046\u306b\u55a9\u3048\u3089\u308c\u308b\u306e\uff1f<\/strong><\/span>
\r\n\u5faa\u74b0\u5668\u306e\u8eab\u4f53\u8a3a\u5bdf\u306b\u304a\u3051\u308b\u6700\u5927\u306e\u30cf\u30a4\u30e9\u30a4\u30c8\u304c\u300c\u5fc3\u81d3\u306e\u8074\u8a3a<\/strong>\u300d heart auscultation<\/strong><\/span> \u3067\u3059\u3002\u3053\u3053\u3067\u306f \u201cI\u2019m going to listen to your heart. Please breathe normally<\/strong> for me.\u201d \u3068\u8a00\u3063\u3066\u304b\u3089 aortic<\/strong> valve \u2192 pulmonary<\/strong> valve \u2192 tricuspid<\/strong> valve \u2192 mitral<\/strong> valve \u306e\u9806\u306b\u300c\u8074\u8a3a\u5668<\/strong>\u300d stethoscope<\/strong> \u306e diaphragm<\/strong> \uff08\u5927\u304d\u3044\u65b9\u306e\u9762\u3067\u9ad8\u3044\u97f3\u306e\u8074\u53d6\u306b\u5411\u3044\u3066\u3044\u308b\uff09\u3092\u5f53\u3066\u3066\u3044\u304d\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u6b63\u5e38\u306e\u5834\u5408\u3001\u8074\u3053\u3048\u308b\u306e\u306f S1<\/strong>\u3068 S2<\/strong> \u306e\u97f3\u3060\u3051\u3067\u3059\u3002\u65e5\u672c\u8a9e\u3067\u306f\u5fc3\u81d3\u306e\u62cd\u52d5\u97f3\u3092\u300c\u30c9\u30c3\u30af\u30f3<\/strong>\u300d\u3068\u8868\u73fe\u3057\u307e\u3059\u304c\u3001\u82f1\u8a9e\u3067\u306f\u3053\u308c\u3092 \u201club dub<\/strong><\/span>\u201d \u306e\u3088\u3046\u306b\u8868\u73fe\u3057\u307e\u3059\u3002\u7686\u3055\u3093\u3054\u5b58\u77e5\u306e\u901a\u308a\u3001\u3053\u306e lub \u3067\u3042\u308b S1<\/strong> \u306f mitral<\/strong>\/tricuspid valve<\/strong> \u304c\u9589\u3058\u308b\u97f3\u3067\u3001dub\u3067\u3042\u308b S2<\/strong> \u306f aortic<\/strong>\/pulmonary valve<\/strong> \u304c\u9589\u3058\u308b\u97f3\u3067\u3059\u3002<\/span><\/p>\r\n\r\n

\u3053\u306eS1\u3068S2\u306b\u52a0\u3048\u3066\u300c\u904e\u5270\u306a\u97f3<\/strong>\u300d\u304c\u8074\u3053\u3048\u308b\u5834\u5408\u3001\u305d\u306e\u97f3\u304c\u300c\u99ac\u304c\u99c6\u3051\u308b\u97f3<\/strong>\u300d\u306b\u4f3c\u3066\u3044\u308b\u305f\u3081\u306b gallops<\/strong><\/span> \u3068\u547c\u3070\u308c\u307e\u3059\u3002\u3053\u306e gallops \u306fS1\u3084S2\u3068\u6bd4\u3079\u3066\u4f4e\u3044\u97f3\u3067\u3042\u308b\u305f\u3081\u3001stethoscope \u306e bell<\/strong>\uff08\u5c0f\u3055\u3044\u65b9\u306e\u9762\u3067\u4f4e\u3044\u97f3\u306e\u8074\u53d6\u306b\u5411\u3044\u3066\u3044\u308b\uff09\u3092\u4f7f\u3063\u3066\u4e01\u5be7\u306b\u97f3\u3092\u8074\u3044\u3066\u3044\u304d\u307e\u3057\u3087\u3046\u3002<\/span><\/p>\r\n\r\n

S1\u3068S2\u304c\u8074\u3053\u3048\u305f\u5f8c\u306b\u3082\u3046\u4e00\u3064\u306e\u97f3<\/strong>\u304c\u300c\u304a\u3063<\/strong>(S1<\/strong>) \u304b<\/strong>(S<\/strong>2) \u3055\u3093<\/strong>(S3<\/strong>)<\/span>\u300d\u306e\u3088\u3046\u306b\u8074\u3053\u3048\u308b\u5834\u5408\u3001\u3053\u308c\u3092 S3<\/strong><\/span> \u3068\u547c\u3073\u307e\u3059\u3002\u3053\u308c\u306f\u5fc3\u5ba4\u306b\u904e\u5270\u306a\u8840\u6db2\u304c\u300c\u6d41\u308c\u8fbc\u3080<\/strong>\u300d slosh in<\/strong> \u969b\u306b\u8074\u3053\u3048\u308b\u3053\u3068\u304b\u3089\u3001\u82f1\u8a9e\u3067\u306f \u201cslosh<\/strong> (S1<\/strong>) ing<\/strong> (S2<\/strong>) in<\/strong> (S3<\/strong>)<\/span>\u201d \u306e\u3088\u3046\u306b\u8868\u73fe\u3055\u308c\u307e\u3059\u3002\u307e\u305f\u5fc3\u5ba4\u306b\u904e\u5270\u306a\u8840\u6db2\u304c\u6d41\u308c\u8fbc\u3093\u3067\u751f\u307e\u308c\u308b\u3053\u3068\u304b\u3089 ventricular gallop<\/strong> \u3068\u3082\u547c\u3070\u308c\u307e\u3059\u3002\u300c\u5fc3\u4e0d\u5168\u300d heart failure \u306a\u3069\u306e\u4ed6\u3001\u5fc3\u80a5\u5927\u3057\u305f\u30a2\u30b9\u30ea\u30fc\u30c8\u306a\u3069\u306b\u3082\u8a8d\u3081\u3089\u308c\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u3053\u308c\u306b\u5bfe\u3057\u3066 S1 \u304c2\u3064\u306b\u5272\u308c\u305f\u3088\u3046\u306a\u97f3<\/strong>\u3068\u3057\u3066\u300c\u304a<\/strong>(S4<\/strong>)<\/span> \u3068\u3063<\/strong>(S1<\/strong>) \u3064\u3041\u3093<\/strong>(S2<\/strong>)\u300d\u306e\u3088\u3046\u306b\u8074\u3053\u3048\u308b\u3068 S4<\/strong><\/span> \u3068\u306a\u308a\u307e\u3059\u3002\u3053\u308c\u306f\u300c\u5fc3\u7b4b\u6897\u585e\u300dmyocardial infarction \u306a\u3069\u3067\u5fc3\u5ba4\u304c\u300c\u786c\u304f<\/strong>\u300d stiff<\/strong>\u306a\u308a\u3001\u5fc3\u623f\u304c\u904e\u5270\u306b\u53ce\u7e2e\u3059\u308b\u3053\u3068\u306b\u3088\u3063\u3066\u751f\u307e\u308c\u308b\u97f3\u306e\u305f\u3081\u3001\u82f1\u8a9e\u3067\u306f \u201ca<\/strong> (S4<\/strong>)<\/span> stiff<\/strong> (S1<\/strong>) wall<\/strong> (S2<\/strong>)\u201d \u306e\u3088\u3046\u306b\u8868\u73fe\u3055\u308c\u307e\u3059\u3002\u5fc3\u623f\u7531\u6765\u306e\u97f3\u306e\u305f\u3081\u306b\u82f1\u8a9e\u3067\u306f atrial gallop<\/strong> \u3084 atrial kick<\/strong> \u3068\u3082\u547c\u3070\u308c\u307e\u3059\u3002\u6b63\u5e38\u306a\u5fc3\u81d3\u3067\u5fc3\u5ba4\u304c\u786c\u304f\u306a\u308b\u3053\u3068\u306f\u7d76\u5bfe\u306b\u8d77\u3053\u308a\u307e\u305b\u3093\u306e\u3067\u3001\u3053\u306eS4\u306f\u300c\u7d76\u5bfe\u7570\u5e38<\/strong>\u300d absolutely pathological<\/strong> \u3068\u306a\u308a\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u8ab0\u3067\u3082\u7c21\u5358\u306b\u3067\u304d\u308b\u5fc3\u96d1\u97f3\u306e\u8a3a\u65ad\u65b9\u6cd5<\/strong><\/span>
\r\n\u3067\u306f\u6700\u5f8c\u306b\u300c\u5fc3\u96d1\u97f3<\/strong>\u300dmurmur<\/strong><\/span> \u306e\u30a2\u30d7\u30ed\u30fc\u30c1\u306b\u95a2\u3057\u3066\u7c21\u5358\u306b\u3054\u8aac\u660e\u3057\u307e\u3057\u3087\u3046\u3002
\r\n\u5fc3\u81d3\u306e\u8074\u8a3a\u3067 S1\u3068S2\u4ee5\u5916\u306e\u300c\u5909\u306a\u97f3\u300d\u304c\u8074\u3053\u3048\u305f\u5834\u5408\u3001\u307e\u305a\u306f\u305d\u308c\u304c gallops \u3067\u3042\u308b\u304b\u3069\u3046\u304b\u3092\u78ba\u8a8d\u3057\u307e\u3057\u3087\u3046\u3002\u3082\u3057\u305d\u308c\u304c gallops \u3067\u306f\u306a\u304f\u3001\u300c\u30d6\u30a9\u30fc\u300d\u306e\u3088\u3046\u306b\u805e\u3053\u3048\u308b\u5834\u5408\u3001\u305d\u308c\u306f\u300c\u5fc3\u96d1\u97f3<\/strong>\u300dmurmur<\/strong><\/span> \u3067\u3059\u3002<\/span><\/p>\r\n\r\n

\u3053\u306e murmur \u304c\u8074\u3053\u3048\u305f\u5834\u5408\u3001\u307e\u305a\u306f\u305d\u308c\u304c\u300c\u53ce\u7e2e\u671f\u96d1\u97f3<\/strong>\u300dsystolic murmur<\/strong><\/span> \u306a\u306e\u304b\u3001\u300c\u62e1\u5f35\u671f\u96d1\u97f3<\/strong>\u300ddiastolic murmur<\/strong><\/span> \u306a\u306e\u304b\u3092\u5224\u65ad\u3057\u306a\u3051\u308c\u3070\u306a\u308a\u307e\u305b\u3093\u3002\u30c8\u30ec\u30fc\u30cb\u30f3\u30b0\u3092\u91cd\u306d\u308c\u3070\u97f3\u3092\u8074\u304f\u3060\u3051\u3067\u8074\u304d\u5206\u3051\u3089\u308c\u308b\u3088\u3046\u306b\u306a\u308a\u307e\u3059\u304c\u3001\u6700\u3082\u7c21\u5358\u306b\u9055\u3044\u3092\u898b\u3064\u3051\u308b\u65b9\u6cd5\u306f\u300c\u9838\u52d5\u8108<\/strong>\u300d carotid artery<\/strong> \u3092\u89e6\u308c\u3066\u3001\u305d\u306e murmur \u304c carotid pulse \u3068\u540c\u6642\u306b\u8074\u3053\u3048\u308b\u304b\u3069\u3046\u304b\u3092\u78ba\u8a8d\u3059\u308c\u3070\u3088\u3044\u306e\u3067\u3059\u3002\u3082\u3057 murmur \u304c carotid pulse \u3068\u540c\u6642\u306b\u8074\u3053\u3048\u308b<\/strong>\u306e\u3067\u3042\u308c\u3070\u3001\u305d\u308c\u306f systolic murmur<\/strong> \u3067\u3001murmur \u3068 carotid pulse \u306b\u4e56\u96e2\u304c\u3042\u308c\u3070<\/strong>\u3001\u305d\u308c\u306f diastolic murmur<\/strong> \u3068\u306a\u308a\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u300c\u5f01\u819c\u75c7<\/strong>\u300dvalve disorders<\/strong> \u306b\u306f\u5927\u304d\u304f\u5206\u3051\u3066\u300c\u72ed\u7a84\u75c7<\/strong>\u300dstenosis<\/strong><\/span> \u3068\u300c\u9006\u6d41\u75c7\u30fb\u9589\u9396\u4e0d\u5168\u75c7<\/strong>\u300d regurgitation<\/strong><\/span> \u306e2\u3064\u304c\u3042\u308a\u307e\u3059\u3002\u300c\u5f01\u304c\u958b\u3044\u3066\u3044\u308b\u6642<\/strong>\u300d\u306b murmur \u304c\u8074\u3053\u3048\u308b\u5834\u5408\u3001\u305d\u308c\u306f\u300c\u5f01\u304c\u72ed\u3044\u304b\u3089<\/strong>\u300d\u751f\u3058\u3066\u3044\u308b\u300c\u72ed\u7a84\u75c7<\/strong>\u300dstenosis<\/strong> \u3068\u306a\u308a\u307e\u3059\u3002\u9006\u306b\u300c\u5f01\u304c\u9589\u3058\u3066\u3044\u308b\u6642<\/strong>\u300d\u306b murmur \u304c\u8074\u3053\u3048\u308b\u5834\u5408\u3001\u305d\u308c\u306f\u300c\u5f01\u304c\u304d\u3061\u3093\u3068\u9589\u3058\u3066\u3044\u306a\u3044\u304b\u3089<\/strong>\u300d\u751f\u3058\u3066\u3044\u308b\u300c\u9589\u9396\u4e0d\u5168\u75c7<\/strong>\u300dregurgitation<\/strong> \u3068\u306a\u308a\u307e\u3059\u3002
\r\n\u300c\u53ce\u7e2e\u671f\u300dsystole \u3067\u306f mitral\/tricuspid valve \u306f\u9589\u3058\u3001aortic\/pulmonary valve \u306f\u958b\u3044\u3066\u3044\u308b\u308f\u3051\u3067\u3059\u304b\u3089\u3001\u300c\u53ce\u7e2e\u671f\u96d1\u97f3<\/strong>\u300dsystolic murmur<\/strong><\/span> \u304c\u8074\u3053\u3048\u305f\u5834\u5408\u3001\u305d\u308c\u306f mitral<\/strong>\/tricuspid regurgitation<\/strong> \u304b\u3001aortic<\/strong>\/pulmonary stenosis<\/strong> \u3068\u306a\u308a\u307e\u3059\u3002\u9006\u306b\u300c\u62e1\u5f35\u671f\u300ddiastole \u3067\u306f mitral\/tricuspid valve \u306f\u958b\u304d\u3001aortic\/pulmonary valve \u306f\u9589\u3058\u3066\u3044\u308b\u308f\u3051\u3067\u3059\u304b\u3089\u3001\u300c\u62e1\u5f35\u671f\u96d1\u97f3<\/strong>\u300ddiastolic murmur<\/strong><\/span> \u304c\u8074\u3053\u3048\u305f\u5834\u5408\u3001\u305d\u308c\u306f mitral<\/strong>\/tricuspid stenosis<\/strong> \u304b\u3001aortic<\/strong>\/pulmonary regurgitation<\/strong> \u3068\u306a\u308b\u308f\u3051\u3067\u3059\u3002<\/span><\/p>\r\n\r\n

\u3053\u308c\u304c\u308f\u304b\u308c\u3070\u5f8c\u306f\u300c\u3069\u306e\u5f01\u3067\u6700\u3082\u5927\u304d\u304f murmur \u304c\u8074\u3053\u3048\u308b\u304b<\/strong>\u300d\u3092\u78ba\u8a8d\u3059\u308b\u3053\u3068\u3067\u5f01\u819c\u75c7\u306e\u8a3a\u65ad\u304c\u3067\u304d\u307e\u3059\u3002\u3064\u307e\u308a systolic murmur \u304caortic valve \u306e\u90e8\u4f4d\u3067\u6700\u3082\u5927\u304d\u304f\u8074\u3053\u3048\u308c\u3070\u3001\u305d\u308c\u306f aortic stenosis \u3067\u3059\u3057\u3001diastolic murmur \u304c mitral valve \u306e\u90e8\u4f4d\u3067\u6700\u3082\u5927\u304d\u304f\u8074\u3053\u3048\u308c\u3070\u3001\u305d\u308c\u306f mitral stenosis \u3068\u306a\u308b\u306e\u3067\u3059\u3002<\/span><\/p>\r\n\r\n

\u307e\u305f\u5fc3\u96d1\u97f3\u300d\u306f murmur \u3067\u3059\u304c\u3001\u300c\u8840\u7ba1\u96d1\u97f3<\/strong>\u300d\u306f bruit<\/strong><\/span>\uff08\u300c\u30d6\u30eb\u30a5<\/strong>\u30a3\u300d\u306e\u3088\u3046\u306b\u767a\u97f3\uff09\u3068\u306a\u308a\u307e\u3059\u3002\u300c\u5927\u52d5\u8108\u5f01\u72ed\u7a84\u75c7\u300daortic stenosis (AS) \u3067\u306f\u4e21\u65b9\u306e\u9838\u52d5\u8108 carotid arteries<\/strong> \u306b\u5fc3\u96d1\u97f3\u304c\u653e\u6563\u3059\u308b\u3053\u3068\u304c\u7279\u5fb4\u3067\u3059\u304c\u3001\u3053\u308c\u306f murmur \u306e\u653e\u6563\u97f3\u3067\u3042\u308a\u3001 bruits \u3067\u306f\u3042\u308a\u307e\u305b\u3093\u306e\u3067\u3054\u6ce8\u610f\u3092\u3002<\/span><\/p>\r\n\r\n

\u691c\u67fb\u6280\u8853\u306e\u9032\u6b69\u306b\u4f34\u3044\u3001\u3053\u3046\u3044\u3063\u305f\u8eab\u4f53\u8a3a\u5bdf physical exam \u306e\u6280\u8853\u306f\u4e16\u754c\u7684\u306b\u3082\u8efd\u8996\u3055\u308c\u308b\u50be\u5411\u306b\u3042\u308a\u307e\u3059\u3002\u3057\u304b\u3057 physical exam \u306f\u8a3a\u65ad\u306b\u5fc5\u8981\u306a\u305f\u304f\u3055\u3093\u306e\u60c5\u5831\u3092\u4e0e\u3048\u3066\u304f\u308c\u308b\u3060\u3051\u3067\u306a\u304f\u3001\u60a3\u8005\u3055\u3093\u3068\u306erapport \u5f62\u6210\u306b\u304a\u3044\u3066\u3082\u4e0d\u53ef\u6b20<\/strong>\u3067\u3059\u3002Stanford \u5927\u5b66\u306e Abraham Verghese \u6559\u6388\u304c2011\u5e74\u306b\u884c\u3063\u305f \u201cA Doctor\u2019s Touch<\/strong><\/span><\/a>\u201d \u306f\u3001\u533b\u5b66\u751f\u3068\u3057\u3066\u5fc5\u898b\u306eTED Talk \u3060\u3068\u601d\u3044\u307e\u3059\u306e\u3067\u3001\u307e\u3060\u8996\u8074\u3055\u308c\u3066\u3044\u306a\u3044\u65b9\u306f\u662f\u975e\u4e00\u5ea6\u3054\u89a7\u304f\u3060\u3055\u3044\u3002\u307e\u305f\u4eca\u56de\u3053\u308c\u3092\u8aad\u3093\u3067\u82f1\u8a9e\u3067\u306e cardiovascular exam \u306b\u8208\u5473\u3092\u6301\u3063\u305f\u65b9\u306f\u3001Geeky Medics<\/span><\/strong><\/a> \u304c\u63d0\u4f9b\u3057\u3066\u3044\u308b\u3053\u3061\u3089\u306e\u52d5\u753b<\/span><\/a>\u3082\u662f\u975e\u3054\u89a7\u304f\u3060\u3055\u3044\u3002<\/span><\/p>\r\n\r\n

\u3055\u3066\u3001\u305d\u308d\u305d\u308d\u30ab\u30c3\u30d7\u306e\u30b3\u30fc\u30d2\u30fc\u3082\u6b8b\u308a\u308f\u305a\u304b\u3067\u3059\u3002\u6700\u5f8c\u306b\u672c\u65e5\u7d39\u4ecb\u3057\u305f\u30dd\u30a4\u30f3\u30c8\u3092\u307e\u3068\u3081\u3066\u304a\u304d\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u3000\u2022<\/strong>\u3000\u82f1\u8a9e\u570f\u3067\u306f\u300c\u8996\u8a3a<\/strong>\u300d inspection<\/strong> \u2192\u300c\u89e6\u8a3a<\/strong>\u300d palpation<\/strong> \u2192\u300c\u6253\u8a3a<\/strong>\u300dpercussion<\/strong> \u2192\u300c\u8074\u8a3a<\/strong>\u300dauscultation<\/strong> \u306e\u9806\u5e8f\u3067 physical examination<\/strong> \u3092\u884c\u3046\u3053\u3068\u304c\u4e00\u822c\u7684
\r\n\u3000\u2022\u3000\u82f1\u8a9e\u570f\u3067\u306f\u300c\u5168\u8eab\u89b3\u5bdf<\/strong>\u300dgeneral inspection<\/strong> \u2192\u300c\u30d0\u30a4\u30bf\u30eb\u30b5\u30a4\u30f3<\/strong>\u300d vital signs<\/strong> \u2192\u300c\u624b\u306e\u8a3a\u5bdf<\/strong>\u300dhand exam<\/strong> \u306e\u8a3a\u5bdf\u306e\u9806\u5e8f\u3067physical exam \u3092\u958b\u59cb\u3059\u308b\u3053\u3068\u304c\u4e00\u822c\u7684
\r\n\u3000\u2022<\/strong>\u3000\u82f1\u8a9e\u570f\u3067\u306f hand exam\u3092\u7d42\u3048\u305f\u5f8c\u3001head<\/strong>, eyes<\/strong>, ears<\/strong>, nose<\/strong>, and throat<\/strong> (HEENT<\/strong>) exam \u2192 neck<\/strong> exam \u2192 cardiovascular<\/strong> exam \u2192 pulmonary<\/strong> exam \u2192 abdominal<\/strong> exam \u2192 neurological<\/strong> exam (+ extremities) \u2192 skin<\/strong> exam \u306e\u9806\u5e8f\u3067\u884c\u3046\u3053\u3068\u304c\u4e00\u822c\u7684
\r\n\u3000\u2022<\/strong>\u3000general inspection \u3067\u300c\u60a3\u8005\u3055\u3093\u304c\u300c\u4eca\u3059\u3050\u51e6\u7f6e\u3092\u5fc5\u8981\u3068\u3059\u308b\u307b\u3069\u82e6\u3057\u3093\u3067\u3044\u308b<\/strong>\u300d\u3068\u5224\u65ad\u3059\u308c\u3070\u3001 \u201cThe patient is in acute distress.<\/strong>\u201d \u3068\u8868\u73fe\u3059\u308b
\r\n\u3000\u2022<\/strong>\u3000\u300c\u624b\u306e\u8996\u8a3a<\/strong>\u300dhand inspection<\/strong> \u3067\u306f clubbing<\/strong>\/cyanosis<\/strong>\/edema<\/strong>\/koilonychia<\/strong>\/Quincke\u2019s pulse<\/strong> \u306b\u6ce8\u610f\u3059\u308b
\r\n\u3000\u2022<\/strong>\u3000\u300c\u624b\u306e\u89e6\u8a3a<\/strong>\u300dhand palpation<\/strong> \u3067\u306f capillary refill time<\/strong> (CRT<\/strong>) \u304c2\u79d2\u4ee5\u5185\u304b\u3092\u78ba\u8a8d\u3059\u308b
\r\n\u3000\u2022<\/strong>\u3000\u300c\u6a48\u9aa8\u52d5\u8108\u306e\u8108<\/strong>\u300dradial pulse<\/strong> \u3067\u306f\u5de6\u53f3\u5dee\u306e\u78ba\u8a8d\u306e\u4ed6\u3001pulsus parvus et tardus<\/strong>\uff08AS<\/strong>\u306e\u6240\u898b\uff09\u3084 Watson\u2019s water hammer pulse<\/strong>\uff08AR<\/strong>\u306esign\uff09\u306a\u3069\u3092\u78ba\u8a8d\u3059\u308b
\r\n\u3000\u2022<\/strong>\u3000\u300c\u981a\u90e8\u306e\u8996\u8a3a<\/strong>\u300dneck inspection<\/strong> \u3067\u306f jugular venous distension<\/strong> (JVD<\/strong>)\uff08right heart failure<\/strong> \u306esign\uff09\u3092\u78ba\u8a8d\u3059\u308b
\r\n\u3000\u2022<\/strong>\u3000\u300c\u80f8\u90e8\u306e\u89e6\u8a3a<\/strong>\u300dchest palpation<\/strong> \u3067\u306f thrills<\/strong>\uff08\u5f37\u5ea6\u306e murmur<\/strong> \u306esign\uff09\u3084 heaves<\/strong>\uff08cardiomegaly<\/strong> \u306esign\uff09\u3001\u305d\u3057\u3066 displaced PMI<\/strong>\uff08cardiomegaly<\/strong> \u306esign\uff09\u3092\u78ba\u8a8d\u3059\u308b
\r\n\u3000\u2022<\/strong>\u3000S1<\/strong> \u3068 S2<\/strong> \u306f\u82f1\u8a9e\u3067\u306f \u201club dub<\/strong>\u201d \u3068\u8868\u73fe\u3055\u308c\u308b
\r\n\u3000\u2022<\/strong>\u3000S1 \u3068 S2 \u4ee5\u5916\u306e S3<\/strong> \u3068 S4<\/strong> \u306f gallops<\/strong> \u3068\u547c\u3070\u308c\u308b
\r\n\u3000\u2022<\/strong>\u3000S1 \u3068S2 \u304c\u8074\u3053\u3048\u305f\u5f8c\u306b\u8074\u3053\u3048\u308b S3<\/strong> \u306f\u3001\u82f1\u8a9e\u3067\u306f \u201cshosh (S1) ing (S2) in<\/strong> (S3<\/strong>)\u201d \u3068\u8868\u73fe\u3055\u308c\u3001ventricular gallop<\/strong> \u3068\u547c\u3070\u308c\u308b
\r\n\u3000\u2022<\/strong>\u3000S1 \u304c2\u3064\u306b\u5272\u308c\u305f\u3088\u3046\u306b\u8074\u3053\u3048\u308b S4<\/strong> \u306f\u3001\u82f1\u8a9e\u3067\u306f \u201ca<\/strong> (S4<\/strong>) stiff (S1) wall (S2)\u201d \u3068\u8868\u73fe\u3055\u308c\u3001atrial gallop<\/strong>\/kick<\/strong> \u3068\u547c\u3070\u308c\u308b
\r\n\u3000\u2022<\/strong>\u3000murmur \u304c\u8074\u3053\u3048\u305f\u5834\u5408\u3001carotid pulse<\/strong> \u3092\u89e6\u308c\u3066\u3001\u305d\u308c\u304c systolic murmur<\/strong> \u304b diastolic murmur<\/strong> \u304b\u3092\u5224\u65ad\u3059\u308b
\r\n\u3000\u2022<\/strong>\u3000\u5f01\u304c\u958b\u3044\u3066\u3044\u308b\u6642<\/strong>\u306b murmur \u304c\u8074\u3053\u3048\u308b\u5834\u5408\u3001\u305d\u306e\u5f01\u306b\u306f stenosis<\/strong> \u304c\u3042\u308a\u3001\u5f01\u304c\u9589\u3058\u3066\u3044\u308b\u6642<\/strong>\u306b murmur \u304c\u8074\u3053\u3048\u308b\u5834\u5408\u3001\u305d\u306e\u5f01\u306b\u306f regurgitation<\/strong> \u304c\u3042\u308b
\r\n\u3000\u2022<\/strong>\u3000systolic\/diastolic murmur \u304c aortic\/pulmonary\/tricuspid\/mitral valve \u306e\u3069\u306e\u5f01\u3067\u6700\u3082\u5927\u304d\u304f\u8074\u3053\u3048\u308b\u304b<\/strong>\u3092\u78ba\u8a8d\u3059\u308b\u3053\u3068\u3067 valve disorder \u306e\u8a3a\u65ad\u304c\u3067\u304d\u308b
\r\n\u3000\u2022<\/strong>\u3000\u300c\u5fc3\u96d1\u97f3\u300d\u306f murmur \u3068\u547c\u3076\u304c\u3001\u300c\u8840\u7ba1\u96d1\u97f3<\/strong>\u300d\u306f bruit<\/strong> \u3068\u547c\u3076<\/span><\/p>\r\n\r\n

\u3067\u306f\u3001\u307e\u305f\u306e\u3054\u6765\u5e97\u3092\u304a\u5f85\u3061\u3057\u3066\u304a\u308a\u307e\u3059\u3002<\/span><\/p>\r\n

\u300cDr. \u62bc\u5473\u306e\u533b\u5b66\u82f1\u8a9e\u30ab\u30d5\u30a7\u300d\u3067\u306f\u7686\u3055\u3093\u304b\u3089\u6271\u3063\u3066\u6b32\u3057\u3044\u30c8\u30d4\u30c3\u30af\u3092\u52df\u96c6\u3044\u305f\u3057\u307e\u3059\u3002\u3053\u3061\u3089\u306e\u30ea\u30f3\u30af<\/strong><\/span><\/a>\u304b\u3089\u3053\u306e\u30ab\u30d5\u30a7\u3067\u6271\u3063\u3066\u6b32\u3057\u3044\u3068\u601d\u3046\u533b\u5b66\u82f1\u8a9e\u306e\u30c8\u30d4\u30c3\u30af\u3092\u3054\u81ea\u7531\u306b\u8a18\u8f09\u304f\u3060\u3055\u3044\u3002<\/span><\/p>\r\n

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