{"id":7161,"date":"2021-02-01T09:00:40","date_gmt":"2021-02-01T00:00:40","guid":{"rendered":"https:\/\/wp.meccari.jp\/?p=7161"},"modified":"2023-12-27T09:39:57","modified_gmt":"2023-12-27T00:39:57","slug":"menu_23","status":"publish","type":"post","link":"https:\/\/wp.meccari.jp\/eigocafe\/menu_23\/","title":{"rendered":"Menu 23\u3000\u547c\u5438\u5668\u3068\u8179\u90e8\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\u547c\u5438\u5668\u3068\u8179\u90e8\u306e\u8eab\u4f53\u8a3a\u5bdf\u306b\u95a2\u3059\u308b\u82f1\u8a9e\u8868\u73fe<\/strong><\/span>\u300d\u3002<\/span><\/p>\r\n\r\n

2021 \u5e741\u670826\u65e5\u306b USMLE Step 2 Clinical Skills<\/strong> (CS<\/strong>) \u306e\u5ec3\u6b62\u304c\u767a\u8868<\/span><\/strong><\/span><\/a><\/span>\u3055\u308c\u307e\u3057\u305f\u3002\u6a21\u64ec\u60a3\u8005\u3055\u3093\u3092\u76f8\u624b\u306b history taking \u3084 physical exam \u3092\u884c\u3046\u3053\u306e\u8a66\u9a13\u306f\u82f1\u8a9e\u3092\u6bcd\u56fd\u8a9e\u3068\u3057\u306a\u3044\u53d7\u9a13\u8005\u306b\u3068\u3063\u3066\u306f\u96e3\u3057\u3044\u8a66\u9a13\u3068\u8003\u3048\u3089\u308c\u3066\u3044\u307e\u3057\u305f\u3002\u4eca\u5f8c\u3057\u3070\u3089\u304f\u306f\u3053\u306e Step 2 CS \u3067\u8a55\u4fa1\u3055\u308c\u3066\u3044\u305f physical exam \u306e\u5185\u5bb9\u304c\u3001\u4ed6\u306e USMLE \u306e\u8a66\u9a13\u3067\u8a55\u4fa1\u3055\u308c\u308b\u3053\u3068\u3068\u306a\u308a\u305d\u3046\u3067\u3059\u3002\u305d\u3057\u3066\u305d\u3046\u3044\u3063\u305f\u8a66\u9a13\u3067\u306f physical exam \u306b\u95a2\u3059\u308b\u300c\u6b63\u3057\u3044<\/strong>\u300d\u82f1\u8a9e\u8868\u73fe\u3092\u77e5\u3063\u3066\u304a\u304f\u3053\u3068\u3082\u91cd\u8981\u3068\u306a\u308a\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u305d\u3053\u3067\u4eca\u6708\u306f\u547c\u5438\u5668\u3068\u8179\u90e8\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

cachexia\u3063\u3066\u4f55\uff1f<\/strong><\/span>
\r\n\u300c\u5faa\u74b0\u5668\u306e\u8eab\u4f53\u8a3a\u5bdf\u306b\u95a2\u3059\u308b\u82f1\u8a9e\u8868\u73fe<\/span><\/a><\/strong><\/span>\u300d\u3067\u3054\u7d39\u4ecb\u3057\u305f\u901a\u308a\u3001\u82f1\u8a9e\u570f\u3067\u306f general inspection<\/strong>\u300c\u5168\u8eab\u89b3\u5bdf<\/strong>\u300d\u306b\u7d9a\u3044\u3066 vital signs<\/strong> \u3092\u78ba\u8a8d\u3057\u305f\u5f8c hand exam<\/strong> \u3092\u884c\u3044\u3001\u305d\u306e\u5f8c\u306fhead\/eyes\/ears\/nose\/throat (HEENT) \u304b\u3089lower extremities \u306b\u5411\u304b\u3063\u3066\u8a3a\u5bdf\u3092\u9032\u3081\u3066\u3044\u304d\u307e\u3059\u3002\u65e5\u672c\u3067\u306f\u300c\u8179\u90e8\u306e\u8eab\u4f53\u8a3a\u5bdf\u300d\u306f\u4fb5\u8972\u304c\u5c11\u306a\u3044\u300c\u8996\u8a3a\u300d\u2192\u300c\u8074\u8a3a\u300d\u2192\u300c\u6253\u8a3a\u300d\u2192\u300c\u89e6\u8a3a\u300d\u306e\u9806\u5e8f\u3067\u884c\u3046\u3053\u3068\u304c\u4e00\u822c\u7684\u3067\u3059\u304c\u3001\u82f1\u8a9e\u570f\u3067\u306f\u8a3a\u5bdf\u3059\u308b\u90e8\u4f4d\u306b\u95a2\u308f\u3089\u305a\u3001inspection<\/strong><\/span>\u300c\u8996\u8a3a<\/strong>\u300d\u2192\u3000 palpation<\/strong><\/span>\u300c\u89e6\u8a3a<\/strong>\u300d\u2192 percussion<\/strong><\/span>\u300c\u6253\u8a3a<\/strong>\u300d\u2192 auscultation<\/strong><\/span>\u300c\u8074\u8a3a<\/strong>\u300d\u306e\u9806\u5e8f\u3067\u884c\u3046\u3053\u3068\u304c\u4e00\u822c\u7684\u3067\u3059\u306e\u3067\u6ce8\u610f\u3057\u3066\u304f\u3060\u3055\u3044\u3002<\/span><\/p>\r\n\r\n\r\n

OSCE \u3067\u3042\u308c\u3070 respiratory exam<\/strong>\u300c\u547c\u5438\u5668\u306e\u8a3a\u5bdf<\/strong>\u300d\u3068 abdominal exam<\/strong>\u300c\u8179\u90e8\u306e\u8a3a\u5bdf<\/strong>\u300d\u306f\u5206\u3051\u3066\u5b9f\u65bd\u3055\u308c\u307e\u3059\u304c\u3001\u4eca\u56de\u306f\u3053\u306e2\u3064\u3092\u540c\u6642\u306b\u3054\u7d39\u4ecb\u3057\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u6700\u521d\u306b\u884c\u3046 general inspection \u306f\u60a3\u8005\u3055\u3093\u306b\u30d9\u30c3\u30c9\u306b\u5ea7\u3063\u3066\u3082\u3089\u3044\u3001 \u201cI\u2019m going to start by having a look from the end of the bed<\/strong><\/span>.\u201d \u3068\u8a00\u3044\u3001\u5fc5\u305a\u60a3\u8005\u3055\u3093\u306e\u30d9\u30c3\u30c9\u306e\u8db3\u5143\u304b\u3089\u5168\u8eab\u3092\u89b3\u5bdf\u3057\u307e\u3059\u3002c<\/strong>hronic o<\/strong>bstructive p<\/strong>ulmonary d<\/strong>isease (COPD<\/strong>) \u3067\u306f\u3053\u306e general inspection \u306b\u95a2\u3057\u3066\u7279\u6709\u306e\u8868\u73fe\u304c\u3042\u308a\u307e\u3059\u3002chronic bronchitis<\/strong><\/span>\u300c\u6162\u6027\u6c17\u7ba1\u652f\u708e<\/strong>\u300d\u306f cyanosis\u300c\u30c1\u30a2\u30ce\u30fc\u30bc\u300d\u304c\u73fe\u308c\u3066 thorax\u300c\u80f8\u90ed\u300d\u304c\u524d\u5f8c\u306b bloated\u300c\u81a8\u3089\u3093\u3060\u300d\u5916\u898b\u3068\u306a\u308b\u305f\u3081\u306b \u201cblue bloater<\/strong><\/span><\/em>\u201d \u3068\u8868\u73fe\u3055\u308c\u307e\u3059\u3002\u3053\u308c\u306b\u5bfe\u3057\u3066 cyanosis \u304c\u73fe\u308c\u305a\u306b\u30d4\u30f3\u30af\u306e\u76ae\u819a\u8272\u3067 puff\u300c\u606f\u3092\u5598\u3050\u300d\u5916\u898b\u304c\u7279\u5fb4\u7684\u306a emphysema<\/strong><\/span>\u300c\u80ba\u6c17\u816b\u300d\u306f \u201cpink puffer<\/strong><\/span><\/em>\u201d \u3068\u8868\u73fe\u3055\u308c\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u3053\u306e\u3088\u3046\u306b general inspection \u3067\u306f body habitus<\/strong><\/span>\u300c\u4f53\u578b<\/strong>\u300d\u306b\u3082\u6ce8\u610f\u304c\u5fc5\u8981\u3067\u3059\u3002\u300c\u60aa\u6db2\u8cea\u300d\u3068\u3044\u3046\u8a33\u8a9e\u304c\u4f7f\u308f\u308c\u3066\u3044\u308b cachexia<\/strong><\/span>\uff08\u300c\u30ab\u30b1<\/strong>\u30af<\/span>\u30b7\u30a3\u30a2\u300d\u306e\u3088\u3046\u306b\u767a\u97f3\uff09\u3067\u3059\u304c\u3001\u3053\u308c\u306f\u300c\u75c5\u7684\u306b\u75e9\u305b\u305f\u72b6\u614b<\/strong>\u300d\u306e\u30a4\u30e1\u30fc\u30b8\u3092\u6301\u3064\u8868\u73fe\u3067\u3001malignancies \u3084 AIDS \u306e\u60a3\u8005\u3055\u3093\u306e\u5916\u898b\u306e\u8868\u73fe\u3067\u3088\u304f\u4f7f\u308f\u308c\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

leukonychia \u3063\u3066\u4f55\uff1f<\/strong><\/span>
\r\n\u6b21\u306b\u5404\u90e8\u306e\u8a3a\u5bdf\u306b\u5165\u308a\u307e\u3059\u3002\u6700\u521d\u306f hand exam<\/strong> \u3067\u3059\u306e\u3067 \u201cI\u2019m going to take a look at your hands.\u201d \u3068\u8a00\u3063\u3066 nail inspection<\/strong> \u304b\u3089\u884c\u3044\u307e\u3057\u3087\u3046\u3002\u722a\u306b\u767d\u3044\u6591\u70b9\u304c\u8a8d\u3081\u3089\u308c\u308b\u5834\u5408\u3001\u305d\u308c\u306f leukonychia<\/strong><\/span> \u3068\u547c\u3070\u308c\u3001hypoalbuminemia<\/strong>\u300c\u4f4e\u30a2\u30eb\u30d6\u30df\u30f3\u8840\u75c7<\/strong>\u300d\u3092\u793a\u5506\u3057\u307e\u3059\u3002\u307e\u305f spoon nails<\/strong> \u3068\u7686\u3055\u3093\u304c\u8a18\u61b6\u3055\u308c\u3066\u3044\u308b\u300c\u3055\u3058\u72b6\u722a<\/strong>\u300d\u306b\u306f koilonychia<\/strong><\/span> \u3068\u3044\u3046\u533b\u5b66\u82f1\u8a9e\u3082\u3042\u308a\u307e\u3059\u3002flapping tremor<\/strong> \u300c\u7fbd\u3070\u305f\u304d\u632f\u6226<\/strong>\u300d\u3068\u3057\u3066\u3082\u77e5\u3089\u308c\u308b asterixis<\/strong><\/span> \u3067\u3059\u304c\u3001\u3053\u306e\u8a3a\u5bdf\u306b\u306f \u201cPlease extend your arms and fingers and hold them.\u201d \u3068\u8a00\u3063\u3066\u3001\u60a3\u8005\u3055\u3093\u306b\u624b\u9996\u3068\u6307\u3092\u4f38\u5c55\u3057\u3066\u3082\u3089\u3046\u5fc5\u8981\u304c\u3042\u308a\u307e\u3059\u3002\u3082\u3057\u7b4b\u7dca\u5f35\u304c\u6d88\u5931\u3057\u3066\u624b\u9996\u3068\u6307\u306e\u4f38\u5c55\u3092\u4fdd\u6301\u3067\u304d\u306a\u3044\u5834\u5408\u3001hepatic encephalopathy<\/strong>\u300c\u809d\u6027\u8133\u75c7<\/strong>\u300d\u306b\u3088\u308b asterixis \u3068\u547c\u3073\u307e\u3059\u3002\u3053\u308c\u306f\u7b4b\u7dca\u5f35\u306e\u6d88\u5931\u306b\u3088\u3063\u3066\u8d77\u3053\u308b\u305f\u3081\u3001negative myoclonus<\/strong> \u3068\u3082\u547c\u3070\u308c\u307e\u3059\u3002\u5b9a\u7fa9\u4e0a\u3053\u308c\u306f tremor \u3068\u306f\u306a\u308a\u307e\u305b\u3093\u306e\u3067\u3054\u6ce8\u610f\u3092\u3002<\/span><\/p>\r\n\r\n

\u6b21\u306b\u4e21\u624b\u3092\u300c\u56de\u5916\u300d\u3057\u3066\u3082\u3089\u3063\u3066 palms<\/strong> \u300c\u624b\u638c<\/strong>\u300d\u3092\u89b3\u5bdf\u3057\u307e\u3057\u3087\u3046\u3002\u624b\u638c\u304c\u8d64\u304f\u306a\u3063\u3066\u3044\u308c\u3070\u3001estrogen<\/strong> \u306e\u5897\u52a0\u306b\u3088\u3063\u3066\u751f\u3058\u305f palmar erythema<\/strong><\/span>\u300c\u624b\u638c\u7d05\u6591<\/strong>\u300d\u3067\u3059\u3002\u3061\u306a\u307f\u306b\u82f1\u8a9e\u3067\u300c\u4f0f\u81e5\u4f4d<\/strong>\u300d\u3092 prone position<\/strong>\u3001\u300c\u4ef0\u81e5\u4f4d<\/strong>\u300d\u3092 supine position<\/strong> \u3068\u8a00\u3044\u307e\u3059\u3002\u3067\u3059\u304b\u3089\u300c\u624b\u306e\u5e73\u3092\u4f0f\u81e5\u4f4d\u306b\u3059\u308b<\/strong>\u300d\u3068\u3044\u3046\u52d5\u304d\u306e\u300c\u56de\u5185<\/strong>\u300d\u306f pronation<\/strong><\/span>\u3001\u300c\u624b\u306e\u5e73\u3092\u4ef0\u81e5\u4f4d\u306b\u3059\u308b\u300d\u3068\u3044\u3046\u52d5\u304d\u306e\u300c\u56de\u5916<\/strong>\u300d\u306f supination<\/strong><\/span> \u3068\u8868\u73fe\u3055\u308c\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u300c\u773c\u7403\u7d50\u819c\u9ec4\u67d3\u300d\u3068\u300c\u773c\u77bc\u7d50\u819c\u84bc\u767d\u300d\u306f\u82f1\u8a9e\u3067\u4f55\u3068\u8a00\u3046\uff1f<\/strong><\/span>
\r\n\u6b21\u306b HEENT<\/strong>\u300c\u982d\u9838\u90e8<\/strong>\u300d\u306e\u8a3a\u5bdf\u3067\u3059\u3002
\r\n\u547c\u5438\u5668\u3068\u8179\u90e8\u306e\u8a3a\u5bdf\u3067\u306f eye inspection<\/strong> \u304c\u91cd\u8981\u3067\u3059\u306e\u3067\u3001\u201cI\u2019m going to pull down your lower eyelid. Please look up for me.\u201d \u3068\u8a00\u3063\u3066\u300c\u773c\u7403\u7d50\u819c\u300d\u3068\u300c\u773c\u77bc\u7d50\u819c\u300d\u3092\u89b3\u5bdf\u3057\u307e\u3057\u3087\u3046\u3002jaundice<\/strong>\u300c\u9ec4\u75b8<\/strong>\u300d\u306e\u6240\u898b\u3067\u3042\u308b\u300c\u773c\u7403\u7d50\u819c\u9ec4\u67d3<\/strong>\u300d\u306f\u82f1\u8a9e\u3067\u306f conjunctival icterus<\/strong><\/span> \u3068\u306a\u308a\u3001anemia<\/strong>\u300c\u8ca7\u8840<\/strong>\u300d\u306e\u6240\u898b\u3067\u3042\u308b\u300c\u773c\u77bc\u7d50\u819c\u84bc\u767d<\/strong>\u300d\u306f conjunctival pallor<\/strong><\/span> \u3068\u306a\u308a\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

neck palpation<\/strong> \u3067\u306f\u300c\u9996\u3092\u89e6\u308a\u307e\u3059\u306d\u300d\u3068\u3044\u3046\u66d6\u6627\u306a\u8868\u73fe\u3088\u308a\u3082\u3001 \u201cI\u2019m going to examine the glands in your neck<\/strong>.\u201d \u306e\u3088\u3046\u306a\u5177\u4f53\u7684\u306a\u8868\u73fe\u306e\u65b9\u304c\u81ea\u7136\u3067\u3059\u3002\u300c\u30ea\u30f3\u30d1\u7bc0\u816b\u8139<\/strong>\u300d\u306f\u4e00\u822c\u82f1\u8a9e\u3067\u306f swollen lymph nodes<\/strong> \u3068\u306a\u308a\u307e\u3059\u304c\u3001\u533b\u5b66\u82f1\u8a9e\u3067\u306f lymphadenopathy<\/strong><\/span> \u3068\u306a\u308a\u307e\u3059\u3002\u8179\u8154\u306e\u30ea\u30f3\u30d1\u6db2\u304c\u96c6\u307e\u308b left supraclavicular lymph node<\/strong>\u300c\u5de6\u9396\u9aa8\u4e0a\u30ea\u30f3\u30d1\u7bc0<\/strong>\u300d\u306f Virchow\u2019s node<\/strong> \u3068\u547c\u3070\u308c\u307e\u3059\u304c\u3001\u3053\u3053\u304c\u816b\u8139\u3059\u308b\u3068 Troisier\u2019s sign<\/strong><\/span> \u3068\u547c\u3070\u308c\u3001\u8179\u8154\u5185\u306e\u60aa\u6027\u816b\u760d\u306e\u8ee2\u79fb\u304c\u7591\u308f\u308c\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

tactile fremitus \u3063\u3066\u3069\u3046\u8a3a\u5bdf\u3059\u308b\u306e\uff1f<\/strong><\/span>
\r\n\u3067\u306f\u3053\u3053\u304b\u3089 chest\u300c\u80f8\u90e8\u300d\u306e\u8a3a\u5bdf\u306b\u5165\u308a\u307e\u3057\u3087\u3046\u3002\u8eab\u4f53\u8a3a\u5bdf\u306b\u304a\u3044\u3066 chest exam<\/strong> \u3068\u8a00\u3048\u3070 lung exam \u306e\u3053\u3068\u3067\u3001\u5fc3\u81d3\u306e\u8a3a\u5bdf\u3067\u3042\u308b heart exam \u3068\u306f\u533a\u5225\u3057\u3066\u4f7f\u308f\u308c\u307e\u3059\u3002lung palpation \u3067\u306f \u201cI\u2019m going to put my hands around your chest<\/span><\/strong>. Could you take some deep breaths for me, please? Please breathe in deeply. And now breathe out.\u201d \u3068\u6307\u793a\u3057\u3066\u81ea\u5206\u306e\u624b\u306e\u52d5\u304d\u3092\u89b3\u5bdf\u3059\u308b\u3053\u3068\u3067 lung expansion \u306e\u6709\u7121\u3092\u78ba\u8a8d\u3057\u307e\u3057\u3087\u3046\u3002<\/span><\/p>\r\n\r\n

\u65e5\u672c\u306e\u8a3a\u7642\u3067\u306f\u3042\u307e\u308a\u884c\u308f\u308c\u308b\u3053\u3068\u304c\u306a\u3044 tactile fremitus<\/strong><\/span> \u3067\u3059\u304c\u3001\u3053\u308c\u306f\u3069\u3093\u306a\u8a3a\u5bdf\u306a\u306e\u3067\u3057\u3087\u3046\u3002\u307e\u305a \u201cI\u2019m going to place my hands on your back.\u201d \u3068\u8a00\u3063\u3066\u60a3\u8005\u3055\u3093\u306e\u80cc\u4e2d\u306b\u4e21\u624b\u3092\u5f53\u3066\u307e\u3059\u3002\u6b21\u306b \u201cCould you say \u2018ninety- nine<\/strong><\/span><\/em>\u2019 for me, please?\u201d \u3068\u8a00\u3063\u3066\u4f4e\u3044\u58f0\u3067 \u201cNinety-nine, ninety-nine, ninety-nine\u2026\u201d \u3068\u8a00\u3044\u7d9a\u3051\u3066\u3082\u3089\u3044\u307e\u3059\u3002\u60a3\u8005\u3055\u3093\u304c \u201cNinety-nine\u201d \u3068\u3044\u3046\u4f4e\u3044\u58f0\u3092\u767a\u3059\u308b\u3068\u80ba\u304c fremitus<\/strong>\u300c\u9707\u76ea<\/strong>\u300d\u3057\u307e\u3059\u3002\u305d\u306efremitus \u3092tactile<\/strong> \u300c\u89e6\u77e5<\/strong>\u300d\u3059\u308b\u3053\u3068\u3067\u80ba\u306e\u72b6\u614b\u3092\u63a8\u5bdf\u3057\u307e\u3059\u3002\u3082\u3057 fremitus \u304c\u5f37\u304f\u306a\u308c\u3070\u80ba\u306e\u5b9f\u8cea\u304c solid<\/strong> \u300c\u786c\u3044<\/strong>\u300d\u72b6\u614b\u306b\u306a\u3063\u3066\u3044\u308b\u3053\u3068\u304c\u63a8\u5bdf\u3055\u308c\u307e\u3059\u3002\u3053\u306e\u3088\u3046\u306b\u80ba\u306e\u5b9f\u8cea\u304c solid \u306a\u72b6\u614b\u306b\u306a\u308b\u3053\u3068\u3092 pulmonary consolidation<\/strong><\/span> \u3068\u547c\u3073\u3001\u80ba\u80de\u5185\u90e8\u306b\u6db2\u4f53\u304c\u8caf\u7559\u3059\u308b typical pneumonia<\/strong>\u300c\u5b9a\u578b\u80ba\u708e<\/strong>\u300d\u3084 left heart failure<\/strong>\u300c\u5de6\u5fc3\u4e0d\u5168<\/strong>\u300d\u306a\u3069\u306e\u6240\u898b\u3068\u306a\u308a\u307e\u3059\u3002\u3053\u308c\u306b\u5bfe\u3057\u3066 fremitus \u304c\u5f31\u304f\u306a\u308c\u3070\u3001\u80ba\u306e\u5916\u5074\u306b\u6db2\u4f53\u3084\u7a7a\u6c17\u304c\u5b58\u5728\u3059\u308b\u3053\u3068\u304c\u63a8\u5bdf\u3055\u308c\u3001pleural effusion<\/strong>\u300c\u80f8\u6c34<\/strong>\u300d\u3084 pneumothorax<\/strong>\u300c\u6c17\u80f8<\/strong>\u300d\u306a\u3069\u306e\u6240\u898b\u3068\u306a\u308a\u307e\u3059\u3002\u3053\u306e tactile fremitus \u306f\u300c\u58f0\u306b\u3088\u3063\u3066\u751f\u3058\u308b\u9707\u76ea<\/strong>\u300d\u3068\u3044\u3046\u610f\u5473\u3067 vocal fremitus<\/strong>\u300c\u58f0\u97f3\u9707\u76ea<\/strong>\u300d\u3068\u3082\u547c\u3070\u308c\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u6b21\u306f lung percussion<\/strong> \u3067\u3059\u3002\u300c\u6253\u8a3a\u300d\u306e\u969b\u306b\u306f hit \u3067\u306f\u306a\u304ftap<\/strong> \u3092\u4f7f\u3063\u3066 \u201cI\u2019m going to tap<\/strong><\/span> on various points of your chest.\u201d \u3068\u4f1d\u3048\u307e\u3059\u3002\u3053\u306e lung percussion \u3067\u306f\u305d\u306e\u97f3\u306e\u8868\u73fe\u3060\u3051\u3067\u306a\u304f\u3001\u305d\u308c\u304c\u793a\u5506\u3059\u308b\u72b6\u614b\u3082\u542b\u3081\u3066\u899a\u3048\u308b\u3053\u3068\u304c\u91cd\u8981\u3067\u3059\u3002\u6b63\u5e38<\/strong>\u306a\u80ba\u306e\u6253\u8a3a\u97f3\u306f resonant<\/strong><\/span> sounds \u3068\u8868\u73fe\u3055\u308c\u307e\u3059\u3002\u3053\u308c\u304c\u9ad8\u304f\u306a\u308b\u3068 hyper-resonant<\/span> <\/strong>sounds \u3068\u306a\u308a\u3001\u80ba\u306e\u5b9f\u8cea\u306e\u5916\u5074\u306b\u7a7a\u6c17\u304c\u5b58\u5728\u3059\u308b\u72b6\u614b\u3001\u3059\u306a\u308f\u3061 pneumothorax<\/strong> \u3092\u793a\u5506\u3057\u307e\u3059\u3002\u6b63\u5e38\u306e resonant \u3088\u308a\u4f4e\u3044\u6253\u8a3a\u97f3\u306f dull<\/strong><\/span> sounds \u3068\u306a\u308a\u3001\u3053\u308c\u306f\u5148\u307b\u3069\u7d39\u4ecb\u3057\u305f pulmonary consolidation<\/strong>\u3001\u3064\u307e\u308a typical pneumonia \u3084 left heart failure \u306a\u3069\u3092\u793a\u5506\u3057\u307e\u3059\u3002\u3053\u306e dull \u304c\u3055\u3089\u306b\u4f4e\u304f\u306a\u308b\u3068\u77f3\u3092\u53e9\u3044\u3066\u3044\u308b\u3088\u3046\u306a stony dull<\/strong><\/span> sounds \u3068\u306a\u308a\u307e\u3059\u3002\u3053\u308c\u306f\u80ba\u306e\u5b9f\u8cea\u306e\u5916\u5074\u306b\u6db2\u4f53\u304c\u5b58\u5728\u3059\u308b\u72b6\u614b\u3001\u3059\u306a\u308f\u3061 pleural effusion<\/strong> \u3092\u793a\u5506\u3059\u308b\u308f\u3051\u3067\u3059\u3002\u3053\u306e\u3088\u3046\u306b lung percussion \u3067\u306f\u3001\u305d\u308c\u305e\u308c\u306e\u97f3\u304c\u793a\u5506\u3059\u308b\u72b6\u614b\u3082\u5fc5\u305a\u4e00\u7dd2\u306b\u899a\u3048\u3066\u304f\u3060\u3055\u3044\u3002<\/span><\/p>\r\n\r\n

\u80ba\u306e\u8074\u8a3a\u3067\u306f\u97f3\u3092\u8996\u899a\u5316\u3059\u308b\u3053\u3068\u304c\u6709\u52b9<\/strong><\/span>
\r\n\u3067\u306f\u3044\u3088\u3044\u3088\u3001chest exam \u306e\u30cf\u30a4\u30e9\u30a4\u30c8\u3067\u3042\u308b lung auscultation<\/strong> \u3092\u898b\u3066\u3044\u304d\u307e\u3057\u3087\u3046\u3002\u4e00\u822c\u7684\u306a lung auscultation \u3092\u3054\u7d39\u4ecb\u3059\u308b\u524d\u306b\u3001tactile fremitus \u540c\u69d8\u306b\u65e5\u672c\u3067\u306f\u3042\u307e\u308a\u77e5\u3089\u308c\u3066\u3044\u306a\u3044 egophony<\/strong><\/span> \u3092\u3054\u7d39\u4ecb\u3057\u307e\u3059\u3002\u3053\u308c\u306f \u201cI\u2019m going to listen to various points of your chest. Could you say \u2018E<\/span><\/strong><\/em>\u2019 for me, please?\u201d \u3068\u6307\u793a\u3057\u3066\u884c\u3044\u307e\u3059\u3002\u3082\u3061\u308d\u3093\u6b63\u5e38\u306a\u80ba\u3067\u3042\u308c\u3070\u60a3\u8005\u3055\u3093\u304c \u2018E<\/span><\/strong><\/em>\u2019 \u3068\u8a00\u3048\u3070 \u2018E<\/span><\/strong><\/em>\u2019 \u3068\u805e\u3053\u3048\u307e\u3059\u3002\u3057\u304b\u3057\u80ba\u306e\u5b9f\u8cea\u304c\u786c\u304f\u306a\u3063\u305f pulmonary consolidation \u306e\u72b6\u614b\u3067\u306f\u3001\u3053\u306e \u2018E<\/span><\/strong><\/em>\u2019 \u304c \u2018A<\/span><\/strong><\/em>\u2019 \u306e\u3088\u3046\u306b\u805e\u3053\u3048\u308b\u306e\u3067\u3059\u3002\u52d5\u7269\u3067\u300c\u30a8\uff5e<\/strong>\u300d\u306e\u3088\u3046\u306b\u9cf4\u304f\u306e\u306f goat<\/strong>\u300c\u30e4\u30ae<\/strong>\u300d\u3067\u3059\u306e\u3067\u3001\u3053\u306e egophony \u306f\u65e5\u672c\u8a9e\u3067\u306f\u300c\u30e4\u30ae\u97f3<\/strong>\u300d\u3068\u547c\u3070\u308c\u308b\u306e\u3067\u3059\u3002\u3061\u306a\u307f\u306b \u201cWhich one is the GOAT<\/strong>? Messi or Cristiano Ronaldo?\u201d \u3067\u4f7f\u308f\u308c\u308b GOAT<\/strong> \u3068\u306f g<\/strong>reatest o<\/strong>f a<\/strong>ll t<\/strong>ime\u300c\u53f2\u4e0a\u6700\u9ad8<\/strong>\uff08\u306e\u9078\u624b\uff09\u306e\u7565\u8a9e\u3067\u3001\u30b9\u30dd\u30fc\u30c4\u306e\u4e16\u754c\u3067\u3088\u304f\u4f7f\u308f\u308c\u308b\u8868\u73fe\u3067\u3059\u3002<\/span><\/p>\r\n\r\n

\u547c\u5438\u97f3\u3092\u8074\u8a3a\u3059\u308b lung auscultation<\/strong> \u3067\u306f\u60a3\u8005\u3055\u3093\u306b \u201cI\u2019m going to listen to various points of your chest. Could you breathe deeply through your mouth, please?\u201d \u3068\u8a00\u3063\u3066\u3001\u5927\u304d\u304f\u53e3\u304b\u3089\u606f\u3092\u3057\u3066\u3082\u3089\u3044\u307e\u3057\u3087\u3046\u3002\u305f\u3060\u5c0f\u5150\u79d1\u306b\u304a\u3044\u3066\u5c0f\u3055\u306a\u5b50\u3069\u3082\u306b\u3053\u306e\u3088\u3046\u306a\u6307\u793a\u3092\u3057\u3066\u3082\u3046\u307e\u304f\u8074\u8a3a\u304c\u3067\u304d\u307e\u305b\u3093\u306d\u3002\u305d\u306e\u3088\u3046\u306a\u5834\u5408\u306b\u306f \u201cOK Sam, please pretend that there is a birthday cake with a lot of candles in front of you. Please blow out all of the candles for me<\/strong>. Great. And again… one more time…\u201d \u306e\u3088\u3046\u306a\u8868\u73fe\u3092\u4f7f\u3046\u3068\u3046\u307e\u304f\u8074\u8a3a\u3059\u308b\u3053\u3068\u304c\u53ef\u80fd\u306b\u306a\u308a\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

heart auscultation<\/span><\/strong><\/span><\/a>\u300c\u5fc3\u97f3\u306e\u8074\u8a3a<\/strong>\u300d\u306b\u304a\u3044\u3066\u3001 murmur<\/strong>\u300c\u5fc3\u96d1\u97f3<\/strong>\u300d\u306e\u8074\u53d6\u3067\u306f\u300c\u53ce\u7e2e\u671f\u96d1\u97f3\u304b\u62e1\u5f35\u671f\u96d1\u97f3\u304b\u300d\u300c\u3069\u306e\u5f01\u3067\u4e00\u756a\u5927\u304d\u306a\u5fc3\u96d1\u97f3\u304c\u805e\u3053\u3048\u308b\u304b\u300d\u3068\u3044\u3063\u305f\u30a2\u30d7\u30ed\u30fc\u30c1\u304c\u6709\u52b9\u3067\u3057\u305f\u304c\u3001lung auscultation\u300c\u547c\u5438\u97f3\u306e\u8074\u8a3a\u300d\u3067\u306f\u97f3\u3092\u8996\u899a\u5316\u3059\u308b\u3053\u3068\u304c\u6709\u52b9\u3068\u8a00\u3048\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

trachea\u300c\u6c17\u7ba1\u300d\u307e\u3067\u306e upper airway\u300c\u4e0a\u6c17\u9053\u300d\u304b\u3089 bronchus\/bronchi\u300c\u6c17\u7ba1\u652f\u300d\u306b\u304b\u3051\u3066\u306e\u9818\u57df\u3067\u306f inspiration\/inhalation\u300c\u5438\u6c17\u300d\u3068 expiration\/exhalation\u300c\u547c\u6c17\u300d\u306e\u5f37\u3055\u3068\u9577\u3055\u304c\u540c\u3058\u3067\u3001\u5438\u6c17\u3068\u547c\u6c17\u306e\u9593\u306b gap \u304c\u751f\u3058\u308b bronchial breath sound<\/strong><\/span>\uff08\u8996\u899a\u5316\u3057\u305f\u30a4\u30e1\u30fc\u30b8\u306f\u3053\u3061\u3089<\/strong><\/span><\/a><\/strong>\uff09\u304c\u4e3b\u306b\u805e\u3053\u3048\u307e\u3059\u3002\u3053\u308c\u306b\u5bfe\u3057\u3066 bronchioles\u300c\u7d30\u6c17\u7ba1\u652f\u300d\u304b\u3089 alveolus\/alveoli\u300c\u80ba\u80de\u300d\u306b\u304b\u3051\u3066\u306e\u9818\u57df\u3067\u306f\u5438\u6c17\u304c\u547c\u6c17\u306b\u5bfe\u3057\u3066\u5f37\u304f\u9577\u304f\u3001\u304b\u3064\u5438\u6c17\u3068\u547c\u6c17\u306e\u9593\u306b gap \u304c\u751f\u3058\u306a\u3044 vesicular breath sounds<\/strong><\/span>\uff08\u30a4\u30e1\u30fc\u30b8\u306f\u3053\u3061\u3089<\/strong><\/span><\/a>\uff09\u304c\u4e3b\u306b\u805e\u3053\u3048\u307e\u3059\u3002\u3082\u3057\u3053\u306e vesicular breath sounds \u304c\u805e\u3053\u3048\u308b\u9818\u57df\u3067\u672c\u6765\u805e\u3053\u3048\u306a\u3044\u306f\u305a\u306e bronchial breath sounds \u304c\u8074\u53d6\u3055\u308c\u305f\u5834\u5408\u3001\u305d\u308c\u306f\u305d\u306e\u9818\u57df\u306b\u554f\u984c\u304c\u3042\u3063\u3066\u672c\u6765\u306e vesicular breath sounds \u304c\u8074\u53d6\u3055\u308c\u306a\u3044\u7570\u5e38\u306a\u72b6\u614b\u304c\u793a\u5506\u3055\u308c\u3001bronchial breathing<\/strong><\/span> \u3068\u547c\u3070\u308c\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u3082\u3057\u3082 bronchial breath sounds \u306e\u9818\u57df\u3067 low-pitched rattling sounds<\/strong>\u300c\u4f4e\u97f3\u306e\u30b4\u30ed\u30b4\u30ed\u3057\u305f\u97f3<\/strong>\u300d\u304c\u8074\u53d6\u3055\u308c\u305f\u5834\u5408\u3001\u305d\u308c\u306f rhonchi<\/strong><\/span>\uff08\u30a4\u30e1\u30fc\u30b8\u306f\u3053\u3061\u3089<\/strong><\/span><\/a>\uff09\u3068\u547c\u3070\u308c\u307e\u3059\u3002\u3053\u308c\u306f bronchitis<\/strong>\u300c\u6c17\u7ba1\u652f\u708e<\/strong>\u300d\u306a\u3069\u3067\u6c17\u7ba1\u652f\u306e\u5185\u9762\u306b\u75f0\u304c\u4ed8\u7740\u3059\u308b\u3053\u3068\u3067\u751f\u3058\u308b\u3001\u5438\u6c17\u3068\u547c\u6c17\u306e\u4e21\u65b9\u3067\u805e\u3053\u3048\u308b\u97f3<\/strong>\u3067\u3001\u65e5\u672c\u8a9e\u3067\u306f\u300c\u3044\u3073\u304d\u97f3<\/strong>\u300d\u3068\u547c\u3070\u308c\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u3053\u308c\u306b\u5bfe\u3057\u3066 vesicular breath sounds \u304c\u805e\u3053\u3048\u308b\u9818\u57df\u3067 high-pitched whistling sounds<\/strong>\u300c\u9ad8\u97f3\u306e\u7b1b\u306e\u3088\u3046\u306a\u97f3<\/strong>\u300d\u304c\u8074\u53d6\u3055\u308c\u305f\u5834\u5408\u3001\u305d\u308c\u306f wheezes<\/span><\/strong>\uff08\u30a4\u30e1\u30fc\u30b8\u306f\u3053\u3061\u3089<\/strong><\/span><\/a>\uff09\u3068\u547c\u3070\u308c\u307e\u3059\u3002\u3053\u308c\u306f COPD<\/strong> \u3084 asthma<\/strong> \u306e\u3088\u3046\u306a lower airway\u300c\u4e0b\u6c17\u9053\u300d\u306e\u9589\u585e\u306b\u4f34\u3044\u751f\u3058\u308b\u3001\u5438\u6c17\u3068\u547c\u6c17\u306e\u4e21\u65b9\u3067\u805e\u3053\u3048\u308b\u97f3\u3067<\/strong>\u3001\u65e5\u672c\u8a9e\u3067\u306f\u300c\u5598\u9cf4<\/strong>\u300d\u3068\u547c\u3070\u308c\u307e\u3059\u3002\u6c17\u3092\u3064\u3051\u3066\u9802\u304d\u305f\u3044\u306e\u304c\u3053\u306e wheezes \u306f\u3042\u304f\u307e\u3067\u3082 stethoscope\u300c\u8074\u8a3a\u5668\u300d\u3092\u901a\u3057\u3066\u306e\u307f\u8074\u53d6\u3055\u308c\u308b\u97f3\u3067\u3042\u308a\u3001\u8074\u8a3a\u5668\u306a\u3057\u3067\u805e\u3053\u3048\u308b\u5598\u9cf4\u306f stridor<\/strong><\/span> \u3068\u547c\u3070\u308c\u307e\u3059\u3002\u3053\u308c\u306fepiglottitis<\/strong>\u300c\u5589\u982d\u84cb\u708e<\/strong>\u300d\u306e\u3088\u3046\u306a upper airway \u306e\u9589\u585e\u306b\u3088\u3063\u3066\u751f\u3058\u308b\u97f3\u3067\u3059\u306e\u3067\u3001wheezes \u3068\u306f\u533a\u5225\u3057\u3066\u899a\u3048\u3066\u304a\u3044\u3066\u304f\u3060\u3055\u3044\u3002<\/span><\/p>\r\n\r\n

\u3053\u308c\u4ee5\u5916\u306b\u3082 vesicular breath sounds \u304c\u805e\u3053\u3048\u308b\u9818\u57df\u3067\u306f\u3001 crackles<\/strong><\/span> \u3068\u547c\u3070\u308c\u308b\u7570\u5e38\u97f3\u304c\u805e\u3053\u3048\u308b\u5834\u5408\u304c\u3042\u308a\u307e\u3059\u3002\u3053\u308c\u306f alveoli \u304b\u3089\u751f\u3058\u308b\u97f3\u3067\u3001\u7c73\u56fd\u3067\u306f rales<\/strong> \u3068\u3001\u305d\u3057\u3066\u82f1\u56fd\u3067\u306f crepitations<\/strong> \u3068\u3082\u547c\u3070\u308c\u307e\u3059\u3002\u5438\u6c17\u306e\u7d42\u308f\u308a\u306b fine popping sounds<\/strong>\u300c\u7d30\u304b\u304f\u5f3e\u3051\u308b\u97f3<\/strong>\u300d\u304c\u8074\u53d6\u3055\u308c\u305f\u5834\u5408\u3001\u305d\u308c\u306f fine crackles<\/strong><\/span>\uff08\u30a4\u30e1\u30fc\u30b8\u306f\u3053\u3061\u3089<\/strong><\/span><\/a>\uff09\u3068\u547c\u3070\u308c\u307e\u3059\u3002\u3053\u308c\u306f\u786c\u304f\u306a\u3063\u305f alveoli \u304c\u5438\u6c17\u306e\u969b\u306b\u81a8\u3089\u3080\u969b\u306b\u805e\u3053\u3048\u308b\u7834\u88c2\u97f3\u3067\u3001pulmonary fibrosis\u300c\u80ba\u7e4a\u7dad\u75c7\u300d\u3084 atypical pneumonia\u300c\u975e\u5b9a\u578b\u80ba\u708e\u300d\u306e\u969b\u306b\u8074\u53d6\u3055\u308c\u307e\u3059\u3002\u307e\u305f\u5438\u6c17\u3060\u3051\u3067\u306a\u304f\u547c\u6c17\u306e\u6700\u521d\u306b coarse bubbling sounds<\/strong>\u300c\u8352\u3044\u6ce1\u304c\u7acb\u3064\u3088\u3046\u306a\u97f3<\/strong>\u300d\u304c\u8074\u53d6\u3055\u308c\u305f\u5834\u5408\u3001\u305d\u308c\u306f coarse crackles<\/strong><\/span>\uff08\u30a4\u30e1\u30fc\u30b8\u306f\u3053\u3061\u3089<\/strong><\/span><\/a>\uff09\u3068\u547c\u3070\u308c\u307e\u3059\u3002\u3053\u308c\u306f alveoli \u306e\u4e2d\u306b\u6db2\u4f53\u304c\u8caf\u7559\u3057\u3001\u305d\u3053\u306b\u7a7a\u6c17\u304c\u5165\u3063\u305f\u969b\u306b\u805e\u3053\u3048\u308b\u6c34\u6ce1\u97f3\u3067\u3001left heart failure<\/strong> \u3084 typical pneumonia<\/strong> \u306e\u969b\u306b\u8074\u53d6\u3055\u308c\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u3053\u306e\u3088\u3046\u306b\u80ba\u306e\u8074\u8a3a\u3067\u306f\u3001\u97f3\u306e\u540d\u79f0\u3092\u8996\u899a\u5316\u3057\u305f\u30a4\u30e1\u30fc\u30b8\u3068\u4e00\u7dd2\u306b\u899a\u3048\u308b\u3068\u5fd8\u308c\u306b\u304f\u3044\u3068\u601d\u3044\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u300c\u7b4b\u6027\u9632\u5fa1\u300d\u306f\u82f1\u8a9e\u3067\u4f55\u3068\u8a00\u3046\uff1f<\/strong><\/span>
\r\n\u3067\u306f\u6700\u5f8c\u306b abdominal exam<\/strong>\u300c\u8179\u90e8\u306e\u8a3a\u5bdf<\/strong>\u300d\u3092\u7c21\u5358\u306b\u898b\u3066\u3044\u304d\u307e\u3057\u3087\u3046\u3002<\/span><\/p>\r\n\r\n

abdominal inspection<\/strong> \u3067\u306f \u201cI\u2019m going to take a look at your tummy\/belly\/abdomen.\u201d \u3068\u8a00\u3063\u3066\u3001\u4e0b\u8a18\u306e\u3088\u3046\u306a\u7570\u5e38\u6240\u898b\u306e\u6709\u7121\u3092\u78ba\u8a8d\u3057\u307e\u3057\u3087\u3046\u3002
\r\n\u3000\u25cf abdominal distention<\/strong>\u300c\u8179\u90e8\u81a8\u6e80<\/strong>\u300d
\r\n\u3000\u25cf scars<\/strong>\u300c\u7622\u75d5<\/strong>\u300d
\r\n\u3000\u25cf striae<\/strong>\/stretch marks<\/strong>\u300c\u76ae\u819a\u7dda\u6761<\/strong>\u300d
\r\n\u3000\u25cf hyperpigmentation<\/strong>\u300c\u8272\u7d20\u6c88\u7740<\/strong>\u300d
\r\n\u3000\u25cf spider nevus<\/strong>\/nevi<\/strong>\u300c\u30af\u30e2\u72b6\u8840\u7ba1\u816b<\/strong>\u300d
\r\n\u3000\u25cf caput medusae<\/strong>\u300c\u30e1\u30c9\u30a5\u30fc\u30b5\u306e\u982d<\/strong>\u300d<\/span><\/p>\r\n\r\n

\u65e5\u672c\u306e\u8a3a\u5bdf\u3067\u306f\u6700\u5f8c\u306b\u884c\u308f\u308c\u308b abdominal palpation \u3067\u3059\u304c\u3001\u305d\u306e\u969b\u306b\u306f \u201cI\u2019m going to press<\/strong> your tummy\/belly\/abdomen.\u201d \u3068 press<\/strong> \u3068\u3044\u3046\u52d5\u8a5e\u3092\u4f7f\u3044\u307e\u3059\u3002\u307e\u305f\u300c\u6d45\u3044\u89e6\u8a3a<\/strong>\u300d\u306f shallow \u3067\u306f\u306a\u304f light \u3092\u4f7f\u3063\u3066 light palpation<\/strong><\/span>\u3068\u8868\u73fe\u3055\u308c\u307e\u3059\u304c\u3001\u300c\u6df1\u3044\u89e6\u8a3a<\/strong>\u300d\u306f\u305d\u306e\u307e\u307e deep palpation<\/strong><\/span> \u3068\u8868\u73fe\u3055\u308c\u3001\u60a3\u8005\u3055\u3093\u306b\u306f \u201cI am going to press<\/strong> deeply.\u201d \u3068\u4f1d\u3048\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u65e5\u672c\u4eba\u306e\u533b\u5e2b\u3067 peritonitis<\/strong>\u300c\u8179\u819c\u708e<\/strong>\u300d\u306e\u6240\u898b\u3067\u3042\u308b\u300c\u7b4b\u6027\u9632\u5fa1<\/strong>\u300d\u306e\u3053\u3068\u3092 muscular defense \u3068\u8868\u73fe\u3055\u308c\u308b\u65b9\u3092\u6563\u898b\u3057\u307e\u3059\u304c\u3001\u82f1\u8a9e\u570f\u3067\u306f guarding<\/strong><\/span> \u3068\u8868\u73fe\u3055\u308c\u308b\u306e\u3067\u899a\u3048\u3066\u304a\u304d\u307e\u3057\u3087\u3046\u3002\u540c\u3058 peritonitis \u306e\u6240\u898b\u3067\u3042\u308b rebound tenderness<\/strong><\/span>\u300c\u53cd\u8df3\u75db<\/strong>\u300d\u306e\u8a3a\u5bdf\u3067\u306f \u201cCould you tell me which hurts more? When I press, or let go?\u201d \u3068\u60a3\u8005\u3055\u3093\u306b\u4f1d\u3048\u308b\u3068\u826f\u3044\u3067\u3057\u3087\u3046\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\r\n

General Inspection<\/strong>\u300c\u5168\u8eab\u89b3\u5bdf<\/strong>\u300d\u3067\u306e\u8868\u73fe<\/strong>
\r\n\u3000\u25cf<\/strong> pink puffer: emphysema\u300c\u80ba\u6c17\u816b\u300d\u60a3\u8005\u306e\u5916\u898b\u8868\u73fe
\r\n\u3000\u25cf<\/strong> blue bloater: chronic bronchitis\u300c\u6162\u6027\u6c17\u7ba1\u652f\u708e\u300d\u60a3\u8005\u306e\u5916\u898b\u8868\u73fe
\r\n\u3000\u25cf<\/strong> body habitus: \u4f53\u578b
\r\n\u3000\u25cf<\/strong> cachexia: \u75c5\u7684\u306b\u75e9\u305b\u305f\u72b6\u614b

\r\n\r\nHand Exam<\/strong>\u300c\u624b\u306e\u8a3a\u5bdf<\/strong>\u300d\u3067\u306e\u8868\u73fe<\/strong>
\r\n\u3000\u25cf<\/strong> leukonychia\u300c\u722a\u306e\u767d\u6591\u300d: hypoalbuminemia\u300c\u4f4e\u30a2\u30eb\u30d6\u30df\u30f3\u8840\u75c7\u300d\u306e\u6240\u898b
\r\n\u3000\u25cf<\/strong> koilonychia\u300c\u3055\u3058\u72b6\u722a\u300d: iron deficiency anemia \u300c\u9244\u6b20\u4e4f\u6027\u8ca7\u8840\u300d\u306e\u6240\u898b
\r\n\u3000\u25cf<\/strong> asterixix\u300c\u7fbd\u3070\u305f\u304d\u632f\u6226\u300d: hepatic encephalopathy\u300c\u809d\u6027\u8133\u75c7\u300d\u306e\u6240\u898b
\r\n\u3000\u25cf<\/strong> palmar erythema\u300c\u624b\u638c\u7d05\u6591\u300d: elevated estrogen \u306e\u6240\u898b

\r\n\r\nNeck Exam<\/strong>\u300c\u9996\u306e\u8a3a\u5bdf<\/strong>\u300d\u3067\u306e\u8868\u73fe<\/strong>
\r\n\u3000\u25cf<\/strong> conjunctival icterus\u300c\u773c\u7403\u7d50\u819c\u9ec4\u67d3\u300d: jaundice\u300c\u9ec4\u75b8\u300d\u306e\u6240\u898b
\r\n\u3000\u25cf<\/strong> conjunctival pallor\u300c\u773c\u77bc\u7d50\u819c\u84bc\u767d\u300d: anemia\u300c\u8ca7\u8840\u300d\u306e\u6240\u898b
\r\n\u3000\u25cf<\/strong> Troisier’s sign\/swollen Virchow’s node (left supraclavicular lymph node): malignancy in the abdominal cavity \u306e\u6240\u898b

\r\n\r\nLung Palpation<\/strong>\u300c\u80ba\u306e\u89e6\u8a3a<\/strong>\u300d\u3067\u306e\u8868\u73fe<\/strong>
\r\n\u3000\u25cf<\/strong> tactile\/vocal fremitus\u300c\u89e6\u899a\u30fb\u58f0\u97f3\u9707\u76ea\u300d: \u60a3\u8005\u306b ‘ninety-nine’ \u3068\u3044\u3046\u4f4e\u3044\u97f3\u3092\u767a\u3057\u3066\u3082\u3089\u3044\u3001\u305d\u306e\u9707\u76ea\u3092\u89e6\u77e5\u3059\u308b\u8a3a\u5bdf\u3002\u9707\u76ea\u304c\u5f37\u304f\u306a\u308c\u3070 pulmonary consolidation \u3068\u3044\u3046\u300c\u80ba\u306e\u5b9f\u8cea\u304c\u786c\u304f\u306a\u3063\u305f\u72b6\u614b\u300d\u3001\u3064\u307e\u308a\u80ba\u80de\u5185\u90e8\u306b\u6db2\u4f53\u304c\u8caf\u7559\u3057\u305f typical pneumonia\u300c\u5b9a\u578b\u80ba\u708e\u300d\u3084 left heart failure\u300c\u5de6\u5fc3\u4e0d\u5168\u300d\u306e\u6240\u898b\u3068\u306a\u308b\u3002\u9006\u306b\u9707\u76ea\u304c\u5f31\u304f\u306a\u308c\u3070\u80ba\u306e\u5916\u5074\u306b\u6db2\u4f53\u304c\u8caf\u7559\u3059\u308b pleural effusion\u300c\u80f8\u6c34\u300d\u3084\u7a7a\u6c17\u304c\u5b58\u5728\u3059\u308b pneumothorax\u300c\u6c17\u80f8\u300d\u306a\u3069\u306e\u6240\u898b\u3068\u306a\u308b\u3002

\r\n\r\nLung Percussion<\/strong>\u300c\u80ba\u306e\u6253\u8a3a<\/strong>\u300d\u3067\u306e\u8868\u73fe<\/strong>
\r\n\u3000\u25cf<\/strong> resonant sounds: \u6b63\u5e38\u306a\u80ba\u306e\u6253\u8a3a\u97f3
\r\n\u3000\u25cf<\/strong> hyper-resonant sounds: pneumothorax\u300c\u6c17\u80f8\u300d\u306e\u6253\u8a3a\u97f3
\r\n\u3000\u25cf<\/strong> dull sounds: pulmonary consolidation\u300c\u80ba\u306e\u5b9f\u8cea\u304c\u786c\u304f\u306a\u3063\u305f\u72b6\u614b\u300d\u306e\u6253\u8a3a\u97f3
\r\n\u3000\u25cf<\/strong> stony dull sounds: pleural effusion\u300c\u80f8\u6c34\u300d\u306e\u6253\u8a3a\u97f3

\r\n\r\nLung Auscultation<\/strong>\u300c\u80ba\u306e\u8074\u8a3a<\/strong>\u300d\u3067\u306e\u8868\u73fe<\/strong>
\r\n\u3000\u25cf<\/strong> egophony\u300c\u30e4\u30ae\u97f3\u300d: \u60a3\u8005\u306bR \u3068\u3044\u3046\u97f3\u3092\u767a\u3057\u3066\u3082\u3089\u3044\u3001\u305d\u306e\u97f3\u3092\u8074\u8a3a\u3057\u3066 ‘A’ \u3068\u30e4\u30ae\u304c\u9cf4\u304f\u3088\u3046\u306a\u97f3\u306b\u5909\u308f\u3063\u305f\u3089 pulmonary consolidation \u306e\u6240\u898b\u3068\u306a\u308b\u3002
\r\n\u3000\u25cf<\/strong> bronchial breath sounds\uff08\u30a4\u30e1\u30fc\u30b8\u306f\u3053\u3061\u3089<\/strong><\/span><\/a>\uff09: \u6c17\u7ba1\u652f\u9818\u57df\u5468\u8fba\u3067\u8074\u53d6\u3055\u308c\u308b\u6b63\u5e38\u97f3
\r\n\u3000\u25cf<\/strong> vesicular breath sounds\uff08\u30a4\u30e1\u30fc\u30b8\u306f\u3053\u3061\u3089<\/strong><\/span><\/a>\uff09: \u80ba\u80de\u9818\u57df\u5468\u8fba\u3067\u8074\u53d6\u3055\u308c\u308b\u6b63\u5e38\u97f3
\r\n\u3000\u25cf<\/strong> bronchial breathing: \u80ba\u80de\u9818\u57df\u3067 bronchial breath sounds \u304c\u8074\u53d6\u3055\u308c\u308b\u7570\u5e38\u306a\u72b6\u614b

\r\n\r\n\u3000\u25cf<\/strong> rhonchi\uff08\u30a4\u30e1\u30fc\u30b8\u306f\u3053\u3061\u3089<\/strong><\/span><\/a>\uff09: \u5438\u6c17\u3068\u547c\u6c17\u306e\u4e21\u65b9\u306b\u8074\u53d6\u3055\u308c\u308b\u4f4e\u3044\u97f3\uff08bronchitis \u306e\u6240\u898b\uff09
\r\n\u3000\u25cf<\/strong> wheezes\uff08\u30a4\u30e1\u30fc\u30b8\u306f\u3053\u3061\u3089<\/strong><\/span><\/a>\uff09: \u5438\u6c17\u3068\u547c\u6c17\u306e\u4e21\u65b9\u306b\u8074\u53d6\u3055\u308c\u308b\u9ad8\u3044\u97f3\uff08lower airway obstruction \u306e\u6240\u898b\uff09
\r\n\u3000\u25cf<\/strong> fine crackles\uff08\u30a4\u30e1\u30fc\u30b8\u306f\u3053\u3061\u3089<\/strong><\/span><\/a>\uff09: \u5438\u6c17\u306e\u7d42\u308f\u308a\u306b\u8074\u53d6\u3055\u308c\u308b\u7d30\u304b\u304f\u5f3e\u3051\u308b\u97f3\uff08pulmonary fibrosis \u306e\u6240\u898b\uff09
\r\n\u3000\u25cf<\/strong> coarse crackles\uff08\u30a4\u30e1\u30fc\u30b8\u306f\u3053\u3061\u3089<\/strong><\/span><\/a>\uff09: \u5438\u6c17\u3068\u547c\u6c17\u306e\u6700\u521d\u306b\u8074\u53d6\u3055\u308c\u308b\u6ce1\u304c\u7acb\u3064\u97f3\uff08typical pneumonia \u306e\u6240\u898b\uff09

\r\n\r\nAbdominal Exam<\/strong>\u300c\u8179\u90e8\u306e\u8a3a\u5bdf<\/strong>\u300d\u3067\u306e\u8868\u73fe<\/strong>
\r\n\u3000\u25cf<\/strong> abdominal distention\u300c\u8179\u90e8\u81a8\u6e80\u300d
\r\n\u3000\u25cf<\/strong> scars\u300c\u7622\u75d5\u300d
\r\n\u3000\u25cf<\/strong> striae\/stretch marks\u300c\u76ae\u819a\u7dda\u6761\u300d
\r\n\u3000\u25cf<\/strong> hyperpigmentation\u300c\u8272\u7d20\u6c88\u7740\u300d
\r\n\u3000\u25cf<\/strong> spider nevus\/nevi\u300c\u30af\u30e2\u72b6\u8840\u7ba1\u816b\u300d
\r\n\u3000\u25cf<\/strong> caput medusae\u300c\u30e1\u30c9\u30a5\u30fc\u30b5\u306e\u982d\u300d

\r\n\r\n\u3000\u25cf<\/strong> light palpation\u300c\u6d45\u3044\u89e6\u8a3a\u300d
\r\n\u3000\u25cf<\/strong> deep palpation\u300c\u6df1\u3044\u89e6\u8a3a\u300d
\r\n\u3000\u25cf<\/strong> guarding\u300c\u7b4b\u6027\u9632\u5fa1\u300d
\r\n\u3000\u25cf<\/strong> rebound tenderness\u300c\u53cd\u8df3\u75db\u300d<\/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

\u56fd\u969b\u533b\u7642\u798f\u7949\u5927\u5b66\u533b\u5b66\u90e8 \u533b\u5b66\u6559\u80b2\u7d71\u62ec\u30bb\u30f3\u30bf\u30fc \u6559\u6388\u3000\u62bc\u5473 \u8cb4\u4e4b<\/p>","protected":false},"excerpt":{"rendered":"\u3053\u3093\u306b\u3061\u306f\u3002\u300c\u533b\u5b66\u82f1\u8a9e\u30ab\u30d5\u30a7\u300d\u306b\u3088\u3046\u3053\u305d\uff01 \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 \u672c\u65e5\u306e\u30c6\u30fc\u30de\u306f\u300c\u547c\u5438\u5668\u3068\u8179\u90e8\u306e\u8eab\u4f53\u8a3a\u5bdf\u306b\u95a2\u3059\u308b\u82f1\u8a9e\u8868\u73fe\u300d\u3002 2021 \u5e741\u670826\u65e5","protected":false},"author":15,"featured_media":6850,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"onecolumn-960.php","format":"standard","meta":{"_acf_changed":false,"_jin_ogp_image_url":"","_jin_last_featured_id":0,"footnotes":""},"categories":[63],"tags":[],"class_list":["post-7161","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-eigocafe"],"acf":[],"_links":{"self":[{"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/posts\/7161","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/users\/15"}],"replies":[{"embeddable":true,"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/comments?post=7161"}],"version-history":[{"count":3,"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/posts\/7161\/revisions"}],"predecessor-version":[{"id":7248,"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/posts\/7161\/revisions\/7248"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/media\/6850"}],"wp:attachment":[{"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/media?parent=7161"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/categories?post=7161"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/tags?post=7161"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}