USMLE

USMLE Step2 CS:臓器症候別の暗記すべき質問集〜その①

USMLE Step 2 CSでは、それぞれの臓器別・症候別に、質問すべき項目は決まっています。それぞれのsystem毎に、これら質問を全て忘れず聞けるよう、何度も練習しましょう。

ちなみに、()外が患者に聞くべき表現で、()内はカルテに記載すべき専門用語です。

Neuro

脳神経

  • Do you have headache/speech difficulties (slurred speech)/difficulty in swallowing (dysphagia)/numbness/weakness/change in your walk (gait disturbance)?
  • Do you lose control of bodily movements (ataxia)?
  • Do you have nausea/vomiting/dizziness/visual change (blurry vision, diplopia)/drooping eyelids/drooping face/rolling of eyeballs (nystagmus)?

その他

  • Did you lose your consciousness(LOC)?
  • Do you nave unintentional shaking movements (tremor)/jerky movements (seizure, myoclonus)?

Vision

  • Do you have change in the vision(blurry vision, diplopia)?
  • Can you see light?
  • Do you have runny eye/eye redness/itchy eyes /eye discharge/eye pain?
  • Do you have headache?

Ears

  • Do you have ear pain (otalgia)/ear discharge/ringing in the ear (tinnitus)/hearing loss/a sensation of fullness in the ear (aural fullness)/dizziness (vertigo or lightheadedness)?

Respi

  • Do you have sore throat/runny nose(nasal discharge, rhinorrhea)/cough?
  • Do you wheeze?
  • Do you have palpitations/dizziness/shortness of breath/difficulty in breathing (SOB/dyspnea)/chest pain?

咳があれば

  • Do you have a cough?
  • Is it dry or does it produce any phlegm? Does anything come up when you cough? How would you describe it? Does it contain blood (hemoptysis)? What’s the color of the phlegm? What’s the amount?
  • Does it occur at a specific time/specific season?
  • Does it change during the day? Do you cough at night?

Cardio

  • Do you have cough?
  • Do you wheeze?
  • Do you have palpitations/dizziness/shortness of breath/difficulty in breathing (SOB/dyspnea)?
  • Is that relieved by sitting (orthopnea)?
  • Do you have sweating (diaphoresis)/chest pain/chest discomfort/leg swelling (edema)?

Throat

  • Do you have sore throat/change in your voice(hoarseness)/difficulty or pain in swallowing (dysphagia, odynophagia)?

Diabetes

  • Tell me about the amount of water you drink(polydipsia).
  • Have you been eating a large amount of food recently (polyphagia)?
  • Do you have increased thirst? Do you feel thirsty?
  • Do you have any change in urinary habit (polyuria, nocturia)/change in weight?

OB/GYN

妊娠の既往に関しては

G (pregnancy)

P (>20w, viable and non-viable)

A (abortion and miscarriage)

  • How often do you get your period? Are your periods (are they) regular? How many days does it last? Are your periods heavy/light/medium?
  • When was the last menstrual period? At what age did you begin your period?
  • Have you ever been pregnant before? How many times have you been pregnant (been pregnant)? How many times have you given birth? Did you have any problem during pregnancy? Have you ever had a miscarriage or an abortion?

妊娠を疑うなら

  • Do you have shortness of breath/pain or swelling of your breast/nausea/vomit/stomachache/change in bowel habit/change in urinary habit/change in appetite/change in weight?
  • Did you plan to be pregnant?

婦人科系なら

  • When was the last time you had a Pap smear? What was the result?
  • Do you have any change in the vaginal area — color, swelling (vulvar erythema, edema)/vaginal itching (pruritus)/pain (vulvodynia)/bleeding (spotting)?
  • Do you have vaginal discharge? How would you describe it? What is the color? Does it have any odor? What’s the amount of the discharge? Did you see any blood in it?
  • Pain/cramps during your period (dysmenorrhea)? Pain during sexual intercourse(dyspareunia)?

Urine

Change in your urinary habits

  • Difficulty in urination (dysuria)? Increased frequency to urinate (urinary frequency or polyuria)? Do you feel any urgency to go to rest room (urinary urgency)? Do you feel that you haven’t completely emptied your bladder after urination (incomplete emptying of the bladder)? Burning/pain during urination? Change in the color of your urine?
  • Is there any blood in your urine (hematuria)? Is it bright blood or clots? Do you bruise easily? Muscle pain? Have you been exercising excessively recently?

Prostate

  • Did you notice weak stream?
  • Do you strain during urination (straining)?
  • Did you notice dribbling of urine (dribbling)?
  • Do you wake up at night to urinate (nocturia)?

 

その②へ続く

ABOUT ME
木村聡
福岡県の研修病院で初期研修修了後、大学に入局。米国オハイオ州に臨床研究で留学するも、知識の欠如を痛感。ハーバード公衆衛生大学院に進学し、MPHを取得。マサチューセッツ工科大学メンバーとの共同研究などに関与。 日本では麻酔・集中治療医として働き、オーストラリアでは小児集中治療を一から学び直しています。 乗り越える壁を見つけ続けることは、なかなか簡単ではありませんよね。アラフォー目前、様々な壁にぶち当たり、それなりに多くの経験をしてきました。私の挑戦や経験・知識、失敗談などが、他の誰かの刺激になり、役に立つことを切に願っています。 プロフィールをもっと詳しく見る

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