USMLE

USMLE Step2 CS:臓器症候別の暗記すべき質問集〜その②

臓器・症候別の質問集①の続きです。

繰り返しますが、CSは丸暗記で合格します。何度も何度も練習しましょう。

()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。専門用語を使って質問しないようにしましょう。

Depressionを疑ったら

  • Do you feel sad?
  • Tell me about your sleep schedule. Do you wake up early in the morning (early-morning awakening)?
  • How is your level of interest (Loss of Interest/anhedonia)?
  • Do you feel guilty about your symptoms?
  • Do you feel tired easily (Loss of Energy/fatigue)? During what time of the day do you feel tired?
  • How is your concentration (Concentration loss/impaired concentration)? How is your performance on your job?
  • How is your appetite (anorexia)?
  • Have you thought about hurting yourself (Suicide ideation/commit suicide)?
  • When was the last baby?

Anxiousを疑ったら

  • Are you worrying or more nervous than usual?
  • What are you worrying about (ex. humiliation, public speaking, social situation)?
  • Do you have any symptom (ex. shortness of breath, hyperventilation, palpitations, tremors, sweating, psychological irritability)?

Anemiaを疑ったら

  • Do you feel tired (Fatigue)?
  • Do you have palpitations/dizziness/shortness of breath?
  • Are your periods heavy/light/medium?(heavy menstrual flow)
  • Do you have constipation/cold intolerance/leg cramps??

Menopauseを疑ったら

  • Do you still have period?
  • When was your last menstrual period?
  • Do you have any hot flashes/mood swings(emotional liability)?
  • Do you have palpitations/dizziness/shortness of breath/night sweats?
  • Do you have any sleep problems?
  • When did your mother begin menopause?
  • Did you notice any vaginal dryness (dyspareunia)?
  • Do you have any pain during sexual intercourse?

Infectionを疑ったら

  • Do you feel tired (fatigue)?
  • Do you have fever/chills/night sweats/rash?
  • Do you have lumps/swollen gland? Where in your body (lymphadenopathy)?
  • Did you lose your weight (weight loss)?
  • How is your appetite?
  • Were you in contact with a sick person?
  • Have you traveled outside the country?
  • When is the last time you had PPD test (TB test)? Have you ever had PPD test?

Collagen diseaseを疑ったら

  • Do you have fever/hair loss (alopecia)/oral or genital ulcer?
  • Do you have rash? Is that worse with sunlight (photosensitivity)?
  • Do you have any joint problem? Is there any redness/swelling/warmth/pain(arthralgia)/stiffness?
  • Does cold temperature cause any problems with your fingers (Raynaud)?

Joint関連の症状なら

  • Is there any redness/swelling/warmth/pain (arthralgia)/stiffness in your joint?
  • During what time of the day do you have the stiffness? How long does it last?
  • Do you have any pain in other joints / anywhere else in your body?

Domestic violenceだと思ったら

  • Do you feel safe at home?
  • Do you feel safe in your relationship
  • Are there any conflicts with your partner?
  • Is there anyone treating you bad?
  • Do you think you are (physically or emotionally hurt or) abused by anybody?
  • Do you have any children?
  • Does your husband abuse your children?
  • Do you feel afraid in this relationship?
  • Are your friends and family aware? Would they support you?
  • Do you have a safe place to go in an emergency?

Sexual assaultのケースでは

Event (general):

  • Please tell me what happened? How can you describe the event?
  • When did that happen?
  • Where did that happen?
  • Do you know the people?
  • Did you report it to the police?

Event (sexual):

  • Was there sexualintercourse/assault?
  • What type of sexual intercourse was it (oral, vaginal, anal)?
  • Did the ejaculation happen? Did they use condom?
  • Do you have stomachache/nausea/vomiting [for pregnancy]?

Patient: 

  • Do you use any contraception?
  • When was the last menstrual period?
  • Did you drink at the time?
  • Were you under the influence of any substances at that time?

Other assault: 

  • Were you beaten on anywhere else in your body?
  • Do you have any other pain?
  • Do you have bruise or bleeding?

Medical Follow-upの症例なら

一般的に

Onset:

  • When were you diagnosed with XX?
  • What symptoms did you have at the time of diagnosis?

Treatment:

  • What treatment do you receive?
  • Are you compliant with your medication?
  • Are you having any side effect of your medication?

Monitor:

  • Do you monitor your (blood sugar) regularly (at home)?
  • What’s the highest/lowest reading?
  • When was the last time you check your BP/HbA1c?
  • What was the number?

DMの合併症

  • Retinopathy: Do you see eye doctor? When was the last eye checkup? Was it normal? Do you have any change in your vision?
  • Neuropathy: Do you have numbness/tingling/foot ulcer? Do you see foot doctor?
  • Hypoglycemia: Did you have dizziness/sweating/palpitation? Have you fainted?
  • Gastroparalysis: Do you have digestive symptoms? Do you have nausea/vomit/change in bowel habit/change in appetite?
  • ED: Do you have any concern about sexual function (trouble in achieving an erection)?

HTNの合併症

  • Stroke
  • Eye: Do you have blurred vision?
  • Orthostatic hypotension: Do you have dizziness when you stand up?
  • IHD
  • Kidney: Tell me about your urine habit.
  • Intestine (bowel movement),
  • ED (erectile dysfunction),
  • Vascular: Do you have any leg or buttock pain while walking (obstruction of arteries/leg claudication)?

子供の経過観察

Dietary:

  • What are you feeding him?
  • Breast milk or formula?(Breast-feed vs. bottle-feed) What formula do you use?
  • When did he start eating solid food?
  • How many times do you feed him per day?
  • Is he sucking well?

Birth history:

  • Tell me about his/her birth history?
  • How long was your pregnancy?
  • Was the baby full-term?
  • Vaginal delivery or caesarean section?
  • Did you have any complications during your delivery or after delivery?
  • Did your child have any medical problems after birth?)

Last checkup (Development):

  • When was your child’s last physical check-up [about weight, height, and language development]? Was it normal?
  • Is your child gaining weight at a good rate?
  • Has there been any sudden gain or loss of physical growth [for DM]?

Vaccinations:

  • Are your child’s vaccinations up to date?

Skinの病変に対しては

  • Is there any problem about your hair (hair loss, hirsutism)?
  • Is it (non-)itchy/(non-)painful?
  • Do you have facial acne?

Alcohol関連のケースでは

CAGE

  • Men: more than 2 drinks a day
  • Women: more than 1 drinks per day, or binges on weekend
  • Have you felt a need to Cut down on drinking?
  • Have you felt Annoyed by criticism of your drinking?
  • Have you felt Guilty about drinking?
  • Have you had a drink (an Eye opener) in the morning to steady your nerves?

Painがあったら

Location:

  • Can you tell me where the location is?
  • Can you point out with one finger?

Movement:

  • Does it move anywhere?

Severity:

  • On a scale from 0 to 10, with 10 being the worst XX you’ve ever had, what’s the severity (when you are in pain)?
  • Is it the worst headache of your life?

Quality:

  • What’s the quality of this pain?
  • How can you describe (dull vs.stabbing/sharp, squeezing, throbbing/pulsating)?

Onset:

  • When did its chest pain start?

Precipitating factor:

  • What do you think causes this?

Constant:

  • Is it constant?
  • Does it come and go? How often does it occur? How long does it last? During what time of the daydoes your pain occur?

Progression:

  • Since that time until now, is it getting better or worse?
  • How has it progressed?
  • What makes it worse/better? Does it change with exercise/rest/position/food/breathing?
  • Is the belly pain related to food? When do you get the pain, before food or after food? How long does it take after eating to get the pain?

おわりに

とりあえず、臓器別・症候別の質問集は以上です。

患者が示した症状からある程度focusを当てる臓器を決め、上記の質問をできる限り聞いてみてください。CSはポイント制なので、(重症な初見を)カルテに書けば書くほどポイントをもらえます。

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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