USMLE 2CS英語レッスン３回目
今回は割とシステムに慣れてきたで、２症例をやってかつ前回の神経学的所見の取り方をおさらいしました。大体の流れはつかめるようになったものの、
１）ところどころスムーズさに欠ける
２）重複が多い
３）必要な医学的質問を忘れている（糖尿病の現状の把握など）
という課題が見えてきますね。あとpatient noteの部分はカバーできていないのですが、これもまた必要な鑑別を忘れてしまいますね。もうちょい突っ込んだトレーニングが必要なようです。
今回からは音声録音で対応することにしました。特に神経学的所見の取り方を含めた復習の部分は忘れそうなのでしっかり録音したのち書き起こしておきました。症例はドラッグが原因と思われる幻覚が主訴の２７歳男性。
多少違っているかもしれませんが、いろいろな意味でテンプレートとしては使えそうです。
テープ起こし
Ah I’m just coming to the physical exam and let me wash my hands.
Ok. One thing frist. I would like to look up Please Ok, and look down, Ok.
Can you clone your eyes tightly like this, and can you open?
Can you raise your eye brows?
I want you to follow my finger without moving your head.
Thank you very much.
I would like you to look at the wall right behind me like at the point there.
I’m just gonna shine you slightly.
I would like you to close your eyes and I’m just gonna touch your head.
Do you feel this?
Do you feel this?
Do you feel this?
Do you feel this?
Is it the same on both sides?
Please keep your eyes closed.
Do you hear this?
Do you hear this?
Is it the same on both sides?
Thank you very much.
OK
Can you tell me your name?
XXXX
Ok, where are we?
Hospital.
OK, who is the president of United States?
Barak Obama
Good I’m gonna give you three words.
Apple, Cat, Pen.
Please remember that, I’m gonna ask you abut that.
What did you have for breakfast?
Bread and Egg.
Can you spell backwards the word Table?
ELBAT
OK good.
Can you remember the words I gave you?
Apple, Cat, Pen
Good, thank you very much.
I’m just going to check your chest and I’m just going through anther practice.
Just breath normally?
You can take deep breath in and out?
In and Out.
In and Out
In and Out.
I’m just gonna listen from behind.
In and Out.
In and Out.
In and Out.
OK good.
Just breath normally.
All right. I would like you to go like this?
I am gonna push you, so please resist me?
OK
I am gonna pull you and please resist me?
Ok
I am gonna push you and please resist me?
OK
Please pull me?
OK. Thank you very much.
Please put your arms like this?
I’m gonna press down.
OK
Please go like this.
OK.
Please squeeze my fingers.
OK. Thank you very much.
Hey, I would like you to stand up. And I would like you close your eyes.
OK, just a few moment.
Good.
Please open up!
I would like you to walk to the door please
Sorry, Are you OK?
Yeap.
Could you walk back to me? And this time, you can walk heel to toe and heel to toe.
All right, good you can sit down.
Last thing, I’m gonna check your reflex.
OK.
I’m just gonna check your feet.
OK.
OK good. I’m all done with my physical exams, and let me give you my impressions.
One possibility is that you have an abnormality right in your brain and so we can diagnose that by imaging studies.
However there is a strong possibility that your hallucinations are caused by the drugs you took. You had Ecstacy and Angel dust yesterday and that is when it started.
So sometimes these drugs if they are taken regular basis, can cause these hallucinations. I need to do some tests and I will do blood test and a few other tests.
In the meantime, I would really strongly like to recommend you to stay away from taking these drugs. These drugs can cause serious health consequences such as hallucinations. Once you start hallucinations, it can get worse. I will also recommend you to give up tobacco. I understand it hard, but tobacco can also cause serious heath problems in the future. If you are interested, I can have a counselor to speak with you for smoking cessation and resources here at the hospital as well as the drugs.
Once again, I would recommend you to stop taking Ecstacy and Angel dust and I hope you stop tobacco. I will go get those tests setup right now and once we get the test results back, I will meet with you again. Ok. Thank you very much.
