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<title>症候から入る小児の身体診察 | 株式会社文光堂</title>


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<meta name="description" content="小児の身体診察を行う際に，症候ごとにチェックすべき身体所見が頭に浮かんでこないと，正確でスムーズな診断にたどり着くことができない．そこで本書では，小児とのコミュニケーションの取り方や，発達・成長の評価方法などの身体診察の基本から，個別の症候において確認すべき身体所見やその取り方，鑑別診断として思い浮かべるべき疾患など，イラストや写真も交えて解説する．上手な身体診察を行い正しい診断へとたどり着くため">

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		<h1 class="catchCopy">重要なポイントを押さえた身体診察こそが，確かな鑑別診断につながる！</h1>
		

		<h1 class="title">症候から入る小児の身体診察<span class="version"></span></h1>
		<h2 class="subTitle">ポイントを押さえたスムーズな診断のコツ</h2>

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					編集：稲毛康司（前 日本大学医学部小児科学系小児科学分野准教授）
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				<ul class="property"><li class="disc">B5判・240頁・2色刷</li><li class="disc">ISBN&nbsp;978-4-8306-3043-9</li><li class="disc">2020年6月25日発行</li></ul>

				
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">小児の身体診察を行う際に，症候ごとにチェックすべき身体所見が頭に浮かんでこないと，正確でスムーズな診断にたどり着くことができない．そこで本書では，小児とのコミュニケーションの取り方や，発達・成長の評価方法などの身体診察の基本から，個別の症候において確認すべき身体所見やその取り方，鑑別診断として思い浮かべるべき疾患など，イラストや写真も交えて解説する．上手な身体診察を行い正しい診断へとたどり着くためのヒントが満載の一冊．</section><section class="preface">序　文<br><br>　本書は，小児科医，小児診療に携わるすべての医師および臨床実習医学生（スチューデント・ドクター）を対象に，症候を端緒に小児の身体診察の基本からその実践までをわかりやすく解説したものです．<br>　医学教育にOSCE（Objective Structured Clinical Examination）が導入されて以来，診察の基本を学んだ若い小児科医が臨床現場で活躍していますが，患児を診察するにあたって，臨床検査オーダー，画像検査オーダー，他科依頼が目に見えて多いと感じるのはこの編者だけでしょうか．他力本願ではなく，自分で正しい身体所見を取って臨床推論をする姿勢が大切だと思います．<br>　とある回診中に研修医は「肝腫大なし」と上申したが，指導医が再診察すると「肝腫大あり」であったならば，この研修医は全く関係のない疾患を診ていたことになってしまいます．これは，正確な身体所見が取れていないことで，誤った情報を共有してしまうベッドサイドでのよくある光景です．本書が医学生の診療参加型臨床実習においても，小児科領域の臨床推論を訓練するために役立てばと願います．<br>　ある症候でチェックすべき身体所見は何なのかが頭に浮かんでこないと，得るべき所見を見逃して徒労に終わってしまいます．××を主訴とする疾患群を頭に浮かべ，鑑別診断を考えながら病歴聴取と身体診察を行えるようになること，高い特異度（high Specificity）の身体所見<br>が陽性（Positive/Negative）の場合，その疾患の診断（Rules in/out）に役立つ（SpPin/SnNOut）をコンセプトにして，本書を企画しました．<br>　総論では，小児科医以外の医師にも必要な成長発達に伴う身体所見の取り方を解説します．①健常小児の身体所見を知ること，②身体所見のパラメーター（身長，体重，頭囲，胸囲など）の計測方法を知ること，③健常小児の成長発達に合わせた身体所見の取り方（手技）を基本となる三本柱として取り上げました．<br>　各論ではより実践的に，「この症候ではここを押さえて身体所見を取る」のように鑑別疾患を念頭に置いて，そつなく診断をする「型」を経験豊富な先生方から伝授してもらいました．よく遭遇する症候を有する仮想患者を題材にして，診断過程全体が予想・計画実現の筋道であるシナリオclinical scenarioになるように所見を組み立てていくように工夫をしました．各題材となる疾患には，雛型にもなる病歴プレゼンテーション例が記載されており，的確な情報収集（病歴聴取，身体聴取）から臨床推論，そして症例の診断に至る過程が段階的に明らかになるような構成になっています．解説文の中には，クリニカルパールが散りばめられており，日々の診療に役立つことと信じています．<br>　多忙にも関わらず，本書の企画に賛同していただきご執筆下さった，斯界のエキスパートの先生方に深謝をいたします．また出版にあたりまして，文光堂編集企画部の佐藤真二氏，伊藤美月氏のご協力をいただいたことに感謝をいたします．<br><br>2020年6月<br>稲毛康司</section><section class="indexes">巻頭カラー<br><br>Ⅰ　総　論<br>　1　症候から入る身体診察のための病歴聴取〜taking a history〜<br>　2　子どもとのコミュニケーションから入る身体診察<br>　3　身体の評価<br>　　A．小児の身体計測 anthropometric（measurement）instrumentation<br>　　B．栄養評価<br>　　C．バイタルサイン（生命徴候）<br>　4　身体診察の手技<br>　5　身体診察に必要な成長評価<br>　　A．身長・体重，頭囲，胸囲<br>　　B．二次性徴<br>　6　乳幼児の発達評価<br>　7　健康な小児の診察─年齢別・正常がわかれば異常がわかる診察のコツ<br>　　A．1か月児<br>　　B．乳　児<br>　　C．幼　児<br>　　D．学　童<br>　　E．思春期<br>　8　形態異常の診察（dysmorphology）<br>　　Column 1　聴診器の使い方<br>　　Column 2　耳鏡の使い方<br>　　Column 3　上手な皮膚の写真の撮り方<br><br>Ⅱ　各　論<br>　1　疼痛の診察<br>　　A．頭　痛<br>　　B．胸　痛<br>　　C．腹痛　虫垂炎を題材として<br>　　D．関節痛<br>　2　発熱の診察<br>　　A．3か月以内の発熱<br>　　B．幼児期の発熱<br>　3　呼吸器疾患<br>　　A．長引く咳嗽<br>　　B．喘　鳴<br>　　C．呼吸困難<br>　4　循環器疾患<br>　　A．心雑音<br>　　B．チアノーゼ<br>　5　肝臓・消化器疾患<br>　　A．嘔吐（乳児<br>　　B．嘔吐（学童）　周期性嘔吐症候群を題材に<br>　　C．下痢・下血（1）<br>　　D．下痢・下血（2）<br>　　E．新生児期以降の黄疸，体を痒がる<br>　6　血液疾患<br>　　A．貧　血<br>　　B．紫　斑<br>　7　腫瘤の診察<br>　　A．頸部腫瘤（甲状腺腫を除く）<br>　　B．甲状腺腫<br>　　C．腹部腫瘤<br>　8　腎泌尿器疾患<br>　　A．乏　尿<br>　　B．浮　腫<br>　9　神経疾患<br>　　A．筋力低下　Duchenne型筋ジストロフィー症を題材に<br>　　B．筋緊張低下　フロッピーインファントを題材に<br>　　C．歩行障害<br>　　D．けいれん発作・重積状態<br>　　E．意識障害<br>　10　精神・心身症<br>　　A．や　せ<br>　　B．不登校<br>　11　耳鼻咽喉科疾患<br>　　A．耳 痛<br>　　B．咽頭痛<br>　12　皮膚疾患<br>　　A．水疱のできる疾患の鑑別<br>　　B．母斑 神経線維腫症1型と他の褐色斑との鑑別<br>　　C．血管腫・血管奇形<br>　13　眼科疾患<br>　　A．斜　視<br>　　B．虹彩・瞳孔の異常<br><br>付　録　巻末資料<br>索　引</section></article>
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