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<title>内科主訴25の確定診断術 | 株式会社文光堂</title>


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<meta name="description" content="特に忙しい救急外来や再診外来では，迅速に今後の診療方針を見極めるために，的確に診断の糸口が捕まえることができて，鑑別診断が効率よくできる質問が重要です．本書では，まず効率よい鑑別のための問診をフロチャートで示しています．次に，疾患の頻度と緊急性を意識した鑑別診断のリストを示し，臨床現場に即した鑑別診断を考えることができるようになっています．最後に各疾患について，穴のない問診が迅速にできるように発症">

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	<section class="book">

		<h1 class="catchCopy">問診にその他の所見を組み合わせて確定診断へ至る筋道をスッキリ整理</h1>
		

		<h1 class="title">内科主訴25の確定診断術<span class="version"></span></h1>
		<h2 class="subTitle">問診スキルでここまで絞り込める！</h2>

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					編集：塩尻俊明（国保旭中央病院部長）
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				<ul class="property"><li class="disc">B5判・352頁・2色刷</li><li class="disc">ISBN&nbsp;978-4-8306-1018-9</li><li class="disc">2013年8月17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">特に忙しい救急外来や再診外来では，迅速に今後の診療方針を見極めるために，的確に診断の糸口が捕まえることができて，鑑別診断が効率よくできる質問が重要です．本書では，まず効率よい鑑別のための問診をフロチャートで示しています．次に，疾患の頻度と緊急性を意識した鑑別診断のリストを示し，臨床現場に即した鑑別診断を考えることができるようになっています．最後に各疾患について，穴のない問診が迅速にできるように発症形式，増悪寛解因子，症状の質，関連する症状，出現部位，重症度，経過を明確に示してあります．問診だけで，できるだけ診断に近づけるような構成になっています．また，各疾患で想定されるバイタルサイン，身体所見，救急外来でできる一般検査所見が記載してあるため，診断のためにフォーカスを絞った身体診察や一般検査のみかたがトレーニングできるようにもなっています．</section><section class="preface">序　文<br><br>　問診に時間をかけるより，採血や画像検査をしたほうが手っとり早い，どうせ検査をするなら最初から検査したほうが問診で鑑別を挙げるより効率的，などといった話はしばしば耳にします．確かに一理ありかもしれません．しかし，喉が痛い患者さんに「水や食べ物を飲み込んでも喉の痛みが強くならない」という病歴があれば，その喉の痛みは，喉もしくは喉周囲の問題ではなく，放散痛を引き起こす疾患をまず考えるべきでしょう．腹痛で来られた患者さんから「食事をしてもお腹の痛みが悪くならない」という病歴が聴き出せれば，その腹痛は消化管疾患以外の原因を考えていくことができます．<br>　じっくり話を聴くことが問診の基本ではありますが，迅速に今後の方針を見極めるためには，鑑別診断が効率良くできる質問が重要であることは周知のとおりです．特に，忙しい救急外来や再診外来でこそ効率の良い問診をし，的確に診断の糸口が捕まれば適切な検査計画や治療を組めるのではないでしょうか．<br>　この本では，まず効率良く鑑別をしていくための問診をフローチャートで示しています．この問診をすることで，鑑別疾患の絞り込みができます．次に，疾患の頻度と緊急性を意識した鑑別診断のリストを示してあるので，臨床現場に即した鑑別診断を考えることができるようになっています．最後に各疾患について，穴のない問診が迅速にできるように発症形式，増悪・寛解因子，症状の質，関連する症状，出現部位，重症度，経過を明確に示してあります．問診だけで，できるだけ診断に近づけるような構成になっています．また，各疾患で想定されるバイタルサイン，身体所見，救急外来でできる一般検査所見が記載してあるため，診断のためにフォーカスを絞った身体診察や一般検査のみかたがトレーニングできるようにもなっています．<br>　この本が，鑑別診断に興味がある初期研修医や若手医師の皆さんの日々の鍛錬に少しでもお役に立てばと考えています．そして鑑別診断に興味を持つ最初のステップになることを期待して，本書の序文といたします．<br><br>平成25年7月<br>塩尻俊明</section><section class="indexes">I．ジェネラル<br>　1. 熱が出た<br>　2. 意識がおかしい<br>　3. 気持ち悪い，吐く<br>　4. 痩せた<br>　5. だるい，元気がない，立てない<br>II．頭頚部<br>　1. 頭が痛い<br>　2. 目が見えない<br>　3. 顔が痛い<br>　4. のどが痛い<br>　5. 飲み込みにくい<br>　6. 首が痛い<br>III．胸部<br>　1. 胸が痛い，背中が痛い<br>　2. 呼吸が苦しい<br>　3. 咳が出る<br>IV．腹部<br>　1. おなかが痛い（女性の下腹部痛を含む）<br>　2. 下痢をした<br>　3. 血を吐いた<br>　4. 血便が出た<br>Ⅴ．四肢<br>　1. 節々が痛い<br>　2. むくみがある<br>VI．神経<br>　1. めまいがする<br>　2. 手足が動かない<br>　3. しびれる<br>VII．その他<br>　1. 皮膚がかゆい<br>　2. 腰が痛い<br>索引</section></article>
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