医学英語 Case 3: Febrile seizure動画全３本まとめ

１本目：【英語で医療面接 】熱性けいれん Febrile Seizure

台本

Doctor: Hello, my name is Dr. Tanaka, part of the healthcare team taking care of you. Before I begin, may I confirm the name and date of birth of the child?
Dad: Hello, his name is Gabriel Tan, date of birth is May 11th, 2019.
Doctor: Alright, and may I also confirm your relationship with Gabriel?
Dad: I’m his father.
Doctor: Alright. How can we help you today?
Dad: You see, he has been having fever for the past 2 days and just this morning I think he had a seizure.
Doctor: I can see that you’re very worried, Mr. Tan. Let me ask you a few questions about what happened to him so we can make the correct diagnosis and give him appropriate treatment, ok?
Dad: Alright doctor.
Doctor: Can you tell me more about the seizure you just mentioned?
Dad: Yeah doc… this morning when he was playing with his toys, he suddenly started shaking.
Doctor: That must’ve been very frightening. How long did the seizure last?
Dad: About 30 seconds.
Doctor: Was his entire body shaking? Or just a part of his body?
Dad: His entire body was shaking.
Doctor: Was Gabriel responsive during the seizure? Did you try calling his name?
Dad: I tried calling his name, but he didn’t respond.
Doctor: Did you notice any uprolling of eyes during the seizure?
Dad: Sorry I can’t remember, I just panicked when Gabriel started shaking.
Doctor: That’s alright. Did he wet or soil himself during the episode?
Dad: Nope.
Doctor: Did he bite his tongue during the seizure?
Dad: I don’t think so.
Doctor: Did he fall or injure his head during the seizure?
Dad: Nope.
Doctor: After the seizure stopped, did you notice that he was perhaps a bit drowsy?
Dad: Oh yeah, he was a bit slow to respond for a while.
Doctor: For how long?
Dad: For about 5 minutes or so I think.
Doctor: Alright. And did he only seize once? Or multiple times?
Dad: Just once.
Doctor: I see. Going back to before the seizure episode, did you notice anything unusual? Like perhaps he was staring into blank space?
Dad: Nope, he was just playing with his toys.
Doctor: And before he started shaking, did his muscles stiffen up?
Dad: Oh yeah, he was quite stiff for a short while before he started shaking.
Doctor: Alright I see. You mentioned earlier that he was recently having a fever?
Dad: Yeah doctor… he has been having a fever for the past 2 days or so.
Doctor: Did you manage to measure his temperature?
Dad: Yeah it was around 38.6 degrees celsius. Besides, he has been vomiting the past few days as well.
Doctor: I see… how many times has he vomited?
Dad: I’d say around 6 times over the past 3 days or so.
Doctor: Any blood or dark green substances in the vomit?
Dad: Nope.
Doctor: Any diarrhea?
Dad: Nope.
Doctor: Have you noticed that your child has been tugging his ears recently?
Dad: Nope.
Doctor: Has your child been complaining of headaches or anything like that?
Dad: Nope.
Doctor: Any cough or runny nose?
Dad: Nope.
Doctor: Any tummy pain? Or any foul-smelling urine?
Dad: Nope I don’t think so.
Doctor: Any rashes?
Dad: Nope.
Doctor: Alright. How has Gabriel’s appetite been the past few days?
Dad: Quite poor actually… he just managed to hold down some fluids since last night.
Doctor: I see… how about his activity level?
Dad: It has been quite poor the past few days.
Doctor: Did you try giving him any medications?
Dad: I tried giving him paracetamol yesterday but I think he vomited it up.
Doctor: Did Gabriel eat any raw or undercooked food recently?
Dad: Nope I don’t think so.
Doctor: Any other family members who are sick or having fever?
Dad: Gabriel’s older sister just recovered from a cold a week ago.
Doctor: I see. Does Gabriel go to daycare?
Dad: Yup he does.
Doctor: Any of his friends at daycare who are also sick?
Dad: Not that I know of.
Doctor: Alright. Does Gabriel have any medical conditions?
Dad: Nope.
Doctor: Is he on any regular medications?
Dad: Nope.
Doctor: Alright. I’m gonna ask more about Gabriel’s birth history. What was his birth weight?
Dad: I think he was around 3200g.
Doctor: And at what week was he born?
Dad: 37 weeks.
Doctor: Was it a normal delivery? Or C-section?
Dad: Normal delivery.
Doctor: Any issues after Gabriel was born? When was Gabriel and his mother discharged?
Dad: I think the doctor said Gabriel’s skin was a bit yellow and had to go under the blue light for a few days but otherwise no issues.
Doctor: Alright. Any family members who also had seizures in the past? Or any brain tumors?
Dad: Nope doctor.
Doctor: Alright. Are Gabriel’s vaccinations up to date?
Dad: Yup.
Doctor: And how has Gabriel’s growth been? I see that he is 2 years old now, is he able to climb stairs already?
Dad: Yup. He can climb stairs with some assistance.
Doctor: Alright. Is he able to use crayons and scribble?
Dad: Yup. In fact, he can draw some shapes already.
Doctor: Wow that’s amazing. Is Gabriel able to talk in phrases, like, at least 2 word phrases?
Dad: Yup.
Doctor: Alright. Is Gabriel able to get along and play with other kids in daycare?
Dad: From what the teachers have been telling me, yes.
Doctor: That’s great. Alright, from what you’ve told me today, it seems like Gabriel is having what we call febrile seizures. It is actually quite common in children under 5, where their brains are a bit more sensitive to changes in body temperature and seize as a result. Since Gabriel is having trouble taking orally, we will admit him and run some blood tests just to make sure nothing else is wrong. Do you have any questions?
Dad: Nope, thank you doctor.

２本目：【解説動画】熱性けいれん - 英語で医療面接　小児科の病歴のとり方

解説ポイント

>> 親に対する同情表現
I can see that you’re very worried.
You must be very worried.
I can see that you’re very concerned.
You must be very concerned.
That is concerning.
That sounds concerning
That is worrying.
That sounds worrying.

>>「怖かったですね」の表現
That must’ve been very frightening. がちょうどいい。
Terrifying だと少しオーバー。
Scared は幼すぎる表現。でも子どもに使うのはいいかも

>> 白目をむく
Did you notice any uprolling of eyes?
Did you notice any eyes rolling upwards?
Did his eyes roll upwards?
カルテに書くときは Uprolling of eyes / No uprolling of eyes

>> 尿失禁、便失禁
以下は非医療従事者でもわかる表現
尿失禁：Wet oneself, lose control of urine
便失禁：Soil oneself, lose control of bowel
カルテに書く場合は urinary incontinence, bowel incontinence

>> Going back to~： ~に戻ると
Going back to before the seizure episode.
Going back to the chief complaint…
Going back to why you came to the hospital…

前駆症状：prodrome

>> てんかんの描写
Did his muscles stiffen up?
Was he stiff?
Did his muscles tense up?
Did he tense up?
Was he tense?

>> においの表現
Foul-smelling
Bad smelling
Unusual smell: Any unusual smell in the urine?
Stinkyは幼い表現なので避ける

>> その他の表現
Hold down：押さえつける
He just managed to hold down some fluidsでは、嘔吐せずに摂取した水分を胃の中に押さえつける、といったニュアンス

>> 生育歴を聞く
誕生時になにか特記すべきことがあったかを聞くときは、
- いつ退院したか
- ICU入室の有無（Did Gabriel go to the ICU at any point?)
を聞くと、客観的な指標を得られることができる
「なにか特記すべきことはありましたか？」という風に聞くと患者や医療者によって答えが変わることがある

→ シンガポールでは、出産後問題なければ翌日退院がスタンダードなので、「いつ退院しましたか」という質問が便利になる。出産翌日に退院したことがわかれば、高確率で特に問題がなかったことになる。

>> ワクチン接種歴
Are Gabriel’s vaccinations up to date?
Is he up to date with his vaccinations?
Did he get all his vaccinations?

Vaccinations = immunizations = jabs
Inoculationはあまり聞かない

>> その他
Seizeは動詞としてそのまま使える
Did he only seize once? けいれんは一度だけでしたか？
The patient is still seizing：患者のけいれんはまだ続いている

３本目：【口頭発表・プレゼン例】熱性けいれん - 英語で医療面接

プレゼン例１

The source of information is the patient’s father. Patient is a 2 years old male with a tonic-clonic seizure, witnessed by his father. It lasted for approximately 30 seconds. He denies any tongue or head trauma. He noted some postictal drowsiness for about 5 minutes after he seized. There is no history of a prior seizure. Patient has had fever for the past two days. Fevers was 38.6 degrees Celsius with 6 times of non-bilious, non-bloody vomiting, lower activity level and history of sick contact with his older sister last week. No rash, lethargy, inconsolability, ear-tugging, headache, or diarrhea.

プレゼン例２

History was taken from patient’s father. Patient is a 2 year old boy who came in with first onset seizure with a background of fever and vomiting for the past 2 days. The seizure happened this morning when the patient was playing with his toys. Pre-ictally, the father didn’t notice anything unusual such as staring into blank space. During the seizure, the father observed Gabriel’s body stiffen up before the whole body started shaking. The seizure lasted for about 30 seconds. Patient did not have any tongue biting, uprolling of eyes, urinary or bowel incontinence, nor any head trauma. Post-ictally, the patient was drowsy for about 5 minutes. Patient only seized once.
Patient has been having fever for the past 2 days, Tmax 38.6 degrees. This is also associated with 6 episodes of non-bilious non-bloody vomiting but no diarrhea. Patient’s father also reports poor oral intake for the last few days or so. Otherwise there are no other localizing symptoms of fever such as headache, URTI, ear tugging, abdominal pain, foul-smelling urine or rashes. Patient has a positive contact history; his sister had URTI symptoms 2 weeks ago.
The patient is a developmentally normal, term child delivered via NVD at 37 weeks with no complications. Birth weight was 3200g. Patient has no past medical history besides neonatal jaundice and underwent phototherapy for few days according to the father. There is no family history of epilepsy or brain tumors, and his vaccinations are up to date.

解説ポイント

>> 例１より
Fever は単数形のみ (feversとは言わない）
Lower activity level より reduced activity level / decreased activity level

>> オープナー
Patient is a 2 year old boy who came in with first onset seizure with a background of fever and vomiting for the past 2 days
オープナーで 1) 主訴がけいれんであること 2)熱性けいれんであること 3) 熱源が胃腸炎であること示唆する
First onset = 初めてであること

>> けいれんの描写
Tonic-clonicと断定する前に、けいれんの様子を描写する
Seizeはそのまま動詞として使える

>> 主訴がけいれんの場合は、時系列で説明する
1. Pre-ictally / Before the seizure
2. Ictally / During the seizure
3. Post-ictally / After the seizure
主訴がFallである場合も、同じように時系列で説明したほうがわかりやすい（pre-fall, fall, post-fall)。

>> Localizing symptoms of fever：熱発の症状
Otherwise there are no other localizing symptoms of fever：熱発と考えられる症状はない

>> 生育歴について
NVD: normal vaginal delivery
ACOG (The American College of Obstetricians and Gynecologists)による分類
Early term: 37 0/7 weeks through 38 6/7 weeks
Full term: 39 0/7 weeks through 40 6/7 weeks
Late term: 41 0/7 weeks through 41 6/7 weeks
Postterm: 42 0/7 weeks and beyond

>> According to~の便利さ
Patient has no past medical history besides neonatal jaundice and underwent phototherapy for few days according to the father.
According to the father: 父親によると～　で少々保険をかける。