□ID & CCを述べずに，HPIを開始する。
□Review of systemsへの言及がない。
2）「Phil Collins」をBasic Sequenceに基づき内容分析（段落分け）してください。
Phil Collins [Based on the PBL tutorial(HCP9/Unit1.15)in the UH/JABSOM MD Program.]
Mr. Phil Collins is a 62-year-old homeless Caucasian male who came to our clinic for the first time complaining of a two-week history of right foot pain.
HPI. The patient was in his usual state of health until approximately two weeks ago when he accidentally stepped on the broken bottle and cut his right heel on a piece of broken glass. The pain gradually worsened and now he can't bear any weight. He described the pain constant and throbbing and rated the pain 7 out of 10. He has noticed that the area of redness and swelling had started in the immediate area around his wound and was still increasing so that now his calf was involved.
He wasn't able to give us any information about his past medical history. However, he did admit he was hospitalized at Hawaii State Hospital a few times, but he didn't know why. He used to take medications from a psychiatrist. However, he stopped going to see him and hasn't seen any physicians for the past two years. He denied any allergies, and he doesn't remember anything about immunizations or childhood illnesses. He couldn't tell me anything about his family history, and in fact didn't know about where his family was. His social history is only significant in the fact that he is homeless. He denied drinking, smoking, or any type of drug use. He spends most of the time at Ala Moana Beach Park. Review of systems is unremarkable. But again I wasn't quite sure if I understood well when I was asking him.
Physical examination. Generally, he was a thin white male, appearing slightly older than his stated age, with very poor personal hygiene. He was alert and cooperative. He favored his right leg. His vital signs were temperature 102 F, heart rate 90／min., regular, respiration 18／min., unlabored, and blood pressure 130／88 mmHg. As for the lower extremities, it revealed a 3-cm wide, shallow ulcer with a necrotic base, and some purulent discharge on his right heel. There was erythema, swelling, and tenderness of the right foot and calf. His pulse on femoral, popliteal, dorsalis pedis, and posterior tibialis, was intact. He also had some tender palpable lymphadenopathy in the right inguinal area. Neurologically, his right leg was normal. The rest of his physical examination was normal.
In summary, this is a 62-year-old homeless Caucasian male with a history of unspecified psychiatric illness who presents two-week progressive right foot pain and now calf pain. His examination is significant only for a temperature of 102 F, a right heel ulcer with associated swelling, erythema, tenderness, and again inguinal lymphadenopathy.
Problem list: #1 Right foot injury, #2 History of psychiatric illness, and #3 Homelessness. Assessment and plan: #1 Right foot injury. The wound requires immediate medical attention. We would obtain a culture from the ulcer, order CBC and X-rays of the foot, perform daily debridement by a surgical consultation, place him on intravenous cefazolin, and give a tetanus vaccination booster. #2 History of psychiatric illness. We assume that he had been treated for chronic schizophrenia. We would perform a mini-mental status examination and then ask a psychiatric consultation. #3 Homelessness. We discuss the issue of placement with our medical social workers.
My impression is that Mr. Collins has a very severe cellulitis, possibly with the involvement of the underlying bone as well. We would arrange for his admission to our hospital.
京都大学大学院工学研究科分子工学専攻 修士課程修了。大阪大学医学部医学科卒業。大阪大学医学部附属病院と大阪府立病院で臨床研修と医員勤務の後，米国臨床留学。東京医科大学八王子医療センター腎臓科助手を経て現職。ハワイ大学医学部でProblem-based Learningを通年で指導する傍ら，同学部でカリキュラム開発を行なうFacultyの1人に日本人として初めて選ばれ，Problem-Solving & Clinical-Reasoningのプログラムを開発中。Speech専門家Doric Little, Ed. D.が主催する英語症例提示教室のClinical Advisorを併任。専門は内科学／腎臓病学であるが，日本と世界，臨床と教育をseamlessにつなぐ国際医学（International Medicine）で活躍中。