History of Present Illness 1Onset of symptoms in relation in to timing of pregnancy 2 Duration chronicity nature and severity of breathlessness 3Exercise tolerance specially in relation to day to day activity ID: 933380
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Slide1
Assessment and investigations of respiratory disease in pregnancy
Slide2History of Present Illness
1.Onset of symptoms in relation in to timing of pregnancy
2. Duration, chronicity , nature and severity of breathlessness.
3.Exercise tolerance specially in relation to day to day activity .
4. Presence / absence of cough , sputum ,
haemoptysis
.
5 .Relief with inhaler
6.
Palpitation,Chest
pain
7. Weight loss, fever, anorexia , malaise
8. Leg pain, Nasal and sinus problem .
9. Sore throat ,
arthrelgia
and
myelgia
Slide3Past Medical history
1.Asthma
, allergy , hay fever , eczema. Nasal block.
2. TB
, previous BCG vaccination , Cystic Fibrosis ,
Bronchiectasis
,
other
3. lung disease. Sarcoidosis ,
Kyphoscoliosis
,Neuromuscular disease
4.Ankylosing Spondylitis , Herat Disease , Recurrent UTI.
5.Malignancy ( breast ), immunosuppression (HIV +
ve
.)
6.Psychiatric illness.
7.Previous history of Pulmonary embolism , DVT
,
8.Thrombophillia . Thyrotoxicosis
Slide4Other contributory
history
Drug History such as
NFT ,
Amioderone
, NSAIDs and inhalers
.
Psychological such as
Anxiety or depression . Rx continuing or stopped
?
Family History Clotting disorder , Asthma ,
Atopy
, Lung cancer , TB , sarcoidosis.
Social
History
such as
Ability to lead normal routine life , specially going to work , climbing stairs , doing house hold work and shopping. Living in travel to high prevalence and contact TB
Slide5Physical
Examination
General
appearance
as
Confusion ,Sweating , tremors, pyrexia , pallor , obesity/ reduced weight , clubbing , cyanosis , lymphadenopathy , BCG vaccination scar , goiter , exophthalmos , lid legging ,edema leg,
DVt
Cardiovascular
Low / high
Bp
, Raise3d Jugular vein pressure , parasternal heave , gallop rhythm , murmurs , pericardial rub ,hepatomegaly , cardiomegaly , basal
crepts
Slide6Past Medical history
Respiratory
as
Tachypnoea
, accessory muscle use to breath ,
Kyphoscoliosis
, tracheal shift , dullness / resonance to percussion ,Bronchial breathing , Wheeze ,
crepts
, reduced / absent breath sounds at base of
lung
Breast
as
any lump / mammography is better.
Neurological
as
muscle wasting , fasciculation's , limb weakness, sensory loss ,cerebral signs if any
Slide7Investigations
Radiology
The
accepted cumulative dose of X ray radiation to which fetus can
be
exposed safely is estimated, ---5
rads
. This is equivalent to n71
thousand
X rays ,
or 3o V/Q scan. It can be concluded
that
, for most of the common tests , exposure to radiation is minimal
and
lease likely to effect the fetus. In the first instance
Xray
chest
is
crucial to reach the diagnosis like pneumonia , pleural effusion
,
hydro /pneumothorax, tuberculosis and sarcoidosis