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Assessment and investigations of respiratory disease in pregnancy

Assessment and investigations of respiratory disease in pregnancy. History 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 .

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Assessment and investigations of respiratory disease in pregnancy

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  1. Assessment and investigations of respiratory disease in pregnancy

  2. History 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

  3. Past 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

  4. Other 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

  5. Physical 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

  6. Past Medical history • Respiratoryas 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

  7. Investigations • 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

  8. Radiological Investigations • V/Q scanning is essential to diagnose pulmonary embolism , an acute life threatening condition • CTPA is still more important in PE when V/Q is showing only an intermediate probability of PE , and the clinical findings are in favor of PE • HR CT is needed to diagnose bronchiectasis and interstitial lung diseases., could be avoided till puerperium , if the clinical outcome is not affected

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