3. Present illness
● CC:Shortness of breath for weeks
● G2P1, pregnancy GA 32wk
● History:
○ polycystic ovary syndrome
○ Termination due to generalized edema
and lower legs twitching(2012/7/17)
○ Prednislolone treatment(2013/2/7-6/30)
4. Present illness
● OPD(8/15,1 week before admission):
○ Lower abdominal tightness
○ General edema+ weight gain 5 kg in 2
months
○ Orthopnea+PND+DOE since 4wk
gestation
○ foamy urine
○ Improved by Ritodrine
5. Present illness
● This time(2 days ago):
● Progressive DOE with proteinuria and
decrease urine output
● severe hypertension(-), headache(-)
visual abnormalities(-), upper abdominal or
epigastric pain(-), N/V(-),mental status
change(-).
6. Social history
Allergy: Kind of painkiller
Alcohol drinking: Denied
Betelnut chewing: Denied
Cigarette smoking: Denied
15. Physical examination
Ears:normal appearance, no obvious hearing loss
Nose:no nasal discharge, no deformity, no sinus tenderness
Mouth & throat: no lips cyanosis, no pallor lips
16. Physical examination
Neck: Supple
no evidence of tracheal deviation, no jugular venous
engorgement,no lymphadenopathy, normal thyroid size,
no palpable thyroid nodules
Heart:Regular heart beats withouth murmur
17. Physical examination
Chest:Symmetric expansion
No focal tenderness
No chest wall lesion
BS: crackles over bilateral lower lung
Abdomen:Soft, no focal tenderness
Liver and spleen: not palpable
Bowel sound: normally active
CV angle: no knocking pain
18. Physical examination
Skin:
No cyanosis
No focal erythema
Extremities:bilateral leg edema,2+
Free movement with full ROM
No clubbing finger
Neurological:
No flapping tremor, Muscle power: full
25. Renal echo 2014/8/22
1. Kidney Size ( cm )
Right : Normal 10.35 x 1.55 cm
Left : Normal 10.81 x 1.56 cm
2. Kidney Outline
Right : Smooth
Left : Smooth
3. Cortical echogenecity
Right Cortical echogenecity : Normal
Left Cortical echogenecity : Normal
26. Renal echo 2014/8/22
4.Central sinus area
Right Central sinus
area : Dilatation
Left Central sinus
area : Normal
Ultrasound Diagnosis
Right mild pelviectasis
27. Heart echo 2014/8/22
Ventricles
.Normal sizes of ventricular chambers.
.LVEF by M-mode is 61.7 %.
.Mitral inflow: E/A ratio 1-2.
.Deceleration time of mitral inflow 0.22 sec.
.Isovolemic relaxation time is 0.05 sec.
.Lateral E' : 10 cm/s.
28. Heart echo 2014/8/22
Valves
.MR jet area is <20% of LA area.
.TR jet area is <20% of RA area.
.Estimated systolic pulmonary artery pressure is 22 mmHg.