CSL 31 Monday- Carla Reed

Patient = 36 yo female

History
Further questions on history
Information on further history
Presenting problems - Pregnant = confirmed with pregnancy test 5 weeks ago
- Fever = up to 40 degrees with aches and shivers (no
longer have fever)
- Feeling hot, sweaty and throat hurts
- Runny nose
- Nausea and vomiting = time course, diarrhoea, colour
(blood), how much, triggers, what she vomits up, relation
with food (for morning sickness), make sure it’s not
hyperemesis gravidarum
- Flu-like symptoms = time course
- Missed period 7.5 weeks ago = 7.5 weeks pregnant
- Breasts are tender (due to progesterone)
Medical history - Infertility
- Past history of genital herpes
Medication - Clomiphene
- Any medications to relieve symptoms
Social history - Sick contacts (work as childcare worker) = children had
slapped cheek (parvovirus)
- Ask about the rash at her work and whether the kids had
similar symptoms
- Vaccination = Rubella, VZV, mumps, measles, hepatitis,
pertussis, meningococcus, influenza, parvovirus,
toxoplasmosis
o She is fully immunised (up to date)
- Alcohol, smoking and drug use
- Diet and exercise
- Who she lives with and household exposures = Darren
smokes outside?
- Sexual history
- Cat = toxoplasmosis (cat faeces and gardening)
Family history - Gestational diabetes
- Preterm pregnancies
Possible causes
Pregnancy - Hydatidiform mole
- Tumour
- Pseudopregnancy (psychological effect)
Fever - Infection = respiratory, gastro
- Endocrine disorders
- Tumour
Flu-like symptoms - Infection = respiratory
- Hay fever
Nausea and vomiting - Morning sickness = high levels of progesterone and
oestrogen in the body (stops by 15 weeks)
- Infections = gastro
- Food problem
- Anxiety
- Medications

Further examination
- Vital signs
- Abdominal exam
- Respiratory exam = lymph nodes
- Cardiovascular exam
- Pelvic exam

Investigations
- Serology = vaccinations
- Blood test for pregnancy
- Full blood exam
- Kidney function test
- Hormone analysis
- ESR and CRP
- Liver function test
- Urine test

Learning issues
1. Common infections causing congenital abnormality
o When is infant most at risk of these infections and why (i.e. stages of
development)?
o How to test for them?
2. Physiological changes that occur during pregnancy
3. Common prenatal screening tests and diagnostic tests
o Including NIPT
o How to screen for diabetes and preeclampsia
4. Foetal development
o Marry it up with infections