A 22-year-old primi with ...

A 22-year-old primi with LMP 3 months ago came to OPD with chief C/O progressive SOB since 1 week associated with 3 episodes of 5-10 ml/episode hemoptysis since 3 days. The patient denies chest pain/cough/fever/ wheeze/weight loss or loss of appetite. SOB is relieved by lying down and increased in the sitting position. She denies PND and Orthopnoe or leg swelling. Sleep is normal, bowel and bladder normal. Past history and family history is insignificant. She works as a clerk in a private firm. Vitals are BP 130/80 mm Hg, HR 105/min, RR 28/min, temperature afebrile, and SpO2 95% baseline. Orthodoxia is positive by 4%. 6MWT results in a 5 % fall with 275 m covered. Physical examination reveals multiple small blanching lesions on the face, lips, buckalew mucusa, and finger tips. The general examination is positive for grade 2 clubbing.