BOF: 47
A 54-year-old female is admitted with a history of
headaches and feeling drowsy. She describes the headaches as affecting the
entire head, they are worse in the morning on awakening. The symptoms had been
present for about a week and started after she developed an upper respiratory
tract infection. She gives a history of breathlessness on exertion for some
time .she had no significant medical history and was not on any medication.
On examination she was obese, weight 130 kgs height 1.63
m. Apart from a blood pressure of 150/ 90 there were no other abnormalities
detected.
Chest x-ray was normal
Blood gases (on air) pH 7.4, pO2 10.4 kPa,
pCO2 6.6 kPa, bicarbonate 32 mmol/L
In this patient which one of the following is the best
management for this patient?
a)
Inhaled bronchodilator
b)
Inhaled bronchodilator and inhaled steroid
c)
Lumbar puncture and drainage of CSF
d)
Oral steroids
e)
Weight reduction
Answer: e)
The patient has headache and drowsiness.
The clues given are that she is grossly obese and has
mild hypertension. This would suggest that obesity is a major factor in the
pathogenesis of the condition. Her blood gases show retention of CO2
with metabolic compensation indicating that this is a long-term problem.
Hypoventilation in the context of severe obesity would
make the diagnosis of obstructive sleep apnoea most likely.
This would be best managed by weight reduction.
Revision Tip
Revise obstructive sleep apnoea
KEYS to SUCCESS in Medicine page 181-182
