The previous question:

A 48 year old gentleman presents with extreme tiredness and difficulty concentrating. His wifes states he is irritable
and he is a very loud snorer and occasionally chokes during the night. His libido is low, he is suffering from
headaches and he has been falling asleep during the day as he feels very unrefreshed after his sleep. His BMI is
35. Polysomnography reveals a apnoea/hyponoea index of 10. His ABGs do not reveal significant hypoxia. Which of
the following is useful initially in the management?
Your answer was BiPAP which is incorrect
Weight loss and lifestyle advice correct answer
CPAP
ABGs
BiPAP
LTOT
Explanation:
The diagnosis is obstructive sleep apneoa and these symptoms are classically of this. It is diagnosed via
polysomnography whereby physiological recordnings are made during sleep and the number of
apnoea/hypopnoea episodes are measured. ABGs can be utilised to assess degree of hypoxia overnight and
to therefore if CPAP is required however do not give the definitive diagnosis. OSA lead to RTAs sue to
daytime sleepiness and it can lead to pulmonary hypertension and corpulmonale. Lifestyle advice such as
weight loss, smoking cessation and reduced alcohol advice should be given and is very useful initially. This
man has a BMI of 35 and therefore weight loss is very important. His polysomnography reveals mild OSA and
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no significant hypoxia and thus CPAP is not indicated at this stage as it is most useful in moderate to severe
and those with significant hypoxia. Other management options include intra oral devisces to anterior displace
the mandible and surgical techniques have been utilised.
Question category: Respiratory
A 44 year old smoker presents with increasing shortness of breath. She
states she has fainted a couple of times on exertion. On examination there is
a right ventricular heave and loud pulmonary second heart sound and an ECG
shows right ventricular hypertrophy. Her chest is clear. A CXR is performed
and is normal. What investigation should be performed for the definitive
diagnosis?
Coagulation screen
Exercise tolerance test
D dimers
Pulmonary function tests
CTPA
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