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Short Answer Questions for ED Fellowship Study

Case: Obesity hypoventilation syndrome

A 44-year-old Polynesian woman presents with a 4-day history of progressive dyspnoea and somnolence. She has a BMI greater than 50, loud snoring and reduced conscious state. Obs are as follows : T 37.1 ; HR 80 ; BP 140/90 ; RR 24 ; Sats 84% RA Air entry is reduced bilaterally with widespread soft polyphonic wheeze and you note pitting oedema to her hips. Her ABG is as follows : FiO2 0.28 pH 7.20 pCO2 96 pO2 70 SaO2 93% HCO3 38 Hb 186

1. Perform two relevant calculations on the ABG and comment on their clinical significance. 4 marks

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2. What is the most likely cause for this presentation? 1 mark

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3. List three differential diagnoses for this presentation. 3 marks

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4. List your immediate steps in managing this patient. 4 marks

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This case forms part of a collaborative marking project designed to support fellowship preparation. In the week leading up to each tutorial, you can contribute answers to any active case. If you contribute, your answers may be reviewed, marked, and used to refine the model answers during the weekly fellowship teaching sessions.

All responses are displayed anonymously or using anonymised avatars. You remain in full control of your answers and may withdraw them at any time.

Your personal results and updated model answers become available the day after the tutorial.

After the tutorial you can still do the case and self-mark your answers, but your answers will not be included in the group review.