Conclusion:
Physical exam in morbidly obese patients is difficult. Procedure related
complications are higher in morbidly obese population due to baseline
compromised respiratory status which can be associated with obstructive
sleep apnea or obesity hypoventilation syndrome. Empiric diagnosis when
not responding to treatment should be questioned and further workup to
pursue alternate diagnosis should continue until a definite diagnosis is
confirmed. A careful and thorough bedside physical examination can
prevent physicians from ordering extensive unnecessary testing saving
significant healthcare resources.