1. Step 6
1.1. Review session 1
1.1.1. Summary of step 5
1.2. Report new knowledge
1.2.1. sleep apnea disorders
1.2.1.1. obesity?
1.2.1.2. other disorders that might cause these symptoms
1.2.1.3. relative antomy
1.2.2. sleep physiology
1.2.3. hypoxia and confusion
1.3. 30 minutes
2. Step 8
2.1. Diagnostic decision
2.1.1. obstructive sleep apnea with complication excerbated by upper airay infection
2.2. Mechanism
2.2.1. airway narrowing and hypoxia causing systemic complications,
2.3. Presentation
2.3.1. had episodes of apnea, obese, hypopnea, confustion, hypoxia, dyspnea and bilateral edema
2.4. Supporting data
2.4.1. cxr, lft, abg, elevated bp, high bmi,
2.5. 10 minutes
3. Step 7
3.1. Inquiry plan and info gathering
3.1.1. History of presenting complain
3.1.1.1. couple of times incidence of apnea
3.1.1.2. dry mouth
3.1.1.3. sudden sleep during day
3.1.1.4. more than 10 seconds
3.1.1.5. stoped driving because of difficulties
3.1.1.6. confusion started 48 hours ago
3.1.1.7. dyspnea
3.1.1.8. fatigue during daytime
3.1.1.9. wife left the room due to his snoring
3.1.1.10. leg movment during sleep
3.1.1.11. cyanosis happened in the last couple of days
3.1.1.12. loud snoring
3.1.1.13. recent memory diffculty
3.1.1.14. yellowish sputum
3.1.1.15. morning headaches
3.1.1.16. apnea episodes
3.1.1.17. leg edema for couple of months
3.1.1.18. renal disease lateley
3.1.2. Previous medical / surgical history
3.1.2.1. dyspnea for several years
3.1.2.2. stopped tennis
3.1.2.3. inguinal hernial repair
3.1.2.4. require o2
3.1.2.5. endotracheal intubation difficulties
3.1.2.6. bp mildly elevated
3.1.3. Drug history / allergy
3.1.3.1. tenazipam
3.1.4. Family history
3.1.4.1. father snored died of mi
3.1.4.2. hypothyrodism in mother
3.1.4.3. unckle died of stroke
3.1.4.4. son is snorer
3.1.5. Social / occupational history
3.1.5.1. drinks 4 glass of beer
3.1.5.2. smokes 20 cig per day (20-26)
3.1.6. Systemic review
3.1.7. Physical examination
3.1.7.1. rr 20
3.1.7.2. pulse 90
3.1.7.3. 165/95 bp
3.1.7.4. 37.2 temp
3.1.7.5. obese
3.1.7.6. 105 kg
3.1.7.7. 170cm
3.1.7.8. bmi 36
3.1.7.9. thick neck
3.1.7.10. crowded upper airway
3.1.7.11. no cyanosis
3.1.7.12. edema
3.1.7.13. soft heart souns
3.1.7.14. no murmur
3.1.7.15. disoriented in place and time (personal ok)
3.1.8. tests results