Command:

This patient presents with a 1-year history of tiredness and sleeping problems.

Please examine the patient and address any issues or concerns raised.

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Follow-Up Questions/Answers

Having taken the history and examined this lady today, can you tell me your findings?

• This lady presents with a history of lethargy and daytime somnolence with features in the history consistent with sleep apnoea.
• These are seen in the context of an increase in hand and feet size.
• On examination, there was clear swelling in the hands, feet and face. There was splaying of the teeth and a clear overbite of the jaw.