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.