Titlebook: Surgery; A Case Based Clinica Christian de Virgilio,Paul N. Frank,Areg Grigorian Book 20151st edition Springer Science+Business Media New Y

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Progressively Hoarse Voices lost the ability to project his voice and is only able to speak in a loud whisper. He endorses blood-tinged sputum with coughing, which has occurred approximately twice a week for the past month. The social history is remarkable for a 40-pack-year smoking history; he continues to smoke one pack pe

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Neck Mass that Moves with Swallowingr laboratory tests demonstrate a TSH of 2 mIU/L (normal 0.4–4) and normal serum free T4 and free T3 levels. An ultrasound confirms the presence of a roughly spherical, well-demarcated 2-cm nodule in the right lobe of the thyroid and normal cervical lymph nodes.

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Aural Fullness, Hearing Loss, and Tinnitus not appear to be erythematous. A vibrating tuning fork placed on the middle of his forehead is appreciated as louder on the left side when compared to the right. The same tuning fork, when placed on the left mastoid bone, is appreciated as louder on the left, while softer when it is placed near the left external auditory meatus.

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Progressively Hoarse Voicend oropharynx are remarkable only for caries, and his neck is supple, without lymphadenopathy. Flexible laryngoscopy performed in clinic reveals friable masses on both vocal cords, with a widely patent airway but with impaired mobility of the left vocal cord.

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