Your patient is a 78-year-old female with a smoking history of 120-pack years. She complains of hoarseness that has developed over the last few months. It is important to exclude the possibility of:
A. Thrush
B. Laryngeal cancer
C. Carotidynia
D. Thyroiditis
ANS: B
Hoarseness may result from squamous cell cancer of the larynx as well as from malignancies within the pulmonary tree, neck, and throat. The risk of malignancy as a cause for hoarseness is greatest in patients with a history of cigarette smoking and/or alcohol abuse. The history usually reveals a progressive onset of hoarseness that has persisted for weeks. The physical examination specific to a complaint of hoarseness should include the ears, nose, throat, neck, lungs, and CNs (particularly CN IX and CN X). When hoarseness is persistent or laryngeal structural disorders are considered, laryngoscopy should be performed to view any redness, edema, motion, and masses or polyps.
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