Case 11 - 62 yo M with hoarseness

Question 1

Information gathering

Answer 1

CC
Onset
Progression (sudden or gradual)
Frequency (constant or intermittent)
Prior episodes
Pain during speaking
Voice overuse recently
Exposure to cold weather or dust
Recent illnesses, such as URIs
Exacerbating and alleviating factors
Heartburn
Stroke or TIA
Weight and appetite changes
Swollen glands or lymph nodes
Fevers, chills or night sweats
Fatigue
N/V/D/C
Palpitations
SOB, wheezing, hemoptysis, cough
PMHx
PSHx
FHx
Social Hx (occupation, tobacco, alcohol and drug use, diet and exercise)
CAGE questionnaire, if needed
Current medications
Drug allergies

Question 2

Physical examination

Answer 2

HEENT exam (included conjunctivae , mouth and throat, lymph nodes, thyroid gland)
CV exam
Pulmonary exam
Abdoinal exam
Extremities (including DTRs)

Question 3

Closure

Answer 3

Lifestyle changes, especially smoking and alcohol
Resources for tobacco and drinking
Do you have any questions for me?

Question 4

Differential diagnosis

Answer 4

Laryngeal cancer
Laryngitis (chronic laryngitis can be due to GERD, smoking)
Vocal cord polyp/nodule

Question 5

Diagnostic work-up

Answer 5

Laryngoscopy (gold standard for evaluating larynx, allowing direct visualization of vocal cords)
ESR (increased in infection and malignancy)
CT - chest and neck
US - neck
CBC with differential