DEEPIKA KAMATH Case presentation

Particulars Thavarya Naik 70 yrs Male Farmer Davangere

Chief complaints H/O difficulty in swallowing – 6months H/O food sticking in throat – 6months H/O swelling over left side of neck – 2 months H/O Change of voice – 1 week

History of presenting illness Difficulty in swallowing Insidous, gradually progressive, Initially for solids, since last week for liquids also. Associated with feeling of food being stuck in throat on attempted swallowing. Burning sensation of throat on taking spicy food items. Patient has increased salivation since last 1 week.

Swelling in left side of neck Insidous, gradually progressive, initially size of pea when first noticed, which later progressed to present size of lemon. No H/O sudden increase or decrease in swelling No H/O pain over the swelling No H/O discharge from the swelling.

Hoarsness Insidious, gradually progressive Dull, muffled type No diurnal variation No aggravating relieving factors

H/O cough since 6 months, associated with yellowish sputum, scanty, non foul smelling, non blood stained. H/O recurrent fever present since last 6 months, associated with chills and rigors. More during evening time. H/O loss of appetite since 1 month H/O loss of weight since 1 month

No H/O regurgitation of food on lying down. No H/O cough on swallowing liquids. No H/O bad smell from mouth. No H/O earache, ear fullness, decreased hearing, ear discharge. No H/O Respiratory difficulty or noisy breathing No H/O Haemoptysis, haematemesis, malena. No H/O bone pains.

MEDICAL history No H/O DM, HTN, TB, BA, Drug allergies, prolonged medication, Blood transfusions.

Treatment history Patient has not shown to any other doctor for the present complaints. Post admission patient has been put on symptomatic treatment. Iv fluids (RL and DNS) Inj Rantac 150mg BD Inj Diclo 50mg BD Inj PCT 500mg TID

Family history No similar complaints in the family

Personal history Appetite – Decreased Diet – Mixed B&B – Regular Sleep – Altered Habits – 1 pack bidi everyday since last 40 years (abstinence since 1 week) Alcohol consumption (Brandy) around 250ml since 40 yrs. (abstinence since 1 week)

General examination 72 year old male patient, moderately built and poorly nourished Conscious, co operative, well oriented to time, place, person VITALS: BP: 120/80 mm hg PR: 76/ MIN RR: 18/ MIN Pallor, clubbing, lymphadenopathy – Present Icterus, cyanosis - Absent

Systemic examination CVS: S1 & S2 heard, no murmurs RS: B/L NVBS heard, no added sounds P/A: soft, non tender, no organomegaly CNS: normal

Local examination Oral Cavity Lips, Angle or mouth, GLS, GBS, tongue, floor of mouth – Normal Mouth opening – adequate Teeth – Upper jaw edentilous, lower jaw lower central incisors absent, rest are nicotine stained Buccal mucosa, hard palate – Nicotine stained RMT - Normal Oropharynx – AP, Tonsil, PP, Base of tongue, PPW – Normal Palpation of base of tongue – Normal

INDIRECT LARYNGOSCOPY

Neck examination Colour and appearance of skin – Normal Laryngeal framework – Inspection – normal, no widening, central, no swelling. Palpation – No swelling appreciated. Laryngeal crepitus present No tenderness

Lymph Node – Inspection – Solitary smooth hemispherical Swelling of size 2.5x2.5 cm present above left middle third of SCM, margins well defined, no signs of inflammation seen. (Level III) Palpation – Inspectory findings confirmed, no local rise of temperature, firm to hard in consistency, skin over swelling pinchable, mobile from side to side, immobile vertically.

EAR RIGHT LEFT Preauricular normal normal Pinna normal normal Postauricular normal normal EAC normal normal

nose Cold spatula test: External appearance: normal ARE Vestibule: normal Left sided DNS Turbinates pale Mucosa normal Paranasal sinuses: Non tender PRE: NORMAL

PROVISIONAL DIAGNOSIS Pyriform fossa malignancy extending to supraglottis