SOCIAL HISTORY: The patient was born and has lived all his life in the Marshall Islands except for one visit to Boston, where he was hospitalized for a thyroidectomy in 1967, He graduated from high school last year. fluent. He has working knowledge of English, although he is not REVIEW OF SYSTEMS: Head: Anacin. The patient gets a rare fronto-occipital headache, which is relieved by The frequency of these headaches has not changed recently. seizure disorder, no history of syncope. Ears ~ No complaints. The ‘pactent does‘not wear glasses. Nose and Mouth - Negative. He has no known Eyes - Vision good. 2, : Pulmonary: 4 ‘No.“chronic cough, no shortness of breath. , oe, . Cardiovascular:. Negative. 2. “Gastrointestinal:: Negative. 7 ee sa e !-Skta: The patient has had multiple skin infections on the legs, often resulting from-cuts and scratches. In addition, he has had boils on the buttocks over the last few months and a mildly prutitic, depigmenting rash over the thorax for the last six months../ “SET. RE *.Lee. . Endocrine: =x ae Subtotal thyroidectomy 5 yrs prior to admission for multiple benign nts . adenomas. On synthyroid since. _A¥ital Signs:i,Blood pressure,110/60; pulse 90; respirations 16. . oa, scalp. tenderness...Pupils are equal, round, and reactive to light and to accommodation. me extraocular movements are intact. Visual fields are intact to confrontation test- ing.,»7There is no-nystagmus. The fundi are normal. The Weber test does not lateralize.. the righe tympanic: membrane is. slightly scarred and retracted; the left tympanic men- brane-is distorted,dull, particularly in the postero-inferior quadrant, with a slight tanexudate at thebase. The pharynx is normal. There is slight inflammetion surrounddng.the. right mandibular thirdmolar, which is partially covered by a soft tissue flap. va eo - wae cet TDL ‘There ts‘nowvenous distention. Two’well-healed horizontal sur- eaantertorly_over the neck. oa B+ ~ Ko palpable thyroid tissue is present. . via tome owe " :cagtweck:” Supple gicaltscars are rt. . Pax eeeChest: The chest" expands’“cyemitrically.“the ‘Lung fields are clear to percussion - bongelap (54) a -64-40 3 09 “eS eA SESE: Says e Or w : Temes e wien aby os we % ae oP ratte on - f. eo . : , ewe welt pass Bain ita e, * ee ett wte + ee. : ol. - cee 4 . ae Te 7 - .. = oe hee - Tage D- ..Le Agu witb . ~~ . . —wom Sie" ‘iGeneral Appearance: This is a well-developed, muscular, young man in no distress. ms Ages. iSaag, : ore. “Head, Eyes, Ears, Nose and Throat: The head is symmetric. There is no bony or a he ind se ee - uew errr * ae nwa tee ae . cedures PHYS ICAL EXAMINATION:id _ 2 a THE CLINICAL e a e T.NATIONAL INSTITUTES OF HEALTH ULA ‘ST eres JR. - 141 - q O Swamery 0 Canedtetian fobowe~ c Cont eens om