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. He has working knowledge of English, although he is not fluent. REVIEW OF SYSTEMS: Head: The patient gets a rare fronto-occipital headache, which is relieved by Anacin. The frequency of these headaches has not changed recently. He has no known seizure disorder, no history of syncope. Ears - No complaints. Eyes - Vision good. The patient does not wear glasses. Nose and Mouth - Negative. Pulmonary: No chronic cough, no shortness of breath. Cardiovascular: Negative. Gastrointestinal: Negative. Skin: 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. Endocrine: Subtotal thyroidectomy 5 yrs prior to admission for multiple benign adenomas. On synthyroid since. PHYSICAL EXAMINATION: Vital Signs: Blood pressure 110/60; pulse 90; respirations 16. General Appearance: This is a well-developed, muscular, young man in no distress. Head, Eyes, Ears, Nose and Throat: The head issymmetric. There is no bony or scalp tenderness. Pupils are equal, round, and reactive to light and to accommodation. The extraocular movements are intact. Visual fields are intact to confrontation testing. There is no nystagmus. The fundi are normal. The Weber test does not lateralize. The right tympanic membrane is slightly scarred and retracted; the left tympanic menbrane is distorted, dull, particularily in the postero-inferior quadrant, with a slight tan exudate at the base. The pharynx is normal. There is slight inflammation surround- ing the right mandibular third molar, which is partially covered by a soft tissue flap. Neck: Supple. There is no venous distention. Two well-healed horizontal surgical scars are present anteriorly over the neck. No palpable thyroid tissue is present. Chest: The chest expands symmetrically. The lung fields are clear to percussion and auscultation. The lungs bases move to percussion. Rongelap (54) CLINICAL @ECORD Bh itesery and Physics! Exemination 09-44-40 3 O -2?2.« TWE CLINICAL CENTER NATIONAL INSTITUTES OF HEALTH - 141 - Suenmery CF Conmsiation 0 Fetiew-w— OC) Contievertton MiLOPP (Rev. 371)