POEUN LAERPRREIRnena STSEN ve Cea ~~ SOCIAL HISTORY: a} 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 noc 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 noc wear glasses. Nose and Mouth ~ Negative, Pulmonary: No chronic cough, no shortness of breath. Cardiovascular: Negative, Castrointestinal: Skin: Negative. The paticot has had multiple skin infections on the legs, often resulting from cuts and scratches, In addition, he has had boils on the buttocks ever che last few months and a mildly prutitic, depigmenting rash over the thorax for the jase six months. Endocrine: Subtotal thyroidectomy 5 yrs prior to admission for multiple benign adenomas. On synthyroid since. PIYSICAL 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 extraccular movements are intact. Visual fields are intacc to confrontation cesting, There is no nystagmus. The fund! are normal, The Weber test docs not lateralize. The right ¢ympanic membrane is slightly scarred and retracted; che left tympanic membrane is distorted, dull, particularly in the postero-inferior quadrant, with a slight tan exudate at the base, The pharynx is normal. There is slight inflammacion surround - ing the right mandibular chird molar, which is partially covered by a soft tissue flap. Neck: Supple, There is no venous distention, Two well-healed horLzonral surgical scars are present anteriorly over the neck, No palpable thyroid tissue is present. Chest: The chest expands symmetrically. and ausculcarcion. Rongelap (54} The lung fields are clear to percussion The lungs bases move to percussion, Clinical RECORD Wh Wetery ond Pipeent Enomnasion 09-44-40 3 CC tvaseny Comeurion -2THE CLINICAL CEMTER NATIONAL INSTITUTIS OF HEALTH OD) tetera o Coneiewesion MIOPe thew. $71) BNI Me ee tte P=