Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:12

Hartnup’s Disease Head and Neck Cancer 657

differential diagnosis

■Autosomal recessive defect in intestinal and kidney neutral amino

acid transport

management

n/a

specific therapy

■Nicotinamide

follow-up

n/a

complications and prognosis

Symptoms are variable but worse on low-protein diet.

Head and Neck Cancer................................

MICHAEL KAPLAN, MD

history & physical

History

■alcohol &/or tobacco abuse in >95%

■for nasopharynx carcinoma (NPC) southern Chinese ancestry

■prior head and neck (H&N) squamous cell carcinoma (SCC): rate of

second SCC

■as much as 4–5% per year (i.e. 20–25% at 5 years)

Signs & Symptoms

■any 1%:

➣new neck mass, bleeding

➣referred otalgia (via CN X) or local pain

➣weight loss

■OP/HP/larynx:

➣persistent change in voice quality (“hoarseness”)

➣airway compromise may occur if large

■NPC:

➣middle ear effusion (MEE) common

➣epistaxis and/or nasal obstruction if large

➣cranial nerve deficits if skull base erosion

Full head & neck exam mandatory, including inspection of

larynx & hypopharynx (HP), nasopharnx (NP), & oropharynx