Hypernasalilty and Ptosis in a 48-yr-old Woman

Review of Systems

  • General: She has generally felt well and has been able to do her usual activities. Since her sinus surgery, she has had occasional shooting pains in the back of her head on the left occiput.

  • Skin: Noncontributory

  • HEENT: No nasal congestion or discharge.

  • Pulmonary: No dyspnea or wheezing.

  • Cardiovascular: No chest pain or palpitations.

  • Gastrointestinal: Good appetite, normal bowel movements, and no recent weight loss or gain.

  • Genitourinary: No difficulty starting or stopping urination and no incontinence. Last normal menstrual period 3 wk ago.

  • Musculoskeletal: No extremity or joint pain. Normal perceived strength.

  • Neurologic: See previous screen (History of Present Illness).

  • Psychiatric: Normal mood, although she is beginning to be concerned about her vocal symptoms.