1. Initial Presentation A 46-year-old Caucasian male complained a sore throat that does not go away, cough, difficulty in swallowing, hoarse voice, and unexplained weight loss.

2. Hx Medical hx: Had a liver transplant 2 years ago Currently taking immunosuppressant Family Hx: Both parents are clear from any chronic illnesses.

3. Hx Cont’d Social/Occupational Hx: Active lifestyle Had divorced 5 times before; currently living with his new girlfriend Used to be heavy drinker before the liver transplant Non-smoker No history of substance abuse

4. Physical Examinations BMI: 22 BP: 115/72 mmHg HR: 79 beats/minute RR: 13 breaths/minute Normal body temperature

5. More Examination Lungs are clear to auscultation and percussion, no rales or wheezes No focal motor or sensory deficits Examiner felt a lump in the neck

6. DDx What test should we order? What organs should we check for?

7. Imaging studies Colonoscopy indicates benign tumors in the lower part of the neck

8. Diagnosis ???

9. Now that we know it’s throat cancer, what is the underlying cause of this? i.e. what causes cancer? Review his history Formulate another DDx and necessary tests

10. Cell culture Positive result on HPV

11. Treatment ???