AKT-1706
A 63-year-old man presents to the clinic with a persistent sore throat. He had visited three weeks ago and was diagnosed with acute tonsillitis by another doctor, for which he was prescribed amoxicillin. At that time, some left submandibular swelling was observed.
The patient is a heavy smoker, consuming around 40 cigarettes per day. Upon further questioning, he reveals that he has been experiencing a sore throat and pain while swallowing for the past three months.
During the examination, his blood pressure is 145/82 mmHg, pulse is 85 and regular. He has heavily nicotine-stained fingers and appears very thin with a BMI of 20 kg/m2. There is noticeable left submandibular gland enlargement, which has apparently grown even more since his last consultation.
Investigations reveal:
– Hb 114 g/L (135-180)
– WCC 6.0 ×109/L (4.5-10)
– PLT 189 ×109/L (150-450)
– Na 138 mmol/L (135-145)
– K 4.8 mmol/L (3.5-5.5)
– Cr 122 µmol/L (70-110)
A chest x-ray taken three months earlier was normal.
What is the most appropriate course of action?