Seven weeks of hoarseness presented as a complete case document with its reasoning trail beneath each section, a recent cold and heavy concert use weighed against a breathy voice, choking on water and weight loss before a paralyzed vocal fold from a chest lesion is ranked first. Searches like "nu 552 unit 10 assignment example", "nu552 unit 10 sample" and "nu552 unit 10 example" land here.
A Choir Director's Voice: A Reasoning Case Presentation of Seven Weeks of Hoarseness After a Cold
[Student Name]
Purdue University Global
NU552: Advanced Health Assessment and Diagnostic Reasoning
Unit 10 Case Presentation
[Instructor Name]
[Date]
The patient is a composite built for the presentation; no real patient is described.
Chief Complaint
"My voice has been rough since I had a cold before Thanksgiving, and it hasn't come back."
Reasoning Trail: Opening List
Hoarseness in adults has a wide differential, and most cases are benign and self-limited (Feierabend & Malik, 2009). It is sorted into four families before any history is taken:
1. Inflammatory: acute or chronic laryngitis, reflux affecting the larynx.
2. Benign structural: vocal fold nodules, polyps or cysts.
3. Neurologic: vocal fold paralysis or weakness, from injury to the recurrent laryngeal nerve or from a central cause.
4. Neoplastic: cancer of the larynx, or a tumor elsewhere affecting the nerve.
The question for the history: is this a voice that was strained and is healing, or a voice that is failing for another reason?
History of Present Illness
Mr. [B.], 67, retired from directing a high school choir eight years ago and now leads a community choir. He had a cold with a sore throat and cough in the second week of November. The cough and sore throat settled within ten days, but his voice stayed hoarse. He led three concerts in December, "shouting over the piano," and assumed his voice would recover over the holidays. It has not.
He describes his voice as breathy and weak rather than rough, and says it tires within minutes. He cannot hold a note. His cough feels weak, "like I can't clear my throat properly." He has choked on water twice in the past month, though not on solid food. He has no throat pain, no pain on swallowing, no ear pain and no heartburn. He has lost about [4] kg since the autumn, which he attributes to "running around with the concerts."
Reasoning Trail: After the Present Illness
Added: a breathy, weak voice, a weak cough and choking on thin liquids together suggest that the vocal folds are not closing fully. That pattern points to a neurologic cause, a vocal fold that is not moving, more than to inflammation or a mass on the fold, which usually produces a rough voice.
The distractor: the cold and the concerts offer a ready explanation. Post-viral laryngitis is common, and heavy voice use can prolong it. The timing fits the easy explanation, but the quality of the voice does not. Strain and inflammation make a voice rough and low; they do not usually make it breathy or cause aspiration.
Kept high: neurologic causes and neoplastic causes, the latter because of the weight loss.
Question for the past and social history: are there risk factors for cancer, and any surgery or illness that could have injured the nerve?
Past Medical, Surgical and Social History
Hypertension, treated with lisinopril. No thyroid, neck or chest surgery. No intubation in the past year.
He smoked a pack a day from age 18 to 57, a history of about 39 pack-years, and quit ten years ago. He drinks two glasses of wine a week. He lives with his wife.
Reasoning Trail: After the History
Removed: surgical injury to the recurrent laryngeal nerve, the most common cause of vocal fold paralysis in many series, because he has had no neck or chest surgery (Rosenthal et al., 2007).
Raised: malignancy. A 39 pack-year history, even with ten years of abstinence, leaves him at increased risk for lung and laryngeal cancer. Tumors in the chest are among the leading nonsurgical causes of vocal fold paralysis (Rosenthal et al., 2007).
The anatomy matters here. The left recurrent laryngeal nerve leaves the vagus nerve in the chest and loops under the arch of the aorta before climbing back to the larynx. A tumor at the left lung hilum, enlarged mediastinal lymph nodes or an aortic aneurysm can compress it. The right nerve loops under the subclavian artery, higher in the neck, so the left is more exposed to disease in the chest.
Question for the examination: is there a mass in the neck, any sign of chest disease, and which side is weak?
Examination
Voice: breathy and weak, with a maximum phonation time of about [6] seconds, well short of typical.
Head and neck: no oral lesion. No thyroid enlargement. A firm, nontender, fixed lymph node, about [1.5] cm, in the left supraclavicular fossa.
Chest: breath sounds slightly reduced over the left upper zone. No wheeze. No clubbing.
Cardiovascular: regular rhythm, no murmur. Blood pressure [138/82].
Neurologic: cranial nerves otherwise intact; no tongue deviation, normal palatal elevation, normal facial sensation and strength. No limb weakness.
Reasoning Trail: After the Examination
The examination changed the list decisively. A firm, fixed left supraclavicular node in a former smoker with weight loss is a sign of possible malignancy in the chest or abdomen, since this node drains the thorax. Reduced breath sounds at the left apex add to the concern. The absence of other cranial nerve findings argues against a lesion at the skull base or brainstem, which would usually affect more than one nerve.
Assessment
1. Left vocal fold paralysis from a lesion in the left chest, most likely lung cancer with mediastinal spread. Leading on likelihood after the examination, and first on danger.
2. Primary laryngeal cancer. Possible given his smoking history; a glottic tumor can also fix a vocal fold. Second on danger.
3. Post-viral laryngitis with vocal strain. Once the most tempting; now low on likelihood because it does not explain the breathy voice, aspiration, weight loss or node.
4. Laryngopharyngeal reflux. Low; no heartburn, and it would not explain the other findings.
Plan
The first step is laryngoscopy, to see whether the vocal folds move and whether there is a mass. A clinical practice guideline on hoarseness recommends laryngoscopy when hoarseness fails to resolve within four weeks, or sooner when a serious underlying cause is suspected (Stachler et al., 2018); both conditions apply. If the left vocal fold is immobile, imaging should cover the whole course of the recurrent laryngeal nerve, from the skull base through the neck to the aortic arch, with computed tomography of the neck and chest. The supraclavicular node offers a route to tissue diagnosis by fine-needle aspiration.
Reasoning Trail: What Would Rearrange the Ranking
1. An immobile left vocal fold with no laryngeal mass: confirms the leading hypothesis and sends the search to the chest.
2. A mass on the vocal fold: moves primary laryngeal cancer to first, though the node still needs explaining.
3. Normal mobility and a swollen, inflamed larynx: lifts laryngitis and reflux. Even then, the weight loss, the node and the chest findings would still require imaging, because an explanation for the voice would not explain them.
References
Feierabend, R. H., & Malik, S. N. (2009). Hoarseness in adults. American Family Physician, 80(4), 363-370.
Rosenthal, L. H. S., Benninger, M. S., & Deeb, R. H. (2007). Vocal fold immobility: A longitudinal analysis of etiology over 20 years. The Laryngoscope, 117(10), 1864-1870. https://doi.org/10.1097/MLG.0b013e3180de4d49
Stachler, R. J., Francis, D. O., Schwartz, S. R., Damask, C. C., Digoy, G. P., Krouse, H. J., McCoy, S. J., Ouellette, D. R., Patel, R. R., Reavis, C. W., Smith, L. J., Smith, M., Strode, S. W., Woo, P., & Nnacheta, L. C. (2018). Clinical practice guideline: Hoarseness (dysphonia) (update). Otolaryngology-Head and Neck Surgery, 158(1 Suppl.), S1-S42. https://doi.org/10.1177/0194599817751030
How this NU552 Unit 10 example is structured
Interleaving is what separates this presentation from an ordinary case write-up. Either strand can be read alone: the write-up as a clinical document, the trail as a record of thinking. Each trail section states the current list, what the preceding section added or removed, and the question the next section must answer. The recent cold and the concert season are handled as a deliberate test of anchoring. The trail admits that strain after a virus was tempting, since it is common and fits the timing, then shows why a breathy voice, a weak cough, choking on thin liquids and weight loss argue against settling there. The left recurrent laryngeal nerve's path under the aortic arch is explained once, because it is why a chest lesion can present in the voice. The final ranking separates likelihood from danger, and the closing section states which laryngoscopy outcome would rearrange the ranking, including mobile vocal folds, which would lift the benign causes.
Get an NU552 Unit 10 example written to your instructions
Your final NU552 presentation may be a paper, a slide deck or a recorded talk. Include the assigned case, or a composite you built, together with the rubric. Expect it within 24-48h, free as a first order and written to those instructions, pairing the complete case document with a visible reasoning trail that never contradicts it. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
NU552 Unit 10 questions, answered
Is the reasoning trail a separate document?
It can be, but interleaving usually reads better. The sample places a short trail box after each write-up section, so the reader sees thinking and data together. Some sections prefer an appendix or a separate reasoning memo; if your instructions specify one, the sample is arranged that way while keeping the two strands consistent.
How should a distracting detail be handled?
Name it, give it a fair hearing and show what argues for and against it. The sample adds the recent antibiotic to the list, admits the appeal of a drug explanation and then weighs it against weight loss and the examination. Ignoring the detail looks careless; settling on it too quickly is the error it was placed to test.
Does the presentation need a management plan?
Many sections ask for a next diagnostic step rather than full management, because the course centers on assessment and reasoning. The sample names imaging and writes out how every imaging outcome would reorder the list. Where a plan is required, it follows the ranked differential and remains tied to the reasoning.