He states that he noticed the lump while shaving two weeks ago, and since then, the lump has remained unchanged and has caused no pain. He is otherwise asymptomatic. He denies any symptoms of hypo or hyperthyroid- ism. His only significant medical problem is diet-controlled diabetes mellitus. His family history is unremarkable.
Vital signs are entirely normal.
Also noted on neck exam is a 1.5 cm Delphian lymph node. There are no bruits noted in the neck. The rest of the physical examination is entirely normal. Work-up reveals the present of hematuria and an IVP shows a ureteral calculus. The emergency room physician ordered a chemistry panel and noted the serum calcium to be 11.8.