A 56-Year-Old Man Comes to the Office for Evaluation of a Gradually

question 79

Multiple Choice

A 56-year-old man comes to the office for evaluation of a gradually enlarging, painless mass above the right angle of the jaw.  He has also recently experienced right-sided facial weakness.  When he was in his 20s, the patient had Hodgkin disease that was treated with radiation to the neck.  Family history is significant for thyroid cancer in his mother.  The patient does not use tobacco, alcohol, or illicit drugs.  He had several male and female sexual partners in his 30s but has been sexually active with only one partner for the past 15 years.  Vital signs are within normal limits.  Physical examination shows a firm, nontender mass in the right parotid gland and weakness of all right-sided facial muscles.  Which of the following is most concerning for malignancy in this patient?

• A)Exposure to oncogenic virus
• B)Family history of malignancy
• C)Lack of salivary gland pain
• D)Origin from parotid gland
• E)Presence of facial droop

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Definitions:

Irritating

Causing annoyance, impatience, or mild anger.

Shaken

Often refers to the physical act of moving something vigorously or a state of emotional disturbance and upset.

Biopsychosocial

An interdisciplinary model that looks at the interconnection between biology, psychology, and socio-environmental factors in understanding health and illness.

Health Professionals

Individuals who offer services that improve, maintain, or restore health through the study, diagnosis, treatment, and prevention of disease and other physical and mental impairments in humans.