325.A 68-year-old woman presents to your ENT clinic because of a small
lump on the right side of her face just anterior to her ear. At first you
thought it might be just an enlarged lymph node, but careful examination
of her ear and scalp doesn’t show any signs of pimples or infections in the
area. The small lump appears to be within the superficial portion of the
parotid salivary gland, anterior to the external ear, yet posterior to the mas-
seter muscle. You perform a needle biopsy of the lump and send it for
pathological assessment. The pathology report comes back as suspicious
for parotid gland cancer (pleomorphic adenoma). You tell your patient that
the tumor needs to be surgically removed and that one of the risk of the
surgical resection is....
a. that she may lose her ability to taste on the right side of her tongue
b. that she may lose her ability to chew on the right side of her month
c. that she may develop right sided facial muscle paralysis
d. that she may lose the ability to move the right side of her tongue
e. that she may develop increased sensitivity to sounds on the right side
326.A 53-year-old woman comes to your office with a hearing problem.
About 2 months ago she first noticed that she did not hear in her left ear as
well as she used to. Within the last 2 weeks she has also had some “ringing”
in her left ear. About a month ago she had a couple of days of dizziness and
felt sick but that seemed to pass. She has had more recent and numerous
headaches, always on the left side. When you perform a complete cranial
nerve exam all cranial nerves are fine except you note a little weakness in
her left facial muscles. You send her for a head MRI because you are con-
cerned about which of the following?
a. she has conductive hearing loss
b. Meniere’s disease
c. acoustic neuroma
d. tic douloureux
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