AANP Family Nurse Practitioner (FNP) Certification ExamAssessmentMedium
A 16-year-old female presents with a 2-day history of sudden onset of right-sided facial weakness. She reports difficulty closing her right eye, drooping of her right mouth, and impaired taste on the right anterior tongue. She denies any other neurological symptoms, fever, or rash. Physical examination confirms complete paralysis of the muscles of facial expression on the right side. Which of the following is the most likely diagnosis?
- AStroke
- BRamsay Hunt syndrome
- CTrigeminal neuralgia
- DBell's Palsy
Show answer & explanationAnswer & explanation
Correct answer: D. Bell's Palsy
The sudden onset of unilateral facial weakness affecting both the upper and lower face, along with impaired taste, is characteristic of Bell's Palsy, an idiopathic facial nerve paralysis. The absence of other neurological symptoms, fever, or rash helps differentiate it from other causes.
Why the other options are wrong
- A. Stroke typically causes contralateral facial weakness that spares the forehead (due to dual innervation), unlike Bell's Palsy.
- B. Ramsay Hunt syndrome (Herpes Zoster Oticus) involves facial paralysis but is accompanied by painful vesicular rash in the ear canal or pharynx, which is absent here.
- C. Trigeminal neuralgia causes severe, lancinating facial pain, not weakness or paralysis.
Bell's Palsy Diagnosis
Clinical diagnosis of acute, idiopathic unilateral facial nerve paralysis, affecting both upper and lower facial muscles.
- Sudden onset, typically maximal within 48-72 hours.
- Involves entire half of the face (forehead included).
- May be associated with altered taste, hyperacusis, or decreased lacrimation.
Memory trick: Bell's Palsy: 'B'oth 'U'pper and 'L'ower face is 'L'ame.