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, an inability to wrinkle her forehead on the right, and a drooping right corner of her mouth. She denies headache, fever, or trauma. On physical examination, the FNP notes complete paralysis of the muscles of facial expression on the right side. Which of the following is the most likely diagnosis?
- AStroke
- BTrigeminal Neuralgia
- CBell's Palsy
- DRamsay Hunt Syndrome
Show answer & explanationAnswer & explanation
Correct answer: C. Bell's Palsy
The patient's presentation of sudden onset, unilateral facial weakness affecting all branches of the facial nerve (inability to wrinkle forehead, close eye, droop at mouth corner) without other neurological deficits is classic for Bell's Palsy. This is a diagnosis of exclusion, and the absence of vesicles (Ramsay Hunt) or other neurological signs (stroke) helps narrow it down.
Why the other options are wrong
- A. A stroke causing facial weakness would typically spare the forehead wrinkling due to bilateral cortical innervation.
- B. Trigeminal neuralgia causes severe facial pain, not weakness.
- D. Ramsay Hunt Syndrome (herpes zoster oticus) would present with painful vesicles in the ear canal or on the ear, which are not described here.
Bell's Palsy Clinical Features
Bell's Palsy is an acute, idiopathic, unilateral facial paralysis resulting from inflammation or damage to the facial nerve (cranial nerve VII). It affects both the upper and lower face.
- Sudden onset, typically reaching maximum weakness within 48-72 hours.
- Affects all facial muscles on the affected side (cannot wrinkle forehead, close eye, smile).
- Often associated with viral infections (e.g., HSV-1) but is idiopathic.
Memory trick: Bell's: Both Brows and Below are Bad!