AANP Family Nurse Practitioner (FNP) Certification ExamAssessmentEasy
A 16-year-old female presents with a 2-day history of sudden onset of right-sided facial weakness, making it difficult to close her right eye, smile, or raise her right eyebrow. She denies any other neurological symptoms, rash, or fever. Physical examination confirms unilateral facial paralysis involving the forehead. What is the most likely diagnosis?
- ABell's Palsy
- BStroke
- CHerpes Zoster Oticus (Ramsay Hunt Syndrome)
- DLyme Disease
Show answer & explanationAnswer & explanation
Correct answer: A. Bell's Palsy
The sudden onset of unilateral facial paralysis affecting both the upper and lower face (inability to close eye, raise eyebrow, or smile), without other neurological deficits, is characteristic of Bell's Palsy. This distinguishes it from a stroke (which typically spares the forehead) and other causes of facial paralysis.
Why the other options are wrong
- B. A stroke affecting the face would typically spare the forehead muscles (due to bilateral cortical innervation), unlike this patient's presentation.
- C. Ramsay Hunt Syndrome would present with painful vesicular rash in the ear canal or on the ear, which is not mentioned here.
- D. Lyme disease can cause bilateral or relapsing facial palsy, but it's less common as an isolated, acute unilateral presentation without other systemic symptoms in this context.
Bell's Palsy Clinical Features
Bell's Palsy is an acute, idiopathic peripheral facial nerve paralysis characterized by sudden onset of unilateral facial weakness affecting all facial muscles, including the forehead.
- Affects cranial nerve VII (facial nerve).
- Involves both upper and lower face on the affected side.
- Absence of other neurological signs helps rule out central causes like stroke.
Memory trick: Bell's Blight Blocks Both Brow and Bottom.