Bell's Palsy

Question 1

Which gender is more commonly affected with Bell’s palsy?

Answer 1

Equal

Question 2

What conditions predispose patients to Bell’s palsy?

Answer 2

• Pregnancy

- DM

Question 3

True or false: Bell’s palsy is a diagnosis of exclusion

Answer 3

True

Question 4

What is the infectious disease that is associated with Bell’s palsy?

Answer 4

Lyme’s disease

Question 5

Is Bell’s palsy generally a slow or gradual onset?

Answer 5

Sudden

Question 6

True or false: there is usually associated ear pathology

Answer 6

False

Question 7

What must be r/o to diagnose Bell’s palsy?

Answer 7

Other signs of CNS pathology

Question 8

What are the supposed etiologies of Bell’s palsy?

Answer 8

• viral
• Nerve ischemia
• Autoimmune

Question 9

What are the viruses associated with Bell’s palsy?

Answer 9

• HSV

- EBV

Question 10

What is the pathophysiology of Bell’s palsy?

Answer 10

Neuropathy

Question 11

What foramen does CN VII come out of?

Answer 11

Stylomastoid foramen

Question 12

What are the branches of CN VII?

Answer 12

• Temporal
• Zygomatic
• Buccal
• Masseter
• Cervical

Question 13

What is the narrowest part of the facial nerve path?

Answer 13

Internal Genu of the internal auditory meatus

Question 14

What is the imaging modality of choice for diagnosing Bell’s palsy (assuming you are not suspecting a brain hemorrhage)?

Answer 14

MRI

Question 15

What is the treatment for Bell’s palsy?

Answer 15

High dose steroids and antivirals

Question 16

What are major sequelae of Bell’s palsy?

Answer 16

• Corneal abrasion
• Alteration of taste
• Synkinesis

Question 17

CN VII provides what part of taste on the tongue?

Answer 17

Anterior 2/3

Question 18

What provides taste to the posterior 1/3 of the tongue?

Answer 18

CN IX

Question 19

True or false: most of the time, Bell’s palsy is a self limited disease

Answer 19

True

Question 20

What is Ramsay Hunt syndrome? What is the classic triad of symptoms?

Answer 20

Reactivation syndrome of herpes zoster in the geniculate ganglion. It has variable presentation which may include a lower motor neuron lesion of the facial nerve, deafness, vertigo, and pain.

-A triad of ipsilateral facial paralysis, ear pain, and vesicles in the auditory canal and auricle is typical for Ramsay Hunt Type II.

Question 21

True or false: full recovery with Ramsay Hunt syndrome is not as likely as Bell’s palsy

Answer 21

True

Question 22

True or false: the s/sx of Ramsay-Hunt syndrome are often more severe than that of Bell’s palsy

Answer 22

True

Question 23

How can you differentiate Bell’s palsy from Ramsay Hunt syndrome?

Answer 23

Vesicles in the ear with Ramsay Hunt syndrome

Question 24

What are acoustic neuromas?

Answer 24

Slow growing, benign tumor of the myelin sheath of the vestibulocochlear nerve

Question 25

Bilateral acoustic neuromas = what disease? What is the gene that is mutated with this?

Answer 25

NF2 | Merlin

Question 26

True or false: most acoustic neuromas are bilateral

Answer 26

False--95% are unilateral

Question 27

What are the s/sx of acoustic neuromas? (4)

Answer 27

- Sudden or gradual hearing loss - New onset tinnitus - New onset vertigo - Facial palsy or pain

Question 28

What is the best screening test for an acoustic neuroma?

Answer 28

Hearing test

Question 29

What is the imaging modality of choice to diagnose acoustic neuromas?

Answer 29

MRI with gadolinium

Question 30

What is the treatment for acoustic neuromas?

Answer 30

Surgery

Question 31

True or false: once hearing loss is had with acoustic neuromas, it is irreversible

Answer 31

True

Question 32

Where do acoustic neuromas usually grow?

Answer 32

- Level of the internal auditory canal | - Cerebellopontine angle

Question 33

How fast (relatively) do acoustic neuromas usually grow?

Answer 33

Slowly

Question 34

What are glomus tumors (paragangliomas)?

Answer 34

Benign neuroendocrine tumor of neural crest cells, that arise in the head/neck/thoracic region.

Question 35

What are the s/sx of glomus tumors?

Answer 35

Pulsatile tinnitus

Question 36

How can you check for a paraganglioma?

Answer 36

Listen to the ear with a stethoscope

Question 37

Recurring facial nerve paralysis is suspicious for what?

Answer 37

Facial nerve neuromas

Question 38

Where are cholesterol granulomas found?

Answer 38

Petrous apex, associated with hemorrhage into air cells

Question 39

Hearing should be above what decibel?

Answer 39

20