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  #1  
Old 11-19-2012
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Arrow Billy Step 1 Questions # 90

A 33-year-old woman presents to the emergency department complaining of right facial weakness and pain behind her right ear since that morning. Neurologic examination confirms complete paralysis of the right side of her face, decreased taste sensation on the right side of her tongue, and increased sensitivity to loud sounds in her right ear. The rest of her neurologic examination is normal. The patient is given a short course of steroids and her facial weakness improved gradually over the next few weeks. In addition to the symptoms described above, which of the following might this patient also develop?


(A) Decreased sensation over her left cheek
(B) Decreased sensation over her right cheek
(C) Deviation of the uvula and soft palate to the left when the patient is asked to say “Ahh”
(D) Deviation of the uvula and soft palate to the right when the patient is asked to say “Ahh”
(E) Dryness in her left eye
(F) Dryness in her right eye
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Old 11-19-2012
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Thanks for the question billy.

I am going to go with F here. It is my understanding that parasympathetic fibers travel with CN VII to lacrimal glands.
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It's F...I guess
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  #4  
Old 11-19-2012
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FF.. Bells palsy
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(F) Dryness in her right eye
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Old 11-19-2012
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Quote:
Originally Posted by billy View Post
A 33-year-old woman presents to the emergency department complaining of right facial weakness and pain behind her right ear since that morning. Neurologic examination confirms complete paralysis of the right side of her face, decreased taste sensation on the right side of her tongue, and increased sensitivity to loud sounds in her right ear. The rest of her neurologic examination is normal. The patient is given a short course of steroids and her facial weakness improved gradually over the next few weeks. In addition to the symptoms described above, which of the following might this patient also develop?


(A) Decreased sensation over her left cheek
(B) Decreased sensation over her right cheek
(C) Deviation of the uvula and soft palate to the left when the patient is asked to say “Ahh”
(D) Deviation of the uvula and soft palate to the right when the patient is asked to say “Ahh”
(E) Dryness in her left eye
(F) Dryness in her right eye
Facial nerve have parasympathetic innervation to lacrimal gland.
So would go with

(F) Dryness in her right eye

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  #7  
Old 11-19-2012
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Default my answer :)

(F) Dryness in her right eye
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  #8  
Old 11-20-2012
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Correct Answer F is correct

This patient’s history and physical exam findings are consistent with Bell’s palsy, which is an acute peripheral facial nerve palsy of unknown cause. The symptoms seen in this patient can be easily understood if one remembers the different nerve fibers carried by the facial nerve (cranial nerve VII): afferent taste fibers from the anterior two thirds of the ipsilateral tongue (decreased taste sensation), general touch and pain sensory fibers from a small area around the ipsilateral ear (retroauricular pain), and motor fibers to the muscles of facial expression (ipsilateral facial paralysis) and stapedius muscle (increased sensitivity to noise in the ipsilateral ear due to weakness of the stapedius muscle). This patient may also experience dryness in her ipsilateral (right) eye because the facial nerve carries parasympathetic fi bers to the ipsilateral lacrimal gland, which provides lubrication to the eye. In addition, weakness of the facial muscles prevents complete eye closure, exacerbating the eye dryness. Patients with facial nerve paralysis should be given lubricating eye drops and instructed to tape their eye closed at night. While facial nerve paralysis can be caused by head trauma, AIDS, Lyme disease, sarcoidosis, or brain stem lesions, in most cases no cause is discovered and the diagnosis of Bell’s palsy is made.
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