Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
A 46-year-old Caucasian male presents to your office with a 'funny sensation' on his face that started yesterday. He has no rash, diarrhea, abdominal pain, joint pain or palpitations. His past medical history is insignificant. He works as a computer programmer at a private firm. He smokes one pack of cigarettes daily and consumes 1-2 bottles of beer every evening. He denies any recreational drug use. He has not recently traveled inside or outside the country. He has been sexually active in a monogamous relationship with his wife for the last ten years. Physical examination reveals asymmetry of the face when he frowns, puffs out his cheeks, and smiles. When he attempts to close his eyes, the right eye does not close completely. Which of the following is the best next step in the management of this patient?
A. Prescribe artificial tears, eye glasses, and patch at night.
B. Do Lyme's disease serology.
C. Test for HIV.
D. Do chest x-ray to exclude sarcoidosis.
E. Treat with acyclovir.
Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
yeah,a.. try rest .
Explanation:
The clinical scenario described is consistent with Bell's palsy, which is an idiopathic paresis of the facial nerve. The definitive treatment of this disease is currently controversial because the available clinical trials involving the different regimens are small and typically inconclusive. Corticosteroids are typically prescribed, sometimes in combination with acyclovir, because herpes simplex virus (HSV) is often implicated as the cause of the disease, and the results of one clinical trial suggest that this combination may be beneficial in promoting recovery. Despite all the controversy, rigid eye care remains as an imperative measure in the management of these patients due to the impaired eye closure and decreased lacrimation. If the course of the disease is atypical (there is no improvement in three weeks), or if additional clinical manifestations are observed, exclusion of secondary causes of Bell's palsy should be considered.
(Choice B) Arthralgias or cardiac rhythm abnormalities may suggest Lyme's disease.
(Choice C) HIV-associated Bell's palsy is rare; however, this diagnosis should be considered if the clinical suspicion is high.
(Choice D) Bilateral Bell's palsy may be observed in patients with sarcoidosis.
(Choice E) Acyclovir alone has not been shown to be effective; however, this drug can be empirically prescribed if corticosteroids are contraindicated.
