er 22------interesting one - sami2004

[ArchivalUser]

KING AND ACE, LARCRU....CHECK THIS ONE OUT

A 34-year-old male dentist presents to your office with
a 1-week history of right facial weakness. He states that
he “just woke up this way one morning.” He would have
come in sooner, but he was busy with his practice and he
has felt fine. He has not noticed any other neurologic
symptoms. He denies pain, fever, or upper respiratory
symptoms. He reports being healthy and taking no
medications. On examination, his vital signs are normal.
You note that his right eyebrow sags, as does the
right corner of his mouth. He cannot close the right eye
completely or raise his right eyebrow, and the right
nasolabial fold is less prominent than the left. The
remainder of the neurologic examination is normal.

You tell the patient that you suspect he has Bell palsy.
He asks what causes this problem.
Which of the following is the most likely cause of
this patient’s Bell palsy?

A) Herpes virus.
B) Tick-borne illness.
C) Diabetes.
D) Adenovirus.


Which of the following treatments is MOST
LIKELY to benefit this patient?
A) Acyclovir.
B) Prednisone.
C) Artificial tears and eye patching at night.
D) A and B.
E) None of the above.

The patient can expect which of the following?
A) Complete resolution (~100% likelihood) with
nearly zero risk of recurrence.
B) Likely resolution (>50% likelihood) with nearly
zero risk of recurrence.
C) Likely resolution (>50% likelihood) with ~10%
risk of recurrence.
D) High probability (~95% likelihood) of persistent
paralysis.

[ArchivalUser]

A..........D...........A..

[ArchivalUser]

A
A
A

[ArchivalUser]

Discussion
The correct answer is A. It seems that many cases of
Bell palsy are due to reactivation of herpes simplex
virus. Other viral etiologies have been implicated as
well, including Epstein-Barr virus, CMV, and coxsackievirus.
Although answer B, tick-borne illnesses (eg
Lyme disease), may cause Bell palsy, these represent a
minority of cases. Answer C, diabetes, may put a patient
at increased risk of contracting Bell palsy, but it does
not cause the disease. Answer D is incorrect because
herpes virus is most commonly associated with Bell
palsy. Remember mycoplasma as a cause of Bell palsy.

Discussion
The correct answer is C. In a patient with Bell palsy
and weakness to eye closure, good eye care and protection
from trauma must be employed to prevent
corneal damage (remember that this patient cannot
close his right eye). The evidence for antiviral therapy
is negative; acyclovir likely doesn’t work. There
may be some slight benefit to corticosteroid. Steroids
are most likely to provide a benefit if started within a
few days after the onset of symptoms. Our patient is
1 week out from the onset of symptoms


Discussion
The correct answer is C. Most patients will recover,
but it may take months. Patients with complete paralysis
are more likely to have persistent symptoms,
whereas those with partial paralysis usually recover
more quickly and completely.

[ArchivalUser]

good qn

[ArchivalUser]

Thanks,I really appreciate it.