“A male student noticed while shaving one morning that he was unable to move the
ID: 127274 • Letter: #
Question
“A male student noticed while shaving one morning that he was unable to move the left side of his face. He had suffered from influenza-like symptoms the week before this sudden attack. On examination at the doctor’s office he could not wrinkle his forehead on the left side, and could not show his teeth or pucker his lips on that side. Taste sensation was also affected. A test to determine tear secretion showed that secretion on the right side was normal, but the left side produced little fluid. The patient was also experiencing “dry mouth” and loud noises caused him discomfort. He showed no additional signs or symptoms and was in good health otherwise.”
Explain the possible anatomical causes for each of these symptoms.
Identify three differential diagnoses (diseases or conditions that present similar signs and symptoms that could possibly account for the student’s symptoms) with appropriate justifications. Provide the most likely diagnosis based on this analyses.
From an anatomy point of view:
Explain the various treatment options for the presenting symptoms.
Propose a management plan for the most likely diagnosis.
Explain the effects of the management plan for this condition.
Explanation / Answer
1. Bell's palsy :
Symptoms associated with Bell's palsy are:
a. Facial paralysis on one side
b. Decrease tearing, loss of blinking control on the affected side
c. Altered sense of taste
Other conditions for similar symptoms include Lyme disease and stroke.
Treatment options:
1. Steroids are prescribed in treatment of Bell's palsy
2. Corticosteroid mostly Prednisone improve the symptoms in six months
3. Eye protective measures are prescribed for eye treatment mostly who are not able to close eyes.
Management plan for the disease:
Patient reporting for Bell's palsy should be immediately treated for Lyme disease. This is an emergency until it proven differently.
Provide wet tissue to clean face
Provide re- wetting drops to lubricate patient eye
Administration of corticosteroid in order to reduce inflammation.
Advice patient to take rest if they still feel pain
Effects of management plan:
Initial symptoms can be controlled if diagnosis is done fast.
Six months continuation of therapy can lead to better outcomes and reduce inflammation.
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