a 33-year-old FEMALE comes to your clinic alarmed about sudden \"drooping\" on t
ID: 3517672 • Letter: A
Question
a 33-year-old FEMALE comes to your clinic alarmed about sudden "drooping" on the right side of the face that began this morning. She complains of excessive tearing and drooling on her right side as well.
1. what physical exam and diagnostic tests would be appropriate to gather more information about the patient's condition. how would the results be used to make a diagnosis
2. identify at least 5 possible conditions that may be considered in a differential diagnosis.
3. consider what history would be necessary to collect from the patient.
Explanation / Answer
1 . Things that will be considered are
- presence or absence of light reflex
- presence or absence of corneal reflex
- presence or absence of proper vision
- movement of mandible.
- hearing reflex
- test for facial expression. Like frowning etc.
This is a possible neurological manifestation and hence these data will provide with actual nerves affected. Eye can be tested for various nerves like occulomoter abducens etc. In the same way hearing is tested and other reflexes.
2. Possible causes can be
Bell's palsy
Myesthania gravis
Brain tumor
Stroke
Muscle stretch.
3. Considering the point of history, data should be collected about time since the symptoms. Acute or chronic onset. Whether there was a head injury. Is it associated with pain.
Has this happened earlier. These are few really important questions to be asked and data should be collected.
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