Neurology: Bell palsy: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Neurology: Bell palsy

Sample item

A 30-year-old man wakes with a drooping right face, cannot close his right eye or wrinkle his right forehead, and notes loss of taste on the anterior tongue and sounds that seem too loud on the right. Limb examination and the ear are normal. What is the most appropriate management?

ASurgical facial nerve decompression within one weekBOral antiviral aloneCUrgent thrombolysisDOral prednisolone started within 72 hours, with eye protection

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Oral prednisolone started within 72 hours, with eye protection

Forehead involvement shows a lower motor neuron lesion, and taste loss with hyperacusis place the lesion in the facial canal, which is typical of Bell palsy. Oral corticosteroids started within 72 hours improve the chance of full recovery, and eye lubrication and taping prevent exposure keratopathy. An upper motor neuron lesion would spare the forehead.

Option by option

A. Surgical facial nerve decompression within one week
Surgery is not indicated for typical Bell palsy.
B. Oral antiviral alone
Antivirals alone do not improve outcomes, and any benefit is only as an adjunct to steroids.
C. Urgent thrombolysis
Thrombolysis is for ischaemic stroke, which spares the forehead and would not cause isolated facial palsy with taste loss.
D. Oral prednisolone started within 72 hours, with eye protection (correct)
Early corticosteroids improve recovery in idiopathic facial palsy and eye care prevents corneal injury.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Oral prednisolone started within 72 hours, with eye protection. Forehead involvement shows a lower motor neuron lesion, and taste loss with hyperacusis place the lesion in the facial canal, which is typical of Bell palsy.

Why is "Surgical facial nerve decompression within one week" not the answer?

Surgery is not indicated for typical Bell palsy.

Why is "Oral antiviral alone" not the answer?

Antivirals alone do not improve outcomes, and any benefit is only as an adjunct to steroids.

Why is "Urgent thrombolysis" not the answer?

Thrombolysis is for ischaemic stroke, which spares the forehead and would not cause isolated facial palsy with taste loss.

What concept does this question test?

It tests Neurology: Bell palsy in General Medicine. Oral corticosteroids started within 72 hours improve the chance of full recovery, and eye lubrication and taping prevent exposure keratopathy. An upper motor neuron lesion would spare the forehead.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neurology: Bell palsy?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.