Blepharospasm and Hemifacial Spasm — MCQs
Most common cause of facial nerve palsy:
A patient with Bell's palsy comes on day 3. Treatment given to him would be:
A patient presented with gradual loss in night vision and peripheral vision. Based on the fundoscopic image provided, what is the most likely diagnosis?
Bilateral facial nerve palsy is seen in
Match the following: A) Glossopharyngeal nerve B) Spinal accessory nerve C) Facial nerve D) Mandibular nerve 1) Shrugging of shoulder 2) Touch sensation from the posterior one-third of the tongue 3) Chewing 4) Taste from the anterior two-thirds of the tongue
All of the following are true regarding Bell's palsy except:
What is the term for the fusion of the palpebral and bulbar conjunctiva?
Which of the following constitutes the classic triad of Meigs' syndrome?
Senile ptosis is:
What is Euryblepharon?
Blepharospasm and Hemifacial Spasm Indian Medical PG Practice Questions and MCQs
Question 1: Most common cause of facial nerve palsy:
- A. Mastoid surgery
- B. Herpes zoster oticus
- C. Chronic suppurative Otitis media
- D. Idiopathic Bell's palsy (Correct Answer)
Explanation: ***Idiopathic Bell's palsy*** - **Bell's palsy** is the most common cause of **facial nerve palsy**, accounting for approximately 60-75% of cases. - It is an **idiopathic** condition, meaning its exact cause is unknown, although it is often linked to viral infections (e.g., herpes simplex virus). [1] *Mastoid surgery* - **Iatrogenic facial nerve injury** during mastoidectomy is a known complication, but it is a relatively rare cause of facial nerve palsy. - While it can cause significant palsy, the incidence is low compared to Bell's palsy. *Herpes zoster oticus* - This condition, also known as **Ramsay Hunt syndrome**, is a cause of facial nerve palsy associated with a **vesicular rash** (zoster) in the ear canal or on the face. - While it is a significant cause of viral-induced facial palsy, it is less common than idiopathic Bell's palsy. *Chronic suppurative Otitis media* - **Chronic otitis media** can, in rare cases, lead to facial nerve palsy due to persistent inflammation spreading to the facial nerve. [2] - This is a less common etiology than Bell's palsy and would typically present with a history of recurrent ear discharge and hearing loss.
Question 2: A patient with Bell's palsy comes on day 3. Treatment given to him would be:
- A. Oral steroids + Acyclovir
- B. Oral steroids + vitamin B (Correct Answer)
- C. Intratympanic steroids
- D. Vitamin B + vasodilators
Explanation: ***Oral steroids + vitamin B*** - **Oral steroids** are the cornerstone of Bell's palsy treatment, especially when initiated within **72 hours** of symptom onset, to reduce inflammation and swelling of the facial nerve [1]. - While **vitamin B** (particularly B12) is often co-administered for its neurotrophic properties, its specific benefit in Bell's palsy is not as strongly evidence-based as steroids, but it may aid in nerve regeneration and recovery. *Oral steroids + Acyclovir* - **Acyclovir** (or other antiviral agents) is sometimes used in Bell's palsy, but primarily when there's suspicion of a **viral etiology** like herpes simplex virus (e.g., in Ramsay Hunt syndrome), which is not explicitly stated here. Antiviral drugs are generally not considered effective for standard idiopathic Bell's palsy [1]. - Antivirals provide minimal additional benefit when given alongside steroids for idiopathic Bell's palsy unless there are specific indications. *Intratympanic steroids* - **Intratympanic steroids** are typically reserved for conditions like **sudden sensorineural hearing loss** or Meniere's disease, where local anti-inflammatory effects in the inner ear are desired. - This route of administration is not the standard treatment for systemic impact on the facial nerve in Bell's palsy. *Vitamin B + vasodilators* - While **vitamin B** may support nerve health, there is no strong evidence to support the use of **vasodilators** in the treatment of Bell's palsy. - The pathophysiology of Bell's palsy is primarily inflammatory, not related to vascular insufficiency that would be amenable to vasodilators.
Question 3: A patient presented with gradual loss in night vision and peripheral vision. Based on the fundoscopic image provided, what is the most likely diagnosis?
- A. Retinitis pigmentosa (Correct Answer)
- B. Retinal hemorrhage
- C. Fundus albipunctatus
- D. Fundus flavimaculatus
Explanation: ***Retinitis pigmentosa*** - The fundoscopic image exhibits **bone spicule-like pigment deposits** in the periphery, **attenuation of retinal vessels**, and a **waxy pallor of the optic disc**, which are characteristic signs of retinitis pigmentosa. The clinical presentation of gradual loss in **night vision (nyctalopia)** and **peripheral vision** (tunnel vision) is classic for this inherited retinal dystrophy, as it primarily affects the **rod photoreceptors** first. *Retinal hemorrhage* - Retinal hemorrhages appear as **red blotches or streaks** on the fundus and are usually associated with conditions like **hypertension**, **diabetes**, or **retinal vein occlusion**. This image does not show acute red hemorrhages, but rather **dark, aggregated pigment**, and the symptoms do not align with sudden vision changes often seen in acute hemorrhages. *Fundus albipunctatus* - This condition is characterized by numerous **small, discrete, white or yellowish dots** scattered throughout the retina, usually sparing the macula. While it can cause night blindness, the fundoscopic image here shows **bone spicule pigmentation** and **vascular attenuation**, not the widespread white dots typical of fundus albipunctatus. *Fundus flavimaculatus* - This refers to Stargardt disease or fundus flavimaculatus, which presents with **yellowish flecks** (pisiform or fish-tail shaped) scattered in the posterior pole and mid-periphery, along with **macular degeneration**. The image does not show these distinct yellow flecks or evident macular changes, and the pigmentary changes are more consistent with retinitis pigmentosa.
Question 4: Bilateral facial nerve palsy is seen in
- A. Melkersen Rosenthal syndrome
- B. Ramsay Hunt syndrome
- C. Guillain Barre syndrome (Correct Answer)
- D. Herpes zoster
Explanation: Guillain Barre syndrome - Guillain-Barré syndrome (GBS) is an acute, rapidly progressive, acquired demyelinating polyneuropathy that can classically present with bilateral facial nerve palsy [1]. - This is due to the widespread nature of the demyelination affecting peripheral nerves, including the facial nerves. Melkersen Rosenthal syndrome - This syndrome is characterized by a triad of recurrent facial paralysis, persistent orofacial swelling (e.g., cheilitis granulomatosa), and a fissured tongue. - While it causes facial nerve palsy, it is typically unilateral and recurrent, though it can occasionally be bilateral. Ramsay Hunt syndrome - This syndrome is caused by the reactivation of the varicella-zoster virus in the geniculate ganglion, leading to herpes zoster oticus. - It presents with unilateral facial paralysis, often accompanied by painful vesicular rash in the external auditory canal or on the auricle, hearing loss, and vertigo [2]. Herpes zoster - Herpes zoster (shingles) is a viral infection caused by the reactivation of the varicella-zoster virus, primarily affecting dermatomes. - While it can cause facial palsy (if it affects the geniculate ganglion, leading to Ramsay Hunt Syndrome), it is generally unilateral and not typically associated with bilateral facial nerve palsy [2].
Question 5: Match the following: A) Glossopharyngeal nerve B) Spinal accessory nerve C) Facial nerve D) Mandibular nerve 1) Shrugging of shoulder 2) Touch sensation from the posterior one-third of the tongue 3) Chewing 4) Taste from the anterior two-thirds of the tongue
- A. A-3 , B-1 , C-4 , D-2
- B. A-2 , B-3 , C-4 , D-1
- C. A-4 , B-1 , C-2 , D-3
- D. A-2 , B-1 , C-4 , D-3 (Correct Answer)
Explanation: ***A-2 , B-1 , C-4 , D-3*** - **A) Glossopharyngeal nerve (CN IX)** is responsible for **general sensation and taste from the posterior one-third of the tongue** [1]. (2). - **B) Spinal Accessory nerve (CN XI)** innervates the **sternocleidomastoid** and **trapezius muscles**, which are involved in shrugging the shoulders (1). - **C) Facial nerve (CN VII)** carries **taste sensation from the anterior two-thirds of the tongue** [1] (4) via the chorda tympani. - **D) Mandibular nerve (V3)**, a branch of the trigeminal nerve, innervates the muscles of mastication, enabling **chewing** (3). *A-3 , B-1 , C-4 , D-2* - This option incorrectly associates the **glossopharyngeal nerve** with chewing, which is a function of the mandibular nerve (V3). - It also incorrectly associates the **mandibular nerve** with touch sensation from the posterior one-third of the tongue, which is a function of the glossopharyngeal nerve [1]. *A-2 , B-3 , C-4 , D-1* - This option incorrectly links the **spinal accessory nerve** with chewing; this nerve primarily controls shoulder and neck movements. - It also incorrectly assigns shrugging of the shoulder to the **mandibular nerve** instead of the spinal accessory nerve. *A-4 , B-1 , C-2 , D-3* - This choice incorrectly attributes **taste from the anterior two-thirds of the tongue** to the glossopharyngeal nerve, which supplies the posterior one-third [1]. - It also incorrectly links **touch sensation from the posterior one-third of the tongue** to the facial nerve, which is involved in taste from the anterior two-thirds [1].
Question 6: All of the following are true regarding Bell's palsy except:
- A. Unilateral facial weakness
- B. Steroids are the treatment of choice
- C. Immediate nerve decompression is required (Correct Answer)
- D. Herpes simplex virus is commonly implicated
Explanation: ***Immediate nerve decompression is required*** - **Bell's palsy** is typically managed with medical therapy, primarily **steroids**, to reduce inflammation and promote recovery. - **Surgical decompression** of the facial nerve is rarely indicated and is not a standard or immediate treatment. *Unilateral facial weakness* - This is the **hallmark symptom** of Bell's palsy, affecting one side of the face. - Patients experience difficulty with facial expressions, eye closure, and oral competence [1]. *Steroids are the treatment of choice* - **Corticosteroids**, such as prednisone, are the primary treatment to reduce inflammation of the **facial nerve (cranial nerve VII)** [1]. - Early initiation of steroids significantly improves the chances of full recovery [1]. *Herpes simplex virus is commonly implicated* - **Reactivation of HSV-1** is thought to be a major underlying cause, leading to inflammation and swelling of the facial nerve. - Other viruses, such as **varicella-zoster virus (VZV)**, can also cause facial paralysis (Ramsay Hunt syndrome), which is clinically distinct.
Question 7: What is the term for the fusion of the palpebral and bulbar conjunctiva?
- A. Trichiasis (inward growth of eyelashes)
- B. Ectropion (outward turning of eyelid)
- C. Symblepharon (Correct Answer)
- D. Tylosis (thickening of skin on palms and soles)
Explanation: ***Symblepharon*** - **Symblepharon** is the term for the adhesion between the **palpebral conjunctiva** (lining the eyelid) and the **bulbar conjunctiva** (covering the eyeball). - This condition can limit eye movement and cause chronic irritation, often resulting from severe conjunctival inflammation or injury. *Trichiasis (inward growth of eyelashes)* - **Trichiasis** refers to the misdirection of eyelashes such that they rub against the cornea or conjunctiva. - It causes irritation, foreign body sensation, and can lead to corneal abrasion, but it does not involve fusion of conjunctival layers. *Ectropion (outward turning of eyelid)* - **Ectropion** is a condition where the lower eyelid turns outward or sags away from the eyeball. - This exposes the conjunctiva, causing dryness, irritation, and epiphora (excessive tearing), but it is not a fusion of conjunctival tissues. *Tylosis (thickening of skin on palms and soles)* - **Tylosis** is a medical term referring to diffuse **hyperkeratosis** or thickening of the skin, typically observed on the palms and soles. - This condition is completely unrelated to the conjunctiva or eye structures.
Question 8: Which of the following constitutes the classic triad of Meigs' syndrome?
- A. Hydrothorax alone
- B. Ascites alone
- C. Benign ovarian fibroma
- D. Benign ovarian fibroma, ascites, and hydrothorax (Correct Answer)
Explanation: ***Benign ovarian fibroma, ascites, and hydrothorax*** - **Meigs' syndrome** is defined by the classical triad of a **benign ovarian fibroma** (or fibroma-like tumor such as thecoma or granulosa cell tumor), **ascites** (fluid accumulation in the abdominal cavity), and **hydrothorax** (pleural effusion, usually right-sided) - All three components must be present for the diagnosis of Meigs' syndrome - The hallmark feature is complete resolution of ascites and hydrothorax after surgical removal of the ovarian tumor - This distinguishes it from malignant processes or other causes of effusions *Benign ovarian fibroma* - A benign ovarian fibroma alone is insufficient to diagnose Meigs' syndrome - The syndrome requires the presence of both ascites and hydrothorax in addition to the tumor - Many ovarian fibromas exist without associated fluid collections *Ascites alone* - Ascites is only one component of the triad and cannot diagnose Meigs' syndrome by itself - Numerous conditions cause ascites including cirrhosis, malignancy, heart failure, and nephrotic syndrome - The specific combination with ovarian fibroma and hydrothorax is what defines Meigs' syndrome *Hydrothorax alone* - Hydrothorax (pleural effusion) alone is insufficient for diagnosis - Although typically right-sided in Meigs' syndrome, isolated pleural effusion has many other causes - Must be accompanied by both ovarian fibroma and ascites to constitute Meigs' syndrome
Question 9: Senile ptosis is:
- A. Neurogenic
- B. Myogenic
- C. Aponeurotic (Correct Answer)
- D. Mechanical
Explanation: **Explanation:** **Senile ptosis** (also known as Involutional ptosis) is the most common form of acquired ptosis in the elderly. **Why Aponeurotic is correct:** The primary pathology in senile ptosis is the **disinsertion, dehiscence, or stretching of the Levator Palpebrae Superioris (LPS) aponeurosis** from its attachment to the tarsal plate. This occurs due to age-related degenerative changes. Characteristically, these patients present with a **high or absent upper eyelid crease** and good levator function, as the muscle itself is healthy, but its "tendon" (aponeurosis) has slipped. **Why other options are incorrect:** * **Neurogenic:** Caused by nerve defects, such as 3rd Nerve Palsy or Horner’s Syndrome. Senile ptosis does not involve nerve dysfunction. * **Myogenic:** Caused by primary muscle disorders (e.g., Myasthenia Gravis or Myotonic Dystrophy). In senile ptosis, the LPS muscle fibers are typically normal. * **Mechanical:** Caused by the weight of a mass (tumor, edema, or chalazion) pulling the lid down. Senile ptosis is due to structural laxity, not added weight. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Sign:** A "high skin crease" is the hallmark of aponeurotic ptosis. * **Thinning of the lid:** The eyelid may appear thin, sometimes allowing the iris to be visible through the skin (due to LPS dehiscence). * **Surgical Management:** The treatment of choice is **LPS Aponeurosis advancement or repair**. * **Differential:** If ptosis is associated with miosis, think Horner’s; if associated with ocular motility issues, think 3rd Nerve Palsy.
Question 10: What is Euryblepharon?
- A. A full-thickness triangular gap in the tissue of the eyelids.
- B. Unilateral or bilateral horizontal widening of the palpebral fissure. (Correct Answer)
- C. Small eyelids.
- D. Failure of the eyelid to develop.
Explanation: **Explanation:** **Euryblepharon** is a rare congenital anomaly characterized by a **horizontal widening of the palpebral fissure**, typically associated with a vertical shortening of the eyelids. 1. **Why Option B is Correct:** The primary defect in euryblepharon is the lateral displacement of the lateral canthus and an enlargement of the eyelid opening. This results in a characteristic "drooping" of the outer half of the lower lid, leading to increased scleral show and potential lagophthalmos (inability to close the eyes completely). It can be unilateral but is more commonly bilateral and symmetrical. 2. **Why Other Options are Incorrect:** * **Option A (Coloboma):** A full-thickness triangular gap in the eyelid is known as an **Eyelid Coloboma**. It most commonly affects the medial third of the upper lid. * **Option C (Microblepharon):** Small eyelids are termed **Microblepharon**. This is a vertical deficiency where the lids are too short to cover the globe. * **Option D (Ablepharon):** The complete failure of the eyelid to develop is called **Ablepharon**. It is often seen in Ablepharon-Macrostomia Syndrome. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Patients often present with epiphora (tearing) and exposure keratopathy due to the malposition of the lids. * **Associations:** It is frequently associated with **lateral canthal dystopia** and **ectropion**. * **Management:** Mild cases require lubricants; severe cases require surgical correction via lateral canthoplasty or skin grafting to address the vertical skin deficiency.
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