A 45-Year-Old Woman Comes to the Office to Discuss Her

question 113

Multiple Choice

A 45-year-old woman comes to the office to discuss her facial asymmetry.  For the past 6 weeks, the right side of her face has been progressively weakening.  The patient notices there are fewer wrinkles on the right side of her forehead than on the left, and the fold in front of her cheek seems less deep.  Sometimes she has "spasms" of the right side of her face, and her right eye feels "gritty, like there is sand in it."  The patient has no chronic medical conditions and takes no medications.  Vital signs are within normal limits.  On examination, the ears are clear with no lesions.  She is unable to hear a finger rub on the right side.  Extraocular movements are intact; there is edema and erythema of the conjunctiva on the right, and normal conjunctiva on the left.  Pupils are equal and reactive to light.  There is asymmetry between the left and right sides of the face at rest.  When asked to move her face, there is a little movement of right-sided parts of the face, including the forehead.  There is incomplete eye closure of the right eye; the left eye closes fully.  Which of the following is the most appropriate next step in diagnosis?

• A)CT angiography of the head
• B)HIV testing
• C)Lumbar puncture
• D)MRI of the head
• E)No additional testing needed

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Definitions:

IV

Intravenous, a method of delivering medication or fluids directly into a vein.

Ml

Abbreviation for milliliter, a unit of volume in the metric system commonly used in medicine and science.

Culturally Competent Care

Healthcare that is respectful of, and responsive to, the health beliefs, practices, and cultural needs of diverse patients.

Ethnocentrism

Ethnocentrism is the belief in the inherent superiority of one's own ethnic group or culture, often accompanied by a feeling of contempt for other cultures.