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Bell's Palsy — UKMLA MCQ

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MediumNeurologyBell's PalsyUKMLAMRCGP AKTPARAMRCEM SBAMRCP Part 1PSA

A 45-year-old man presents with a 2-week history of unilateral facial weakness affecting his forehead, eye closure, and mouth drooping on the left side. He also reports mild earache on the same side just before the weakness started. Examination confirms LMN facial nerve palsy. What is the most appropriate initial management?

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Correct answer: B — Prednisolone

This presentation is typical of Bell's Palsy (idiopathic lower motor neurone facial nerve palsy). NICE CKS recommends offering oral prednisolone (e.g., 50mg daily for 10 days or 60mg for 5 days then tapered) within 72 hours of onset to increase the chance of complete recovery. Antivirals (like acyclovir) are not recommended routinely unless Ramsay Hunt syndrome (herpes zoster oticus) is suspected. Artificial tears are important for eye care if eye closure is incomplete. ENT referral or MRI might be considered if atypical features or no improvement, but initial management is corticosteroids.

Reference: NICE CKS: Bell's palsy