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Ramsay Hunt Syndrome — MFDS Part 1 MCQ

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ModerateOral MedicineRamsay Hunt SyndromeMFDS Part 1

A patient presents with severe unilateral otalgia, vesicles in the external auditory canal and an ipsilateral lower motor neurone facial nerve palsy. Reactivation of varicella-zoster virus in which ganglion causes this syndrome?

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Correct answer: EGeniculate ganglion of the facial nerve

The correct answer is **A: the geniculate ganglion of the facial nerve**. The combination of unilateral otalgia, vesicles in the external auditory canal and an ipsilateral lower motor neurone facial palsy is characteristic of Ramsay Hunt syndrome (herpes zoster oticus), caused by reactivation of latent varicella-zoster virus involving the geniculate ganglion of cranial nerve VII. Vestibulocochlear symptoms may occur because cranial nerve VIII lies nearby. The trigeminal ganglion is a site of VZV latency and can produce trigeminal-distribution zoster, but it does not account for the characteristic facial nerve palsy syndrome. The otic and pterygopalatine ganglia are parasympathetic ganglia, while the superior cervical ganglion is sympathetic; none is the defining site in Ramsay Hunt syndrome.

Reference: Jiao S. From zoster to polyneuropathy: manifestations, mechanisms, and differential diagnosis of cranial nerve involvement in Ramsay Hunt Syndrome. Frontiers in Neurology. 2026. https://pubmed.ncbi.nlm.nih.gov/42037679/