Ocular nerve, maxillary nerve, mandibular nerve, buccal nerve and cervical nerve.
B ophthalmic nerve, ototemporal nerve, buccal nerve, mandibular nerve and cervical nerve
C. Ophthalmic branch, maxillary branch, mandibular branch, mandibular marginal branch and cervical branch
Temporal branch, zygomatic branch, buccal branch, mandibular marginal branch and cervical branch.
E. cervical, zygomatic, buccal, submandibular and sublingual branches
2. Bell's facial paralysis can be divided into three stages: acute stage, recovery stage and sequela stage. The following treatments are suitable for acute phase:
A. Application of hormone drugs
B. Strong facial acupuncture
C. facial nerve canal decompression
D. facial nerve anastomosis
E. give electroacupuncture treatment.
A patient, a 45-year-old woman, had a fan blowing straight in her face all morning because of the sultry weather. After a nap, I found that my mouth was leaking when I brushed my teeth, and it was inconvenient to gargle. When I looked in the mirror, I found that the right corner of my mouth was drooping and the left side was skewed upward. The most likely diagnosis is:
A. Right central facial paralysis
B. Left supranuclear facial paralysis
C. right bell palsy
D. Zobel's palsy
E. right hemifacial spasm
4. The onset time of Bell's palsy is only 1 day. At present, the best treatment should be:
A. High-dose glucocorticoid plus aspirin
B. Ten nutritional health products with high dose of glucocorticoid and aspirin (vitamin B 1, vitamin B 12)
C. High-dose glucocorticoid+aspirin+nutritional health products (vitamin B 1, vitamin B 12)+ eye protection.
D. High-dose glucocorticoid+aspirin+neurotrophic drugs (vitamin B 1, vitamin B 12)+ eye protection+strong acupuncture treatment.
E. high-dose glucocorticoid and aspirin plus nutritional drugs (vitamin B 1 and vitamin B 12)+ eye protection+immediate facial nerve canal decompression.
5. The tumors prone to facial paralysis mainly include:
A. mixed tumor
B. mucoepidermoid carcinoma
C. acinar cell carcinoma
D. Adenoid cystic carcinoma
E. adenolymphoma
6. The most effective way to prove whether the knee ganglion is involved in Bell's palsy is:
A. Tear inspection (Schirmer test)
B. Taste test
C. corneal reflex examination
D. Examination of masticatory motor function
E. Auditory examination
Reference answer and analysis
1. Reference answer D. The facial nerve enters the facial nerve canal through the internal auditory canal and passes through the skull through the stylomastoid foramen. Forward through the parotid gland, fan-shaped distribution in facial expression muscles. With the stylomastoid foramen as the boundary, the facial nerve can be divided into facial nerve canal segment and extracranial segment. Extracranial branches: from top to bottom: temporal branch (the branch is damaged and the ipsilateral frontal line disappears), zygomatic branch (the eyelid cannot be closed after injury), buccal branch (the nasolabial groove becomes shallow or disappears after injury, the upper lip movement is weakened or deviated, and the buccal gingival groove accumulates food, etc. ), mandibular marginal branch (injury can lead to sagging and salivation of the affected side) and cervical branch (injury).
2. Reference answer A. Analysis: The acute phase is within 1 ~ 2 weeks after onset. This stage is mainly to control inflammation and edema, improve local blood circulation and reduce nerve compression. At present, glucocorticoid combined with antiviral drugs has the best effect. In addition, vitamin B 1 100mg was given by intramuscular injection, 1 time/day; Vitamin B 12500ug intramuscular injection, 1 time/day. Can do physical therapy, can give stylomastoid foramen ultrashort wave diathermy or infrared radiation. During this period, strong acupuncture and electroacupuncture should not be used to avoid secondary hemifacial spasm. Local hot compress and muscle massage can be given. Patients should be instructed to protect their eyes and prevent exposure conjunctivitis.
3. Reference answer C. Analysis: The typical symptoms of Bell's facial paralysis are: the affected side is drooping and the healthy side is skewed upwards; The upper and lower lips can't be closed tightly because of the paralysis of orbicularis oris muscle, and there are functional obstacles such as water leakage, inability to drum cheeks and blowing. The upper and lower eyelids can not be closed, which leads to the expansion of eyelid fissure, incomplete closure and exposed conjunctiva; When forcibly closed, the eyeball turns outwards and upwards, which is called bell sign; Because you can't close your eyes, you are prone to conjunctivitis. In the lower conjunctival sac, tears often accumulate or overflow.
4. Reference answer C. Analysis: The acute phase is within 1 ~ 2 weeks after onset. This stage is mainly to control inflammation and edema, improve local blood circulation and reduce nerve compression. At present, glucocorticoid combined with antiviral drugs has the best effect. In addition, vitamin B 1 100mg was given by intramuscular injection, 1 time/day; Vitamin B 12500ug intramuscular injection, 1 time/day. Can do physical therapy, can give stylomastoid foramen ultrashort wave diathermy or infrared radiation. During this period, strong acupuncture and electroacupuncture should not be used to avoid secondary hemifacial spasm. Local hot compress and muscle massage can be given. Patients should be instructed to protect their eyes and prevent exposure conjunctivitis.
5. Reference answer D. Analysis: Adenoid cystic carcinoma grows slowly, but it has no capsule and is very aggressive. The infiltration range often exceeds the tumor range seen by the naked eye during surgery. Therefore, it is easy to relapse after operation, and lymphatic metastasis of tumor is rare. Most of them are blood-borne metastasis to the lungs and bones, which occurs in the parotid gland. 1/3 has facial paralysis, orbital bone destruction, and posterior invasion can lead to orbital apex syndrome.
6. Reference answer A. Analysis: The facial nerve sends out the greater petrosal nerve at the geniculate ganglion to control tear secretion, so it is necessary to check the tear secretion function. Schirmer test was used to detect the secretory function of lacrimal gland. With 5mm? Place two 35mm filter papers at the junction of 1/3 and middle 1/3 with drooping eyelids, and check the wet length of the filter papers after closing your eyes for 5 minutes. If it is less than 5mm, the tear secretion is reduced.
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