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Discussion

How are these 2 patients different?

Yesterday I rounded with the PA. Upon learning that I was a new grad, the PA felt the need to quiz my knowledge. I failed the quiz. But, here is the question:

You have 2 trauma patients.

Patient one has a left facial droop, but can raise both eyebrows.

Patient two has a left facial droop and cannot raise the left eyebrow.

What is the difference between the injuries in these two patients. He told me it has nothing to do with cranial nerves.

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    • Experts

    Think Bells Palsy.

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    Could it be one is facial injury and the other is having a stroke?

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    The patient that can lift both eyebrows is most likely experiencing

    Bell's Palsy.

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    Next time you see him, ask him what the glabella is. :) (see also Shem's classic, The House of God)

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    A stroke victim usually can control the upper half of their face, so the eyebrows could move (patient 1 had a stroke).

    Bell's palsy, which is dysfunction of cranial nerve VII of some sort, the patient can't move any part of one side (like patient 2). It is typically acute, and is thought to be caused by viruses. It typically heals on it's own within a few weeks to months.

    The odd part is, that has A LOT to due with cranial nerves. It also doesn't explain why these are "trauma" patients.

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    Bells Palsy vs. stroke

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    Arrogant PA - trying to make him/herself appear more knowledgeable by "House-ing" a newbie. Crass behavior.

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    Arrogant PA - trying to make him/herself appear more knowledgeable by "House-ing" a newbie. Crass behavior.

    I beg to differ. It's all in the presentation. If he was nice, joking about it it's one thing. If he went out of his way to make the OP feel stupid, "Ugh, I can't believe you don't know that! Nurses! *sigh* *head shake*" it's different. I learned (and continue to learn) a lot of good things this way.

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    • Experts

    A good PA would have gone on to explain why and why not.

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    Maybe he was planning to after giving her a chance to research?

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    One of my favorite attendings had a clinical pearl or fun fact or bit of trivia at the beginning of every day's rounds. It lightened things up and you could learn some interesting things. Take a few minutes to research about a dozen of them and spit it out at the beginning of report or rounds every day and start a new tradition. Have some fun with it.

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