Facial Nerve (Anatomy, Disorders, Acoustic Neuroma) MCQs

ENT · 54 free questions with answers & explanations.

1. A patient with Ramsay Hunt syndrome (herpes zoster oticus) presents with vesicular eruption in the concha, complete LMN facial palsy, and severe ipsilateral otalgia. Compared to Bell's palsy, Ramsay Hunt syndrome generally has:
2. The House-Brackmann grading system for facial nerve function classifies a patient with moderate dysfunction — obvious weakness with noticeable but not disfiguring difference between sides, complete eye closure with effort, and slight weakness of mouth movement — as grade:
3. A 45-year-old patient has a 3 cm acoustic neuroma (vestibular schwannoma) in the cerebellopontine angle with useful hearing (speech discrimination score >50%). The surgical approach that best preserves hearing is:
4. A patient with Bell's palsy presenting with complete facial paralysis (House-Brackmann grade VI) after 10 days is being considered for electrophysiological prognostication. Electroneuronography (ENoG) showing >90% degeneration before day 14 correlates with which prognosis?
5. In the surgical anatomy of the facial nerve in the temporal bone, which segment of the facial nerve is LONGEST?
6. A 40-year-old presents with unilateral progressive SNHL, tinnitus, and disequilibrium. MRI shows a 2.5 cm enhancing mass in the cerebellopontine angle (CPA) compressing the brainstem. Gadolinium MRI shows a 'ice-cream on cone' appearance. Which is the most appropriate primary management according to current guidelines?
7. Ramsay Hunt syndrome (herpes zoster oticus) is caused by reactivation of VZV. Which nerve ganglion is primarily affected, and what is the characteristic clinical triad?
8. In Bell's palsy (idiopathic facial nerve palsy), the site of maximum nerve oedema is the:
9. House-Brackmann grading of facial palsy: a patient with obvious facial weakness, asymmetry at rest, moderate to severe forehead dysfunction, with eye closure only possible with effort, is classified as:
10. Acoustic neuroma (vestibular schwannoma) most commonly arises from which division of the vestibulocochlear nerve?
11. The Sunnybrook Facial Grading System (eFACE) and FNGS 2.0 have been developed as improvements over House-Brackmann. However, for small acoustic neuroma surgery (<1.5 cm), the recommended management option that BEST preserves hearing is:
12. A patient with acoustic neuroma undergoes surgery via the retrosigmoid approach. Intraoperatively, the ABR waveform is being monitored. Sudden loss of Wave V amplitude suggests injury to which structure?
13. A 40-year-old presents with unilateral progressive sensorineural hearing loss, tinnitus, and unsteadiness. MRI with gadolinium shows a 1.8 cm mass in the internal auditory canal/CPA with intense enhancement. The superior vestibular nerve is identified as the nerve of origin. This is best classified as:
14. The House-Brackmann (HB) grading system for facial nerve function is standardized. A patient who has near-normal facial function at rest, slight weakness on close inspection with effort, complete eye closure with minimal effort, and slight mouth asymmetry — is classified as:
15. In Bell's palsy, the site of edema and nerve compression is classically at which narrowest segment of the facial canal, and the electrophysiological test that accurately predicts the degree of axonal degeneration within the first 2 weeks of onset is:
16. A 50-year-old presents with hearing loss, tinnitus, and cerebellar symptoms. MRI with gadolinium shows an enhancing lesion at the fundus of the internal auditory canal extending into the cerebellopontine angle. The most common histological origin of acoustic neuroma (vestibular schwannoma) is from which specific cell type and which part of CN VIII?
17. A patient with left-sided facial palsy of LMN type following parotid surgery has complete transection of the main trunk of the facial nerve proximal to the pes anserinus. The expected House-Brackmann grade immediately post-operatively and the recommended timing of nerve repair are:
18. In topognostic testing of facial nerve palsy, a patient has absent stapedial reflex, absent taste to the anterior 2/3 tongue, but normal lacrimation. The lesion is most likely located:
19. A 25-year-old presents with bilateral acoustic neuromas (vestibular schwannomas). Genetic testing confirms a germline mutation. Which tumor suppressor gene is mutated?
20. For a small (<1.5 cm) intracanalicular acoustic neuroma in a 70-year-old with moderate hearing loss and no serviceable hearing, what is the CURRENT recommended management approach?
21. In Bell's palsy, electrodiagnostic testing at 3 days shows 90% degeneration on electroneurography (ENoG). What does this finding indicate regarding prognosis?
22. A patient with complete Bell's palsy undergoes electroneurography (ENoG) at 12 days and shows 92% degeneration. No voluntary motor unit potentials are seen on needle EMG. According to guidelines, what is the significance of this finding regarding surgical decompression?
23. The earliest and most common presenting symptom of a vestibular schwannoma (acoustic neuroma) is:
24. In House-Brackmann grading of facial nerve function, Grade III (moderate dysfunction) is characterised by which combination?
25. A patient undergoes surgery for acoustic neuroma (vestibular schwannoma) via the retrosigmoid approach. Post-operatively, there is normal lacrimation and stapedial reflex, but the patient cannot close the eye and has loss of taste on the anterior two-thirds of the tongue. At which anatomical segment of the facial nerve was the surgical injury most likely?
26. According to the House-Brackmann grading system, Grade IV facial palsy is characterised by:
27. Which surgical approach to acoustic neuroma (vestibular schwannoma) provides NO chance of hearing preservation but offers complete removal of even large tumors with direct visualization of the IAC fundus?
28. A 45-year-old patient develops House-Brackmann Grade IV facial palsy. Electroneuronography (ENoG) at 14 days shows 91% degeneration compared to the normal side. What does this finding most reliably predict, and what is the clinical implication?
29. A 38-year-old female presents with a right-sided unilateral sensorineural hearing loss of gradual onset, tinnitus, and mild unsteadiness. MRI with gadolinium shows a 2.5 cm mass in the internal auditory canal and cerebellopontine angle with intense enhancement. The most likely origin of this tumor is from which cell type?
30. A patient undergoes mastoid surgery and sustains an iatrogenic facial nerve injury. Post-operatively, the nerve monitor shows a 100% degeneration on Electroneuronography (ENoG) on day 10. According to the House-Brackmann scale, the clinical finding that MOST urgently indicates surgical facial nerve decompression is:
31. Acoustic neuroma (vestibular schwannoma) most commonly arises from which part of the vestibulocochlear nerve?
32. A patient presents with right-sided lower motor neuron facial palsy and vesicular eruptions in the right external auditory canal and soft palate. The condition is Ramsay Hunt syndrome. The virus responsible and its site of latency are:
33. A 45-year-old woman presents with unilateral progressive sensorineural hearing loss, tinnitus, and mild unsteadiness. MRI with gadolinium shows a 2.5 cm enhancing mass in the right internal auditory canal extending into the cerebellopontine angle. The most common nerve of origin of an acoustic neuroma (vestibular schwannoma) is:
34. A 45-year-old patient presents with sudden complete unilateral facial palsy, post-auricular pain, and vesicular eruption over the concha and external auditory meatus. Hearing is reduced on the affected side. The diagnosis is Ramsay Hunt syndrome. Which nerve is the reservoir of viral latency, and what is the expected prognosis compared to Bell's palsy?
35. Vestibular schwannoma (acoustic neuroma) most commonly arises from which specific cell population and at which anatomical location within the internal auditory canal?
36. A patient with left Bell's palsy (LMN facial palsy) has preserved forehead movements on the left. This indicates the lesion is:
37. Electroneuroography (ENoG/ENOG) in Bell's palsy measures compound muscle action potential amplitude compared to the normal side. An ENoG showing >90% degeneration within 2 weeks is significant because:
38. A patient develops complete unilateral lower motor neuron facial palsy (House-Brackmann Grade VI) after a parotid surgery. Electrophysiological testing performed on day 3 shows complete electrical excitability of the facial nerve distal to the lesion. What does this finding indicate about the prognosis and nerve injury type?
39. An MRI shows a 2.2 cm acoustic neuroma (vestibular schwannoma) centered at the internal auditory canal with extension into the cerebellopontine angle cistern. The Koos grading for this tumor would be:
40. A patient presents with acoustic neuroma (vestibular schwannoma). Which MRI sequence is the gold standard for its detection, and what does the tumor characteristically appear as?
41. A patient with a 3 cm acoustic neuroma (VS) and serviceable hearing (AAO-HNS Class A/B) on the affected side requests hearing preservation surgery. Which surgical approach provides the best chance of hearing preservation?
42. The chorda tympani nerve, a branch of the facial nerve, exits the petrotympanic fissure and joins the lingual nerve. Which functions does it carry?
43. A patient with a vestibular schwannoma (acoustic neuroma) of 2 cm is found on gadolinium-enhanced MRI. He is 65 years old with mild imbalance and unilateral high-frequency hearing loss. The most appropriate management strategy is:
44. Bell's palsy is treated with prednisolone. The addition of antiviral therapy (acyclovir/valacyclovir) to steroids is supported by evidence because:
45. A patient with acoustic neuroma (vestibular schwannoma) is found to have a 2.5 cm tumour in the cerebellopontine angle with involvement of the internal auditory canal and serviceable hearing (Gardner-Robertson grade I). The most appropriate management strategy is:
46. In Ramsay Hunt syndrome, vesicular eruptions classically occur in the:
47. The site of the facial nerve most vulnerable to injury during parotidectomy is at:
48. A patient with a right-sided acoustic neuroma (vestibular schwannoma) undergoes the Schirmer test, stapedial reflex testing, and taste testing to localize facial nerve involvement. The Schirmer test (lacrimation) is normal but taste on the anterior 2/3 of tongue is impaired. The lesion is located:
49. House-Brackmann grade V facial nerve palsy is characterised by:
50. A 40-year-old presents with sudden unilateral sensorineural hearing loss (60 dB), constant tinnitus, and mild imbalance for 3 months. MRI with gadolinium shows a 2 cm enhancing mass in the right internal auditory canal extending to the cerebellopontine angle. The most common origin of this mass is from which nerve?
51. A patient presents with right-sided lower motor neurone facial palsy, loss of taste over the anterior two-thirds of tongue, and hyperacusis. There is no evidence of vesicular eruption. The lesion is most likely located:
52. The most common cause of unilateral lower motor neurone facial palsy in clinical practice is:
53. House-Brackmann grading system is used to assess:
54. A patient with sudden-onset ipsilateral complete facial palsy, herpetic vesicles in the ear canal and concha, severe otalgia, and ipsilateral sensorineural hearing loss with vertigo is diagnosed with Ramsay Hunt syndrome. The causative organism is: