Mrs. Seema is a 54-year-old woman who is being admitted to the medical ward with trigeminal neuralgia. The nurse anticipates that Mrs. Seema will demonstrate which of the following major complaints?

1. A

   Painless eye spasm

2. B

   Unilateral facial drop

3. C

   Excruciating, intermittent, paroxysmal facial pain

4. D

   Mildly painful unilateral eye twitching

Appeared in: HPSSC - 2015

Explanation

• Trigeminal neuralgia (also known as tic douloureux) is a disorder of the fifth cranial nerve (CN V).
• The classic and major complaint is excruciating, paroxysmal (sudden, intermittent) pain that feels like an electric shock.
• The pain is typically unilateral, affecting the areas supplied by the trigeminal nerve, such as the lips, gums, cheek, or chin.
• Attacks are often set off by specific triggers like chewing, talking, or touching the face.

Why Other Options Were Wrong

• Option A: The pain of trigeminal neuralgia is excruciating, not painless. While muscle twitching can occur due to the pain, the primary symptom is the pain itself.
• Option B: A unilateral facial drop is a hallmark sign of Bell's palsy, which is caused by dysfunction of the facial nerve (CN VII), not the trigeminal nerve (CN V).
• Option D: The pain associated with trigeminal neuralgia is characteristically severe and excruciating, not 'mildly painful'. This option significantly understates the intensity of the pain.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Clinical Manifestations of Trigeminal Neuralgia to guide bedside assessment, documentation, and the next nursing action.
• Nursing care for a patient with trigeminal neuralgia is centered on pain management and preventing trigger-induced attacks.
• Patient education is crucial. Nurses must teach patients to avoid triggers by eating soft, lukewarm foods, using a soft toothbrush, and protecting their face from cold air.
• The first-line medication is typically an anticonvulsant, such as carbamazepine, which helps to calm the hyperactive nerve signals. Nurses must monitor for side effects like dizziness, drowsiness, and bone marrow suppression.

How to Approach the Question

• First, identify the key diagnosis in the question stem: 'trigeminal neuralgia'.
• Second, recall the classic, textbook presentation of this condition. The name itself gives clues: 'neuralgia' means nerve pain.
• Third, analyze the options based on the defining characteristics of the pain. Look for words that describe the intensity (excruciating), pattern (paroxysmal, intermittent), and type (sharp, shooting, electric-like).
• Fourth, eliminate options that describe symptoms of other conditions. Recognize that 'unilateral facial drop' is the key sign of Bell's palsy (affecting CN VII), a common distractor for questions about trigeminal neuralgia (affecting CN V).
• Finally, select the option that most accurately and completely describes the hallmark symptom of trigeminal neuralgia.

Concept Tested & Keywords

• Concept Tested: Clinical Manifestations of Trigeminal Neuralgia
• Stem keywords: trigeminal neuralgia, major complaints
• Lead-in keywords: will demonstrate which
• Clinical cues: 54-year-old woman
• Clinical cues: admitted to the medical ward

Question ID

QWu3yPT1pZDAXMyxYllFvl

Copy ID

Reference Book

E6 Medicine Harrison 22e Part 2 pp. 1455-1457, 1456-1458

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 2 p. 140-142