Ear and audiology: Lyme disease and facial palsy: practice question

A ENT question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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ENT · Ear and audiology: Lyme disease and facial palsy

Sample item

A forest worker has bilateral lower motor neuron facial palsy two weeks after an expanding circular skin rash that followed a tick bite. Which organism is responsible?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Borrelia burgdorferi

Facial palsy, sometimes bilateral, is the commonest cranial neuropathy of Lyme disease and follows the erythema migrans rash from an Ixodes tick bite. Serology confirms it and doxycycline or ceftriaxone treats it. Bilateral palsy should prompt a search for Lyme disease.

Option by option

  • A. Mycobacterium leprae

    Mycobacterium leprae can cause facial weakness from nerve thickening but not after a tick bite with expanding rash.

  • B. Treponema pallidum

    Treponema pallidum causes syphilis with painless chancre and later neurosyphilis, not a tick-borne rash.

  • C. Varicella zoster virus

    Varicella zoster virus causes vesicular Ramsay Hunt syndrome, usually unilateral.

  • D. Borrelia burgdorferi (correct)

    Correct. Borrelia burgdorferi from an Ixodes tick causes erythema migrans followed by facial palsy.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More ENT questions

Questions about this ENT question

What is the answer to this ENT question?

The best answer is D, Borrelia burgdorferi. Facial palsy, sometimes bilateral, is the commonest cranial neuropathy of Lyme disease and follows the erythema migrans rash from an Ixodes tick bite.

Why is "Mycobacterium leprae" not the answer?

Mycobacterium leprae can cause facial weakness from nerve thickening but not after a tick bite with expanding rash.

Why is "Treponema pallidum" not the answer?

Treponema pallidum causes syphilis with painless chancre and later neurosyphilis, not a tick-borne rash.

Why is "Varicella zoster virus" not the answer?

Varicella zoster virus causes vesicular Ramsay Hunt syndrome, usually unilateral.

What concept does this question test?

It tests Ear and audiology: Lyme disease and facial palsy in ENT. Serology confirms it and doxycycline or ceftriaxone treats it. Bilateral palsy should prompt a search for Lyme disease.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Ear and audiology: Lyme disease and facial palsy?

Learn tuning fork results and audiogram patterns by sketching them. Then use the flashcards and the other ENT questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.