Welcome, my name is Devine. This is episode 495 of the Devine Intervention Podcasts.

And into these podcasts we're going to be continuing the rapid review series for the USMLE

Step 2 can Step 3 exams. There's going to be series 107. Again these things are pretty

high-yield things. I would highly encourage you to make sure you kind of study them for your

test. Okay, so what if they give you a question about a 26 year old female?

They tell you that she comes to the emergency room because she has noticed over the last 24 hours that she is unable to smile on one side of the face. And you notice that

wow the on physical exam you notice that man one side of the face she can really wrinkle it properly both the forehead and the you know lower part of the face

You know they tell you that she recently visited Boston for a conference or something like that. But what should you be thinking about?

I would hope you're saying Devine, this sounds an awful lot like Bell's palsy. Like, wait, what?

Yeah, Bell's palsy. Now what caused this person's Bell's palsy? Well the thing that caused

this person's bell's palsy is Lyme disease. Lyme disease, right? So you may wonder

Devine why you really focusing on this forehead business? Well this forehead business is actually

pretty high yield to know. Well why is that? Well here's the thing. The thing is when you have

Bell's palsy you have damage to the Cranial 7 nucleus. When you have bells palsy you have damage to the cranial 7 nucleus.

When you have bellspose you have damage to the cranial 7 nucleus.

So since it's a problem in the brainstem, you're going to see a facial muscle weakness

in the upper and lower face. That's a very nice way to

differentiate this from an MCE stroke. Remember when you have an MCE stroke an

MCE stroke is only going to affect the contralateral lower face. I'm going to say that again the

contralateral lower face. Why is that? Well the reasoning behind that is that your

your the upper face has blood supply from both middle cerebral arteries.

It has like collateral supply.

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