Facial droop with preserved eye closure

Correct answer: A. Cranial nerve VII (facial)

• A. Correct. The FACIAL NERVE (CN VII) supplies all the muscles of facial expression; weakness of these muscles produces the facial droop.
• B. The trigeminal nerve (CN V) is primarily SENSORY to the face and supplies the muscles of MASTICATION — not facial expression. Its lesions cause facial numbness or jaw weakness, not droop.
• C. CN IX supplies taste and sensation to the posterior third of the tongue and motor supply to stylopharyngeus.
• D. CN III controls most extraocular movement and the levator palpebrae; its palsy causes ptosis and a 'down-and-out' eye, not a drooping cheek and mouth.

Note: ⚠️ IMPORTANT NUANCE. PRESERVED eye closure with lower-face droop points to an UPPER MOTOR NEURON (central) lesion — a stroke — because the forehead and orbicularis oculi receive BILATERAL cortical input. A LOWER motor neuron lesion (Bell's palsy, Ramsay Hunt) paralyses the WHOLE side including eye closure. The exam intended CN VII, but this distinction is high-yield and could be the point of the question.

Correct answer: C. Antiviral

• A. Antibacterials have no role in a viral cranial neuropathy.
• B. Antihistamines treat type I hypersensitivity reactions.
• C. Correct. Acute peripheral facial palsy — whether Bell's palsy (HSV-1 reactivation) or Ramsay Hunt syndrome (VZV reactivation) — is treated with an ANTIVIRAL (aciclovir, valaciclovir or famciclovir) COMBINED WITH CORTICOSTEROIDS, started as early as possible, ideally within 72 hours of onset.
• D. Antifungals treat candidiasis and other fungal disease; there is no fungal aetiology here.

Note: Corticosteroids are the treatment with the strongest evidence in Bell's palsy; antivirals are added, and their benefit is clearest in Ramsay Hunt syndrome.

Correct answer: C. Stylomastoid foramen

• A. The jugular foramen transmits cranial nerves IX, X and XI along with the internal jugular vein.
• B. The foramen ovale transmits V3, the mandibular division of the trigeminal nerve.
• C. Correct. The facial nerve enters the internal acoustic meatus, traverses the facial canal in the petrous temporal bone (giving off the greater petrosal nerve, nerve to stapedius and chorda tympani), and EXITS THE SKULL through the STYLOMASTOID FORAMEN before entering the parotid gland and dividing into its five terminal branches.
• D. The foramen rotundum transmits V2, the maxillary division of the trigeminal nerve.

Note: Facial nerve branch mnemonic after the stylomastoid foramen: Temporal, Zygomatic, Buccal, Marginal mandibular, Cervical — 'To Zanzibar By Motor Car'.