Adult-Gerontology Clinical Nurse Specialist (CNS) Practice Exam

A patient reports "electric-like shock" pain on her left facial side, occurring during meals. What is the most likely diagnosis?

1. Bells palsy

2. Trigeminal neuralgia

3. Migraine headache

4. Herpes zoster neuralgia

The correct answer is: Trigeminal neuralgia

The presentation of "electric-like shock" pain on the facial side during meals is characteristic of trigeminal neuralgia, making it the most likely diagnosis in this case. Trigeminal neuralgia is known for causing sudden and severe facial pain that is often triggered by routine activities, such as chewing, speaking, or even light touch. This intense pain occurs along the distribution of the trigeminal nerve, which is responsible for sensation in the face. The phrase "electric-like shock" accurately describes the quality of pain experienced in trigeminal neuralgia, which can feel sharp and sudden. In contrast, Bell's palsy typically presents with facial drooping and weakness, affecting muscle control on one side of the face, rather than episodic pain. Migraine headaches usually involve bilateral pain and may be accompanied by other neurological symptoms, making them less likely in this context. Herpes zoster neuralgia is associated with a history of shingles, presenting with rash and chronic pain, whereas the symptoms described point more specifically toward trigeminal neuralgia without additional findings related to herpes zoster infection. Therefore, the characteristics of the patient's pain align most closely with trigeminal neuralgia as the primary diagnosis.