MBBS OSCE · General Medicine
OSCE — Trigeminal Neuralgia & Bell Palsy
Eight-minute OSCE station on Trigeminal Neuralgia & Bell Palsy: focused history, examination priorities, investigations, emergency and definitive management.
On this page
Study tools
Exam tags
Brief (to candidate)
You will assess a patient with a presentation consistent with Trigeminal Neuralgia & Bell Palsy.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Trigeminal neuralgia (TN, tic douloureux) is severe, paroxysmal, electric-shock-like facial pain in the distribution of the trigeminal nerve (usually V2/V3), lasting seconds and provoked by light touch (washing, eating, cold air). It is usually caused by neurovascular compression of the trigeminal root at the root-entry zone, producing focal demyelination and ephaptic transmission. Carbamazepine is first-line; refractory cases need microvascular decompression (Jannetta), gamma knife or percutaneous procedures. Bell palsy is an acute, unilateral lower motor neurone (LMN) facial nerve (CN VII) palsy of idiopathic (likely viral) cause producing facial asymmetry with forehead involvement, inabil
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Trigeminal neuralgia with sensory loss, young onset (under 40) or bilaterality — |
| Safety | Facial palsy with FOREHEAD SPARING — upper motor neurone lesion (stroke); urgent |
| Safety | Facial palsy with vesicles in the ear or palate — Ramsay Hunt syndrome (herpes z |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.