Dental MCQ
Symptom localization · Head & Neck · INBDE Patient Cases

Cranial Nerves INBDE Patient Cases

By Dr. Isaac Sun, DDS

12 ADA INBDE-format patient cases on cranial nerves. Each case is a shared patient box (chief complaint, history, medications, allergies, exam) followed by linked multiple-choice questions with full distractor explanations. Practice the way the real exam is structured.

12 patient cases60 linked questionsADA INBDE formatFull distractor explanations

Twelve ADA INBDE-format patient cases on the trigeminal nerve, facial nerve, vestibulocochlear nerve, glossopharyngeal nerve, vagus nerve, oculomotor nerve, and hypoglossal nerve. Topics include facial droop after an IAN block, Ramsay Hunt syndrome, Frey's syndrome after parotid surgery, trigeminal neuralgia versus a cracked tooth, lingual nerve paresthesia after third molar extraction, numb chin syndrome from metastatic cancer, pupil-sparing oculomotor palsy in a diabetic, cavernous sinus thrombosis from an odontogenic infection, vestibular schwannoma, glossopharyngeal neuralgia, uvula deviation in a hoarse smoker, and tongue deviation found on a routine oral cancer screen.

Case Coverage Map
What each case is testing
Facial droop after IAN block:
CN VII, parotid diffusion, eye protection.
Ear pain with ear canal vesicles:
Ramsay Hunt syndrome (CN VII + VIII), antivirals plus steroids.
Sweating cheek after parotid surgery:
Frey's syndrome, aberrant parasympathetic regeneration via the auriculotemporal nerve (CN IX → V3).
Electric jaw pain:
CN V2, trigeminal neuralgia versus cracked tooth.
Tongue numbness after wisdom tooth extraction:
Lingual nerve (V3) and chorda tympani (CN VII) injury.
Spreading lower lip and chin numbness:
Numb chin syndrome, mental nerve (V3), metastatic referral.
Drooping eyelid and double vision:
CN III, pupil-sparing versus aneurysm concern.
Facial swelling, proptosis, diplopia from a maxillary abscess:
Cavernous sinus thrombosis (CN III, IV, V1, V2, VI), odontogenic emergency.
Unilateral hearing loss with diminished corneal reflex:
Vestibular schwannoma (CN VIII, then CN V at the cerebellopontine angle).
Electric throat and ear pain triggered by swallowing:
Glossopharyngeal neuralgia (CN IX), vagal syncope link.
Hoarse smoker with uvula deviation:
CN X, ENT/cancer referral.
Tongue deviation:
CN XII, LMN lesion, skull base/brainstem concern.
Patient case: Facial droop after an IAN block
0 of 5 answered, 0 correct
Patient
Male, 42 years old
Chief Complaint
"I just got numbed for my extraction and now the right side of my face is drooping and my eye won't close."
Background and/or Patient History
  • Hypertension, controlled
  • Presented for extraction of tooth #30
  • IAN block placed with 2% lidocaine and 1:100,000 epinephrine
  • Right-sided facial weakness within 5 minutes of injection
  • Unable to fully close the right eye
Allergies
NKDA
Medications
  • Lisinopril 10 mg daily
Dental History
  • Routine 6-month cleanings
  • No prior LA reactions
Current Findings
  • Vitals stable
  • Profound mandibular anesthesia
  • Right-sided weakness of forehead, eye closure, and lower face
  • No vesicles in the ear canal
  1. Question 1
    Easy
    The most likely cause of this patient's facial droop is:
  2. Question 2
    Moderate
    Appropriate immediate management is:
  3. Question 3
    Easy
    Expected timeline for resolution is:
  4. Question 4
    Hard
    If the droop began the day before, spared the forehead, and came with slurred speech, the most likely cause would be:
  5. Question 5
    Hard
    To reduce risk on the next IAN attempt, the key technique change is to:

Reset this case?

This clears your answers for this patient case only.

Patient case: Ear pain and facial weakness with ear canal vesicles
0 of 5 answered, 0 correct
Patient
Male, 58 years old
Chief Complaint
"I've had pain deep in my right ear for three days, my hearing feels off, and this morning the right side of my face wouldn't move."
Background and/or Patient History
  • Rheumatoid arthritis on chronic low-dose prednisone
  • Three days of severe right-sided ear pain
  • Woke up today with right facial weakness
  • Reports vertigo and ringing in the right ear
  • Sound seems unusually loud on the right
Allergies
NKDA
Medications
  • Prednisone 10 mg daily
  • Methotrexate weekly
Dental History
  • Regular maintenance
  • No recent dental procedures
Current Findings
  • Vesicular rash inside the right external auditory canal
  • Right peripheral CN VII palsy involving the forehead
  • Unable to close the right eye fully
  • Decreased hearing on the right
  • Mild horizontal nystagmus
  1. Question 1
    Moderate
    The most likely diagnosis is:
  2. Question 2
    Moderate
    Vertigo and hearing loss occur in Ramsay Hunt because:
  3. Question 3
    Moderate
    First-line treatment, started ideally within 72 hours, is:
  4. Question 4
    Moderate
    Compared with Bell's palsy, the prognosis for Ramsay Hunt is:
  5. Question 5
    Easy
    Because the patient cannot close the right eye, the most important immediate dental counseling is to:

Reset this case?

This clears your answers for this patient case only.

Patient case: Sweating and flushing of the cheek with meals after parotid surgery
0 of 5 answered, 0 correct
Patient
Female, 47 years old
Chief Complaint
"Ever since my parotid surgery last year, my right cheek gets sweaty and bright red whenever I eat."
Background and/or Patient History
  • Superficial parotidectomy 10 months ago for a benign pleomorphic adenoma
  • Surgical site healed without infection
  • Symptoms began roughly 5 months post-op and have worsened
  • Triggered by chewing or anticipating tasty food
  • Socially embarrassing; no pain
Allergies
NKDA
Medications
  • None
Dental History
  • Routine 6-month recalls
  • Crown on tooth #14 placed years ago
Current Findings
  • Pre-auricular surgical scar, well healed
  • Visible flushing and beads of sweat on the right cheek during a citrus stimulus test
  • Minor's iodine-starch test positive over the surgical field
  • Cranial nerves otherwise intact
  1. Question 1
    Moderate
    The most likely diagnosis is:
  2. Question 2
    Hard
    The mechanism of Frey's syndrome is best described as:
  3. Question 3
    Hard
    The parasympathetic fibers misdirected in Frey's syndrome originate from:
  4. Question 4
    Moderate
    First-line conservative treatment is:
  5. Question 5
    Moderate
    If the same patient later develops new ipsilateral facial weakness after a parotid abscess, the structure most likely involved is:

Reset this case?

This clears your answers for this patient case only.

Patient case: Electric jaw pain mimicking a cracked tooth
0 of 5 answered, 0 correct
Patient
Female, 58 years old
Chief Complaint
"I keep getting horrible electric-shock pains in my upper right jaw when I chew, brush my teeth, or feel a cold breeze. I think I cracked a tooth."
Background and/or Patient History
  • Hypertension
  • Type 2 diabetes (HbA1c 7.1)
  • Brief, stabbing right-midface pain for 3 months
  • Triggered by chewing, light touch to the cheek, brushing, and cold air
  • Pain-free between attacks
  • No spontaneous pain or swelling
Allergies
Sulfa drugs (rash)
Medications
  • Metformin
  • Lisinopril
Dental History
  • Regular maintenance
  • Last cleaning 8 months ago
Current Findings
  • Teeth #2 through #5: percussion negative, pulp testing normal
  • No caries on bitewings, periodontium healthy
  • Light touch in the right V2 distribution reproduces the pain
  • No vesicles
  • Neuro exam otherwise normal
  1. Question 1
    Easy
    The most likely diagnosis is:
  2. Question 2
    Moderate
    The maxillary nerve (V2) exits the skull through the:
  3. Question 3
    Moderate
    First-line medical therapy is:
  4. Question 4
    Moderate
    Before extraction on a patient newly started on carbamazepine, the key lab to review is:
  5. Question 5
    Hard
    If the same patient instead had constant dull ache with developing lower-lip and chin numbness, the urgent concern is:

Reset this case?

This clears your answers for this patient case only.

Patient case: Tongue numbness and altered taste after wisdom tooth extraction
0 of 5 answered, 0 correct
Patient
Female, 24 years old
Chief Complaint
"The right side of my tongue has been numb since my wisdom teeth came out four weeks ago, and food tastes weird on that side."
Background and/or Patient History
  • Surgical extraction of partially bony-impacted tooth #32 four weeks ago
  • Surgery described as difficult with extended lingual flap retraction
  • Numbness and altered taste noticed immediately on waking from sedation
  • Some tingling has returned but a dull numbness persists
  • No infection, no swelling
Allergies
NKDA
Medications
  • Oral contraceptive
Dental History
  • Routine recalls
  • First surgical extractions were #32 and #17
Current Findings
  • Extraction socket healed, no swelling or purulence
  • Decreased two-point discrimination on the right anterior 2/3 of the tongue
  • Altered taste perception (sweet and salt) on the same side
  • General sensation of the right lower lip and chin is intact
  • Right tongue moves normally
  1. Question 1
    Easy
    The nerve most likely injured is:
  2. Question 2
    Moderate
    The altered taste sensation on the affected side is explained by:
  3. Question 3
    Moderate
    The intraoperative step most commonly associated with lingual nerve injury during a third molar extraction is:
  4. Question 4
    Moderate
    The most appropriate action at this visit is to:
  5. Question 5
    Moderate
    A reasonable guide to prognosis is:

Reset this case?

This clears your answers for this patient case only.

Patient case: Spreading lower lip and chin numbness in a breast cancer survivor
0 of 5 answered, 0 correct
Patient
Female, 54 years old
Chief Complaint
"My lower lip and chin on the left side have been going numb over the past three weeks. I haven't had any dental work."
Background and/or Patient History
  • Stage II ER-positive breast cancer 4 years ago
  • Treated with lumpectomy, radiation, and tamoxifen
  • No surveillance imaging in the past 18 months
  • No dental procedures, no trauma, no infection
  • Numbness has expanded gradually and is now constant
Allergies
Codeine (nausea)
Medications
  • Tamoxifen
Dental History
  • Regular maintenance
  • Tooth #19 root canal 6 years ago, asymptomatic
Current Findings
  • Dense numbness in the left lower lip and chin (mental nerve distribution)
  • No facial weakness, no oral lesions
  • Tooth #19 percussion negative, normal pulp tests on adjacent teeth
  • Subtle ill-defined radiolucency near the left mandibular body on the panoramic radiograph
  • No palpable cervical lymphadenopathy
  1. Question 1
    Moderate
    The most concerning diagnosis here is:
  2. Question 2
    Easy
    The mental nerve is a terminal branch of:
  3. Question 3
    Moderate
    The most appropriate next step is to:
  4. Question 4
    Hard
    The malignancies most commonly responsible for numb chin syndrome in adults are:
  5. Question 5
    Moderate
    Imaging confirms a metastatic deposit at the apex of tooth #19. The correct dental plan is:

Reset this case?

This clears your answers for this patient case only.

Patient case: Drooping eyelid and double vision in a diabetic
0 of 5 answered, 0 correct
Patient
Male, 67 years old
Chief Complaint
"I'm here for my crown prep, but my right eyelid started drooping yesterday and I'm seeing double. Should I be worried?"
Background and/or Patient History
  • Type 2 diabetes (HbA1c 8.4)
  • Hyperlipidemia
  • Hypertension
  • Presented for crown prep on tooth #14
  • New-onset right ptosis and binocular diplopia since yesterday morning
  • No headache or orbital pain
Allergies
NKDA
Medications
  • Metformin
  • Atorvastatin
  • Amlodipine
  • Low-dose aspirin
Dental History
  • Routine maintenance
  • Crown indicated for fractured cusp
Current Findings
  • BP 148/86
  • Right eye ptosed and deviated down and out
  • Pupil normal size, briskly reactive bilaterally
  • Left eye normal
  • No facial droop
  • No other neuro deficits
  1. Question 1
    Easy
    The cranial nerve involved is:
  2. Question 2
    Moderate
    The parasympathetic pupillary fibers of CN III travel:
  3. Question 3
    Hard
    Pupil-sparing here most strongly suggests:
  4. Question 4
    Moderate
    The most appropriate immediate action is to:
  5. Question 5
    Hard
    If the right pupil were dilated and sluggish instead, the priority next step is:

Reset this case?

This clears your answers for this patient case only.

Patient case: Facial swelling, proptosis, and diplopia from a maxillary abscess
0 of 5 answered, 0 correct
Patient
Female, 38 years old
Chief Complaint
"My face has been swelling for a week from a tooth on the top, and now my eye is bulging and I'm seeing double."
Background and/or Patient History
  • Untreated maxillary abscess on tooth #14 for 10 days
  • Initial cheek swelling progressed to the periorbital area
  • New onset of double vision and drooping right upper eyelid today
  • Fever and chills since yesterday
  • Did not take antibiotics or see a dentist sooner
Allergies
NKDA
Medications
  • Ibuprofen as needed
Dental History
  • Has not seen a dentist in 5 years
  • Multiple untreated carious lesions
Current Findings
  • Temperature 39.1 C, heart rate 118
  • Right periorbital edema with proptosis
  • Right ptosis, dilated pupil, limited extraocular movements
  • Numbness over the right forehead and cheek (V1 and V2)
  • Carious, percussion-tender tooth #14 with buccal vestibular swelling
  1. Question 1
    Moderate
    The most likely diagnosis is:
  2. Question 2
    Moderate
    Cranial nerves that traverse the cavernous sinus are:
  3. Question 3
    Hard
    The anatomic route from a maxillary tooth infection to the cavernous sinus is best described as:
  4. Question 4
    Easy
    Immediate management requires:
  5. Question 5
    Hard
    Without treatment, cavernous sinus thrombosis carries a mortality of:

Reset this case?

This clears your answers for this patient case only.

Patient case: Hearing loss and a blunted corneal reflex found at a dental recall
0 of 5 answered, 0 correct
Patient
Male, 52 years old
Chief Complaint
"I'm just here for my cleaning, but since you asked, my right ear has slowly lost hearing over six months and rings constantly."
Background and/or Patient History
  • Presented for a routine recall and cleaning
  • Mentioned 6 months of progressive right-sided hearing loss and constant tinnitus
  • Occasional unsteadiness, no true rotatory vertigo
  • No ear pain, no prior ear infections
  • Otherwise healthy, no family history of neurofibromatosis
Allergies
NKDA
Medications
  • None
Dental History
  • Regular maintenance
  • No facial surgeries
Current Findings
  • Right sensorineural hearing loss on audiometry
  • Diminished right corneal reflex
  • Mild right facial sensation reduction in the V1 distribution
  • Facial expression symmetric (CN VII intact)
  • Romberg with mild rightward sway
  1. Question 1
    Moderate
    The most likely diagnosis is:
  2. Question 2
    Moderate
    Vestibular schwannoma arises from:
  3. Question 3
    Hard
    As the tumor enlarges in the cerebellopontine angle, the next cranial nerve typically affected is:
  4. Question 4
    Moderate
    The best initial imaging study is:
  5. Question 5
    Hard
    Bilateral vestibular schwannomas in a young patient should prompt evaluation for:

Reset this case?

This clears your answers for this patient case only.

Patient case: Electric throat and ear pain triggered by swallowing
0 of 5 answered, 0 correct
Patient
Male, 62 years old
Chief Complaint
"I get electric shocks deep in my right throat and ear every time I swallow or yawn. I think I have a bad tooth back there."
Background and/or Patient History
  • Brief, severe stabbing pain in the right posterior tongue, tonsillar pillar, and ear for 6 weeks
  • Triggered by swallowing, yawning, talking, or coughing
  • Pain-free between attacks
  • Each episode lasts seconds, then resolves
  • Has fainted twice during severe attacks
Allergies
NKDA
Medications
  • Atorvastatin
  • Aspirin 81 mg
Dental History
  • Routine maintenance
  • Full dentition, healthy periodontium
Current Findings
  • Right molars: percussion negative, normal pulp testing
  • No caries, no periapical pathology on bitewings or periapical radiographs
  • Touching the right tonsillar pillar with a cotton swab reproduces the pain
  • Posterior 1/3 of the right tongue mildly hypoesthetic to taste
  • Neuro exam otherwise normal
  1. Question 1
    Moderate
    The most likely diagnosis is:
  2. Question 2
    Moderate
    CN IX sensory innervation includes:
  3. Question 3
    Hard
    The fainting episodes during severe attacks are explained by:
  4. Question 4
    Moderate
    First-line medical therapy is:
  5. Question 5
    Moderate
    Before considering medical or surgical therapy, the key structural workup is:

Reset this case?

This clears your answers for this patient case only.

Patient case: Hoarse smoker with uvula deviation at denture visit
0 of 5 answered, 0 correct
Patient
Male, 71 years old
Chief Complaint
"I just want my dentures relined, but my voice has been hoarse for two months."
Background and/or Patient History
  • Hypertension
  • COPD
  • 40-pack-year smoker
  • Presented for denture maintenance
  • Persistent hoarseness for 2 months
  • Occasional choking on liquids
  • No fever or pain
Allergies
NKDA
Medications
  • Lisinopril
  • Tiotropium inhaler
Dental History
  • Edentulous
  • Upper and lower complete dentures, 8 years old, loose
Current Findings
  • Hoarse voice
  • On saying "ahhh," uvula deviates to the LEFT
  • Soft palate elevates asymmetrically (right weak)
  • Gag absent on the right
  • No oral lesions
  • No palpable cervical nodes
  1. Question 1
    Easy
    Uvula deviation to the LEFT indicates a lesion of:
  2. Question 2
    Moderate
    CN IX, X, and XI exit the skull together through the:
  3. Question 3
    Hard
    Given his smoking, hoarseness, dysphagia, and CN X palsy, the next step is to:
  4. Question 4
    Moderate
    When taking impressions, his absent right-sided gag means the dentist should:
  5. Question 5
    Moderate
    The left recurrent laryngeal nerve hooks around which structure?

Reset this case?

This clears your answers for this patient case only.

Patient case: Tongue deviation found on a routine oral cancer screen
0 of 5 answered, 0 correct
Patient
Female, 62 years old
Chief Complaint
"I just came in for my six-month cleaning. I haven't noticed anything wrong."
Background and/or Patient History
  • Hypertension
  • Otherwise healthy
  • Presented for routine recall
  • Asymptomatic
  • Tongue deviation noted during the oral cancer screen
Allergies
Penicillin (rash)
Medications
  • Hydrochlorothiazide
Dental History
  • Regular maintenance
  • No recent procedures
Current Findings
  • Tongue deviates LEFT on protrusion
  • Left half slightly atrophic with faint fasciculations at rest
  • No oral lesions
  • No cervical lymphadenopathy
  • Speech and swallowing intact
  • Rest of cranial nerve exam normal
  1. Question 1
    Easy
    Tongue deviation to the LEFT (LMN) indicates a lesion of:
  2. Question 2
    Moderate
    CN XII exits the skull through the:
  3. Question 3
    Moderate
    Atrophy and fasciculations of the affected half of the tongue point to:
  4. Question 4
    Hard
    The most appropriate next step is to:
  5. Question 5
    Moderate
    If permanent left tongue paralysis follows surgical resection, the main long-term dental concern is:

Reset this case?

This clears your answers for this patient case only.

Keep studying
Cranial Nerves core recall

Refresh the anatomy facts these cases depend on: nerve numbers, foramina, functions, and lesion findings.

← Back to Cranial Nerves