Episodic SOAP note: sudden facial drooping case
The brief says the post must be in SOAP format rather than narrative, which is unusual for a discussion board and is graded. The clinical core is one distinction: is this facial nerve or is it central?
Editorial process
Last reviewed · August 15, 2026
SOAP format, not narrative — and Case 3 is facial drooping
Two instructions govern this post and both are easy to lose. The first is formatting: your response must be an Episodic/Focused SOAP note rather than the usual narrative discussion post, which means subjective, objective, assessment and plan as actual headed sections. The second is that all episodic notes have specific required data, so the note must be complete even where the case description is thin — you write what you would collect, not only what you were given. The case itself is a 33-year-old woman with sudden right-sided facial drooping that began this morning, with excessive tearing and drooling on the same side, and its clinical core is a single discrimination, and every other element of the note exists to serve it. Get that discrimination right and the rest of the note follows from it; get it wrong and no amount of detail elsewhere recovers the answer.
That discrimination is peripheral versus central. In a peripheral facial nerve palsy the whole side of the face is affected including the forehead, because the upper face receives bilateral cortical input; in a central lesion the forehead is spared. Asking the patient to raise her eyebrows is therefore the single most informative manoeuvre in the examination, and a note that does not record forehead involvement has omitted the finding that matters most. Build the five differentials around that axis — Bell's palsy, stroke, Ramsay Hunt syndrome, Lyme disease, and a space-occupying lesion — and give each a discriminating feature rather than listing them. The plan should address eye protection explicitly, because incomplete closure risks corneal injury and it is the element most often forgotten, along with the time-critical question of whether this needs urgent imaging rather than reassurance. Sudden unilateral facial weakness in a young adult is benign far more often than not, which is exactly why the dangerous version gets missed.
Likely learning objectives
Inferred from the brief — check these against your own rubric.
- 01Produce a complete episodic SOAP note rather than a narrative response.
- 02Discriminate peripheral from central facial weakness on examination.
- 03Build a differential where each candidate carries a discriminating feature.
Read the full question
Review every instruction before using the planning guidance that follows.
Course-wide instructions that accompany this question
Important information for writing discussion questions and participationHi Class, Please read through the following information on writing a Discussion question response and participation posts. Contact me if you have any questions. Important information on Writing a Discussion Question Your response needs to be a minimum of 150 words (not including your list of references) There needs to be at least TWO references with ONE being a peer reviewed professional journal article. Include in-text citations in your response Do not include quotes—instead summarize and paraphrase the information Follow APA-7th edition Points will be deducted if the above is not followed Participation –replies to your classmates or instructor A minimum of 6 responses per week, on at least 3 days of the week. 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Turn the brief into deliverables
- 01A post structured as subjective, objective, assessment and plan.
- 02A history and examination that would establish the key discrimination.
- 03At least five differential conditions.
- 04A plan including eye protection and urgency, with APA citations.
History and exam through to five differentials
Subjective
Take the history — onset, progression, pain, hearing change, taste, rash, tick exposure, prior episodes.
Objective
Record the cranial nerve examination with forehead involvement stated, plus limb and speech findings.
Assessment: the five differentials
Name five conditions with the feature that supports or argues against each.
Diagnostics and how results would be used
State which tests you would order and what each result would change.
Plan
Address treatment, eye protection, follow-up and the threshold for urgent escalation.
Sources for sudden unilateral facial weakness
Recommended databases
- Your Sullivan text, Chapter 2 for the SOAP template
- PubMed
- American Academy of Neurology guidelines
- UpToDate or your point-of-care resource
- Week 5 Learning Resources
Search sequence
- 1.Use the Episodic/Focused SOAP template in the Week 5 resources so the format matches what is being marked.
- 2.Read a current guideline on acute facial palsy management for the treatment and eye care elements.
- 3.Check the evidence on corticosteroid and antiviral use, which has changed and is frequently misstated.
- 4.Verify the discriminating features for each differential rather than relying on recall.
Reference shortlist
These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.
Nothing here is cleared for citation until you have read it.
- 01
Hypothesis Testing, P Values, Confidence Intervals, and Significance
StatPearls, NCBI Bookshelf · 2023
Grounds how much a single examination finding should shift diagnostic probability, which is what the forehead test is doing.
- 02
Non-cancerous Breast Conditions
American Cancer Society · 2024
A model of separating benign from serious causes by discriminating features, the same reasoning structure this case needs.
- 03
About CAHPS
Agency for Healthcare Research and Quality · 2024
Evidence on how clearly a plan must be communicated for a patient to follow it, relevant to the eye protection instructions.
- 04
Expanding knowledge and roles for authority and practice boundaries of Emergency Department nurses: a grounded theory study
International Journal of Qualitative Studies on Health and Well-being · 2019
Qualitative evidence on how clinicians escalate uncertainty, relevant to the threshold for urgent imaging in this case.
Review before submission
Common mistakes
- Writing a narrative discussion post when the brief requires SOAP format.
- Omitting forehead involvement, which is the decisive examination finding.
- Listing five conditions without discriminating features.
- Forgetting eye protection in the plan for incomplete lid closure.
Submission checklist
- Is the post in actual SOAP sections?
- Does the objective section record forehead involvement explicitly?
- Do all five differentials carry a distinguishing feature?
- Does the plan address eye protection and the urgency question?
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Written by
Aaron Bishop
MA, Education
assignment interpretation and research-methods coaching across disciplines
Aaron leads the EssayCrackers editorial desk. He works on how assignment briefs are read — what a rubric is actually asking for, and where students most often answer a different question than the one set.
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Dr. Nathan Cole
PhD, Rhetoric & Composition
Argumentation and thesis development
Nathan teaches first-year composition and directs a university writing center. He reviews EssayCrackers guides for argumentative soundness and citation accuracy.