American Board of Internal Medicine (ABIM) Certification Practice Exam

For Lyme disease presenting with cranial nerve palsies or meningitis, what is the recommended treatment for facial nerve palsy specifically?

1. Oral amoxicillin

2. Doxycycline

3. Ceftriaxone

4. Intravenous vancomycin

The correct answer is: Doxycycline

Doxycycline is the recommended treatment for Lyme disease presenting with cranial nerve palsies, including facial nerve palsy. This recommendation is based on the efficacy of doxycycline in treating early localized or early disseminated Lyme disease, especially when neurosymptoms such as cranial nerve involvement are present. Doxycycline, a tetracycline antibiotic, has excellent penetration into the central nervous system and is effective against the Borrelia burgdorferi bacteria that cause Lyme disease. The choice of doxycycline is particularly pertinent in cases of facial nerve palsy, as it helps address both the neurological symptoms and the underlying infectious process. It is also often preferred due to its safety profile and oral bioavailability, making it a practical option for outpatient management in cases not associated with severe complications. Alternative treatments such as ceftriaxone are generally reserved for more severe manifestations of Lyme disease or cases that do not respond to oral therapy, while vancomycin is not appropriate unless there is a concern for an additional bacterial infection like MRSA. Amoxicillin is effective for early Lyme disease but does not have the same efficacy profile for neurological manifestations compared to doxycycline.