American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the next best step in management for a patient with incomplete recovery from facial nerve palsy after 3 months?

1. Physical therapy

2. EMG study

3. MRI of the brain

4. Referral to a specialist

The correct answer is: MRI of the brain

In the context of managing incomplete recovery from facial nerve palsy after 3 months, obtaining an MRI of the brain is particularly important. This imaging study allows for the identification of any structural abnormalities or lesions that might be contributing to the ongoing symptoms. Conditions such as a tumor, a stroke, or multiple sclerosis can affect the facial nerve's function, and those would typically require different management strategies than simple facial nerve palsy. In cases where recovery is incomplete beyond the expected timeframe, which is usually around 3 months for facial nerve function, further investigation is warranted to assess the situation. An MRI can help rule out secondary causes and provide clarity on the underlying pathology, ensuring that appropriate and timely interventions can be made if necessary. Physical therapy typically plays a supportive role but assumes that there aren't more pressing pathological issues at play. EMG studies may help in assessing nerve function and recovery, but an imaging study would provide a broader perspective on potential structural causes. Referring to a specialist may also be beneficial; however, obtaining an MRI first can provide critical information that could direct that referral more effectively.