American Board of Internal Medicine (ABIM) Certification Practice Exam

Which medication is recommended to expedite recovery in cases of Bell's palsy when given within the first 72 hours?

1. Acyclovir

2. Corticosteroids

3. Prednisone

4. Antibiotics

The correct answer is: Prednisone

The recommendation for corticosteroids, particularly prednisone, in the management of Bell's palsy is well-supported. Administering corticosteroids within the first 72 hours of symptom onset has been shown to expedite recovery and improve outcomes in patients with Bell's palsy. Corticosteroids help reduce inflammation and edema in the facial nerve, which can lead to quicker resolution of symptoms and better overall recovery of facial function. The effectiveness of corticosteroids in this context is based on their ability to counteract the inflammatory process thought to be involved in the condition. While acyclovir can be useful in cases where a herpes simplex virus infection is suspected to be the underlying cause, it is not universally recommended as part of the standard treatment for Bell's palsy itself, particularly when corticosteroids are available. Antibiotics are not indicated in Bell's palsy unless there is a concurrent bacterial infection. They do not address the underlying inflammatory process affecting the facial nerve. Therefore, the focus remains on corticosteroids like prednisone for managing the condition effectively in the acute phase.