Guillain Barré Syndrome

Question 1

Guillain-Barre syndrome (GBS) describes an immune mediated demyelination of the peripheral nervous. What is the incidence of GBS?

1 - 1000 / 100,000
2 - 100 / 100,000
3 - 10 / 100,000
4 - 1 / 100,000

Answer 1

4 - 1 / 100,000

Question 2

Guillain-Barre syndrome (GBS) describes an immune mediated demyelination of the peripheral nervous. Typically, what age does GBS typically peak?

1 - 5-10
2 - 20-30
3 - 40-50
4 - 70-80

Answer 2

2 - 20-30

BUT can occur at any age
Rare in children

Question 3

Guillain-Barre syndrome (GBS) describes an immune mediated demyelination of the peripheral nervous. Is GBS more common in men or women?

Answer 3

• men

3:2 ratio

Question 4

Guillain-Barre syndrome (GBS) describes an immune mediated demyelination of the peripheral nervous. Is GBS typically an acute or chronic conditoon?

Answer 4

• acute

Also called Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP)

Polyradiculoneuropathy = Diseases characterised by injury or dysfunction involving multiple peripheral nerves and nerve roots

Question 5

Infection often precedes Guillain-Barre syndrome (GBS) (although not always), but what infection is most common associated with causing GBS?

1 - Cytomegalovirus
2 - Epstein Barr Virus
3 - Campylobacter jejuni
4 - Influenza
5 - HIV

Answer 5

3 - Campylobacter jejuni

Can also occur following vaccination

Question 6

Infection often precedes Guillain-Barre syndrome (GBS) (although not always), with Campylobacter jejuni being the most associated with GBS. Typically GBS occurs within how long post infection?

1 - <12 weeks
2 - <6 weeks
3 - <4 weeks
4 - <1 week

Answer 6

3 - <4 weeks

Question 7

Which 2 of the following are the typical signs of Guillain-Barre syndrome (GBS)?

1 - worsening ascending weakness
2 - rigidity and hypertonia
3 - areflexia
4 - hypereflexia

Answer 7

1 - worsening ascending weakness

3 - areflexia (lack of reflexes)

Both of these are LMN presentations

Question 8

Is Guillain-Barre syndrome (GBS) a UMN or LMN demyelinating condition?

Answer 8

• LMN

Attacks Schwann cells

The most common flaccid paralysis causing condition and increasing for some reason

Question 9

Guillain-Barre syndrome (GBS) typically presents with an ascending weakness (legs 1st then arms) and a lack of reflexes, common in LMN conditions. Are there major sensory symptoms?

Answer 9

• no

If present these symptoms are mild and can present like glove and stockings

Question 10

In addition to the ascending weakness (legs 1st then arms) and areflexia (lack of reflexes), which of the following do patients NOT typically present with in Guillain-Barre syndrome (GBS)?

1 - back pain
2 - history of gastroenteritis or URTI
3 - cranial nerve involvement e.g. diplopia
4 - babinski sign
5 - autonomic involvement: e.g. urinary retention, diarrhoea

Answer 10

4 - babinski sign

Present in UMN lesions

Question 11

Guillain-Barre syndrome (GBS) is though to be due to molecular mimicry, where pathogens imitate host antigens. Which of the following antibodies are most commonly associated with GBS?

1 - Anti-schwann antibodies
2 - Anti-ganglioside antibodies
3 - Anti-oligodeendroctes
4 - Anti-macularcytes

Answer 11

2 - Anti-ganglioside antibodies

Written as GM-1 and typically present in 25% of patients with GBS

Question 12

Guillain-Barre syndrome (GBS) is though to be due to molecular mimicry, where pathogens imitate host antigens. Anti-ganglioside antibodies are most commonly associated with GBS. Are these useful in diagnosing patients?

Answer 12

• no

Typically present following the condition

Question 13

Guillain-Barre syndrome (GBS) is typically a clinical diagnosis, with patients presenting with ascending weakness (legs 1st then arms) and areflexia (lack of reflexes) and mild sensory symptoms. A lumbar puncture could be performed to aid with diagnosis, but which of the following would be observed in GBS?

1 - high protein and high WBC
2 - high glucose and high WBC
3 - high protein and normal WBC
4 - low protein and high WBC

Answer 13

3 - high protein and normal WBC

May also be normal in early disease course

Nerve conduction studies (show demyelinating pattern) and imaging can be supportive

Question 14

Miller Fisher syndrome (MFS) is a variant of Guillain-Barre syndrome (GBS). Although the following can present in a similar way to GBC, what is typically affected first in MFS compared to GBS?

1 - sensory affects
2 - upper limbs
3 - bulbar symptoms
4 - eye muscles

Answer 14

4 - eye muscles

MFS typically presents as a descending paralysis

Anti-GQ1b antibodies are present in 90% of cases

Question 15

As patients with Guillain-Barre syndrome (GBS) experience neuropathic pain, which 2 of the following are most likely to be given to help with the pain?

1 - gabapentin
2 - amitriptyline
3 - sertraline
4 - carbamazepine

Answer 15

1 - gabapentin
4 - carbamazepine

Question 16

Are steroids effective in Guillain-Barre syndrome (GBS)?

Answer 16

• no

Question 17

Steroid are ineffective in Guillain-Barre syndrome (GBS). What can patients with GBS be given instead?

1 - IV immunoglobulins
2 - Methotrexate
3 - Mycophenolate mofetil
4 - Ciclosporin

Answer 17

1 - IV immunoglobulins

Plasmapheresis can also be used to remove the auto-antibodies from the blood

Question 18

Cardiac and respiratory function need to be monitored in patients with Guillain-Barre syndrome (GBS). Which of the following is the most effective at monitoring respiratory function?

1 - O2 saturations
2 - forced vital capacity
3 - ABG
4 - FBC

Answer 18

2 - forced vital capacity

Question 19

If treated appropriately patients with Guillain-Barre syndrome (GBS) have a good prognosis and recover in what time frame?

1 - <1-2 weeks
2 - <3-4 weeks
3 - <8-12 weeks
4 - <3-6 months

Answer 19

3 - <8-12 weeks

Can be longer though and 15 % may be unable to walk unaided at 6 months

Question 20

What is the mortality rate in Guillain-Barre syndrome (GBS)?

1 - 50%
2 - 35%
3 - 15%
4 - 5%

Answer 20

4 - 5%