S3_L2: Guillain-Barre Syndrome

Question 1

Enteric organism that is most frequent identifiable antecedent infection

Answer 1

Campylobacter jejuni

Question 2

The highest attack rates for GBS is between what age range?

Answer 2

50-74 y/o

Question 3

Antecedent events are also called?

Answer 3

Triggers

Question 4

Which phase of GBS is described as with weakness of LE and difficulty in arising from chair?

Answer 4

Phase 2

Question 5

Which phase of GBS is described as tingling of hands and feet?

Answer 5

Phase 1

Question 6

Which phase of GBS is described as respiratory monitoring as GBS is notorious for respiratory failure?

Answer 6

Phase 4

Question 7

Which phase of GBS is described as the recovery and full activity phase?

Answer 7

Phase 6

Question 8

Which phase of GBS is described as mechanical ventilation is done, natural course is achieved, and rehabilitation is necessary?

Answer 8

Phase 5

Question 9

Which phase of GBS is described as having areflexia, weakness, and distal sensory loss?

Answer 9

Phase 3

Question 10

Determine whether the variant of GBS is regional or system specific

1. Pandysautonomia
2. Predominant paraparesis
3. Pure sensory
4. Oculopharyngeal weakness
5. Fisher syndrome

A. Regional
B. System specific

Answer 10

1. B
2. A
3. B
4. A
5. A

Question 11

Determine whether the variant of GBS is regional or system specific

1. Pure motor
2. Cervico-brachial-pharyngeal weakness
3. Ophthalmoplegia with GQ1b autoantibodies
4. Axonal (AMAN)
5. Bilateral facial or abducens weakness with distal paresthesias
6. Generalized ataxia without dysarthria or nystagmus

A. Regional
B. System specific

Answer 11

1. B
2. A
3. A
4. B
5. A
6. B

Question 12

What comprises the triad of Miller Fisher syndrome?

Answer 12

1. Ophthalmoplegia
2. Ataxia
3. Areflexia

Question 13

Acute Panautonomic Neuropathy is also known as?

Answer 13

Idiopathic autonomic neuropathy

Question 14

Determine whether GBS or MG is described

1. Normal sensations
2. Neuromuscular junction pathology
3. Poly-radiculoneuropathy pathology
4. Normal deep tendon reflexes

A. Guillain-Barre Syndrome
B. Myasthenia Gravis

Answer 14

1. B
2. B
3. A
4. B

Question 15

Determine whether GBS or MG is described

1. “Progressive” weakness
2. Decreased or zero deep tendon reflexes
3. Sensations are slightly affected
4. “Fluctuating” weakness

A. Guillain-Barre Syndrome
B. Myasthenia Gravis

Answer 15

1. A
2. A
3. A
4. B

Question 16

The motor pattern in acute axonal forms of GBS is wallerian degeneration prominent in ____?

Answer 16

Ventral roots

Question 17

The motor-sensory pattern in acute axonal forms of GBS is wallerian degeneration prominent in ___?

Answer 17

Ventral & dorsal roots

Question 18

Determine whether weakness is predominant or not in the ff forms of GBS

1. Acute Motor Axonal Neuropathy
2. Fisher Syndrome
3. Pure sensory neuropathy
4. Acute Inflammatory Demyelinating Polyradiculoneuropathy
5. Acute Motor Sensory Axonal Neuropathy
6. Acute panautonomic neuropathy

A. Weakness is predominant
B. Weakness is not predominant

Answer 18

1. A
2. B
3. B
4. A
5. A
6. B

Question 19

Where is/are the landmark/s for lumbar puncture in adults?

Answer 19

Between L3-L4

Question 20

What is the most common form of GBS?

Answer 20

Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP)

Question 21

In acute axonal forms of GBS, which kind of nerve is more affected?

Answer 21

Roots
(vs peripheral nerves)

Question 22

What is the most common finding / clinical manifestation of GBS?

Answer 22

Loss of deep tendon reflexes

Question 23

What is the most common cause of acute or subacute generalized paralysis?

Answer 23

Guillain-Barre Syndrome

Question 24

Who gave the most accurate description of Guillain-Barre Syndrome?

Answer 24

Landry

Additional: His description was “acute, ascending, predominantly motor paralysis with respiratory failure leading to death” (Source: Adams & Victor)

Question 25

The antecedent events of GBS usually occur how long before the onset of clinical symptoms?

Answer 25

1-3 weeks

Question 26

What is the most often reported antecedent event of GBS?

Answer 26

Benign upper respiratory infection

Question 27

Which stage in the pathogenesis of GBS is described as more lymphocytes extrude and macrophages appear. Segmental demyelination begins; however, axons not yet affected

Answer 27

Stage 2

Question 28

Which stage in the pathogenesis of GBS is described as extensive axonal destruction. Some nerve cell bodies irreversibly damaged, but function may be preserved because of adjacent less-affected nerve fibers

Answer 28

Stage 4

Question 29

Which stage in the pathogenesis of GBS is described as multifocal myelin sheath and axonal damage. Central chromatolysis of nerve cell body occurs, and muscle begins to develop denervation atrophy

Answer 29

Stage 3

Question 30

Which stage in the pathogenesis of GBS is described as the lymphocytes migrate through endoneurial vessels and surrounding nerve fiber, but the myelin sheath and axon are not yet damaged.

Answer 30

Stage 1

Question 31

TRUE OR FALSE: Plasma exchange and intravenous immunoglobulin are of equal efficacy and are recommended for all pts with GBS

Answer 31

True

Question 32

It is characterized as an acute-onset, monophasic, immune-mediated polyneuropathy that often follows an antecedent infection

Answer 32

Guillain-Barre Syndrome

Question 33

GBS is usually preceded by 1-3 week history of mild 1)___ or 2)___ symptoms

Answer 33

1-2) respiratory, gastrointestinal

Question 34

The age range for GBS is from?

Answer 34

8 months - 81 y/o

Question 35

TRUE OR FALSE: The prevalence of GBS is 0.4-1.7% per year

Answer 35

True

Question 36

Determine whether it is a viral or bacterial infection 1. Campylobacter jejuni 2. Influenza 3. Epstein-Barr 4. Mycoplasma pneumoniae 5. Herpes A. Viral B. Bacterial

Answer 36

1. B 2. A 3. A 4. B 5. A

Question 37

TRUE OR FALSE: In APN, the CSF has elevated protein without pleocytosis (abnormal cells or albuminocytologic dissociation)

Answer 37

True

Question 38

TRUE OR FALSE: In APN, what nerve may be normal or show mild changes including loss of myelinated and unmyelinated fibers, mild axonal degeneration, and scattered demyelination?

Answer 38

Sural nerve

Question 39

In APN, the onset occurs over ___ weeks in most patients?

Answer 39

1-2

Question 40

In Miller Fisher Syndrome, there is an ___ prognosis for recovery

Answer 40

Excellent

Question 41

In Miller Fisher, the CSF protein is elevated after how many days?

Answer 41

7-10

Question 42

TRUE OR FALSE: In Miller Fisher, the CSF has significant pleocytosis

Answer 42

False

Question 43

TRUE OR FALSE: In the outcome for GBS, a large percentage still have minor deficits not interfering with activities of daily living

Answer 43

True

Question 44

Enumerate the 6 predictors of poor outcomes of GBS

Answer 44

1. Old age 2. Rapid onset 3. Artificial ventilation 4. Severely reduced cMAP (<20% of normal) 5. Acute axonal form 6. Preceding illness with C. jejuni

Question 45

TRUE OR FALSE: In Miller Fisher, sensory loss is usually mild in the distal limbs and complete ophthalmoplegia evolves over several days

Answer 45

True

Question 46

TRUE OR FALSE: GBS specifically targets the myelin sheath. A total loss of myelin results in the inefficiency of the axons in transmitting responses

Answer 46

True

Question 47

In APN, nerve conduction studies are usually ___

Answer 47

Normal

Question 48

TRUE OR FALSE: A very prominent feature of APN is seen in the vital signs, such as fluctuating BP and tachycardia

Answer 48

True

Question 49

It is a well known feature of atypical GBS present in APN

Answer 49

Autonomic instability

Question 50

What is Ophthalmoplegia?

Answer 50

Difficulty moving the eyes

Question 51

In the electrodiagnostic studies of GBS variants, a common finding is ___ amplitude of sensory nerve action potentials that return with time.

Answer 51

Decreased

Question 52

TRUE OR FALSE: Waksman and Adams used the first animal model of a noninfectious inflammatory neuritis.

Answer 52

True

Question 53

The axonal subtypes of GBS are caused by antibodies to gangliosides on the axolemma that target macrophages to invade the axon at the ___?

Answer 53

Node of Ranvier

Question 54

It is the preferred treatment for acute panautonomia d/t cardiovascular instability

Answer 54

Intravenous immunoglobin

Question 55

Plasma exchange is carried out over to ___ days, totaling to 200-250 ml/kg

Answer 55

10-14

Question 56

What is the cornerstone of treatment for GBS?

Answer 56

Supportive care (ICU monitoring, ventilatory support, DVT precautions, pain management, nutritional support)

Question 57

What ancillary procedure is used to check the CSF?

Answer 57

Lumbar puncture

Question 58

In the pathogenesis of GBS, circumscribed areas contain (1-3)___ are present and scattered throughout the PNS

Answer 58

1-3) Lymphocytes, macrophages, and localized demyelination

Question 59

TRUE OR FALSE: In GBS, weakness is symmetrical and paresthesias & slight numbness in the toes & fingers are the earliest sx

Answer 59

True

Question 60

In GBS, the sensory loss is higher in the 1)___ sensations compared to the 2)___ ones.

Answer 60

1. Deep 2. Superficial

Question 61

Match the GBS variant with the associated antibody found in each disease. 1. Pure motor variant 2. Pure dysautonomia 3. Pharyngeal cervical brachial weakness 4. Ataxic w/ or w/o ophthalmoplegia 5. Paraparectic variant 6. Acral paresthesias A. GT1a antibody B. GD1b antibody C. GM1 antibody D. None

Answer 61

1. C 2. D 3. A 4. B 5. D 6. D