Test 4 Ch. 29 - Gullain-Barre Syndrome

Question 1

GBS is an _______ disease that causes acute peripheral nervous system disorder called polyneuropathy, that results in a flaccid paralysis of the skeletal muscles and loss of muscle reflexes.

Answer 1

Autoimmune

Question 2

What are the major pathological and structural changes of the lungs associated with poorly managed GBS?

Answer 2

• Mucus accumulation
• Airway obstruction
• Alveolar consolidation
• Atelectasis

Question 3

GBS occurs worldwide with an overall incidence of _______ per 100,000 people.

Answer 3

1 to 2

Question 4

Where is GBS slightly more frequent?

Answer 4

More frequent in males than females

Question 5

The incidence of GBS is greater in what type of people?

Answer 5

Those over 50 years of age

Question 6

GBS is ______% more common in whites than blacks.

Answer 6

50-60%

Question 7

In about ________ of the cases, the onset of GBS occurs 1-4 weeks after a febrile episode caused by a mild respiratory or GI viral or bacterial infection.

Answer 7

Two-thirds

Question 8

What is the most common form of GBS in North America and Europe, representing about 75-80% of cases?

Answer 8

AIDP - Acute Inflammatory Demyelinating Polyradiculopathy

Question 9

_____________ is similar to AIDP, but without sensory symptoms, affects the motor axons of the nerves.

Answer 9

AMAN - Acute Motor Axonal Neuropathy

Question 10

________________ is a severe variant of GBS that is more prevalent in Asia, Central America and South America. It causes severe, rapid destruction to nerves throughout the body.

Answer 10

AMSAN - Acute Motor and Sensory Axonal Neuropathy

Question 11

What is Miller Fisher Syndrome (subtype of GBS) characterized by?

Answer 11

• Double vision
• Loss of appetite
• Loss of deep tendon reflexes

Question 12

AIDP is caused by an immunologic attack that results in peripheral nerve demyelination and inflammation. ___________ and _____________ appear to attack an strip of the myelin sheath of the peripheral nerve and leave swelling and fragmentation of the neural axon.

Answer 12

Lymphocytes and macrophages

Question 13

With AIDP, it is believed that the ________________ is the actual target of the immune attack.

Answer 13

Myelin sheath covering the peripheral nerves

Question 14

Although the precise infectious cause of GBS is not fully understood, it is known that many patients with GBS have had ____________ before developing GBS.

Answer 14

CMV infection and campylobacterjejuni

Question 15

Today, about ____% of patients with GBS will die.

Answer 15

2-3%

Question 16

What is the general clinical history of patients with GBS?

Answer 16

• Symmetric muscle weakness in the distal extremities accompanied by paresthesia (tingling, burning, shocklike sensations) or dysesthesias (unpleasant, abnormal sense of touch)
• Pain (Throbbing, aching especially in lower back, buttocks and legs)
• Numbness

Question 17

Muscle paralysis that spreads upward is called _____________.

Answer 17

Ascending paralysis

Question 18

With GBS, muscle paralysis generally peaks in about ______.

Answer 18

2 weeks

Question 19

With GBS, oculomotor weakness occurs in about ____% of cases.

Answer 19

15

Question 20

With GBS, more than ________ of patients experience severe pain.

Answer 20

HALF

Question 21

With GBS, about _________ of patients have autonomic symptoms.

Answer 21

two-thirds

Question 22

In ________% of GBS cases, respiratory muscle paralysis develops, followed by acute ventilatory failure (hypercapnic respiratory failure)

Answer 22

10-30%

Question 23

Although GB is typically an ascending paralysis — that is, moving from the lower portions of legs and body upward - in about ____% of cases, muscle paralysis affects the facial and arm muscles and then moves downward.

Answer 23

10

Question 24

Between _____% of GBS patients have permanent residual neurologic deficits.

Answer 24

10-20%

Question 25

About _____% of GBS patients make a full recovery, but recovery time may be as long as 3 years.

Answer 25

90

Question 26

The diagnosis of GBS is based on:

Answer 26

1. Patient’s clinical history
2. CSF findings (obtained through a lumbar puncture)
3. Thorough neurophysiology studies by way of an EMG or nerve conduction studies

Question 27

In 80-90% of cases, the typical finding of CSF is an ______________.

Answer 27

Elevated protein level (100-1000 mg/dL) with a normal WBC.

Question 28

What is the physical examination of GBS look like?

Answer 28

• RR varies with the degree of respiratory muscle paralysis
• Apnea in severe cases
• Anxiety
• Cyanosis
• Diminished breath sounds
• Crackles

Question 29

What are the radiologic findings of GBS?

Answer 29

• Normal or
• Increased opacity (when atelectasis or consolidation are present)

Question 30

What are some autonomic nervous system dysfunctions associated with GBS?

Answer 30

• Dysautonomia occurs in about 70% of cases. Symptoms include:
• Cardiac arrythmias
• Tachycardia - Most common
• Bradycardia, ventricular tachycardia, atrial flutter, a-fib and asystole
• Urinary retention
• Hypertension alternating with hypotension
• Orthostatic hypotension
• Obstruction of the intestines (ileus)
• Loss of sweating

Question 31

About _____% of GBS case develop acute ventilatory failure and require mechanical ventilation.

Answer 31

30

Question 32

The primary treatment of GBS should be directed at what?

Answer 32

Stabilization of vital signs and supportive care of the patient

Question 33

What should be closely monitored/frequently measured for patient with GBS?

Answer 33

• FVC
• MIP
• MEP
• Blood pressure
• Oxygenation saturation
• When indicated, ABGs

Question 34

What are good clinical indicators of impending acute ventilatory failure?

Answer 34

• FVC <20mL/kg
• MIP <-30 cmH2o
• MEP <40
• PaCO2 >45
• pH <7.35

Question 35

What are primary treatment modalities for GBS?

Answer 35

• Plasmapheresis (plasma exchange)
• Intravenous immune globulin (IVIG)

Question 36

_____________ entails the removal of damaged antibodies from the patient’s blood plasma, followed by the transfusion of blood.

Answer 36

Plasmapheresis

Question 37

The effects of IVIG last between ____________.

Answer 37

2 weeks and 3 months

Question 38

With GBS, Nonsteroidal antiinflammatory agents are helpful for what?

Answer 38

Pain control

Question 39

What is commonly used to relieve pain and facilitate limb movement for GBS?

Answer 39

Hydrotherapy (Whirlpool therapy)

Full recovery make occur in as little as a few weeks or as long as 3 years.