Test 4 Ch.29 Guillain- Barré Syndrome

Question 1

An autoimmune disease that causes an acute peripheral nervous system disorder that results in flaccid paralysis of the skeletal muscles and loss of muscle reflexes

Answer 1

Gullian- Barré syndrome (GBS)

Question 2

Another name for GBS

Answer 2

polyneuropathy

Question 3

In severe cases, what can develop?

Answer 3

Paralysis of the diaphragm and ventilatory failure, Clinically it is a medical emergency

Question 4

If pt is not properly managed then what can happen? (3)

Answer 4

• mucus accumulation
• airway obstruction
• atelectasis

Question 5

Pathologic or structural changes of the lungs w/ poorly GBS are: (4)

Answer 5

• Mucus accumulation
• Airway obstruction
• Alveolar consolidation
• Atelectasis

Question 6

GBS etiology is

Answer 6

idiopathic

Question 7

GBS occurs w/ an overall incidence of 1 to 2 per

Answer 7

100,000 people

Question 8

The incidence of GBS is slightly more frequent in

Answer 8

males than in females and greater in ppl over 50 y/o

Question 9

2/3 of cases happen after

Answer 9

respiratory or GI infection

Question 10

GBS is ___ % to ___% more common in ______ than blacks

Answer 10

50 - 60
whites

Question 11

All forms of GBS are autoimmune disease from an

Answer 11

immune response to foreign that attack the nerve tissue

Question 12

This is thought to be caused by an immunologic attack that results in peripheral nerve demyelination and inflammation

Answer 12

acute inflammatory demyelinating polyradiculopathy (AIDP)

Question 13

Clinical history of pts w/ GBS is

Answer 13

1. symmetric mule weakness in the distal extremities accompanied by paresthesia or dysesthesias
2. pain (throbbing, aching in lower back, butt, and legs)
3. numbness (ascending) paralysis to arms, trunk, face)

Question 14

What is paresthesia?

Answer 14

tingling, burning, shock-like sensations

Question 15

What is dysesthesias?

Answer 15

unpleasant, abnormal sense of touch

Question 16

When does the muscle paralysis generally peek?

Answer 16

2 weeks

Question 17

The pt often

Answer 17

drools and has difficulty chewing, swelling and speaking

Question 18

GBS starts where?

Answer 18

at the feet then moves up

Question 19

______________ weakness occurs in about ___% of cases

Answer 19

Oculomotor
15

Question 20

10% to 30% of cases, what develops?

Answer 20

respiratory muscle paralysis, followed by ventilatory failure (hypercapnic respiratory failure)

Question 21

ascending paralysis is defined as

Answer 21

moving from the lower portions of the legs and body upward

Question 22

Between what percentage of pts have permanent residual neurologic deficits

Answer 22

10% to 30%

Question 23

About how many pts will fully recover?

Answer 23

90%

Question 24

The diagnosis is typically based on (3)

Answer 24

1. the pts clinical history
2. cerebrospinal fluid (CSF) findings (obtained through a lumbar spinal puncture)
3. neurophysiology studies by way of electromyography (EMG) or a nerve conduction studies (NCS)

Question 25

In 80% to 90% of cases, the typical CSF finding is an

Answer 25

elevated protein level (100 to 1000) w/ a normal WBC count

Question 26

Clinical manifestations of GBS (3)

Answer 26

- Atelectasis - Alveolar consolidation - Excessive bronchial secretions

Question 27

Respiratory Rate

Answer 27

- Varies w/ the degree of respiratory muscle paralysis - Apnea - Anxiety

Question 28

Chest assessment findings (breath sounds)

Answer 28

- Diminished - Crackles

Question 29

Radiologic Findings

Answer 29

- Normal - Increased opacity (when atelectasis or consolidation is present)

Question 30

Autonomic nervous system dysfunction

Answer 30

occurs in 70% of cases

Question 31

ANSD symptoms include

Answer 31

- Cardiac arrhythmias - Urinary retention - Hypertension alternating w/ hypotension - Orthostatic hypotension - Obstruction of intestines - Loss of sweating

Question 32

General Management of GBS w. frequent measurements of the pts's

Answer 32

- vital capacity (FVC) - maximum inspiratory pressure (MIP) (NIF) - maximum expiratory pressure - BP - o2 sats - ABG

Question 33

Clinical inductors for impending acute ventilatory failure include:

Answer 33

- FVC <20mL/kg - MIP <-30 - MEP <40 cmH2o - PaCO >45 mm Hg - pH <7.35

Question 34

MIP of -15 cm H20 would confirm

Answer 34

severe muscle weakness and acute vent failure is likely

Question 35

The primary txs modalities for GBS are (2)

Answer 35

1. plasmapheresis (plasma exchange) 2. intravenous immune globulin (IVIG)

Question 36

This test has been shown to be effective in decreasing morbidity and shortening the clinical course of GBS

Answer 36

plasmapheresis

Question 37

The removal of damaged antibodies from the pt's blood plasma followed by the transfusion of the blood

Answer 37

plasmapheresis

Question 38

This tx has shown to be the least as effective

Answer 38

high dose IVIG

Question 39

Is a blood product that contains the pooled immunoglobulins IgG from thousands of donors

Answer 39

IVIG

Question 40

**Questions from the back** In GBS, which of the following pathologic changes develop? 1. Inflammation 2. Increased ability to transmit nerve impulses 3. Demyelination 4. Edema

Answer 40

1. Inflammation 3. Demyelination 4. Edema

Question 41

Which of the following is are associated w/ GBS 1. Alveolar consolidation 2. Mucus accumulation 3. Alveolar hyperinflation 4. Atelectasis

Answer 41

1. Alveolar consolidation 2. Mucus accumulation 4. Atelectasis

Question 42

GBS is more common in: 1. People older than 50 years old 2. Blacks 3. Males than females 4. Early childhood

Answer 42

1. People older than 50 years old 3. Males than females

Question 43

Which of the following are possible precursors to GBS 1. Mumps 2. Swine influenza vaccine 3. Infectious mononucleosis 4. Measles

Answer 43

1. Mumps 2. Swine influenza vaccine 3. Infectious mononucleosis 4. Measles

Question 44

Full recovery from GBS is expected in approximately what percentage a. 30% b. 40% c. 50% d. 90%

Answer 44

D. 90%

Question 45

Which of the following are indicators for intubation and MV in pts w/ GBS? 1. pH >7.40 2. PaCO2 >45 3. FVC < 20mL/kg 4. MIP <-30 cm H2O

Answer 45

2. PaCO2 >45 3. FVC < 20mL/kg 4. MIP <-30 cm H2O