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(2) MS: Neurological Conditions 🩺 > S3_L2: Guillain-Barre Syndrome > Flashcards

S3_L2: Guillain-Barre Syndrome Flashcards

1
Q

Enteric organism that is most frequent identifiable antecedent infection

A

Campylobacter jejuni

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2
Q

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

A

50-74 y/o

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3
Q

Antecedent events are also called?

A

Triggers

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4
Q

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

A

Phase 2

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5
Q

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

A

Phase 1

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6
Q

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

A

Phase 4

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7
Q

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

A

Phase 6

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8
Q

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

A

Phase 5

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9
Q

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

A

Phase 3

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10
Q

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

A
  1. B
  2. A
  3. B
  4. A
  5. A
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11
Q

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

A
  1. B
  2. A
  3. A
  4. B
  5. A
  6. B
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12
Q

What comprises the triad of Miller Fisher syndrome?

A
  1. Ophthalmoplegia
  2. Ataxia
  3. Areflexia
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13
Q

Acute Panautonomic Neuropathy is also known as?

A

Idiopathic autonomic neuropathy

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14
Q

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

A
  1. B
  2. B
  3. A
  4. B
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15
Q

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

A
  1. A
  2. A
  3. A
  4. B
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16
Q

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

A

Ventral roots

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17
Q

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

A

Ventral & dorsal roots

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18
Q

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

A
  1. A
  2. B
  3. B
  4. A
  5. A
  6. B
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19
Q

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

A

Between L3-L4

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20
Q

What is the most common form of GBS?

A

Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP)

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21
Q

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

A

Roots
(vs peripheral nerves)

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22
Q

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

A

Loss of deep tendon reflexes

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23
Q

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

A

Guillain-Barre Syndrome

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24
Q

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

A

Landry

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

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25
Q

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

A

1-3 weeks

26
Q

What is the most often reported antecedent event of GBS?

A

Benign upper respiratory infection

27
Q

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

A

Stage 2

28
Q

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

A

Stage 4

29
Q

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

A

Stage 3

30
Q

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.

A

Stage 1

31
Q

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

A

True

32
Q

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

A

Guillain-Barre Syndrome

33
Q

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

A

1-2) respiratory, gastrointestinal

34
Q

The age range for GBS is from?

A

8 months - 81 y/o

35
Q

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

A

True

36
Q

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

A
  1. B
  2. A
  3. A
  4. B
  5. A
37
Q

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

A

True

38
Q

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?

A

Sural nerve

39
Q

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

A

1-2

40
Q

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

A

Excellent

41
Q

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

A

7-10

42
Q

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

A

False

43
Q

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

A

True

44
Q

Enumerate the 6 predictors of poor outcomes of GBS

A
  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
45
Q

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

A

True

46
Q

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

A

True

47
Q

In APN, nerve conduction studies are usually ___

A

Normal

48
Q

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

A

True

49
Q

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

A

Autonomic instability

50
Q

What is Ophthalmoplegia?

A

Difficulty moving the eyes

51
Q

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

A

Decreased

52
Q

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

A

True

53
Q

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

A

Node of Ranvier

54
Q

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

A

Intravenous immunoglobin

55
Q

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

A

10-14

56
Q

What is the cornerstone of treatment for GBS?

A

Supportive care

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

57
Q

What ancillary procedure is used to check the CSF?

A

Lumbar puncture

58
Q

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

A

1-3) Lymphocytes, macrophages, and localized demyelination

59
Q

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

A

True

60
Q

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

A
  1. Deep
  2. Superficial
61
Q

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

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

(2) MS: Neurological Conditions 🩺 (12 decks)

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