Deck 29: Guillain-Barré Syndrome

Question 1

A 75-kg, 50-year-old male patient has Guillain-Barré syndrome. His most recent assessment indicates his VC is 900 mL and NIF is -16 cm H₂O. What plan should the respiratory therapist recommend?

A) Initiate EMG monitoring.
B) Initiate continuous positive airway pressure (CPAP).
C) Initiate mechanical ventilation.
D) Reassess the patient each hour.

Answer 1

Initiate mechanical ventilation.

Question 2

In the United States and Europe, what is the most common subtype of GBS?

A) Miller Fisher syndrome (MFS)
B) Acute motor axonal neuropathy (AMAN)
C) Acute pandysautonomic neuropathy (APN)
D) Acute inflammatory demyelinating polyneuropathy (AIDP)

Answer 2

Acute inflammatory demyelinating polyneuropathy (AIDP)

Question 3

Common noncardiopulmonary manifestations associated with Guillain-Barré are:
1) asymmetric muscle weakness in distal extremities.
2) leg pain.
3) distal paresthesia.
4) muscle paralysis that most often spreads downward from the face to the arms and trunk.

A)1
B)2, 3
C)1, 2, 4
D)2, 3, 4

Answer 3

2, 3

Question 4

Under microscopic inspection, the skeletal muscle nerves of a Guillain-Barré patient show which of the following?
1) Hypertrophy
2) Edema
3) Inflammation
4) Demyelination

A)1, 3
B)1, 2, 4
C)2, 3, 4
D)1, 2, 3

Question 5

Approximately what percentage of patients with GBS develop respiratory muscle paralysis?

A) <5%
B) 6% to 9%
C) 10% to 30%
D) 31% to 50%

Question 6

Clinical indications that a patient has impending acute ventilatory failure include:
1) pH < 7.35.
2) FVC < 20 mL/kg.
3) PaCO₂ > 45 mm Hg.
4) MEP > 40 cm H₂O.

A)1, 3
B)1, 2, 3
C)2, 4
D)2, 3, 4

Question 7

The diagnosis of Guillain-Barré syndrome is based on:
1) urinalysis, which shows elevated blood urea nitrogen.
2) abnormal electromyography results.
3) cerebrospinal fluid, which shows elevated protein level.
4) clinical history.

A)4
B)1, 2, 4
C)2, 3, 4
D)1, 2, 3

Question 8

A patient with Guillain-Barré is paralyzed and on mechanical ventilatory support. Which of the following pulmonary complications is most likely to occur as the result of prolonged immobilization?

A) Pneumonia
B) Pressure sores
C) Thromboembolism
D) Atelectasis

Question 9

A Guillain-Barré syndrome patient has autonomic nervous system dysfunction which can result in which of the following?
1) Tachycardia
2) Hypotension
3) Urinary retention
4) Fever

A)1, 3
B)1, 2, 4
C)2, 3, 4
D)1, 2, 3

Question 10

In which of the following persons would Guillain-Barré syndrome most likely occur?

A) African-American female-22 years of age
B) Hispanic male-31 years of age
C) Asian female-17 years of age
D) Caucasian male-53 years of age

Question 11

A patient with Guillain-Barré syndrome developed atelectasis. His chest radiograph findings would be expected to show:

A) "ground-glass" appearance.
B) "honeycombing."
C) increased opacity.
D) blunted costophrenic angles.

Question 12

The major pathologic or structural changes of the lungs associated with ventilator failure accompanying Guillain-Barré syndrome include:
1) alveolar consolidation.
2) airway distortion and dilation.
3) mucosal edema.
4) atelectasis.

A)1, 4
B)2, 3
C)1, 2, 3
D)2, 3, 4

Question 13

Which of the following has been shown to shorten the course of a severe case of Guillain-Barré syndrome?

A) Renal dialysis
B) Plasmapheresis
C) Blood transfusion
D) NSAIDs

Question 14

Typical chest assessment findings in a patient with Guillain-Barré syndrome include:
1) diminished breath sounds.
2) crackles.
3) tracheal deviation.
4) depressed diaphragms.

A)1, 3, 4
B)1, 2
C)3, 4
D)2, 3, 4

Question 15

When a person has Guillain-Barré syndrome, how are peripheral nerves affected?

A) They hypertrophy.
B) They fail to reproduce.
C) The myelin sheath is removed.
D) Schwann cells attack the peripheral nerves.

Question 16

Which of the following are identified as the causative organisms of the respiratory or gastrointestinal infections that precede the onset of most cases of GBS?

A) Chlamydia psittaci and Campylobacter jejuni
B) Cytomegalovirus and mononucleosis
C) Campylobacter jejuni and cytomegalovirus
D) Mononucleosis and parainfluenza 2

Question 17

The peripheral nervous system problems found with Guillain-Barré syndrome (GBS) include:
1) loss of reflexes.
2) increased reflex reactions.
3) flaccid paralysis of skeletal muscles.
4) tetany of skeletal muscles.

A)2, 3
B)1, 4
C)1, 3
D)2, 4