Guillain Barre Syndrome

Anatomy

100

(Yes/No question) Alpha-2 Receptor Agonist need to be stimulated in case of Spasticity?

Yes. Alpha-2 receptor is located in the CNS synapses (inhibitory). Agonist use in Hypertension and spasticity

200

In peripheral nerve injury - Axonal interruption (Axonotmesis)- is classified in which class?

Class 2. Total loss of function occurs in the nerve until there is a regeneration of the damaged axon.

300

Type of Fiber that transmits pain ?

Dorsal root

400

Meralgia parasthetica is caused by injury to which nerve?

Lateral cutaneous Nerve of the thigh. patient may report burning, pain, numbness and parasthesia in lateral aspect of the thigh

500

Enkephalins transmitter primary CNS Location?

Pain suppression pathways in spinal cord and Brain. General effect of Excitation

Pathophysiology

100

Anti-GDIa is invloved with which type of GBS?

Axonal ( AMAN,AMSAN)

200

dys-synchrony of conduction occurs in?

GBS

300

Patient known case of GBS developed pressure ulcer in his back. what are the 5 stages for developing pressure ulcer?

1. Skin discoloration 2. Open skin with some tissue death 3. Pus sore -Fat layer 4. Eschar - muscle and bone 5. Unstagable

400

Campylobacter jejuni causes GBS Due to Molecular mimicry. Mention one other disease that can be caused by same mechanism?

Chronic inflammatory demyelinating polyneuropathy.

500

Describe Mode of Action of Intravenous Immunoglobulins (IVIG)?

1- Inactivate auto-reactive T-cells by competing for and interrupting their interaction with antigen presenting cells. 2- Interfere with and prevent the passage of auto-immune T-cells into the blood-nerve barrier 3- Affect innate immunity by interrupting the steps in the complement activation cascade and blocking Fc-receptor mediated activity

Inv. & Management

100

Guillain–Barré syndrome (GBS) may be treated with all. Except ? A) Rehabilitation B) Plasmapheresis C) Steroids D) IV immunoglobulins (IVIgs)

Steroids

200

In case of GBS the protein amount found in CSF is usually higher than (mg/dL) ?

> 100 mg/dL

300

Patient is hospitalized with GBS. Which assessment finding is the most significant? A. Even, unlabored respirations B. Soft, non distended abdomen C. Urine output of 50 ml/hr D. Warm skin

A. Even, unlabored respirations

400

Which of the following is NOT a common condition that a neuropsychologist would evaluate or treat? A) Dementia B) Cerebrovascular accident (CVA) C) Depression D) Neuropathy

D. Neuropathy

500

Duration of Action of Meperidine (Demerol)?

2-4 hrs. Meperidine is used to relieve moderate to severe pain. a class of medications opiate (narcotic) analgesics. It works by changing the way the brain and nervous system respond to pain.

Prognosis

100

Dysautonomia can cause life threatening complication such as ?

Cardiac arrhythmia

200

Which one of the following is associated with poor prognosis of GBS? A. Age <40 B. CMAP >20% C. Inexcitable nerve D. High MRC Sum Score

C. Inexcitable nerve

300

A 40 year old male patient is complaining of chronic progressive and mental deterioration is admitted to the unit. The nurse recognizes that these characteristics indicate a disease that results in degeneration of the basal ganglia and cerebral cortex. The disease is called:

Huntingtons disease is a hereditary disease in which degeneration of the basal ganglia and cerebral cortex causes chronic progressive chorea (muscle twitching) and mental deterioration, ending in dementia. Huntingtons disease usually strikes people ages 25 to 55.

400

Which patient should be assigned to the traveling nurse, new to neurologic nursing care, who has been on the neurologic unit for 1 week? A) 56-year-old patient with Guillain-Barre syndrome (GBS) in respiratory distress B) 25-year-old patient admitted with CA level spinal cord injury (SCI) C) 68-year-old patient with chronic amyotrophic lateral sclerosis (ALS) D) 34-year-old patient newly diagnosed with multiple sclerosis (MS)

C. The traveling is relatively new to neurologic nursing and should be assigned patients whose conditions are stable and not complex. The newly diagnosed patient will need to be transferred to the ICU. The patient with C4 SCI is at risk for respiratory arrest. All three of these patients should be assigned to nurses experienced in neurologic nursing care.

500

Patient with GBS develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis? A. PH, 5.0; PaCO2 30 mm Hg B. PH, 7.40; PaCO2 35 mm Hg C. pH, 7.35; PaCO2 40 mm Hg D. PH, 7.25; PaCO2 50 mm Hg

(D) In respiratory acidosis, ABG analysis reveals an arterial pH below 7.35 and partial pressure of arterial carbon dioxide (PaCO2) above 45 mm Hg. Therefore, the combination of a pH value of 7.25 and a PaCO2 value of 50 mm Hg confirms respiratory acidosis. A pH value of 5.0 with a PaCO2 value of 30 mm Hg indicates respiratory alkalosis.

Rehabilitation

100

Pace recovery process. Is a type of rehab used in ?

GBS. to obtain maximal function as re-innervation occurs

200

(Yes/No question) In GBS muscle strength return in ascending pattern?

No

300

(Yes/No) Antiarrythmic can be used in the management of patient with autonomic dysfunction ?

Yes.But very cautiously because of facilitated and unexpected proarrhythmic properties on the denervated heart.

400

In airway clearance. A technique in which the patient is positioned to facilitate gravity drainage of secretions from the airways. This technique is called?

Postural drainage

500

Pregnant lady known case of multiple sclerosis complaining of spasticity. what is the safest management for her spasticity ? A. Oral Baclofen B. ITB C. Botox injection D. Dentrolen

B. Intrathecal Baclofen This is the fifth reported case of intrathecal baclofen administered during pregnancy and adds to the knowledge that thus far it is relatively safe in pregnancy and may in fact be safer for the infant than oral baclofen. This is the first case report of the use of intrathecal baclofen in pregnancy and MS.