[MCQ] Guillain-Barré syndrome (GBS) - Part 2

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Guillain-Barré syndrome (GBS) - Part 2

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Question 1

In CSF of GBS patient, increase in which of the following reflects axonal damage & predicts a residual deficit ?

A	Tau
B	Amyloid precursor protein (APP)
C	Chymotrypsin
D	Apolipoprotein E

Question 1 Explanation:

Tau & 14-3-3 protein levels are elevated early in some cases of GBS. Tau increases in CSF may reflect axonal damage & predict a residual deficit.

Question 2

Differential diagnosis of Guillain-Barré syndrome includes ?

A	Hypokalaemia
B	Polymyositis
C	Porphyria
D	All of the above

Question 2 Explanation:

Differential diagnosis of Guillain-Barré syndrome include transverse myelitis & neuromyelitis optica, Lyme polyradiculitis, porphyria, vasculitic neuropathy, poliomyelitis, West Nile virus, CMV polyradiculitis, critical illness neuropathy or myopathy, myasthenia gravis, botulism, poisonings with organophosphates, thallium, or arsenic, paralytic shellfish poisoning, severe hypophosphatemia.

Question 3

What length of time after the first motor symptoms in GBS, immunotherapy is no longer effective ?

A	3 days
B	14 days
C	30 days
D	60 days

Question 3 Explanation:

Each day counts in the treatment of GBS. ~2 weeks after first motor symptoms, immunotherapy is no longer effective.

Question 4

Which of the following about treatment of GBS is false ?

A	High-dose IVIg & plasmapheresis are equally effective
B	Combination of IVIg & plasmapheresis offers no advantage
C	After successful treatment of GBS, relapse may occur in II or III week
D	None of the above

Question 4 Explanation:

IVIg is administered as five daily infusions for a total dose of 2 g/kg body weight. A course of plasmapheresis usually consists of 40–50 mL/kg plasma exchange (PE) four to five times over a week. Glucocorticoids have not been found to be effective in GBS. 30% of patients with GBS require ventilatory assistance.

Question 5

Which of the following is not found in Miller Fisher syndrome ?

A	Ataxia
B	Areflexia of limbs
C	Weakness of limbs
D	Ophthalmoplegia

Question 6

Which of the following is false about Miller Fisher syndrome ?

A	Rapidly evolving ataxia
B	Areflexia of limbs without weakness
C	Ophthalmoplegia often with pupillary paralysis
D	None of the above

Question 7

MFS is strongly associated with which of the following antibodies ?

A	GQ1a
B	GQ1b
C	GQ1c
D	GQ1d

Question 7 Explanation:

Miller Fisher syndrome (MFS) presents as rapidly evolving ataxia & areflexia of limbs without weakness, and ophthalmoplegia, often with pupillary paralysis. MFS is strongly associated with antibodies to ganglioside GQ1b.

Question 8

Which of the following statements about Gullain-Barre syndrome (GBS) is false ?

A	Escape of activated B cells from Peyers patches into regional lymph nodes
B	Anti GQ1b IgG antibodies are found in >90% of patients with Miller Fisher subtype of GBS
C	Glucocorticoids are effective in GBS
D	Severe proximal motor & sensory axonal damage is a poor prognostic sign

Question 8 Explanation:

Glucocorticoids have not been found to be effective in GBS. CIDP responds to glucocorticoids, whereas GBS does not.

Question 9

Classic chronic inflammatory demyelinating polyneuropathy is characterized by all except ?

A	Symmetrical weakness in proximal muscles
B	Symmetrical weakness in distal muscles
C	Weakness progressively increases for > 2 months
D	Not associated with impaired sensation

Question 10

Which of the following electrodiagnostic findings is not a feature of Classic chronic inflammatory demyelinating polyneuropathy ?

A	Partial motor-nerve conduction block
B	Reduced motor-nerve conduction velocity
C	Prolonged distal motor latencies
D	Absent F-wave latencies

Question 10 Explanation:

Edx findings in CIDP reveal variable degrees of conduction slowing, prolonged distal latencies, distal and temporal dispersion of CMAPs, and conduction block as the principal features. Presence of conduction block is a certain sign of an acquired demyelinating process. Evidence of axonal loss, presumably secondary to demyelination, is present in >50% of patients

Question 11

Chronic inflammatory demyelinating polyneuropathy may be associated with all of the following except ?

A	HIV
B	SLE
C	Diabetes mellitus
D	Hypothyroidism

Question 11 Explanation:

In all patients with presumptive CIDP, it is also reasonable to exclude vasculitis, collagen vascular disease (SLE), chronic hepatitis, HIV infection, amyloidosis, diabetes mellitus, inflammatory bowel disease and lymphoma.

Question 12

Which of the following treatments is effective in CIDP ?

A	High-dose IVIg
B	Plasma exchange (PE)
C	Glucocorticoids
D	All of the above

Question 12 Explanation:

Controlled studies have shown that high-dose IVIg, PE, and glucocorticoids are all more effective than placebo. Patients who fail therapy with IVIg, PE & glucocorticoids may benefit from treatment with azathioprine, methotrexate, cyclosporine, cyclophosphamide, and anti-CD20 (rituximab).

Question 13

Lewis-Sumner Syndrome is ?

A	Multifocal Acquired Demyelinating Sensory and Motor Neuropathy
B	Multifocal Motor Neuropathy
C	Distal Acquired Demyelinating Symmetric Neuropathy
D	Motor neuron disease

Question 13 Explanation:

Lewis-Sumner syndrome is also called multifocal acquired demyelinating sensory and motor (MADSAM) neuropathy. It is a variant of CIDP in which discrete peripheral nerves are involved

Question 14

Lewis-Sumner Syndrome is characterized by all except ?

A	Motor and sensory deficits
B	Elevated CSF protein content
C	Asymmetrical presentation of symptoms
D	Poor response to intravenous immune globulin in presence of antibodies to gangliosides

Question 14 Explanation:

Weakness of the limbs is usually symmetric in CIDP, but can be strikingly asymmetric in Lewis- Sumner syndrome.

Question 15

Intravenous immune globulin has been established to be efficacious in ?

A	Guillain-Barré syndrome
B	Chronic inflammatory demyelinating polyneuropathy
C	Myasthenia gravis
D	All of the above

Question 16

Intravenous immune globulin has been established to be efficacious in ?

A	Corticosteroid-resistant dermatomyositis
B	Kawasaki’s syndrome
C	GVHD prevention in allogeneic BM transplants
D	All of the above

Question 16 Explanation:

IVIg blocks reticuloendothelial cell function and immune complex clearance in immune thrombocytopenia. In addition, IVIg is useful for prevention of tissue damage in certain inflammatory syndromes such as Kawasaki disease and as Ig replacement therapy for certain types of immunoglobulin deficiencies. IVIg is also useful in selected patients with graft-versus-host disease, multiple sclerosis, myasthenia gravis, Guillain-Barré syndrome, and chronic demyelinating polyneuropathy

Question 17

The mode of action of immune globulin involves ?

A	Modulation of expression & function of Fc receptors
B	Interference with activation of complement & cytokines
C	Provision of antiidiotypic antibodies
D	All of the above

Question 18

The half-life of infused immune globulin in immunocompetent persons is ?

A	Two weeks
B	Three weeks
C	Four weeks
D	Five weeks

Question 19

Most natural autoantibodies in adult serum are of ?

A	IgG class
B	IgM class
C	IgA class
D	All of the above

Question 20

Which of the following about total dose of Intravenous immune globulin is true ?

A	1 grams per kilogram over 3 days
B	1 grams per kilogram over 5 days
C	2 grams per kilogram over 3 days
D	2 grams per kilogram over 5 days

Question 20 Explanation:

Intravenous immune globulin has replaced plasma exchange as the treatment of choice in GBS patients who are not able to walk unaided. Immune globulin is given at a total dose of 2 grams per kilogram of body weight over a period of 5 days.

Question 21

Which of the following is true regarding definition of partial nerve conduction block ?

A	Drop of 20% or more in negative peak area
B	Drop of 20% or more in peak-to-peak amplitude
C	Change of <15% in duration between proximal & distal site stimulation
D	All of the above

Question 22

Which of the is false about Multifocal Motor Neuropathy ?

A	Symmetric weakness
B	Relative sparing of sensory fibres
C	Starts in distal arm muscles
D	A partial motor-conduction block at multiple sites

Question 22 Explanation:

Multifocal motor neuropathy (MMN) presents as slowly progressive motor weakness & atrophy evolving over years in the distribution of selected nerve trunks, associated with sites of persistent focal motor conduction block in the same nerve trunks. Sensory fibers are relatively spared. The arms are affected more frequently than the legs, and >75% of all patients are male.

Question 23

Which of the following is effective in the treatment of Multifocal Motor Neuropathy ?

A	Corticosteroids
B	Plasma exchange (PE)
C	Immune globulin therapy
D	Methotrexate

Question 24

Which of the following is effective in the treatment of Multifocal Motor Neuropathy ?

A	Corticosteroids
B	Plasma exchange (PE)
C	Cyclophosphamide
D	Methotrexate

Question 24 Explanation:

Most patients with Multifocal motor neuropathy (MMN) respond to high-dose IVIg. Refractory patients may respond to rituximab or cyclophosphamide. Glucocorticoids and PE are not effective.

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See all quizzes of Guillain-Barré syndrome (GBS) – Part 2 here:

1 In CSF of GBS patient, increase in which of the following reflects
axonal damage & predicts a residual deficit ?
A. Tau
B. Amyloid precursor protein (APP)
C. Chymotrypsin
D. Apolipoprotein E

2 Differential diagnosis of Guillain-Barré syndrome includes ?
A. Hypokalaemia
B. Polymyositis
C. Porphyria
D. All of the above

3 What length of time after the first motor symptoms in GBS,
immunotherapy is no longer effective ?
A. 3 days
B. 14 days
C. 30 days
D. 60 days

4 Which of the following about treatment of GBS is false ?
A. High-dose IVIg & plasmapheresis are equally effective
B. Combination of IVIg & plasmapheresis offers no advantage
C. After successful treatment of GBS, relapse may occur in II or III week
D. None of the above

5 Which of the following is not found in Miller Fisher syndrome ?
A. Ataxia
B. Areflexia of limbs
C. Weakness of limbs
D. Ophthalmoplegia
6 Which of the following is false about Miller Fisher syndrome ?
A. Rapidly evolving ataxia
B. Areflexia of limbs without weakness
C. Ophthalmoplegia often with pupillary paralysis
D. None of the above
7 MFS is strongly associated with which of the following
antibodies ?
A. GQ1a
B. GQ1b
C. GQ1c
D. GQ1d

8 Which of the following statements about Gullain-Barre syndrome
(GBS) is false ?
A. Escape of activated B cells from Peyers patches into regional
lymph nodes
B. Anti GQ1b IgG antibodies are found in >90% of patients with
Miller Fisher subtype of GBS
C. Glucocorticoids are effective in GBS
D. Severe proximal motor & sensory axonal damage is a poor
prognostic sign

9 Classic chronic inflammatory demyelinating polyneuropathy is
characterized by all except ?
A. Symmetrical weakness in proximal muscles
B. Symmetrical weakness in distal muscles
C. Weakness progressively increases for > 2 months
D. Not associated with impaired sensation

10 Which of the following electrodiagnostic findings is not a feature
of Classic chronic inflammatory demyelinating polyneuropathy ?
A. Partial motor-nerve conduction block
B. Reduced motor-nerve conduction velocity
C. Prolonged distal motor latencies
D. Absent F-wave latencies

11 Chronic inflammatory demyelinating polyneuropathy may be
associated with all of the following except ?
A. HIV
B. SLE
C. Diabetes mellitus
D. Hypothyroidism

12 Which of the following treatments is effective in CIDP ?
A. High-dose IVIg
B. Plasma exchange (PE)
C. Glucocorticoids
D. All of the above

13 Lewis-Sumner Syndrome is ?
A. Multifocal Acquired Demyelinating Sensory and Motor
Neuropathy
B. Multifocal Motor Neuropathy
C. Distal Acquired Demyelinating Symmetric Neuropathy
D. Motor neuron disease

14 Lewis-Sumner Syndrome is characterized by all except ?
A. Motor and sensory deficits
B. Elevated CSF protein content
C. Asymmetrical presentation of symptoms
D. Poor response to intravenous immune globulin in presence of
antibodies to gangliosides

15 Intravenous immune globulin has been established to be
efficacious in ?
A. Guillain-Barré syndrome
B. Chronic inflammatory demyelinating polyneuropathy
C. Myasthenia gravis
D. All of the above
16 Intravenous immune globulin has been established to be
efficacious in ?
A. Corticosteroid-resistant dermatomyositis
B. Kawasaki’s syndrome
C. GVHD prevention in allogeneic BM transplants
D. All of the above

17 The mode of action of immune globulin involves ?
A. Modulation of expression & function of Fc receptors
B. Interference with activation of complement & cytokines
C. Provision of antiidiotypic antibodies
D. All of the above
18 The half-life of infused immune globulin in immunocompetent
persons is ?
A. Two weeks
B. Three weeks
C. Four weeks
D. Five weeks
19 Most natural autoantibodies in adult serum are of ?
A. IgG class
B. IgM class
C. IgA class
D. All of the above
20 Which of the following about total dose of Intravenous immune
globulin is true ?
A. 1 grams per kilogram over 3 days
B. 1 grams per kilogram over 5 days
C. 2 grams per kilogram over 3 days
D. 2 grams per kilogram over 5 days

21 Which of the following is true regarding definition of partial
nerve conduction block ?
A. Drop of 20% or more in negative peak area
B. Drop of 20% or more in peak-to-peak amplitude
C. Change of <15% in duration between proximal & distal site
stimulation
D. All of the above
22 Which of the is false about Multifocal Motor Neuropathy ?
A. Symmetric weakness
B. Relative sparing of sensory fibres
C. Starts in distal arm muscles
D. A partial motor-conduction block at multiple sites

23 Which of the following is effective in the treatment of Multifocal
Motor Neuropathy ?
A. Corticosteroids
B. Plasma exchange (PE)
C. Immune globulin therapy
D. Methotrexate
24 Which of the following is effective in the treatment of Multifocal
Motor Neuropathy ?
A. Corticosteroids
B. Plasma exchange (PE)
C. Cyclophosphamide
D. Methotrexate

[MCQ] Guillain-Barré syndrome (GBS) – Part 2

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Guillain-Barré syndrome (GBS) - Part 2

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