[MCQ] Guillain-Barré syndrome (GBS) - Part 1

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Guillain-Barré syndrome (GBS)- Part 1

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Question 1

Guillain-Barré syndrome was first described in which year ?

A	1869
B	1898
C	1916
D	1934

Question 1 Explanation:

Guillain–Barré syndrome, characterized by acute areflexic paralysis with albuminocytologic dissociation (elevated protein in CSF and normal cell counts), was described in 1916.

Question 2

Miller Fisher syndrome was first reported in which year ?

A	1923
B	1943
C	1956
D	1966

Question 2 Explanation:

Miller Fisher syndrome, characterized by ophthalmoplegia, ataxia & areflexia, was reported in 1956 as a likely variant of Guillain–Barré syndrome, because the CSF of affected patients showed albuminocytologic dissociation.

Question 3

Feature not typical of Guillain-Barre syndrome is ?

A	Acute onset
B	Males & females are at equal risk
C	Autoimmune
D	Polyradiculoneuropathy

Question 3 Explanation:

Males are at 1.5-fold higher risk for GBS than females. Adults are more frequently affected than children.

Question 4

Facial diparesis is present in what proportion of GBS patients ?

A	10 %
B	20 %
C	50 %
D	80 %

Question 4 Explanation:

Facial diparesis is present in 50% of GBS patients

Question 5

Which of the following is not typical of Guillain-Barre syndrome ?

A	Fever & constitutional symptoms are absent at onset
B	Lower cranial nerves are frequently involved
C	DTRs disappear within first few days of onset
D	Bladder dysfunction is a prominent feature

Question 5 Explanation:

Presence of fever & constitutional symptoms at onset cast doubt on the diagnosis of GBS. Transient bladder dysfunction may occur in severe GBS. If bladder dysfunction is a prominent & early in the course, GBS is unlikely.

Question 6

Which of the following is not typical of Guillain-Barre syndrome ?

A	Fever & constitutional symptoms are absent at onset
B	Lower cranial nerves are frequently involved
C	DTRs disappear within first few days of onset
D	Bladder dysfunction is a prominent feature

Question 6 Explanation:

Question 7

In GBS, clinical worsening reaches a plateau in how many weeks of onset ?

A	1 week
B	4 weeks
C	8 weeks
D	12 weeks

Question 7 Explanation:

Clinical worsening stops and GBS patient reaches a plateau almost always within 4 weeks of onset.

Question 8

Limited or regional GBS syndromes include ?

A	Acute motor axonal neuropathy (AMAN)
B	Acute motor sensory axonal neuropathy (AMSAN)
C	Miller Fisher syndrome (MFS)
D	All of the above

Question 8 Explanation:

Limited or regional GBS syndromes are Miller Fisher syndrome, pure sensory forms, ophthalmoplegia with anti-GQ1b antibodies (severe motor-sensory GBS), GBS with severe bulbar & facial paralysis associated with cytomegalovirus (CMV) infection & anti-GM2 antibodies & acute pandysautonomia.

Question 9

Which of the following is the most common form of GBS ?

A	Acute inflammatory demyelinating polyradiculoneuropathy
B	Acute axonal motor disorder
C	Acute sensory & motor axonal neuropathy
D	Miller Fisher syndrome (MFS)

Question 9 Explanation:

In Europe & North America ~95% of GBS are acute inflammatory demyelinating polyradiculoneuropathy. ~5% are AMAN & AMSAN.

Question 10

Nationality of Charles Miller Fisher was ?

A	Canadian
B	American
C	British
D	Brazilian

Question 10 Explanation:

Charles Miller Fisher was a Canadian stroke specialist.

Question 11

Which of the following is a demyelinating disorder ?

A	Acute motor axonal neuropathy (AMAN)
B	Acute motor sensory axonal neuropathy (AMSAN)
C	Miller Fisher syndrome (MFS)
D	All of the above

Question 11 Explanation:

Acute motor axonal neuropathy (AMAN) and acute motor sensory axonal neuropathy (AMSAN) subtypes are axonal variants of Guillain-Barré syndrome (GBS).

Question 12

Organisms involved in antecedent infections in Guillain-Barre syndrome include ?

A	Campylobacter jejuni
B	Human herpes virus
C	Cytomegalovirus
D	All of the above

Question 12 Explanation:

~70% of GBS occur 1-3 weeks after an acute infectious process (respiratory or gastrointestinal). Antecedent infection or reinfection with Campylobacter jejuni, human herpes virus infection, CMV or Epstein-Barr virus & Mycoplasma pneumoniae have been identified.

Question 13

Which of the following vaccinations could predispose to Guillain- Barre syndrome ?

A	Swine influenza vaccine
B	Influenza vaccine
C	Older type rabies vaccine
D	All of the above

Question 13 Explanation:

Immunizations with swine influenza vaccine, influenza vaccines and older-type rabies vaccine are implicated as a trigger of GBS. There is no increased risk of GBS with meningococcal vaccinations.

Question 14

Guillain-Barre syndrome occurs more frequently in patients with following diseases eHodgkin’s diseasexcept ?

A	Hodgkin’s disease
B	Chronic myeloid leukemia
C	HIV-seropositive individuals
D	Systemic lupus erythematosus

Question 14 Explanation:

GBS also occurs more frequently in patients with lymphoma (Hodgkin’s disease), HIV-seropositive individuals and in patients with SLE.

Question 15

Which of the following statements is false about GBS ?

A	Both cellular & humoral immune mechanisms involved
B	Analogous to experimental allergic neuritis (EAN)
C	Molecular mimicry mechanism
D	None of the above

Question 16

Which of the following is the critical event in the development of GBS ?

A	B cells recognize glycoconjugates on C. jejuni
B	Activation of B cells T cell
C	Escape of activated B cells from Peyer’s patches into regional lymph nodes
D	All of the above

Question 16 Explanation:

In the immunopathogenesis of GBS, a critical event in the development of GBS is the escape of activated B cells from Peyer’s patches into regional lymph nodes.

Question 17

Which of the following is false about Miller Fisher syndrome ?

A	Anti-GQ1b antibodies are found in > 90% patients
B	IgG titers are highest early in the course
C	Areflexia of limbs without weakness
D	None of the above

Question 17 Explanation:

Anti-GQ1b IgG antibodies are found in >90% of patients with MFS, and titers of IgG are highest early in the course. Anti-GQ1b antibodies are not found in other forms of GBS unless there is extraocular motor nerve involvement.

Question 18

Which of the following antiganglioside antibody is common in GBS ?

A	Anti GM1
B	Anti GM2
C	Anti GM3
D	Anti GM4

Question 18 Explanation:

Anti GM1, an antiganglioside antibody is common in GBS (20 - 50%), particularly in those preceded by C. jejuni infection

Question 19

Which of the following is most relevant to Gangliosides ?

A	Lectin
B	Heparan
C	Ceramide
D	Mannose

Question 19 Explanation:

Gangliosides are composed of a ceramide attached to one or more sugars (hexoses) and contain sialic acid (N-acetylneuraminic acid) linked to an oligosaccharide core. Gangliosides are important components of the peripheral nerves.

Question 20

Which of the following is a Ganglioside ?

A	GM1
B	GD1a
C	GT1a
D	All of the above

Question 20 Explanation:

GM1, GD1a, GT1a, and GQ1b are gangliosides

Question 21

Which of the following is a central nervous system variant of Miller Fisher syndrome ?

A	Anti-Hu–Associated Paraneoplastic Encephalitis (PEM)
B	Bickerstaff’s brain-stem encephalitis
C	Post–infectious brainstem encephalitis
D	All of the above

Question 21 Explanation:

Antibodies against ganglioside GQ1b have also been detected in patients with Bickerstaff’s brainstem encephalitis. Bickerstaff’s encephalitis is characterized by ophthalmoplegia and ataxia but is also accompanied by pyramidal and sensory tract findings and cerebrospinal fluid pleocytosis

Question 22

Which of the following gangliosides is strongly expressed at the nodes of Ranvier ?

A	GM1
B	GT1a
C	GQ1b
D	All of the above

Question 22 Explanation:

Gangliosides GM1 and GD1a are strongly expressed at the nodes of Ranvier, where voltage-gated sodium (Nav) channels are localized. Contactin associated protein (Caspr) & voltage-gated potassium (Kv) channels are present at paranodes and juxtaparanodes respectively. IgG anti-GM1 or anti- GD1a autoantibodies bind to the nodal axolemma, leading to membrane-attack complex (MAC) formation. This results in disappearance of Nav clusters and detachment of paranodal myelin, which can lead to nerve-conduction failure and muscle weakness.

Question 23

IgG autoantibodies to GQ1b cross-react with which of the following ?

A	GM1
B	GD1a
C	GT1a
D	All of the above

Question 23 Explanation:

IgG autoantibodies to GQ1b, which cross-react with GT1a, are strongly associated with the Miller Fisher syndrome, its incomplete forms (acute ophthalmoparesis and acute ataxic neuropathy), and its CNS variant, Bickerstaff’s brain-stem encephalitis (acute ophthalmoplegia, ataxia, and impaired consciousness after an infectious episode).

Question 24

The anti-GQ1b antibody syndrome includes which of the following ?

A	Bickerstaff’s brain-stem encephalitis
B	Miller Fisher syndrome
C	Pharyngeal–cervical–brachial weakness
D	All of the above

Question 24 Explanation:

The anti-GQ1b antibody syndrome includes the Miller Fisher syndrome, acute ophthalmoparesis, acute ataxic neuropathy, Bickerstaff’s brain-stem encephalitis, and pharyngeal–cervical–brachial weakness.

Question 25

GQ1b is strongly expressed in which of the following cranial nerves ?

A	Oculomotor nerve
B	Trochlear nerve
C	Abducens nerve
D	All of the above

Question 25 Explanation:

GQ1b is strongly expressed in the oculomotor, trochlear, and abducens nerves, as well as muscle spindles in the limbs. Glossopharyngeal and vagus nerves strongly express GT1a and GQ1b, possibly accounting for dysphagia.

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See all quizzes of Guillain-Barré syndrome (GBS) – Part 1 here:

1 Guillain-Barré syndrome was first described in which year ?
N Engl J Med 2012;366:2294-304
A. 1869
B. 1898
C. 1916
D. 1934

2 Miller Fisher syndrome was first reported in which year ?
A. 1923
B. 1943
C. 1956
D. 1966

3 Feature not typical of Guillain-Barre syndrome is ?
A. Acute onset
B. Males & females are at equal risk
C. Autoimmune
D. Polyradiculoneuropathy

4 Facial diparesis is present in what proportion of GBS patients ?
A. 10 %
B. 20 %
C. 50 %
D. 80 %

5 Which of the following is not typical of Guillain-Barre syndrome
?
A. Fever & constitutional symptoms are absent at onset
B. Lower cranial nerves are frequently involved
C. DTRs disappear within first few days of onset
D. Bladder dysfunction is a prominent feature

6 In GBS, clinical worsening reaches a plateau in how many weeks
of onset ?
A. 1 week
B. 4 weeks
C. 8 weeks
D. 12 weeks

7 Limited or regional GBS syndromes include ?
A. Acute motor axonal neuropathy (AMAN)
B. Acute motor sensory axonal neuropathy (AMSAN)
C. Miller Fisher syndrome (MFS)
D. All of the above

8 Which of the following is the most common form of GBS ?
A. Acute inflammatory demyelinating polyradiculoneuropathy
B. Acute axonal motor disorder
C. Acute sensory & motor axonal neuropathy
D. Miller Fisher syndrome (MFS)

9 Nationality of Charles Miller Fisher was ?
A. Canadian
B. American
C. British
D. Brazilian

10 Which of the following is a demyelinating disorder ?
A. Acute motor axonal neuropathy (AMAN)
B. Acute motor sensory axonal neuropathy (AMSAN)
C. Miller Fisher syndrome (MFS)
D. All of the above

11 Organisms involved in antecedent infections in Guillain-Barre
syndrome include ?
A. Campylobacter jejuni
B. Human herpes virus
C. Cytomegalovirus
D. All of the above

12 Which of the following vaccinations could predispose to Guillain-
Barre syndrome ?
A. Swine influenza vaccine
B. Influenza vaccine
C. Older type rabies vaccine
D. All of the above

13 Guillain-Barre syndrome occurs more frequently in patients with
following diseases except ?
A. Hodgkin’s disease
B. Chronic myeloid leukemia
C. HIV-seropositive individuals
D. Systemic lupus erythematosus

14 Which of the following statements is false about GBS ?
A. Both cellular & humoral immune mechanisms involved
B. Analogous to experimental allergic neuritis (EAN)
C. Molecular mimicry mechanism
D. None of the above
15 Which of the following is the critical event in the development of
GBS ?
A. B cells recognize glycoconjugates on C. jejuni
B. Activation of B cells T cell
C. Escape of activated B cells from Peyer’s patches into
regional lymph nodes
D. All of the above

16 Which of the following is false about Miller Fisher syndrome ?
A. Anti-GQ1b antibodies are found in > 90% patients
B. IgG titers are highest early in the course
C. Areflexia of limbs without weakness
D. None of the above

17 Which of the following antiganglioside antibody is common in
GBS ?
A. Anti GM1
B. Anti GM2
C. Anti GM3
D. Anti GM4

18 Which of the following is most relevant to Gangliosides ?
A. Lectin
B. Heparan
C. Ceramide
D. Mannose

19 Which of the following is a Ganglioside ?
A. GM1
B. GD1a
C. GT1a
D. All of the above

20 Which of the following is a central nervous system variant of
Miller Fisher syndrome ?
A. Anti-Hu–Associated Paraneoplastic Encephalitis (PEM)
B. Bickerstaff’s brain-stem encephalitis
C. Post–infectious brainstem encephalitis
D. All of the above

21 Which of the following gangliosides is strongly expressed at the
nodes of Ranvier ?
A. GM1
B. GT1a
C. GQ1b
D. All of the above

22 IgG autoantibodies to GQ1b cross-react with which of the
following ?
A. GM1
B. GD1a
C. GT1a
D. All of the above

23 The anti-GQ1b antibody syndrome includes which of the following
?
A. Bickerstaff’s brain-stem encephalitis
B. Miller Fisher syndrome
C. Pharyngeal–cervical–brachial weakness
D. All of the above

24 GQ1b is strongly expressed in which of the following cranial
nerves ?
A. Oculomotor nerve
B. Trochlear nerve
C. Abducens nerve
D. All of the above

25 In demyelinating GBS, basis for flaccid paralysis & sensory
disturbance is ?
A. Conduction block
B. Neurodegeneration
C. Apoptosis
D. All of the above

26 CSF findings in Guillain-Barre syndrome include all except ?
A. Elevated CSF proteins
B. CSF protein elevated by end of first week
C. No pleocytosis
D. CSF is normal when symptoms are present for < 6 hours

Guillain-Barré syndrome (GBS) - Part 1

[MCQ] Guillain-Barré syndrome (GBS) – Part 1

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Guillain-Barré syndrome (GBS)- Part 1

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