GBS Diagnosis; CSF or EMG! - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 03-28-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 585 Times in 354 Posts
Reputation: 595
Question GBS Diagnosis; CSF or EMG!

A 40-year-old postal worker presents with a 2 week history of difficulty walking and shortness of breath. Approximately 10 days after an episode of watery diarrhea, he noticed numbness and tingling in his feet that progressed up to his knees. A couple of days later, he developed weakness in his lower extremities. Approximately 5 days later, the numbness also involved his fingertips, and he developed a tight sensation around his chest, with increasing shortness of breath. His voice also became somewhat hoarse, and he noticed difficulty swallowing food. On admission, his vital signs are as follows: blood pressure (BP), 185/110 mm Hg; heart rate (HR), 105 beats/minute; respiration rate (RR), 30 breaths/minute; temperature (T), 37°C (98.6°F). He has a very soft voice, bilateral upper and lower facial palsy, motor strength is 3/5 in all extremities, worse distally, and no reflexes can be elicited. He does have loss of all sensory modalities in his legs and arms, up to hip and mid-forearm respectively. His negative inspiratory force (NIF) is -20, and his ventilatory capacity (VC) is 750 mL. He is intubated electively and admitted to the intensive care unit (ICU). What is the next most appropriate test to confirm the diagnosis?

A. Cerebrospinal fluid (CSF) examination
B. Computed tomography (CT) of the head
C. Electrocardiogram (EKG)
D. Electromyography (EMG)/nerve conduction studies (NCS)
E. Magnetic resonance imaging (MRI) of the cervical spine
Reply With Quote Quick reply to this message



  #2  
Old 03-28-2012
USMLE Forums Guru
 
Steps History: 1 + CS
Posts: 405
Threads: 55
Thanked 523 Times in 155 Posts
Reputation: 533
Default

A. Cerebrospinal fluid (CSF) examination - Albuminocytologic dissociation for GBS.
Reply With Quote Quick reply to this message
  #3  
Old 03-28-2012
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 76
Threads: 10
Thanked 31 Times in 27 Posts
Reputation: 41
Default

ans.D electromyography
Reply With Quote Quick reply to this message
  #4  
Old 03-28-2012
USMLE Forums Scout
 
Steps History: Not yet
Posts: 52
Threads: 12
Thanked 4 Times in 4 Posts
Reputation: 14
Default

best initial is ------albumino cytological dissociation
most accurate-----electromyelography
Reply With Quote Quick reply to this message
  #5  
Old 03-29-2012
USMLE Forums Addict
 
Steps History: Not yet
Posts: 137
Threads: 2
Thanked 65 Times in 40 Posts
Reputation: 75
Default

D.(
Most, but not all, patients with GBS have an elevated CSF protein level (>400 mg/L), with normal CSF cell counts. Elevated or rising protein levels on serial lumbar punctures and 10 or fewer mononuclear cells/mm3 strongly support the diagnosis.
A normal CSF protein level does not rule out GBS, however, as the level may remain normal in 10% of patients. CSF protein may not rise until 1-2 weeks after the onset of weakness) .(MEDSCAPE)
Reply With Quote Quick reply to this message
  #6  
Old 03-29-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 585 Times in 354 Posts
Reputation: 595
Default

guys answer here is LP. its not EMG. i did EMG because it is confirmatory. may be its emergency setting that LP is the answer...what say?
Reply With Quote Quick reply to this message
  #7  
Old 03-29-2012
Seetal's Avatar
USMLE Forums Master
 
Steps History: Step 1 Only
Posts: 919
Threads: 134
Thanked 1,301 Times in 364 Posts
Reputation: 1324
Send a message via MSN to Seetal
Default

Quote:
Originally Posted by tyagee View Post
guys answer here is LP. its not EMG. i did EMG because it is confirmatory. may be its emergency setting that LP is the answer...what say?
definitely CSF. EMG will not help in this case. after proving that it is myopathy, what would you treat? the myopathy or the underlying disease?

with CSF we can rule out GBS or other diseases that may cause the myopathy and hence direct our treatment that way. also a LP is much cheaper and done faster as compared to EMG. also, MG and GBS will have the same EMG results. but a CSF examination can differentiate the two.
Reply With Quote Quick reply to this message
The above post was thanked by:
podebrad (05-09-2012), Teresa (04-23-2012), tyagee (03-29-2012)



Reply

Tags
Internal-Medicine-, Neurology-, Step-2-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
What is the most likely diagnosis? aktorque USMLE Step 1 Forum 12 07-13-2015 03:44 AM
Which Imaging to diagnose MS? homa_7 USMLE Step 2 CK Forum 3 05-04-2012 11:54 AM
HIV diagnosis indigo USMLE Step 1 Forum 1 12-13-2011 03:14 AM
What is your diagnosis? aktorque USMLE Step 1 Forum 12 02-15-2011 12:38 PM
It's about the diagnosis Teodoro88 USMLE Step 2 CS Forum 1 09-28-2009 03:57 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)