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  #1  
Old 09-10-2012
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Default case of ascending weakness

A 14-year-old male presents with a complaint of soreness, and weakness in his legs for the past day that has slowly spread from his calves to his thighs. He now complains of weakness in his trunk and arms. On examination he appears tired and lays on the examining table. His temperature is 37 C (98.6 F), pulse is 48/min, and respirations are 22/min. Both of his legs are diffusely tender. Deep tendon reflexes are absent in the lower extremities, and sensation is greatly diminished. Which of the following studies is essential for this patient's diagnosis?

a)Creatinine phosphokinase levels
b)Stool culture for Campylobacter jejuni
c)Motor nerve conduction test
d)Cerebrospinal fluid studies
e)Muscle biopsy
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Old 09-10-2012
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Originally Posted by K06100 View Post
A 14-year-old male presents with a complaint of soreness, and weakness in his legs for the past day that has slowly spread from his calves to his thighs. He now complains of weakness in his trunk and arms. On examination he appears tired and lays on the examining table. His temperature is 37 C (98.6 F), pulse is 48/min, and respirations are 22/min. Both of his legs are diffusely tender. Deep tendon reflexes are absent in the lower extremities, and sensation is greatly diminished. Which of the following studies is essential for this patient's diagnosis?

a)Creatinine phosphokinase levels
b)Stool culture for Campylobacter jejuni
c)Motor nerve conduction test
d)Cerebrospinal fluid studies
e)Muscle biopsy

I dont like this, Guillain barre is purely motor and doesnt jump from the legs to the arms and sparing the diaphragm so i dont think thats the diagnosis...
I dont know the answer ill choose E :/
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I dont like this, Guillain barre is purely motor and doesnt jump from the legs to the arms and sparing the diaphragm so i dont think thats the diagnosis...
I dont know the answer ill choose E :/
U r wrong man.......try to think differently .....haha
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a)Creatinine phosphokinase levels
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Originally Posted by K06100 View Post
A 14-year-old male presents with a complaint of soreness, and weakness in his legs for the past day that has slowly spread from his calves to his thighs. He now complains of weakness in his trunk and arms. On examination he appears tired and lays on the examining table. His temperature is 37 C (98.6 F), pulse is 48/min, and respirations are 22/min. Both of his legs are diffusely tender. Deep tendon reflexes are absent in the lower extremities, and sensation is greatly diminished. Which of the following studies is essential for this patient's diagnosis?

a)Creatinine phosphokinase levels
b)Stool culture for Campylobacter jejuni
c)Motor nerve conduction test
d)Cerebrospinal fluid studies
e)Muscle biopsy
Would go with D, Gullian Barre syndrom is polyneuropathy dis. but i confused about the tenderness of legs.
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U will all be surprised to know the answer ......


The correct answer is
B. Guillain-Barré syndrome (GBS) is a postinfectious polyneuropathy that causes demyelination of BOTH motor and occasionally, sensory nerves. It is classically an ascending paralysis. CSF studies are essential for diagnosis and reveal a protein level usually twice normal values but with normal amounts of white blood cells, normal glucose level and an absence of pleocytosis (elevated lymphocytes). Autonomic nervous system involvement can produce the bradycardia seen in this vignette. Creatinine phosphokinase levels (choice A) may be mildly elevated and sometimes are normal, but are not essential for diagnosis. Motor nerve conduction tests (choice C) would show decreased velocities, but are not specific for GBS. A muscle biopsy (choice D) is not indicated and can be normal in early stages. Late disease reveals denervation atrophy. Stool culture for Campylobacter jejuni(choice E), a well recognized infection associated with GBS, is again not essential for diagnosis. By the time the disease presents stool cultures are often negative.
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i think its C..........

some types do cause a loss in sensation , not necessary to be C . jejuni other bacteria and viruses also possible , increase CPK for myopathy
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Originally Posted by K06100 View Post
U will all be surprised to know the answer ......


The correct answer is
B. Guillain-Barré syndrome (GBS) is a postinfectious polyneuropathy that causes demyelination of BOTH motor and occasionally, sensory nerves. It is classically an ascending paralysis. CSF studies are essential for diagnosis and reveal a protein level usually twice normal values but with normal amounts of white blood cells, normal glucose level and an absence of pleocytosis (elevated lymphocytes). Autonomic nervous system involvement can produce the bradycardia seen in this vignette. Creatinine phosphokinase levels (choice A) may be mildly elevated and sometimes are normal, but are not essential for diagnosis. Motor nerve conduction tests (choice C) would show decreased velocities, but are not specific for GBS. A muscle biopsy (choice D) is not indicated and can be normal in early stages. Late disease reveals denervation atrophy. Stool culture for Campylobacter jejuni(choice E), a well recognized infection associated with GBS, is again not essential for diagnosis. By the time the disease presents stool cultures are often negative.
Shouldn't the answer be D (Cerebrospinal fluid studies) then?
The explanations don't match with the question
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I think answer shud be C......most accurate test for GBS is electromyography /nerve conduction studies ......

what say???
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oops you posted the ans while i was typing ......

need to type faster ......
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I think answer shud be C......most accurate test for GBS is electromyography /nerve conduction studies ......

what say???

yup i said the same thing ......

but c jejuni will be found in stools why CSF ???? and its not necessary to find c jejuni to confirm GBS ........ i think the qs should be phased the best next step ?????
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yep ...answer shud be D......i got it.......now i read the explanation

actually I only saw the ''B''......and thought it is the answer......

Quote:
Shouldn't the answer be D (Cerebrospinal fluid studies) then?
The explanations don't match with the question
@novobiocin......u r right sir......
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yep ...answer shud be D......i got it.......now i read the explanation

actually I only saw the ''B''......and thought it is the answer......



@novobiocin......u r right sir......

yup i got it too......
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WUT! LOL!
I was owned by guillain barre then jesus christ -_-

I swear i didnt know it also caused sensory problems and could jump from legs to arms without affecting diaphragm... hope i dont get this kind of question in the exam
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WUT! LOL!
I was owned by guillain barre then jesus christ -_-

I swear i didnt know it also caused sensory problems and could jump from legs to arms without affecting diaphragm... hope i dont get this kind of question in the exam
Weird thing happen when they are named in French............no offense to French people.
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Originally Posted by K06100 View Post
I think answer shud be C......most accurate test for GBS is electromyography /nerve conduction studies ......

what say???
I also thought so,


I would have gone for C, as its a more sensitive test I guess.

Quote:
Originally Posted by Emedicine

Guillain-Barré syndrome (GBS) is generally diagnosed on clinical grounds. Basic laboratory studies, such as complete blood counts and metabolic panels, are of limited value in the diagnosis of GBS. They are often ordered, however, to exclude other diagnoses, and to better assess functional status and prognosis. The ordering of specific tests should be guided by the patient's history and presentation.

Abnormalities in nerve conduction studies (NCS) that are consistent with demyelination are sensitive and represent specific findings for classic GBS.[80] Frequent evaluations of these parameters should be performed at bedside to monitor respiratory status and the need for ventilatory assistance.

Lumbar puncture for cerebrospinal fluid (CSF) studies is recommended. During the acute phase of GBS, characteristic findings on CSF analysis include albuminocytologic dissociation, which is an elevation in CSF protein (>0.55 g/L) without an elevation in white blood cells. The increase in CSF protein is thought to reflect the widespread inflammation of the nerve roots.
Source : http://emedicine.medscape.com/articl...workup#showall
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