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Old 10-26-2012
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Arrow Gyrus Daily Questions; Internal Medicine #57

A man comes to the emergency department with weakness in his leg that has been getting markedly worse over the last few days. He has weakness and loss of deep tendon reflexes the legs.He recalls an upper respiratory illness about 2 - 4 weeks prior that resolved.What is the most urgent steps?
A.Steroids
B. intravenous Immunoglobulins.
C. Peak inspiratory pressure.
D. Intubation .
E. Lumbar puncture

Q from Condroid Fissure.
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C. Peak inspiratory pressure.
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Quote:
Originally Posted by Novobiocin View Post
C. Peak inspiratory pressure.
Why this patient has weakness of lower limb ?
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Originally Posted by cingulate.gyrus View Post
Why this patient has weakness of lower limb ?
GBS: demyelination of peripheral nerves due to autoantibodies.
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Quote:
Originally Posted by cingulate.gyrus View Post
A man comes to the emergency department with weakness in his leg that has been getting markedly worse over the last few days. He has weakness and loss of deep tendon reflexes the legs.He recalls an upper respiratory illness about 2 - 4 weeks prior that resolved.What is the most urgent steps?
A.Steroids
B. intravenous Immunoglobulins.
C. Peak inspiratory pressure.
D. Intubation .
E. Lumbar puncture

Q from Condroid Fissure.
Its letter C (in fact the measure of Vital Capacity on the bedside is the accurate answer)

This is because respiratory function tests will tell you who will need to be closely monitored and who doesnt, this in case they require an endotracheal intubation (which a lot will)
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Quote:
Originally Posted by Novobiocin View Post
GBS: demyelination of peripheral nerves due to autoantibodies.
I mean this patient has weakness of lower limb only.There is nothing in the question to sugeest for a respiratory failure except for a respiratory infection 2 - 4 weeks back possibley viral infection which predispose to GBS.
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Originally Posted by cingulate.gyrus View Post
I mean this patient has weakness of lower limb only.There is nothing in the question to sugeest for a respiratory failure except for a respiratory infection 2 - 4 weeks back possibley viral infection which predispose to GBS.
Yes, there is nothing in the question stem to suggest respiratory failure except that "weakness in his leg that has been getting markedly worse over the last few days". Anyway, you want to rule out an impending respiratory failure i.e. before it happens to compromise his respiration which can be done by doing serial measurements of his Peak inspiratory pressure or VC. I believe measuring Peak inspiratory pressure is easier than measuring VC.

Besides, this is the best option to choose among the choices since:

A.Steroids -don't help in GBS
B. intravenous Immunoglobulins-only given once respiratory failure sets in or other life threatening complications.
C. Peak inspiratory pressure.
D. Intubation - no indication
E. Lumbar puncture-no indication

Quote:
Peak inspiratory pressure (PIP) is the highest level of pressure applied to the lungs during inhalation[1]. In mechanical ventilation the number reflects a positive pressure in centimeters of water pressure (cmH2O). In normal breathing, it may sometimes be referred to as the maximal inspiratory pressure (MIPO), which is a negative value[2].

Maximum inspiratory pressure (MIP) is the value representing the highest level of negative pressure a person can generate on their own during an inhalation.[1] Represented by centimeters of water pressure (cmH2O) and measured with a manometer. Maximum inspiratory pressure is an important and noninvasive index of diaphragm strength and an independent tool for diagnosing many illnesses[2] .
Quote:
A person's vital capacity can be measured by a spirometer which can be a wet or regular spirometer. In combination with other physiological measurements, the vital capacity can help make a diagnosis of underlying lung disease.
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Last edited by Novobiocin; 10-26-2012 at 08:18 PM.
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C is the answer............we have to keep checking for the respiratory function to detect impending failure...most imp step to consider in GBS......

we love your explanations Novobiocin........ Thank you for taking the pain
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Originally Posted by anomali View Post
C is the answer............we have to keep checking for the respiratory function to detect impending failure...most imp step to consider in GBS......

we love your explanations Novobiocin........ Thank you for taking the pain
No pain, no gain...........

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If little labour, little are our gains:
Man's fate is according to his pains.
Hesperides 752.
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You all are correct
Anser is C Peak inspiratory pressure.

This case is Guillian Barre .Ascending weakness with loss of deep tendon reflex is charecteristic. Peak inspiratory pressure is the correct answer.
The peak inspiratory pressure diminishes as the diaphragm is weakened.peak inspiratory pressure predicts who will have respiratory failure before it happens .

It is more important than to start therapy with either intravenous immunoglobulins or plasmapheresis. Combinations of these medications are not effective.
Steroids are not effective.Lumbar puncture ill show an elevated protien levesl with no cells.
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