Question 1

A 75-kg, 50-year-old male patient has Guillain-Barré syndrome. His most recent assessment indicates his VC is 900 mL and NIF is -16 cm H₂O. What plan should the respiratory therapist recommend?

Accepted Answer

Initiating mechanical ventilation is recommended for a patient with Guillain-Barré syndrome when vital capacity (VC) is less than 1,000 mL or negative inspiratory force (NIF) is weaker than -20 cm H2O, indicating significant respiratory muscle weakness and risk of respiratory failure.

Question 2

In the United States and Europe, what is the most common subtype of GBS?

Accepted Answer

Acute inflammatory demyelinating polyneuropathy (AIDP) is the most common subtype of Guillain-Barré Syndrome (GBS) in the United States and Europe, characterized by demyelination of peripheral nerves leading to rapidly progressive muscle weakness and paralysis.

Question 3

Common noncardiopulmonary manifestations associated with Guillain-Barré are:
1) asymmetric muscle weakness in distal extremities.
2) leg pain.
3) distal paresthesia.
4) muscle paralysis that most often spreads downward from the face to the arms and trunk.

Accepted Answer

Guillain-Barré syndrome typically presents with symmetric muscle weakness (not asymmetric), often starting in the lower extremities and moving upward, leg pain, and distal paresthesia. Muscle paralysis in Guillain-Barré usually spreads upward, not downward.

Question 4

Under microscopic inspection, the skeletal muscle nerves of a Guillain-Barré patient show which of the following?
1) Hypertrophy
2) Edema
3) Inflammation
4) Demyelination

Accepted Answer

Guillain-Barré syndrome is characterized by edema, inflammation, and demyelination of the peripheral nerves, not hypertrophy.

Question 5

Approximately what percentage of patients with GBS develop respiratory muscle paralysis?

Accepted Answer

Approximately 10% to 30% of patients with Guillain-Barré Syndrome (GBS) develop respiratory muscle paralysis, necessitating mechanical ventilation.

Question 6

Clinical indications that a patient has impending acute ventilatory failure include: 1) pH < 7.35. 2) FVC < 20 mL/kg. 3) PaCO₂ > 45 mm Hg. 4) MEP > 40 cm H₂O.

Accepted Answer

A pH < 7.35 indicates acidosis, FVC < 20 mL/kg suggests inadequate ventilation capacity, and PaCO2 > 45 mm Hg indicates hypercapnia, all of which are signs of impending acute ventilatory failure. MEP > 40 cm H2O is not indicative of ventilatory failure.

Question 7

The diagnosis of Guillain-Barré syndrome is based on:
1) urinalysis, which shows elevated blood urea nitrogen.
2) abnormal electromyography results.
3) cerebrospinal fluid, which shows elevated protein level.
4) clinical history.

Accepted Answer

The diagnosis of Guillain-Barré syndrome (GBS) is primarily based on clinical history, abnormal electromyography (EMG) results indicating nerve damage, and cerebrospinal fluid analysis showing elevated protein levels with a normal white cell count, which is characteristic of GBS. Urinalysis and elevated blood urea nitrogen are not diagnostic criteria for GBS.

Question 8

A patient with Guillain-Barré is paralyzed and on mechanical ventilatory support. Which of the following pulmonary complications is most likely to occur as the result of prolonged immobilization?

Accepted Answer

The answer of A patient with Guillain-Barré is paralyzed and...

Question 9

A Guillain-Barré syndrome patient has autonomic nervous system dysfunction which can result in which of the following?
1) Tachycardia
2) Hypotension
3) Urinary retention
4) Fever

Accepted Answer

Guillain-Barré syndrome (GBS) can affect the autonomic nervous system, leading to symptoms such as tachycardia (rapid heart rate), hypotension (low blood pressure), and urinary retention due to the dysfunction of the autonomic nerves that control these functions. Fever is not directly caused by autonomic dysfunction in GBS.

Question 10

In which of the following persons would Guillain-Barré syndrome most likely occur?

Accepted Answer

Guillain-Barré syndrome (GBS) can occur in any person regardless of age, gender, or ethnicity. However, it is slightly more common in males and increases in incidence with age, making a Caucasian male aged 53 years a more likely candidate compared to the other options provided.

Question 11

A patient with Guillain-Barré syndrome developed atelectasis. His chest radiograph findings would be expected to show:

Accepted Answer

Atelectasis refers to the collapse of lung tissue, leading to reduced gas exchange and often presenting as increased opacity on a chest radiograph due to the consolidation of lung tissue.

Question 12

The major pathologic or structural changes of the lungs associated with ventilator failure accompanying Guillain-Barré syndrome include:
1) alveolar consolidation.
2) airway distortion and dilation.
3) mucosal edema.
4) atelectasis.

Accepted Answer

Guillain-Barré syndrome primarily affects the nervous system, leading to muscle weakness and paralysis, which can impair the ability to breathe and cause ventilator failure. The major lung changes associated with ventilator failure in this context are alveolar consolidation and atelectasis, due to reduced lung volumes and ineffective airway clearance, rather than airway distortion, dilation, or mucosal edema, which are more characteristic of direct lung injuries or diseases.

Question 13

Which of the following has been shown to shorten the course of a severe case of Guillain-Barré syndrome?

Accepted Answer

Plasmapheresis has been shown to shorten the course of a severe case of Guillain-Barré syndrome by removing antibodies from the blood that are believed to be involved in the immune attack on the peripheral nerves.

Question 14

Typical chest assessment findings in a patient with Guillain-Barré syndrome include:
1) diminished breath sounds.
2) crackles.
3) tracheal deviation.
4) depressed diaphragms.

Accepted Answer

Guillain-Barré syndrome can lead to respiratory muscle weakness, resulting in diminished breath sounds and possibly crackles due to atelectasis or secretions. Tracheal deviation and depressed diaphragms are not typical findings associated with this condition.

Question 15

When a person has Guillain-Barré syndrome, how are peripheral nerves affected?

Accepted Answer

Guillain-Barré syndrome is characterized by the immune system attacking the peripheral nerves, specifically targeting the myelin sheath, which leads to demyelination and affects nerve signal transmission.

Question 16

Which of the following are identified as the causative organisms of the respiratory or gastrointestinal infections that precede the onset of most cases of GBS?

Accepted Answer

Campylobacter jejuni and cytomegalovirus are recognized as common preceding infections associated with Guillain-Barré Syndrome (GBS), often leading to the condition following respiratory or gastrointestinal infections.

Question 17

The peripheral nervous system problems found with Guillain-Barré syndrome (GBS) include:
1) loss of reflexes.
2) increased reflex reactions.
3) flaccid paralysis of skeletal muscles.
4) tetany of skeletal muscles.

Accepted Answer

Guillain-Barré syndrome (GBS) is characterized by the loss of reflexes and flaccid paralysis of skeletal muscles, as the immune system mistakenly attacks the peripheral nerves.

Quiz 29: Guillain-Barré Syndrome

A 75-kg, 50-year-old male patient has Guillain-Barré syndrome. His most recent assessment indicates his VC is 900 mL and NIF is -16 cm H2O. What plan should the respiratory therapist recommend?

In the United States and Europe, what is the most common subtype of GBS?

Common noncardiopulmonary manifestations associated with Guillain-Barré are: 1) asymmetric muscle weakness in distal extremities. 2) leg pain. 3) distal paresthesia. 4) muscle paralysis that most often spreads downward from the face to the arms and trunk.

Under microscopic inspection, the skeletal muscle nerves of a Guillain-Barré patient show which of the following? 1) Hypertrophy 2) Edema 3) Inflammation 4) Demyelination

Approximately what percentage of patients with GBS develop respiratory muscle paralysis?

Clinical indications that a patient has impending acute ventilatory failure include: 1) pH < 7.35. 2) FVC < 20 mL/kg. 3) PaCO2 > 45 mm Hg. 4) MEP > 40 cm H2O.

The diagnosis of Guillain-Barré syndrome is based on: 1) urinalysis, which shows elevated blood urea nitrogen. 2) abnormal electromyography results. 3) cerebrospinal fluid, which shows elevated protein level. 4) clinical history.

A patient with Guillain-Barré is paralyzed and on mechanical ventilatory support. Which of the following pulmonary complications is most likely to occur as the result of prolonged immobilization?

A Guillain-Barré syndrome patient has autonomic nervous system dysfunction which can result in which of the following? 1) Tachycardia 2) Hypotension 3) Urinary retention 4) Fever