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* CMS Neuro 1
  sandhu123 - 09/01/18 13:48
  Previuosly healthy 27 Yr male comes to ED with 3 day H/O progressive weakness and shooting pains in lower extremities and a 6 Hr history of difficulty rising from a chair and climbing stairs, Temp is 37C. Muscle strength in lower extremity is markedly decreased proximally and distally, there is weakness of intrinsic hand muscles bilaterally. DTRs are absent throughout. Most likely diagnosis is

1. ALS 2. GBS 3. lumbar SPINAL STENOSIS 4. poliomyelitis 5. Polymyositis
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* Re:CMS Neuro 1
  cardio69 - 09/01/18 21:20
  Q1/you can ask yourself which neuropathies begin PROXimally rather than distally? 2nd Q/What would be 2 main pathologically distinct pic of GBS?

Acute pic if lower extremity shooting PAIN/combo weakness combo initial presenting symptoms & progressive ascending symmetric weakness of the lower extremities hours… DTR is absent at the time of presentation…whats Dx?

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* Re:CMS Neuro 1
  sandhu123 - 09/01/18 23:37
  Well, they didnt state where did the myopathy start, GBS should normally have more of proximal than distal weakness. Also, shooting pain and absence of paresethsias, no H/O antecedent infection goes against GBS.  
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* Re:CMS Neuro 1
  cardio69 - 09/02/18 20:58
I’m gone point all things you missing

In GBC the motor symp are most prevalent, however, you can have some paresthesia hand/feet in pat but or CN…but sensory abnorm on the exam is frequently mild. Classically GBS affect LOWER limb that usually where start (which you miss) ascends upwards Lower> upper extremities (feet before the legs) over hrs of days… on real setting clinical the GBS suspicion;
- Relatively new onset of weakness dev within day to 3-4…
- Symmetrical weakness rather than Unilateral
- Q preach of typical an ascending pattern of weakness* (“Difficulty climbing stairs, getting up from a chair/bed/floor, or standing up” & loss of tendon reflexes the hallmark of the disorder.
- Hx of pat could be recent infection/diarrheal/URTI/HSV/HIV… What you need to understand even 4 practicing “NOT ALL PATs are going to remember the infection” … NOT HIV or herpes 😊 that they remember. SO YOU CANT REALLY rely on the infection, you certainly CAN NOT use the absence of an infection to rule out GBS> however if the pat has had an infection particularly a diarrhea infection w/in last mon -> ↑the probability of GBS…
- * acute weakness OR paresthesia isolated to LEG should ALWAYS alarm you suspicious of GBS

Disease course Days/weakness dev abruptly over weeks -> 2/3 pat reach their weakest point (nadir) w/in 2 weeks -> plateaus phase can last days to weeks -> Mons/recovery phase.

Dx cytoabluminlogic dissoc/MRI spine-> may reveal N roots enhancement & NCS (slowed conduction velocity of impulses traveling along the N.

Know what I preach here & you will be fine. By now everything should be crystal clear for you.
& if you think ans is NOT GBS, then tell me what you pick as ans?

Q for you, the is no cure for it. Do you think if we give combo of IVIG + Plasma exchange has BEST of benefit? YES or NO ans will do…
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* Re:CMS Neuro 1
  sandhu123 - 09/02/18 23:21
  I have seen patients improve without meds, IVIG is expensive. Yes. there's evidence they hasten recovery. Do you have any reference that nerve root compression symptoms like rooting pain ?  
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* Re:CMS Neuro 1
  cardio69 - 09/03/18 23:16

You not reading Qs with care nor what been ask of you.
Ans: NO
Plasma exchange “OR” IVIG can be used There’s no benefit to using them BOTH together Rx reduces the time necessary > Combo tx with IVIG + PE confers NO clinically significant BENEFIT.

For your last Q you tell me what you don’t understand that I can help you with it. Reference, you can search it by yourself pal.
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* Re:CMS Neuro 1
  hellu_usmle - 09/04/18 14:14
  Thanks for the discussion guys.  
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* Re:CMS Neuro 1
  kapprep2011 - 09/04/18 16:00
  2. GBS  
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* Re:CMS Neuro 1
  sandhu123 - 09/04/18 22:30
  lol your telepathic question. I wont even imagine combining the two. Where did you read that GBS can cause that was my question but never mind  
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* Re:CMS Neuro 1
  sandhu123 - 09/08/18 14:11
  @cardio69 do you have offline NBME or want to discuss them ?  
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* Re:CMS Neuro 1
  cardio69 - 09/08/18 19:12
  No, have done it online & timed way back... I recommend you do the same. If you have any doubt in any Qs post it here as I helped you & many members, more than be happy to help you & dissect it for you FREE:) with no thank you...  
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