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Adult-Gerontology Acute Care (AGACNP)

Adult-Gerontology Acute Care Nurse Practitioner Board Certification Examination


The Anatomy of a Question


A 39-year-old woman presents with a ten-day history of progressive weakness. She is having more difficulty walking today. She has noted increased weakness in her arms and face. She states I feel like I cant breathe very deeply. but denies vision changes or headache. She denies fever now, but did have fever accompanied by diarrhea and abdominal pain three weeks ago. There is notable extremity muscle weakness to resistance and she is unable to walk without assistance. Achilles and patellar reflexes are absent. Which of the following is the most likely cause for these findings?

Answer choice options
  • A. Diabetic neuropathy
  • B. Guillain-Barré syndrome
  • C. Huntington’s disease
  • D. Multiple sclerosis

The incorrect options (distractors) are not totally wrong. These options can be diagramed as follows:

Most Correct
Least Correct
  • B.
    Guillain-Barré syndrome Presents with progressive weakness and loss of DTRs.
  • D.
    Multiple sclerosis May have acute exacerbations of weakness.
  • C.
    Huntington’s disease A progressive neurologic disorder but develops over years.
  • A.
    Diabetic neuropathy Chronic and typically involves sensory deficits.

The Anatomy of an Explanation

Guillain-Barré syndrome is an acute illness manifested by rapidly progressive polyneuropathy with weakness and possible paralysis. The condition is caused by an immune response to a preceding infection. The myelin or peripheral nerve axon are targets of this immune reaction. Campylobacter jejuni is the most common preceding infectious cause. Cytomegalovirus, Epstein-Barr, Zika, and human immunodeficiency viruses have also been associated. Other less common triggers include immunization, surgery, trauma, and bone marrow transplantation. Guillain-Barr occurs worldwide and in all ages, but the risk increases with age. The manifestation of muscle weakness usually starts in the legs, is symmetric, progressive in nature, and accompanied by the loss of deep tendon reflexes. Pain to the back and extremities may also be present. The progression of symptoms is generally two weeks from onset, with most reaching the nadir of the disease by four weeks from onset. The diagnosis of Guillain-Barr is made by clinical presentation but supported by cerebrospinal fluid analysis revealing normal white blood cell count and elevated protein. Up to 30 percent of patients will require ventilator support due to severe respiratory weakness. Treatment involves significant supportive care which may include ventilator support, intensive care, pain management and physical therapy. Plasma exchange and intravenous immune globulin are the main forms of disease modifying treatment.

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