WBR0007

Author	PageAuthor::
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Internal medicine
Sub Category	SubCategory::Neurology
Prompt	[[Prompt::A 32-year-old man is brought to the emergency room and he states that for the past month he has been losing feeling and motor function of both his lower extremities. This problem has progressed until now when he cannot walk and must be carried onto the exam bed. He states that he has not had a history of trauma and the only illness was nausea, vomiting, and diarrhea 3 months earlier, although he recovered fully without medications. On exam, motor strength is 1/5 in both legs and deep tendon reflexes are impaired. What is the most appropriate next step in treatment?]]
Answer A	AnswerA::Admission to the hospital and infusion of IVIG.
Answer A Explanation	AnswerAExp::
Answer B	AnswerB::Admission to the hospital and infusion of continuous drip dexamethasone.
Answer B Explanation	AnswerBExp::
Answer C	AnswerC::Outpatient therapy consisting of metronidazole (Flagyl) and follow-up the next day.
Answer C Explanation	AnswerCExp::
Answer D	AnswerD::Outpatient therapy consisting of a tapered regimen of prednisone orally and follow-up the next week.
Answer D Explanation	AnswerDExp::
Answer E	AnswerE::Admission to the ICU and intubation when inevitable respiratory collapse occurs.
Answer E Explanation	AnswerEExp::
Right Answer	RightAnswer::A
Explanation	[[Explanation::Guillan-Barre is a serious neurologic disease, in which the patient must be monitored as an inpatient because of its high likelihood for the need of intubation. Infusion of IVIG or plasmaphoresis is often attempted during therapy but progression commonly occurs. Although commonly self limited, progression may progress to respiratory compromise and the need for intubation. Educational Objective: References: ]]
Approved	Approved::No
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