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Guillain-Barré syndrome — MCCQE Part 1 MCQ

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ModerateWeaknessGuillain-Barré syndromeMCCQE Part 1

41-year-old man after diarrhoeal illness presents with progressive leg weakness. Reflexes are absent and he has mild shortness of breath. Which of the following is the most appropriate next step?

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Correct answer: D — Admit for respiratory monitoring, IVIG/plasma exchange consideration and neurology consultation

Admit for respiratory monitoring, IVIG/plasma exchange consideration and neurology consultation is best because ascending areflexic weakness after infection suggests Guillain-Barré syndrome. Discharge with reassurance and routine follow-up only is suboptimal because it underestimates acute or progressive risk; Treat symptomatically and defer definitive assessment is suboptimal because symptom control alone does not address the likely underlying diagnosis; Arrange non-urgent outpatient imaging in several months is suboptimal because delayed imaging is unsafe when the presentation has red flags; Start long-term corticosteroids without confirming the diagnosis is suboptimal because empiric steroids can obscure infection, malignancy or other diagnoses. Vital capacity monitoring can be lifesaving.

Reference: Canadian Neurological Sciences Federation guidance