Paediatric infections: poliomyelitis versus Guillain-Barre syndrome: practice question

A Pediatrics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pediatrics · Paediatric infections: poliomyelitis versus Guillain-Barre syndrome

Sample item

A 3-year-old has fever followed by sudden, asymmetric flaccid weakness of one leg with absent knee jerk and intact sensation. Which additional feature favours poliomyelitis rather than Guillain-Barre syndrome?

AParalysis starting during the febrile phase with pleocytosis in CSFBBilateral facial palsy before limb involvementCStocking-glove sensory lossDSymmetric ascending weakness with normal CSF cell count

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Paralysis starting during the febrile phase with pleocytosis in CSF

Poliomyelitis causes asymmetric flaccid paralysis that develops while fever is present, with CSF showing mild lymphocytic pleocytosis. Guillain-Barre syndrome is a symmetric ascending polyneuropathy following a prior illness, with albuminocytological dissociation in CSF. Sensory symptoms and facial weakness favour GBS.

Option by option

A. Paralysis starting during the febrile phase with pleocytosis in CSF (correct)
Correct. Asymmetric paralysis during fever with CSF cells favours polio.
B. Bilateral facial palsy before limb involvement
Early bilateral facial palsy is a GBS pattern.
C. Stocking-glove sensory loss
Sensory loss indicates a polyneuropathy and not an anterior horn cell disease.
D. Symmetric ascending weakness with normal CSF cell count
Symmetric ascending weakness with raised protein is GBS.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is A, Paralysis starting during the febrile phase with pleocytosis in CSF. Poliomyelitis causes asymmetric flaccid paralysis that develops while fever is present, with CSF showing mild lymphocytic pleocytosis.

Why is "Bilateral facial palsy before limb involvement" not the answer?

Early bilateral facial palsy is a GBS pattern.

Why is "Stocking-glove sensory loss" not the answer?

Sensory loss indicates a polyneuropathy and not an anterior horn cell disease.

Why is "Symmetric ascending weakness with normal CSF cell count" not the answer?

Symmetric ascending weakness with raised protein is GBS.

What concept does this question test?

It tests Paediatric infections: poliomyelitis versus Guillain-Barre syndrome in Pediatrics. Guillain-Barre syndrome is a symmetric ascending polyneuropathy following a prior illness, with albuminocytological dissociation in CSF. Sensory symptoms and facial weakness favour GBS.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Paediatric infections: poliomyelitis versus Guillain-Barre syndrome?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.