Vascular neurology questions and answers - part 1 doc

Jamieson, MD The only review book for the largest subspecialty in neurology, Vascular Neurology: Questions and Answers contains over 500 multiple-choice questions, each with an answer, d

9 781933 864242

9 0 0 0 0

ISBN-10: 1-933864-24-9 ISBN-13: 978-1-933864-24-2

Nancy Futrell, MD and Dara G Jamieson, MD

The only review book for the largest subspecialty in neurology, Vascular Neurology:

Questions and Answers contains over 500 multiple-choice questions, each with an

answer, detailed explanation, and references for further review

Vascular Neurology covers everything from the basics of neuroscience to

“must-know” clinical neurology to neurovascular specifics It includes Board-formatted

review questions and is divided into nine key sections for targeted topic study

Key features include:

• Over 500 Board-type questions and answers used throughout

• References for each question to further study

• In-depth coverage of all key topics for the vascular neurology subspecialty

examination

• Profusely illustrated with nearly 100 black & white and color images

• Applicability to a wide range of physicians, including medical students,

neurology residents, vascular neurologists, cardiologists, neurosurgeons,

internists, and hospitalists

Vascular Neurology: Questions and Answers is a must-have review tool for

anyone taking the vascular neurology subspecialty exam, the neurology Board

exam, and the Residency In-service Training Exam, and for any physician who

wants to review vascular neurology, test his or her skills, or better understand this

important topic It is the most effective way to prepare for exams and assess

your knowledge of the field

TOPICS:

Basic Science Pharmacology

Clinical Stroke Clinical Cardiology

Clinical Hematology Clinical Pediatrics

Imaging Clinical Pathology

Rehabilitation

Demos Medical Publishing

386 Park Avenue South

Nancy Futrell, MD

Director

Intermountain Stroke Center

Salt Lake City, Utah

Dara G Jamieson, MD

Associate Professor of Clinical Neurology

New York Presbyterian Hospital

Weill Medical College of Cornell University

New York, New York

Visit our website at www.demosmedpub.com

© 2008 Demos Medical Publishing, LLC All rights reserved Th is book is protected

by copyright No part of it may be reproduced, stored in a retrieval system, or

trans-mitted in any form or by any means, electronic, mechanical, photocopying,

record-ing, or otherwise, without the prior written permission of the publisher.

L I B R A RY O F C O N G R E S S C ATA L O G I N G - I N- P U B L I C AT I O N DATA

Futrell, Nancy.

Vascular neurology : questions and answers / Nancy Futrell, Dara G Jamieson.

p ; cm.

Includes bibliographical references and index.

ISBN-13: 978-1-933864-24-2 (pbk : alk paper)

ISBN-10: 1-933864-24-9 (pbk : alk paper)

1 Cerebrovascular disease—Examinations, questions, etc 2 Neurology—

Examinations, questions, etc I Jamieson, Dara G II Title.

[DNLM: 1 Cerebrovascular Accident—Examination Questions 2 Neurology—

Examination Questions WL 18.2 F996v 2008]

RC388.5.F88 2008

616.8’10076—dc22

2007046823

Medicine is an ever-changing science undergoing continual development Research

and clinical experience are continually expanding our knowledge, in particular our

knowledge of proper treatment and drug therapy Th e authors, editors, and publisher

have made every eff ort to ensure that all information in this book is in accordance

with the state of knowledge at the time of production of the book

Nevertheless, this does not imply or express any guarantee or responsibility on the

part of the authors, editors, or publisher with respect to any dosage instructions and

forms of application stated in the book Every reader should examine carefully the

package inserts accompanying each drug and check with a his physician or specialist

whether the dosage schedules mentioned therein or the contraindications stated by

the manufacturer diff er from the statements made in this book Such examination is

particularly important with drugs that are either rarely used or have been newly

re-leased on the market Every dosage schedule or every form of application used is

en-tirely at the reader’s own risk and responsibility Th e editors and publisher welcome

any reader to report to the publisher any discrepancies or inaccuracies noticed

Special discounts on bulk quantities of Demos Medical Publishing books are

avail-able to corporations, professional associations, pharmaceutical companies, health

care organizations, and other qualifying groups For details, please contact:

Special Sales Department

Demos Medical Publishing

386 Park Avenue South, Suite 301

Preface vii Acknowledgments xi

ST R O K E I S T H E T H I R D M O ST C O M M O N C AU S E of death and disability in the US It is a complex disease, with many causes, many presentations, and many levels of severity De-spite recent medical advances, stroke remains a diffi cult disease

to diagnose and treat In recognition of the importance of this common disorder, the American Board of Psychiatry and Neu-rology (ABPN) instituted a new subspecialty examination in

2005 According to the ABPN’s website, this exam is intended

“to offi cially establish the fi eld of vascular neurology as a defi nite area of subspecialization in neurology and child neurology and to provide a means of identifying properly trained and ex-perienced vascular neurologists.”

-Vascular Neurology: Questions and Answers, is intended to

be a comprehensive study guide for the ABPN’s vascular rology subspecialty exam In addition, this book can be used by any physician who wants to thoroughly and systematically re-view the topic of vascular neurology, self-assess his or her skills,

neu-or prepare fneu-or another examination that contains questions on this important topic

While the ABPN’s exam consists of 200 multiple-choice

questions administered during a 4-hour period, Vascular

Neu-rology: Questions and Answers contains over 500

multiple-choice questions, each with an answer, detailed explanation,

and one or more references for further study and review as

de-sired We have included almost 100 illustrations (some in full

color) keyed to many of the questions Th e book is divided into

chapters with questions providing detailed coverage of basic

science, pharmacology, clinical stroke, hematology, cardiology,

pediatrics, neuroimaging, neuropathology, and rehabilitation

All of these topics are important components to an in-depth

understanding of the fi eld, and all are important components of

the ABPN’s vascular neurology subspecialty examination

Th ose readers who are preparing for the ABPN’s exam are

strongly encouraged to visit the ABPN website for

informa-tion about, and requirements for, the exam: www.abpn.org It

is important to note that there will be a “grandfathering period”

through 2009 During this time, Board-certifi ed neurologists

may apply to take the exam if they can provide documentation

that they have “a minimum of 25% of practice time devoted to

vascular neurology.” After 2009, all applicants will need to have

successfully completed a 1-year vascular neurology fellowship

program

Stroke is a topic of critical relevance to neurologists,

cardi-ologists, emergency room physicians, internists, vascular and

neurosurgeons, and physiatrists worldwide While not

intend-ed to be an authoritative reference source, Vascular Neurology:

Questions and Answers will provide these professionals with an

excellent (and fun) resource that will enable them to test their

knowledge, clinical skills, and exam-readiness in a relatively

short period of time

As with any book, the authors may learn the most

Devel-oping questions in areas outside of neurology required

gain-ing a higher level of understandgain-ing in some areas, such as fetal

development of the heart and perinatal changes in circulation

Th e questions and answers contained in this book are designed

to synthesize complex information into an easily understood

format As we wrote this book, each of us developed half of the

questions and the other did a self-test with these questions We

found approaching the questions as a test, while comparing our

v i i i P R E F A C E

answers with the correct answer, was fun and informative We hope our readers will have the same experience.

For those using this book to prepare for the ABPN’s lar neurology subspecialty exam, we wish you luck For those using this book as a means of better understanding this impor-tant topic, we wish you happy reading and learning

neurol-— NF

We would also like to thank NeuroLogica Corporation, vers, Massachusetts, for their generosity in making the color prints possible

Dan-1. Th e atherogenicity of lipoproteins is related to size Which of the following statements is true?

A Th e largest lipoproteins are the most atherogenic

B Th e smallest lipoproteins are the most atherogenic

C Th e intermediate sized lipoproteins are the most atherogenic

D Th e large- and intermediate-sized lipoproteins are most atherogenic

E Th e intermediate- and small-sized lipoproteins are most atherogenic

2. Th e intimal layer of arteries is lined with endothelial cells and also contains:

A Smooth muscle cells in humans and rodents

B Smooth muscle cells in humans, but not in rodents

C Extracellular matrix, but no smooth muscle cells in humans or animals

D Heat shock proteins

E All of the above

4. Intimal thickening at arterial bifurcations:

A Is present at birth

B Is present in infancy and childhood only in individuals at high risk for the development of diff use atherosclerosis during adulthood

C Develops shortly after puberty

D Develops in early adulthood

E Develops in middle adulthood

2 B A S I C S C I E N C E : Q U E S T I O N S

5. Fatty streaks in arteries:

A Do not develop in the fetus

B Can be seen in the aorta in children

C Are composed of extracellular lipids

D Form most often in individuals who will eventually develop signifi cant

atherosclerosis

6. Th e main regulator of blood pressure is:

A Th e sympathetic nervous system

B Th e parasympathetic nervous system

C Atrial natriuretic peptide

D Th e parasympathetic nervous system

8 Th e artery of Percheron:

A Arises from the distal basilar artery

B Supplies the cerebellar peduncle

C When occluded, results in bilateral thalamic/midbrain infarcts

D Is a vestigial remnant seen in 1% of cerebral arteriograms

9. Nitric oxide (NO):

A Raises blood pressure

B Lowers blood pressure

C Has variable eff ects on blood pressure

D Has no eff ect on blood pressure

10. Shear stress causes:

A Stretching injury of the vessel

B Alignment of endothelial cells along the linear axis of the laminar fl ow

C Decreased release of NO

D Increased superoxide levels

B A S I C S C I E N C E : Q U E S T I O N S 3

11. Vascular smooth muscle hypertrophy is stimulated by:

A Mechanical vascular injury

B Platelet-derived growth factor

C Angiotensin II

D Fibroblast-derived growth factor (FDGF)

12. Vascular smooth muscle hyperplasia is stimulated by:

A Hypertension

B Th rombin

C Angiotensin II

D Infl ammatory cytokines

13. Which statement best describes apolipoprotein A-1 (apoA-1)?

A Elevated levels of apoA-1 may indicate vascular risk in women

B ApoA-1 comprises about 70% of the total protein mass of high-density lipoprotein (HDL)

C ApoA-1 plays a minimal role in reverse cholesterol transport

D ApoA-1 is a less accurate predictor of vascular risk than is HDL

E ApoA-1 levels must be measured after fasting leading to variable and poorly standardized results

14. When decreased cerebral perfusion causes autoregulatory failure, what pens to each of the following parameters? Each response may be used more than once

hap-A Cerebral blood fl ow (CBF) 1 Increased

B Cerebral blood volume (CBV) 2 Decreased

C Mean transit time (MTT) 3 Unchanged

D Oxygen extraction fraction (OEF)

E Cerebral metabolic rate of O2 (CMRO2)

15. Lipoprotein-associated phospholipase A2 (Lp-PL A2):

A Is an enzyme that is secreted by macrophages, T lymphocytes, and mast cells

B Is primarily bound to HDL and very low-density lipoprotein (VLDL)

C Should be assayed routinely to dictate patient management and vascular risk reduction

D Is a risk factor for cardiovascular disease that is dependent on diabetes

E All of the above

4 B A S I C S C I E N C E : Q U E S T I O N S

16. Which of the following usually mediates neuronal apoptosis (programmed

cell death) in brain ischemia?

A Cysteine-requiring aspartate-directed proteases (caspases)

B Apoptosis-inducing factor (AIF)

C Endonucleases

D Matrix metalloproteinases (MMPs)

E Bradykinin

17. Vascular endothelial growth factor (VEGF):

A Aff ects blood vessels but not neurons or glial cells and plays no role in

neurogenesis

B Has no role in diseases of the peripheral nervous system

C Is induced by hypoxia through hypoxia-inducible factor (HIF-1)

transcrip-tion factor

D Promotes angiogenesis, the diff erentiation of angioblasts into endothelial

cells to form de novo blood vessels

E Has a deleterious eff ect on recovery from cerebral ischemia

18. Match the level of cerebral blood fl ow to the cellular events:

A 35–25 mL/100 g/min 1 Electrical failure

B 18–25 mL/100 g/min 2 Deterioration of transmembrane

C 50–55 mL/100 g/min ionic gradients

B Antagonism of glutamate receptors in animal models of ischemia has

translated into effi cacy in human neuroprotection

C Glutamate may mediate anoxic and hypoglycemic hippocampal and

cor-tical neuronal injury

D Ischemia results in the release of glutamate, which activates ligand-gated

calcium (Ca2+) channels in presynaptic neurons

B A S I C S C I E N C E : Q U E S T I O N S 5

20. Endothelial cells produce:

A Anticoagulant and thrombolytic substances, but no prothrombotic stances

sub-B Anticoagulant, thrombolytic, and prothrombotic substances

C Only thrombolytic substances, with no anticoagulant or prothrombotic substances

D Anticoagulant substances, with no thrombolytic or prothrombotic stances

sub-21. Nitric oxide:

A Is a byproduct of l-arginine

B Release is decreased by shear stress

C Production is decreased by exercise

D Produces vasoconstriction

22. Th e posterior spinal artery generally branches from which artery?

A Vertebral artery

B Basilar artery

C Posterior inferior cerebellar artery

D Anterior inferior cerebellar artery

23. Which cranial nerve exits the brainstem between the posterior cerebral tery and the superior cerebellar artery?

A Consists of apolipoprotein(a) covalently linked to apolipoprotein B-100

B May be involved in thrombolysis based on the apoB-100 moiety

C Diff ers from low-density lipoprotein (LDL) cholesterol LDL-C by the

apoB-100 component

D Has little role in the pathogenesis of cerebrovascular disease