Vascular Neurology Board Review Questions and Answers (2nd Edition) PDF

SECOND Vascular Neurology EDITION An Imprint of Springer Publishing...

SECOND Vascular Neurology EDITION An Imprint of Springer Publishing Second Edition Board Review Second Edition Vascular Vascular Neurology Board Review Questions and Answers Neurology Nancy Futrell, MD Dara G. Jamieson, MD Expanded and updated successor to the only question and answer review book for vascular neurology! Now with 620 questions—more than 250 completely new to this edition—this review guide has been thoroughly revised to reflect current science and clinical knowledge. With improved diagnostic-quality images, an emphasis on new drugs, and added chapters devoted to anatomy, clinical trials and ethics, neuro-ophthalmology, and case studies, this comprehensive review covers the full range of topics tested on the ABPN vascular neurology certification and MOC exams. Board Review Vascular Neurology Board Review is an engaging, active method to gauge proficiency and identify gaps for further study. Questions and answers with detailed rationales address a broad mix of topics including basic science, pharmacology, epidemiology and prevention, recovery and rehabilitation, and recognition, evaluation, and treatment of cerebrovascular diseases and associated clinical problems. Each answer is accompanied by a relevant reference to guide further study. The book is a must-have review tool for anyone taking the vascular neurology subspecialty exam, and for physicians who want to enhance their understanding of stroke and stroke-related issues and concerns. Key Features: Futrell Jamieson Contains 620 board-style questions and answers with rationales and references Covers all topic areas on the ABPN content outline for vascular neurology boards and the MOC exam 85 images reinforce key diagnostic points and build interpretive skills 5 new chapters Questions and Answers All questions reviewed and updated to include the latest scientific, clinical, and treatment information Includes downloadable ebook to broaden study options Recommended Shelving Category: Neurology Nancy Futrell An Imprint of Springer Publishing Dara G. Jamieson 11 W. 42nd Street New York, NY 10036 9 780826 168528 www.springerpub.com Vascular Neurology Board Review  Vascular Neurology Board Review: Questions and Answers Second Edition Nancy Futrell, MD Director of Clinical Care and Research Intermountain Stroke Center Salt Lake City, Utah Visiting Scientist University of Copenhagen Copenhagen, Denmark Dara G. Jamieson, MD Associate Professor of Clinical Neurology Weill Cornell Medicine, New York Presbyterian New York, New York An Imprint of Springer Publishing Visit our website at www.springerpub.com ISBN: 9780826168528 ebook ISBN: 9780826168535 Acquisitions Editor: Beth Barry Compositor: Exeter Premedia Services Private Ltd. Copyright © 2018 Springer Publishing Company. Demos Medical Publishing is an imprint of Springer Publishing Company, LLC. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher. Medicine is an ever-changing science. Research and clinical experience are continually expanding our knowledge, in particular our understanding of proper treatment and drug therapy. The authors, editors, and publisher have made every effort 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, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the contents of the publication. Every reader should examine carefully the package inserts accompanying each drug and should carefully check whether the dosage schedules mentioned therein or the contraindications stated by the manufac- turer differ from the statements made in this book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. Library of Congress Cataloging-in-Publication Data Names: Futrell, Nancy, author. | Jamieson, Dara G., author. Title: Vascular neurology board review: questions and answers / Nancy Futrell, Dara G. Jamieson. Other titles: Vascular neurology Description: Second edition. | New York: Demos Medical Publishing, an imprint of Springer Publishing Company, LLC, | Preceded by Vascular neurology: questions and answers / Nancy Futrell, Dara G. Jamieson. 2008. | Includes bibliographical references and index. Identifiers: LCCN 2017027313| ISBN 9780826168528 | ISBN 9780826168535 (e-book) Subjects: | MESH: Cerebrovascular Disorders | Neurology | Examination Questions Classification: LCC RC388.5 | NLM WL 18.2 | DDC 616.8/10076—dc23 LC record available at https://lccn.loc.gov/2017027313 Contact us to receive discount rates on bulk purchases. We can also customize our books to meet your needs. For more information please contact: [email protected] Printed in the United States of America by Sheridan Books, Inc. 17 18 19 20 21 / 5 4 3 2 1 To my late husband, Clark H. Millikan, MD, a giant in the field of vascular neurology. Nancy Futrell, MD To those in my past and present who have given me the strength to complete this edition. Dara G. Jamieson, MD  Contents Contributors ix Preface xi Share Vascular Neurology Board Review: Questions and Answers, Second Edition 1. Basic Science 1 2. Vascular and Brain Anatomy 13 3. Clinical Pathology 21 4. Pharmacology and Pharmacokinetics 35 5. Epidemiology, Genetics, and Primary Prevention 71 6. Ischemic Disease of the Brain and Spinal Cord 91 7. Hemorrhagic Disease of the Brain and Spinal Cord 117 8. Neuro-Ophthalmology 133 9. Cardiovascular Disease 141 10. Hematology 159 11. Pediatric Cerebrovascular Disease 171 12. Neurovascular Imaging 187 13. Clinical Trials and Ethics 233 14. Recovery and Rehabilitation 251 15. Case Studies in Cerebrovascular Disease 265 Abbreviations 289 Index 297 vii  Contributors Lee S. Chung, MD, Assistant Professor, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah David Z. Wang, DO, Vice Chair and Clinical Professor, Department of Neurology, University of Illinois College of Medicine at Peoria, Peoria, Illinois Jana J. Wold, MD, Vascular Neurologist/Associate Professor of Neurology, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah ix  Preface Since the publication of the first edition of Vascular Neurology: Questions and Answers, the science and clinical knowledge in this field have grown exponentially. The first group of us who sat for the board exam have now taken the first MOC exam, which included topics not in the original exam, such as questions on medical ethics. We have had multiple requests from candidates for both exams to pro- duce an undated book in the practice exam format, and this second edition has been written to fulfill that need. The second edition has been expanded from 512 questions to over 600 questions. There are more than 250 new questions. We have included new sections on ethics and neuro-ophthalmology. Some outdated questions from the first edition were omitted and most other questions were completely reworked in view of changes in the basic and clinical sciences over the past 10 years. Every question in the second edition has been reviewed multiple times for accuracy and we have worked diligently to avoid errors, with the addition of collaborators to add another layer to the review process. We have improved the quality of the images. Image quality is a chronic complaint on the board exam. This is likely (at least in part) due to the expectation that we, as vascular neurologists, must interpret images produced with both cutting-edge technology and some older technologies with less- than-perfect resolution and patient positioning, along with motion artifacts. The point of reviewing images in this book and in the board exam is that (a) the images are of diagnostic quality, and (b) systematic review of the images should lead the reader (examinee) to the correct diagnosis. This book is written as a study guide/self-evaluation tool to prepare for the ABPN exam and MOC exam in vascular neurology. It is representative of the areas tested on the exam, including the stan- dard clinical and basic science of stroke and some of the esoterica that appear on the exam. The book should also serve as a study guide for any neurologist, internist, or family practitioner interested in expanding his or her knowledge in this important field. The authors have found this practice exam question-and-answer format to be an effective and engaging study method, as opposed to a didactic review or summary reader. We find it useful also to identify areas of weakness that require further study. Explanatory answers with appropriate refer- ences are included to facilitate learning. Most of the references are relatively recent, but for certain topics, we have included the classic references, such as Niels Lassen’s work on incomplete cerebral ischemia and Anthony Furlan’s classic description of retinal ischemia presenting as visual change in bright light. As with the first edition, the authors and the collaborators have learned a tremendous amount in the process of preparing this learning tool for our colleagues. We hope this book will provide you with an interesting and rewarding learning tool. Nancy Futrell xi  Share Vascular Neurology Board Review: Questions and Answers, Second Edition  101 Basic Science QUESTIONS 1. Which statement is true of cerebral venous sinuses? A) Like other structures in the venous system, they have thin walls. B) Like other structures in the venous system, they have no endothelial lining. C) They are encased within dura that defines and forms their walls. D) Jugular bulb flow and size are highly symmetrical. E) Irregularities in the transverse sinuses most often indicate thrombus. 2. Which statement is true about vascular endothelium and endogenous antithrombotic substances in humans? A) Platelet aggregation and thrombus formation generally do not occur on the surface of an intact blood vessel. B) Tissue factor is an endogenous anticoagulant. C) Heparan sulfate is a plasma protein that is synthesized by platelets. D) Prostacyclin is an anticoagulant synthesized by endothelial cells. E) Protein C and protein S are synthesized in the endothelial cell. 3. Which of the following substances is atherogenic? A) Tissue factor B) Interferon gamma C) CD4+ T cells D) Heat shock proteins E) All of the above 4. Which statement is true about cholesterol? A) Cholesterol is a member of the steroid family. B) Cholesterol is synthesized by the liver and then transported in the blood in its original form. C) Cholesterol is detrimental to the function of many cells. D) Cholesterol in cell membranes is the first step in atherogenesis. E) Cholesterol and triglyceride levels are relatively stable throughout the day and unaffected by dietary intake. 5. Which of the following statements is true about apoproteins and lipoproteins? A) Apoproteins are the protein component on the outer surface of lipoproteins. B) Apoproteins are involved in receptor recognition at cell surfaces and in enzyme regulation. C) Lipoprotein (a) or Lp(a), frequently called “L P little a,” is produced in the liver with a com- bination of low-density lipoprotein (LDL) and apoprotein (a). (continued) ANSWERS TO THIS SECTION CAN BE FOUND ON PAGE 7 1 2 BASIC SCIENCE D) Lp(a) elevation is a risk factor for atherosclerosis and is of greater significance in the setting of elevated LDL. E) All of the above 6. Which statement is true about high- and low-density lipoproteins (HDL and LDL)? A) HDL carries cholesterol from the liver to body tissues. B) LDL receptors transport LDL into cells, where the LDL remains unchanged. C) Defects of LDL receptors are protective against atherosclerosis. D) HDL transports cholesterol from the tissues back to the liver. E) None of the above 7. Which of the following particles is the smallest? A) Cholesterol B) Chylomicrons C) Very-low-density lipoprotein (VLDL) D) Low-density lipoprotein (LDL) E) High-density lipoprotein (HDL) 8. Which of the following statements is true about lipoproteins? A) Very-low-density lipoprotein (VLDL) is the largest and least dense of the lipoproteins. B) VLDL levels are decreased in diabetes. C) Chylomicrons are synthesized by the liver. D) VLDLs are synthesized in the intestinal cell walls. E) Chylomicrons and VLDL are key in the transport of triglycerides. 9. Which choice is correct regarding the formation of atherosclerosis? A) Susceptible areas of the arterial wall will initially demonstrate intimal thickening in young adulthood. B) Lipoprotein entry into the subendothelial space begins in middle age. C) Lipoprotein retention can lead to inflammatory responses in the 20s. D) Lowering plasma apolipoprotein B cannot promote removal of atherogenic components already present in the vessel wall. E) Inhibition of the inflammatory response will prevent the development of atherosclerosis. 10. The main regulator of blood pressure is A) The sympathetic nervous system B) The parasympathetic nervous system C) The kidneys D) The adrenal gland E) The brain 11. Which one of the following endogenous substances decreases blood pressure? A) Aldosterone B) Endothelin C) Angiotensin II D) Atrial natriuretic peptide E) None of the above  BASIC SCIENCE: Questions 3 12. The intimal layer of normal arteries is lined with endothelial cells and also contains A) Cholesterol and macrophages B) Smooth muscle cells C) Extracellular matrix, but no smooth muscle cells in humans or animals D) Adipose cells E) T cells 13. 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 eventually develop significant atherosclerosis E) None of the above 14. Vascular smooth muscle hypertrophy is stimulated by A) Mechanical vascular injury B) Platelet-derived growth factor (PDGF) C) Angiotensin II D) Fibroblast-derived growth factor (FDGF) E) None of the above 15. When decreased cerebral perfusion causes autoregulatory failure, what happens to each of the following parameters? Each response may be used more than once. A) Cerebral blood flow (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) 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. Match the level of cerebral blood flow (CBF) 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 ionic gradients C) 50–55 mL/100 g/min 3. Homeostasis D)