Vascular Neurology covers everything from the basics of neuroscience to “mustknow” clinical neurology to neurovascular specifics It includes Board-formatted review questions and is divided into nine key sections for targeted topic study 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 Clinical Stroke Clinical Hematology Imaging Rehabilitation Pharmacology Clinical Cardiology Clinical Pediatrics Clinical Pathology ISBN-13: 978-1-933864-24-2 ISBN-10: 1-933864-24-9 386 Park Avenue South New York, NY 10016 www.demosmedpub.com EAN Demos Medical Publishing 781933 864242 90000 Futrell / Jamieson 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 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 Questions and Answeres Nancy Futrell, MD and Dara G Jamieson, MD Futrell 00.indd i 11/19/07 10:40:56 AM Futrell 00.indd ii 11/19/07 10:40:57 AM 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 Futrell 00.indd 0iii 11/19/07 10:40:57 AM AC Q U I SI T I O N S E D I TO R : R Craig Percy C O V E R D E SI GN : A Good Thing C OP Y E D I TOR : Joann Woy C OMP O SI TOR : Patricia Wallenburg P R I N T E R : Transcontinental Printing Visit our website at www.demosmedpub.com © 2008 Demos Medical Publishing, 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 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 ATI 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) Cerebrovascular disease—Examinations, questions, etc Neurology— Examinations, questions, etc I Jamieson, Dara G II Title [DNLM: Cerebrovascular Accident—Examination Questions 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 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, 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 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 Every dosage schedule or every form of application used is entirely at the reader’s own risk and responsibility The 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 available 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 New York, NY 10016 Phone: 800–532–8663 or 212–683–0072 Fax: 212–683–0118 Email: orderdept@demosmedpub.com M A D E I N T H E U N I T E D STATE S O F A ME R I C A 08 09 10 Futrell 00.indd 0iv 11/19/07 10:40:57 AM Preface vii Acknowledgments xi Basic Science Pharmacology 13 Clinical Stroke 60 Clinical Cardiology 161 Clinical Hematology 181 Clinical Pediatrics 194 Imaging 209 Clinical Pathology 255 Rehabilitation 269 References 283 Abbreviations 307 Futrell 00.indd 0v 11/19/07 10:40:57 AM Futrell 00.indd 0vi 11/19/07 10:40:57 AM S of death and disability in the US It is a complex disease, with many causes, many presentations, and many levels of severity Despite recent medical advances, stroke remains a difficult disease to diagnose and treat In recognition of the importance of this common disorder, the American Board of Psychiatry and Neurology (ABPN) instituted a new subspecialty examination in 2005 According to the ABPN’s website, this exam is intended “to officially establish the field of vascular neurology as a definite area of subspecialization in neurology and child neurology and to provide a means of identifying properly trained and experienced vascular neurologists.” Vascular Neurology: Questions and Answers, is intended to be a comprehensive study guide for the ABPN’s vascular neurology subspecialty exam In addition, this book can be used by any physician who wants to thoroughly and systematically review the topic of vascular neurology, self-assess his or her skills, or prepare for 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 Neurology: Questions and Answers contains over 500 multipleT 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 Futrell 00.indd 0vii 11/19/07 10:40:57 AM viii P R E FAC E choice questions, each with an answer, detailed explanation, and one or more references for further study and review as desired We have included almost 100 illustrations (some in full color) keyed to many of the questions The 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 field, and all are important components of the ABPN’s vascular neurology subspecialty examination Those readers who are preparing for the ABPN’s exam are strongly encouraged to visit the ABPN website for information 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-certified 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, cardiologists, emergency room physicians, internists, vascular and neurosurgeons, and physiatrists worldwide While not intended 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 Developing questions in areas outside of neurology required gaining a higher level of understanding in some areas, such as fetal development of the heart and perinatal changes in circulation The 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 Futrell 00.indd 0viii 11/19/07 10:40:57 AM BASIC SCIENCE: QUESTIONS 16 Which of the following usually mediates neuronal apoptosis (programmed cell death) in brain ischemia? A B C D E Cysteine-requiring aspartate-directed proteases (caspases) Apoptosis-inducing factor (AIF) Endonucleases Matrix metalloproteinases (MMPs) Bradykinin 17 Vascular endothelial growth factor (VEGF): A Affects 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) transcription factor D Promotes angiogenesis, the differentiation of angioblasts into endothelial cells to form de novo blood vessels E Has a deleterious effect on recovery from cerebral ischemia 18 Match the level of cerebral blood flow to the cellular events: A B C D 35–25 mL/100 g/min 18–25 mL/100 g/min 50–55 mL/100 g/min < 10–12 mL/100 g/min Electrical failure Deterioration of transmembrane ionic gradients Homeostasis Increased glycolysis 19 Which of the following statements best describes the role of glutamate in cerebral ischemia? A Glutamate is released into the extracellular space with an rCBF of 10% of normal (