Chapter 34 - CVD Flashcards by Faye Garciano

What is the most common cause of diagnostic error in stroke?*
A. Inadequate history
B. Differentiating between ischemic and hemorrhagic stroke
C. Inadequate observation period
D. None of the above

A. Inadequate history (p. 780)

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Most frequently involved site on cerebral embolism
A. MCA superior division
B. MCA inferior division
C. ICA
D. Basilar artery

A. MCA superior division (p. 783)

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Artery that is most susceptible to the migrating or traveling embolus syndrome
A. Basilar artery
B. ICA
C. MCA
D. ACA

A. Basilar artery (p. 785)

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Normal average diameter of the lumen of the ICA
A. 5mm
B. 6mm
C. 7mm
D. 8mm

C. 7mm (p. 788)

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In general, hemodynamic changes in the retinal or cerebral circulation make their appearance when the lumen of the ICA is reduced to
A. 2mm
B. 3mm
C. 5mm
D. 6mm

A. 2mm (p. 788)

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Bruit in stenosis of the proximal ICA is heard best where?
A. Angle of jaw
B. Lower neck
C. Posterior neck
D. Anterior neck

A. Angle of jaw (p. 794)

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Crystalline cholesterol emboli seen in retinal examination of patients with carotid disease
A. Hollenhorst plaque
B. Bitot’s spots
C. Roth’s spots
D. MacCallum plaques

A. Hollenhorst plaques (p. 794)

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Origin of the right common carotid artery
A. Brachiocephalic artery
B. Aortic arch
C. Right subclavian artery
D. Thyrocervical artery

A. Brachiocephalic artery (p. 795)

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Origin of the left common carotid artery
A. Brachiocephalic artery
B. Aortic arch
C. Right subclavian artery
D. Thyrocervical artery

B. Aortic arch (p. 795)

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Termination of the common carotid arteries
A. C3 level
B. C4 level
C. C5 level
D. C6 level

B. C4 level (p. 795)

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Headache associated with occlusion of the ICA is typically felt where?
A. Above the eyebrow
B. At the temple
C. In or behind the eye
D. Vertex

A. Above the eyebrow (p. 796)

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Headache associated with occlusion of the MCA is typically felt where?
A. Above the eyebrow
B. At the temple
C. In or behind the eye
D. Vertex

B. At the temple (p. 796)

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Headache associated with occlusion of the PCA is typically felt where?
A. Above the eyebrow
B. At the temple
C. In or behind the eye
D. Vertex

C. In or behind the eye (p. 796)

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Brachiofacial paralysis is usually associated with infarction of which arterial territory?
A. MCA stem
B. MCA superior division
C. MCA inferior division
D. ACA

B. MCA superior division (p. 798)

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Infarction of the head of the caudate is usually associated with which artery?
A. MCA stem
B. MCA superior division
C. MCA inferior division 
D. Recurrent artery of Heubner

D. Recurrent artery of Heubner (p. 798)

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The thalamic syndrome of Dejerine and Roussy results from occlusion of which artery?
A. Interpenduncular arteries
B. Artery of Percheron
C. Thalamoperforate arteries
D. Thalamogeniculate arteries

D. Thalamogeniculate arteries (p. 804)

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Oculomotor palsy with crossed hemiplegia
A. Weber syndrome 
B. Claude syndrome 
C. Benedikt syndrome
D. Millard-Gubler syndrome

A. Weber syndrome (p. 805)

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Oculomotor palsy with contralateral cerebellar ataxia and tremor
A. Weber syndrome 
B. Claude syndrome 
C. Benedikt syndrome
D. Millard-Gubler syndrome

B. Claude syndrome (p. 805)

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Oculomotor palsy with contralateral cerebellar ataxia, tremor, and corticospinal signs, may have choreoathetosis*
A. Weber syndrome 
B. Claude syndrome 
C. Benedikt syndrome
D. Millard-Gubler syndrome

C. Benedikt syndrome (p. 805)

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Paralysis of soft palate and vocal cord and contralateral hemianesthesia
A. Raymond-Foville syndrome
B. Avellis syndrome
C. Jackson syndrome
D. Wallenberg syndrome

B. Avellis syndrome (p. 805)

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Paralysis of soft palate and vocal cord,  contralateral hemianesthesia, and ipsilateral tongue paralysis
A. Raymond-Foville syndrome
B. Avellis syndrome
C. Jackson syndrome
D. Wallenberg syndrome

C. Jackson syndrome (p. 805)

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Ipsilateral V, IX, X, XI palsy, Horner syndrome, and cerebellar ataxia; contralateral loss of pain and temperature sense
A. Raymond-Foville syndrome
B. Avellis syndrome
C. Jackson syndrome
D. Wallenberg syndrome

D. Wallenberg syndrome (p. 805)

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Anteromedial-inferior thalamic syndromes, which present with extrapyramidal movement disorder is associated with occlusion of which artery?
A. Interpenduncular arteries
B. Artery of Percheron
C. Thalamoperforate arteries
D. Thalamogeniculate arteries

C. Thalamoperforate arteries (p. 804)

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Wallenberg syndrome is traditionally attributed to occlusion of which artery?
A. PICA
B. Basilar artery
C. AICA
D. SCA

A. PICA (p. 808)

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``` The most rostral circumferential branch of the basilar artery A. PICA B. AICA C. Superior cerebellar artery D. PCA ```

C. Superior cerebellar artery (p. 810)

``` Most common location of lacunar infarctions A. Putamen B. Thalamus C. Pons D. Internal capsule ```

A. Putamen (p. 811)

``` A lacunar stroke leading to pure motor hemiplegia is due to occlusion of which artery? A. Lenticulostriate B. Posterior choroidal C. Anterior choroidal D. Thalamoperforate ```

A. Lenticulostriate (p. 811)

``` Which antiplatelet agent is most likely to cause neutropenia? A. Aspirin B. Ticlopidine C. Clopidogrel D. Dipyridamole ```

B. Ticlopidine (p. 818)

``` Which antiplatelet agent is most likely to cause thrombotic thrombocytopenic purpura? A. Aspirin B. Ticlopidine C. Clopidogrel D. Dipyridamole ```

C. Clopidogrel (p. 818)

``` Which antiplatelet agent is most likely to cause dizziness induced by peripheral vasodilation? A. Aspirin B. Ticlopidine C. Clopidogrel D. Dipyridamole ```

D. Dipyridamole (p. 818)

``` A trial that failed to show benefit for the addition of extended release of dipyridamole to aspirin A. IST B. CAST C. ESPRIT D. CHANCE ```

C. ESPRIT (p. 818)

``` This trial demonstrated a reduction in stroke recurrence during the first 90 days after the first minor stroke or TIA by adding clopidogrel to aspirin, and no increase in cerebral hemorrhages A. IST B. CAST C. ESPRIT D. CHANCE ```

D. CHANCE (p. 818)

``` This study concluded that carotid endarterectomy for symptomatic lesions causing degrees of stenosis >70-80% in diameter reduces the incidence of ipsilateral hemispheral strokes A. NASCET B. CAVATAS C. SPACE D. ACAS ```

A. NASCET (p. 821)

``` Most common symptom of hyperperfusion syndrome developing several days to a week after carotid endarterectomy A. Unilateral severe headache B. Hemiplegia C. Seizures D. Drowsiness ```

A. Unilateral severe headache (p. 822)

``` A bruit over the carotid artery generally corresponds to the reduction in luminal diameter of the artery to A. 1 mm or less B. 2 mm or less C. 3 mm or less D. 4 mm or less ```

B. 2 mm or less (p. 823)

``` Artery most frequently involved in fibromuscular dysplasia A. ICA B. MCA C. Basilar D. Vertebral ```

A. ICA (p. 826)

``` Angiography findings of carotid artery dissection* A. Beads on a string B. String sign C. Puff of smoke D. Segmental vasospasm ```

B. String sign (p. 828)

``` Radiologic picture of fibromuscular dysplasia A. Beads on a string B. String sign C. Puff of smoke D. Segmental vasospasm ```

A. Beads on a string (p. 826)

``` Main features of Binswanger disease except A. Dementia B. Pseudobulbar state C. Gait disorder D. Seizures ```

D. Seizures (p. 831)

``` CADASIL is attributed to missense mutation of NOTCH 3 on which chromosome?* A. 17 B. 18 C. 19 D. 20 ```

C. 19 (p. 832)

Features that distinguish CADASIL from Binswanger disease except A. Patent arteriosclerotic small vessels B. Autosomal dominant familial trait C. Anterior temporal hyperintensities on T2 FLAIR MRI D. Migraine episodes preceding strokes

A. Patent arteriosclerotic small vessels (p. 833)

``` Gene affected in CADASIL A. Notch 3 B. HTAR 1 C. Apolipoprotein a D. Apolipoprotein E4 ```

A. Notch 3 (p. 834)

``` Gene affected in CARASIL A. Notch 3 B. HTAR 1 C. Apolipoprotein a D. Apolipoprotein E4 ```

B. HTAR 1 (p. 834)

Most common sites of cerebral hemorrhage in approximate order of frequency A. Putamen, lobar, thalamus, cerebellar hemispheres, pons B. Putamen, thalamus, cerebellar hemispheres, lobar, pons C. Putamen, thalamus, pons, lobar, cerebellar hemispheres D. Putamen, cerebellar hemispheres, thalamus, pons, lobar

A. Putamen, lobar, thalamus, cerebellar hemispheres, pons (p. 837)

``` Cardinal features of hemorrhagic stroke except A. Headache B. Acute hypertension C. Vomiting D. Drowsiness ```

D. Drowsiness (p. 840)

``` Components of the ICH score except A. GCS B. Volume C. Presence of intraventricular hemorrhage D. Age E. Preexisting cognitive impairment ```

E. Preexisting cognitive impairment (p. 842)

4 most common sites of aneurysms in the circle of Willis (from most common to least common) A. Proximal portions of AComm, origin of PComm from the stem of ICA, bifurcation of MCA, bifurcation of ICA B. Proximal portions of AComm, origin of PComm from the stem of ICA, bifurcation of ICA, bifurcation of MCA C. Origin of PComm from the stem of ICA, proximal portions of AComm, bifurcation of MCA, bifurcation of ICA D. Origin of PComm from the stem of ICA, proximal portions of AComm, bifurcation of ICA, bifurcation of MCA

A. Proximal portions of AComm, origin of PComm from the stem of ICA, bifurcation of MCA, bifurcation of ICA (p. 845)

``` Most common initial manifestation of Moyamoya disease in adults* A. Hemiparesis B. Seizure C. Visual disturbance D. SAH ```

D. SAH (p. 831)

``` MRI sequence where SAH can best be appreciated after a day has passed* A. DWI B. T1 C. T2 D. GRE E. FLAIR ```

E. FLAIR (p. 847)

``` How soon after SAH rupture is blood usually detected in the CSF via LP? A. At the onset B. After 10 minutes C. After 20 minutes D. After 30 minutes ```

D. After 30 minutes (p. 847)

``` Unilateral preretinal (subhyaloid) hemorrhage associated with SAH A. Terson syndrome B. Bell phenomenon C. Bitot spots D. Roth spot ```

A. Terson syndrome (p. 849)

``` Giant cerebral aneurysms are by definition A. > 1.5 cm B. > 2.0 cm C. > 2.5 cm D. > 3 cm ```

C. > 2.5 cm (p. 852)

``` Most common clinical manifestation of AVMs A. SAH B. Seizure C. Headache D. Hemiparesis ```

A. SAH (p. 854)

``` Spetzler-Martin grade AVMs that usually require interventional embolization followed by surgical resection* A. Grade I B. Grade II C. Grade III D. Grade IV E. Grade V ```

C. Grade III (p. 855)

``` Spetzler-Martin grade of AVMs that are generally not resected A. Grade I B. Grade II C. Grade III D. Grade IV ```

D. Grade IV (p. 855)

``` Phase of DSA where the nidus of an AVM is seen* A. Early arterial B. Late arterial C. Capillary D. Early venous E. Late venous ```

B. Late arterial (see Osborn)

Attributes of cavernomas that set them apart from other vascular malformations EXCEPT A. Their tendency to bleed is probably no less than that of the more common AVMs B. Hemorrhages from cavernomas are often devastating clinically C. They are quite often multiple D. Cumulative risk of bleeding in any one patient is higher due to multiplicity of lesions

B. Hemorrhages from cavernomas are often devastating clinically (p. 857)

``` Which among the following vascular malformations respond poorly to radiation? A. AVM B. Dural AVF C. Cavernoma D. Deep venous anomaly ```

C. Cavernoma (p. 858)

``` What is the most common cerebral vascular malformation? A. AVM B. Dural AVF C. Cavernoma D. Deep venous anomaly ```

D. Deep venous anomaly (p. 858)

``` Characteristic of this vascular malformation is a caput medusa draining into a small collecting vein A. AVM B. Dural AVF C. Cavernoma D. Deep venous anomaly ```

D. Deep venous anomaly (p. 858)

``` Apolipoprotein associated with severe amyloid angiopathy and a risk of ICH A. Apo A B. Apo E1 C. Apo E3 D. Apo E4 ```

D. Apo E4 (p. 859)

``` Relatively specific and sensitive marker for Wegener granulomatosis A. cANCA B. pANCA C. ESR D. CRP ```

A. cANCA (p. 867)

``` What artery is mainly affected in Call-Fleming syndrome? A. ICA B. MCA C. ACA D. PCA ```

B. MCA (p. 863)

``` Diseases that affect large caliber vessels EXCEPT A. Temporal arteritis B. Granulomatous arteritis of the brain C. Takayasu arteritis D. Wegener granulomatosis ```

D. Wegener granulomatosis (p. 865)

``` Diseases that affect medium- and smaller-sized vessels EXCEPT A. Polyarteritis nodosa B. Churg-Strauss arteritis C. Behcet disease D. Giant cell arteritis ```

D. Giant cell arteritis (p. 865)

``` Occlusion of the stem of the ACA may result in the following deficits EXCEPT* A. Paraplegia B. Incontinence C. Abulia D. Nonfluent aphasia E. None of the above ```

E. None of the above (p. 800)

``` Which of the following has been generally abandoned in the treatment of SAH* A. Early volume expansion B. Calcium channel blockers C. Blood pressure control D. Use of antifibrinolytic agents ```

D. Use of antifibrinolytic agents (p. 851)

Pathophysiology of stroke in certain systemic adenocarcinomas A. Tumor arterial embolism B. Large artery occlusion due to hypercoagulable state C. Non-bacterial thrombotic vegetations in heart valves leading to embolism D. Protein C and S resistance

C. Non-bacterial thrombotic vegetations in heart valves leading to embolism (p. 792, 971)

``` Most common site of atheromatous plaque formation* A. ICA B. Vertebral artery C. MCA D. PCA E. ACA ```

A. ICA (p. 782)

``` Also known as pulseless disease A. Takayasu diseaae B. PAN C. Churg-Strauss angiitis D. Wegener granulomatosis ```

A. Takayasu disease (p. 866)

``` Usual neurologic manifestations of SLE EXCEPT A. Altered consciousness B. Seizure C. Cranial nerve signs D. Hemiparesis ```

D. Hemiparesis (p. 867)

``` What is the most likely diagnosis in a meningitic patient who also presents with recurrent aphthous ulcers, genital ulceration, and erythema nodosum? A. Chrug-Strauss angiitis B. SLE C. Susac syndrome D. Behcet disease ```

D. Behcet disease (p. 868)

Which of the following is not true of Takayasu disease?* A. ESR is elevated in early and active stages B. Vertebral arteries are seldom affected C. Blurring of vision, dizziness, and hemiparetic syndroms are the usual neurologic manifestations D. Corticosteroids improves the prognosis

B. Vertebral arteries are seldom affected (p. 866)

``` Thrombosis of the vein of Labba causes infarction where? A. Superior temporal lobe B. Inferior temporal lobe C. Medial temporal lobe D. Parietal cortex ```

A. Superior temporal lobe (p. 869)

``` Thrombosis of the vein of Trolard causes infarction where? A. Superior temporal lobe B. Inferior temporal lobe C. Medial temporal lobe D. Parietal cortex ```

D. Parietal cortex (p. 869)

True about the transverse sinuses EXCEPT A. The transverse sinuses are usually asymmetrical B. Slightly more than half of individuals have a dominant left vein C. The larger sinus corresponds to a smaller occipital lobe on that side D. Unilateral occlusion of the non-dominant transverse sinus may not be symptomatic

B. Slightly more than half of individuals have a dominant left vein (p. 870)

``` Antibody that is most specific for APAS A. Lupus anticoagulant B. Anticardiolipin C. Mixed antibodies D. Antibodies to B2 glycoprotein 1 ```

D. Antibodies to B2 glycoprotein 1 (p. 872)

``` Main laboratory feature of APAS A. Prolonged PTT B. Prolonged prothrombin time C. Thrombocytopenia D. Prolonged clotting time ```

A. Prolonged PTT (p. 872)

``` Titer of this antibody correlates with the risk of thrombosis in APAS A. Lupus anticoagulant B. Anticardiolipin C. Mixed antibodies D. Antibodies to B2 glycoprotein 1 ```

B. Anticardiolipin (p. 872)

``` Most frequent neurologic abnormality in APAS A. TIA B. Stroke C. Migraine D. Seizure ```

A. TIA (p. 872)

``` Most common neurologic complication of sickle cell disease A. Cerebral ischemia B. ICH B. SAH B. Subdural hemorrhage ```

A. Cerebral ischemia (p. 874)

``` Incidence of post stroke seizure* A. 1-2% B. 2-4% C. 4-6% D. About 6% ```

D. About 6% (p. 875)

``` Most typical sign of CVD A. Hemiplegia B. Sensory deficits on one side of the body C. Aphasia D. Visual field defects E. Dysarthria ```

A. Hemiplegia (p. 779)

Degree of carotid stenosis that is most likely to be associated with strokes in the distal territory of the vessel A. > 60% of original lumen is compromised B. > 70% of original lumen is compromised C. > 80% of original lumen is compromised D. > 90% of original lumen is compromised

D. > 90% of original lumen is compromised (p. 783)

``` Degree of carotid stenosis that is most likely to be associated with strokes in the distal territory of the vessel A. Residual lumen < 2 mm B. Residual lumen < 3 mm C. Residual lumen < 4 mm D. Residual lumen < 5 mm ```

A. Residual lumen < 2 mm (p. 783)

``` Most common cause of all types of stroke A. Atherothrombosis B. Cerebral embolism C. Intracerebral hemorrhage D. Subarachnoid hemorrhage ```

B. Cerebral embolism (p. 783)

``` Cardinal clinical sign of stenoses, ulcerations, and dissections of the ICAs A. Hemiplegia B. Aphasia C. Transient monocular blindness D. TIAs ```

D. TIAs (p. 797)

``` Contralateral hemiplegia, hemihypesthesia, and homonymous sectorial hemianopia is usually due to occlusion of which artery?* A. A1 segment of the ACA B. A2 segment of the ACA C. Anterior choroidal artery D. Artery of Percheron E. Thalamogeniculate artery ```

C. Anterior choroidal artery (p. 801)

``` Excitatory neurotransmitters formed from glycolytic intermediates of the Krebs cycle during a stroke* A. Glutamate + GABA B. Histamine + glutamate C. Glutamate + aspartate D. GABA + aspartate ```

C. Glutamate + aspartate (p. 791)

True of transient monocular blindness EXCEPT* A. Visual episodes evolve swiftly, over 5-30 seconds B. Described as a horizontal shade falling or rising smoothly over the visual field C. The eye becomes incompletely and painlessly blind D. The attack clears slowly and uniformly

C. The eye becomes incompletely and painlessly blind (p. 787)

``` Syndrome wherein the patient is unaware of being blind and denies the problem even when it is pointed out to him/her A. Jackson syndrome B. Wallenberg syndrome C. Anton syndrome D. Balint syndrome ```

C. Anton syndrome (p. 804)

``` Contraindication to expand giving of rTPA to 4.5 hours* A. Age younger than 80 years B. NIHSS below 25 C. Diabetes D. Not taking OACs E. Age above 18 years ```

C. Diabetes (p. 814)

``` Match the ocular sign with the location of hemorrhage Column A 1. Putamen 2. Thalamus 3. Pons 4. Cerebellum ``` Column B A. Deviated to opposite side of lesion; ocular bobbing B. Downward deviation; pupils non-reactive C. Deviated to opposite side of paralysis D. Fixed eyeballs; tiny reactive pupils

1. C 2. B 3. D 4. A (p. 840)

``` Most likely cause of stroke in systemic cancer* A. Arterial embolism B. Venous sinus thrombosis C. Protein C and S deficiency D. Vasospasm ```

B. Venous sinus thrombosis (p. 792)

``` Most common cause of stroke in children* A. Venous occlusion B. Arterial occlusion C. Sickle cell disease D. Protein C deficiency ```

A. Venous occlusion (p. 833)

``` Risk of stroke in a 70-year-old diabetic and hypertensive male patient with new-onset atrial fibrillation without prior history of stroke or TIA. His recent 2D echo findings showed normal ejection fraction. A. 2.2 % B. 3.2 % C. 4% D. 6.7 % ```

B. 3.2 % (p. 784, Table 34-3)

Which of the following is NOT true regarding decompressive hemicraniectomy in patients with massive cerebral infarction?* A. Pooled analysis of RCTS showed a large advantage in survival of patients younger than age 60 years who were operated within 48 hours. B. There is a beneficial effect of hemicraniectomy in patients over age 60 by preventing death from brain swelling after a stroke. C. The proportion of survivors with good functional outcomes in the older age group was the same as for younger patients. D. Hemicraniectomy combined with overlying duraplasty is undertaken if the patient is progressing from a stuporous state to coma and imaging studies show increasing mass effect.

C. The proportion of survivors with good functional outcomes in the older age group was the same as for younger patients. (p. 820)

``` Post-stroke depression is most commonly seen in patients with strokes that involve which lobe?* A. Left frontal lobe B. Right frontal lobe C. Left temporoparietal cortex D. Right temporoparietal cortex ```

A. Left frontal lobe (p. 825)

Vertebral artery dissection commonly originates in which segment?* A. V1 (preforaminal) B. V2 (foraminal) C. V3 (atlantic, extradural, or extraspinal) D. V4 (intradural or intracranial)

C. V3 (atlantic, extradural, or extraspinal) (p. 829)

``` An 80-year-old female was brought to the ER due to decrease in sensorium. Initial GCS score was 8. CT scan was done and showed a hemorrhage measuring 30 mL in the left cerebellar hemisphere with no intraventricular extension. What is the mortality point estimate prediction based on the ICH score?* A. 100% B. 97% C. 72% D. 26% E. 13% F. 0% ```

B. 97% (Table 34-9, p. 842)

Enumerate the symptomatic presentation of lacunar strokes*

1. Pure motor hemiplegia 2. Pure sensory stroke 3. Clumsy hand-dysarthria 4. Ipsilateral hemiparesis-ataxia (p. 811)

Enumerate the symptoms/presentation of "top of the basilar" artery occlusion*

1. Transient loss of consciousness 2. Oculomotor disturbances 3. Hemianopia 4. Bilateral ptosis 5. Pupillary enlargement with preserved reaction to light (p. 809)

``` Stroke syndrome which results in bilateral homonymous hemianopia with unformed visual hallucinations is due to strokes in which territory?* A. ICA B. MCA C. VA D. BA E. ACA ```

D. BA (p. 804)

``` Lack of motivation and spontaneity in all reactions is seen in strokes involving which territory?* A. ACA B. ICA C. MCA D. BA C. VA ```

A. ACA (p. 800)

NOT true of cerebral amyloid angiopathy* A. There is deposition of amyloid in the media and adventitia of small vessels B. Hemorrhages are more common in the anterior parts of the brain C. Causes multiple hemorrhages D. It is the main cause of otherwise unexplained hemorrhages in older people

B. Hemorrhages are more common in the anterior parts of the brain (p. 861)

NOT true of PRES* A. A gradual increase in blood pressure is responsible for the syndrome B. The neurologic syndrome is usually dominated by symptoms referable to the occipital and adjacent parietal region C. The basic neuropathologic changes include clustering of multiple microinfarcts and petechial hemorrhages D. There is change in the permeability of blood vessels

A. A gradual increase in blood pressure is responsible for the syndrome (p. 861)

Most common segment involved in vertebral artery dissection* A. At their confluence to form the basilar artery B. C1-C2 segment C. From C6 to C2 D. From origin to C6

B. C1-C2 segment (p. 829)

Not recommended in the acute management of SAH* A. Maintain SBP at 150 mmHg or less B. Nimodipine 60 mg every 4 hours C. Pain-releiving medication for headache D. Use of antifibrinolytics

D. Use of antifibrinolytics (p. 851)