[MCQ] Cerebrovascular Diseases Ischemic stroke- Part 5

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Question 1

Hippocampus-fornix-anterior thalamus-cingulate gyrus-cingulum bundle-perihippocampal cortex-hippocampus - this circuit is called ?

A	Papez’s circuit
B	Hafez’s circuit
C	Parkinson’s circuit
D	Peter’s ciircuit

Question 2

Moyamoya disease results from progressive stenosis and occlusion of ?

A	Distal Basilar artery
B	Distal vertebral artery
C	Distal internal carotid artery
D	None of the above

Question 2 Explanation:

Moyamoya disease is an occlusive disease involving large intracranial arteries, especially distal internal carotid artery and stem of middle and anterior cerebral arteries

Question 3

‘Moyamoya’ in Japanese language means ?

A	Cotton ball
B	Pin head
C	Puff of smoke
D	Needle

Question 3 Explanation:

Lenticulostriate arteries (anterior circulation) develop a rich collateral circulation around the occlusive lesion, which on conventional x-ray angiography appears like a “puff of smoke” (moyamoya in Japanese).

Question 4

In Moyamoya disease, vascular inflammation is ?

A	Absent
B	Mild
C	Moderate
D	Severe

Question 4 Explanation:

In Moyamoya disease, vascular inflammation is absent.

Question 5

CADASIL is due to mutations in which gene ?

A	Notch-1
B	Notch-2
C	Notch-3
D	Notch-4

Question 5 Explanation:

Stroke due to monogenic disorders represent <1% of all stroke patients. They are cerebral autosomaldominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), cerebral autosomal-recessive arteriosclerosis with subcortical infarcts and leukoencephalopathy (CARASIL), hereditary endotheliopathy with retinopathy, nephropathy, and stroke (HERNS), Fabry disease, pseudoxanthoma elasticum, Neurofibromatosis type 1, familial MoyaMoya disease, Ehlers-Danlos syndrome type IV, Marfan syndrome

Question 6

Which of the following is false about CADASIL ?

A	Onset is in IV or V decade of life
B	Autosomal recessive condition
C	Presents as small-vessel strokes, progressive dementia
D	Extensive symmetric white matter changes in MRI

Question 6 Explanation:

CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is an autosomal dominant inherited disorder.

Question 7

Which of the following is a monogenic ischemic stroke syndrome ?

A	CARASIL
B	HERNS
C	CADASIL
D	All of the above

Question 8

Which of the following is a monogenic ischemic stroke syndrome ?

A	Moyamoya disease
B	Binswanger’s disease
C	CADASIL
D	None of the above

Question 8 Explanation:

CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is a monogenic ischemic stroke syndrome. Genetic testing is available. Other monogenic ischemic stroke syndromes include cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL) and hereditary endotheliopathy, retinopathy, nephropathy, and stroke (HERNS).

Question 9

Which of the following disorders can mimic Multiple Sclerosis ?

A	Acute disseminated encephalomyelitis (ADEM)
B	Mitochondrial encephalopathy with lactic acidosis and stroke (MELAS)
C	Cerebral autosomal dominant arteriopathy, subcortical infarcts, and leukoencephalopathy (CADASIL)
D	All of the above

Question 10

Chronic progressive subcortical arteriosclerotic leukoencephalopathy is called ?

A	Moyamoya disease
B	Binswanger’s disease
C	CADASIL
D	None of the above

Question 10 Explanation:

Binswanger’s disease is also called chronic progressive subcortical encephalopathy. It is one of the most common causes of dementia. The term Binswanger’s disease should be used with caution, because it does not clearly identify a single entity.

Question 11

Small-vessel strokes, progressive dementia, and extensive symmetric white matter changes in MRI is suggestive of which of the following ?

A	Moyamoya disease
B	Binswanger’s disease
C	CADASIL
D	None of the above

Question 11 Explanation:

CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is an inherited disorder that presents as small-vessel strokes, progressive dementia, and extensive symmetric white matter changes visualized by MRI in the fourth or fifth decade of life. It is caused by one of several mutations in Notch-3 gene.

Question 12

Out of the following, which drug is of least importance in reducing the risk of stroke in hypertensives with TIA ?

A	Thiazide diuretics
B	Calcium channel blockers
C	Angiotensin-converting enzyme inhibitors
D	Angiotensin receptor blockers

Question 12 Explanation:

Lowering BP to normotensive levels reduces risk of stroke in hypertensives with TIA. Drugs of value are thiazide diuretics, ACE inhibitors & ARBs. Statins reduce it by 16-30%. In diabetics, pioglitazone is effective.

Question 13

Which of the following is related to the trial ‘SPARCL’ ?

A	Aspirin
B	Pioglitazone
C	Atorvastatin
D	Clopidogrel

Question 14

Which of the following is false about Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial ?

A	Done on patients with recent stroke or TIA
B	Secondary stroke reduction
C	Dose of atorvastatin used was 80 mg/day
D	None of the above

Question 14 Explanation:

SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) trial showed benefit in secondary stroke reduction for patients with recent stroke or TIA who were prescribed atorvastatin, 80 mg/day.

Question 15

Which of the following is a primary prevention trial advocating use of statins to reduce the risk of stroke ?

A	SPARCL
B	CAPRIE
C	JUPITER
D	MATCH

Question 15 Explanation:

Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) was a primary prevention trial. It found that patients with low LDL (<130 mg/dL) caused by elevated C-reactive protein benefitted by daily use of rosuvastatin. Primary stroke occurrence was reduced by 51% with no increase in rates of intracranial hemorrhage.

Question 16

Which of the following platelet antiaggregation agents is least preferred to prevent atherothrombotic events ?

A	Aspirin
B	Clopidogrel
C	Dipyridamole
D	Ticlopidine

Question 16 Explanation:

Though Ticlopidine is more effective than aspirin, it has been abandoned because of its adverse effects like diarrhea, skin rash, neutropenia and thrombotic thrombocytopenic purpura (TTP).

Question 17

Which of the following drug was studied in the CAPRIE, MATCH and CHARISMA trials ?

A	Ticlopidine
B	Dipyridamole
C	Clopidogrel & Aspirin
D	Statins

Question 17 Explanation:

These three trials concluded that use of clopidogrel in combination with aspirin is not recommended for stroke prevention. But, may be beneficial in acute period.

Question 18

Which of the following drug was studied in the ESPS II, ESPRIT and PRoFESS trials ?

A	Ticlopidine & Aspirin
B	Dipyridamole & Aspirin
C	Clopidogrel & Aspirin
D	Statins & Aspirin

Question 18 Explanation:

Dipyridamole with aspirin combination drug was studied in three trials.

Question 19

Which of the following is the principal side effect of dipyridamole ?

A	Diarrhea
B	Headache
C	Skin rash
D	Neutropenia

Question 19 Explanation:

The principal side effect of dipyridamole is headache.

Question 20

What is the overall ‘relative’ reduction in risk of all vascular events with antiplatelet agents ?

A	5 %
B	10 %
C	18 %
D	25 %

Question 20 Explanation:

Antiplatelet agents produce an overall relative reduction in risk of nonfatal stroke of about 25-30% and of all vascular events of about 25%.

Question 21

In chronic nonvalvular, nonrheumatic AF, anticoagulation with warfarin reduces risk of cerebral embolism by ?

A	~ 17 %
B	~ 27 %
C	~ 47 %
D	~ 67 %

Question 21 Explanation:

In chronic nonvalvular, nonrheumatic atrial fibrillation, warfarin (a vitamin K antagonist - VKA) reduces the risk of cerebral embolism by ~67% both for primary & secondary prevention of stroke or TIA. The risk of a major bleeding complication is 1–3% per year.

Question 22

In ACTIVE-A trial, which of the following drugs was not used ?

A	Clopidogrel
B	Aspirin
C	Ticlopidine
D	Irbesartan

Question 22 Explanation:

In Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events (ACTIVEA) trial, patients who cannot take anticoagulants, clopidogrel plus aspirin was compared to aspirin alone.

Question 23

Which of the following trails does not address carotid endarterectomy ?

A	ACAS
B	ECST
C	WARSS
D	NASCET

Question 23 Explanation:

Warfarin-Aspirin Reinfarction Stroke Study (WARSS) study found no benefit of warfarin sodium over aspirin for secondary prevention of stroke. Similarly, Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) study demonstrated no benefit of warfarin over aspirin in patients with symptomatic intracranial atherosclerosis. North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the European Carotid Surgery Trial (ECST) showed a substantial benefit for surgery in patients with a symptomatic carotid stenosis of >=70%. ECST found harm for patients with stenosis <30% treated surgically. Meta-analysis of NASCET and ECST trials showed that endarterectomy is most beneficial when performed within 2 weeks of symptom onset, in patients >75 years, and men appear to benefit more than women.

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See all quizzes of Cerebrovascular Diseases Ischemic stroke at here:

Cerebrovascular Diseases Ischemic stroke- Part 1| Cerebrovascular Diseases Ischemic stroke- Part 2| Cerebrovascular Diseases Ischemic stroke- Part 3|Cerebrovascular Diseases Ischemic stroke- Part 4|Cerebrovascular Diseases Ischemic stroke- Part 5| Cerebrovascular Diseases Ischemic stroke- Part 6| Cerebrovascular Diseases Ischemic stroke- Part 7|Cerebrovascular Diseases Ischemic stroke- Part 8

1 Hippocampus-fornix-anterior thalamus-cingulate gyrus-cingulum
bundle-perihippocampal cortex-hippocampus – this circuit is
called ?
A. Papez’s circuit
B. Hafez’s circuit
C. Parkinson’s circuit
D. Peter’s ciircuit
2 Moyamoya disease results from progressive stenosis and
occlusion of ?
A. Distal Basilar artery
B. Distal vertebral artery
C. Distal internal carotid artery
D. None of the above

3 ‘Moyamoya’ in Japanese language means ?
A. Cotton ball
B. Pin head
C. Puff of smoke
D. Needle

4 In Moyamoya disease, vascular inflammation is ?
A. Absent
B. Mild
C. Moderate
D. Severe

5 CADASIL is due to mutations in which gene ?
A. Notch-1
B. Notch-2
C. Notch-3
D. Notch-4

6 Which of the following is categorized under monogenic disorders
as a cause of stroke ?
A. CADASIL
B. CARASIL
C. HERNS
D. All of the above

7 Which of the following is false about CADASIL ?
A. Onset is in IV or V decade of life
B. Autosomal recessive condition
C. Presents as small-vessel strokes, progressive dementia
D. Extensive symmetric white matter changes in MRI

8 Which of the following is a monogenic ischemic stroke syndrome ?
A. CARASIL
B. HERNS
C. CADASIL
D. All of the above
9 Which of the following is a monogenic ischemic stroke syndrome ?
A. Moyamoya disease
B. Binswanger’s disease
C. CADASIL
D. None of the above

10 Which of the following disorders can mimic Multiple Sclerosis ?
A. Acute disseminated encephalomyelitis (ADEM)
B. Mitochondrial encephalopathy with lactic acidosis and stroke
(MELAS)
C. Cerebral autosomal dominant arteriopathy, subcortical
infarcts, and leukoencephalopathy (CADASIL)
D. All of the above
11 Chronic progressive subcortical arteriosclerotic
leukoencephalopathy is called ?
A. Moyamoya disease
B. Binswanger’s disease
C. CADASIL
D. None of the above

12 Small-vessel strokes, progressive dementia, and extensive
symmetric white matter changes in MRI is suggestive of which of
the following ?
A. Moyamoya disease
B. Binswanger’s disease
C. CADASIL
D. None of the above

13 Out of the following, which drug is of least importance in reducing
the risk of stroke in hypertensives with TIA ?
A. Thiazide diuretics
B. Calcium channel blockers
C. Angiotensin-converting enzyme inhibitors
D. Angiotensin receptor blockers

14 Which of the following is related to the trial ‘SPARCL’ ?
A. Aspirin
B. Pioglitazone
C. Atorvastatin
D. Clopidogrel
15 Which of the following is false about Stroke Prevention by
Aggressive Reduction in Cholesterol Levels (SPARCL) trial ?
A. Done on patients with recent stroke or TIA
B. Secondary stroke reduction
C. Dose of atorvastatin used was 80 mg/day
D. None of the above

16 Which of the following is a primary prevention trial advocating
use of statins to reduce the risk of stroke ?
A. SPARCL
B. CAPRIE
C. JUPITER
D. MATCH

17 Which of the following platelet antiaggregation agents is least
preferred to prevent atherothrombotic events ?
A. Aspirin
B. Clopidogrel
C. Dipyridamole
D. Ticlopidine

18 Which of the following drug was studied in the CAPRIE, MATCH
and CHARISMA trials ?
A. Ticlopidine
B. Dipyridamole
C. Clopidogrel & Aspirin
D. Statins

19 Which of the following drug was studied in the ESPS II, ESPRIT
and PRoFESS trials ?
A. Ticlopidine & Aspirin
B. Dipyridamole & Aspirin
C. Clopidogrel & Aspirin
D. Statins & Aspirin

20 Which of the following is the principal side effect of dipyridamole ?
A. Diarrhea
B. Headache
C. Skin rash
D. Neutropenia

21 What is the overall ‘relative’ reduction in risk of all vascular
events with antiplatelet agents ?
A. 5 %
B. 10 %
C. 18 %
D. 25 %

22 In chronic nonvalvular, nonrheumatic AF, anticoagulation with
warfarin reduces risk of cerebral embolism by ?
A. ~ 17 %
B. ~ 27 %
C. ~ 47 %
D. ~ 67 %

23 In ACTIVE-A trial, which of the following drugs was not used ?
A. Clopidogrel
B. Aspirin
C. Ticlopidine
D. Irbesartan

24 Which of the following trails does not address carotid
endarterectomy ?
A. ACAS
B. ECST
C. WARSS
D. NASCET

Cerebrovascular Diseases Ischemic stroke

[MCQ] Cerebrovascular Diseases Ischemic stroke- Part 5

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Cerebrovascular Diseases Ischemic stroke- Part 5

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