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Number of questions: 200 questions Percent

01. Basic science aspects of vascular neurology 4-6%

02. Risk factors and epidemiology 8-12%

03. Clinical features of cerebrovascular diseases 8-12%

04. Evaluation of the patient with cerebrovascular disease 13-17%

05. Causes of stroke 18-22%

06. Complications of stroke 4-6%

07. Treatment of patients with stroke 28-32%

08. Recovery, regenerative approaches, and rehabilitation 4-6%

TOTAL 100%



Content Areas

01. Basic science aspects of vascular neurology

A. Vascular neuroanatomy

1. Extracranial arterial anatomy

2. Intracranial arterial anatomy

3. Collaterals

4. Alterations of vascular anatomy

5. Venous anatomy

6. Spinal cord vascular anatomy

7. Specific vascular-brain anatomic correlations

8. End vessel syndromes

B. Stroke pathophysiology

1. Cerebral blood flow

a. Vascular smooth muscle control

b. Vasodilation and vasoconstriction

c. Autoregulation

d. Vasospasm

e. Rheology

f. Blood flow in stroke

2. Blood-brain barrier in stroke

3. Coagulation cascade

a. Clotting factors

b. Platelet function

c. Endothelium function

d. Biochemical factors

4. Metabolic and cellular consequences of ischemia

a. Ischemic cascade

b. Reperfusion changes

c. Electrophysiology

d. Gene regulation

5. Inflammation and stroke

6. Brain edema and increased ICP

a. Secondary effects

7. Restoration and recovery following stroke

8. Secondary consequences from intracranial bleeding

C. Neuropathology of stroke

1. Vascular neuropathology

2. Atherosclerosis and atherosclerotic plaque

3. Brain and meningeal biopsy

a. Indications

4. Pathological/imaging/clinical correlations

02. Prevention, risk factors, and epidemiology

A. Populations at risk for stroke

1. Non-modifiable risk factors

2. Age, gender, ethnicity, geography, family history

B. Modifiable risk factors for stroke

1. Hypertension

2. Diabetes mellitus

3. Cholesterol

4. Homocysteine

5. Obesity

6. Alcohol abuse

7. Tobacco use

8. Drug abuse

9. Practice and other lifestyle factors

C. Infections predisposing to stroke

D. Genetic factors predicting stroke

E. Stroke as a complication of other medical illness

F. Special populations at risk for stroke

1. Children and adolescents

2. Young adults

3. Pregnancy

G. Stroke education programs and regional health services

1. Screening

2. Medical economics

3. Primary versus high risk prevention

4. National stroke programs

H. Concepts of clinical research

1. Use and interpretation of statistics

2. Clinical trial design and methodology

3. Understanding the medical literature

4. Rules of evidence and guidelines

5. Rating instruments and stroke scales

I. Outcomes

1. Prognosis

2. Mortality and morbidity of stroke subtypes

03. Clinical features of cerebrovascular diseases

A. Neuro-otology

1. Head and neck pathology

2. Vertigo and hearing loss in stroke

B. Neuro-ophthalmology

1. Retinal changes of vascular disease, including arterial hypertension

and retinal embolism

2. Other ocular manifestations of vascular disease

a. Ischemic oculopathy

b. Horner syndrome

c. Cavernous sinus syndrome

3. Disorders of ocular motility

4. Visual field defects

C. Transient ischemic attack (TIA)

1. General features of TIA

2. Carotid circulation TIA including amaurosis fugax

3. Vertebrobasilar circulation TIA

4. Asymptomatic carotid bruit or stenosis

5. Differential diagnosis of TIA

D. Ischemic stroke syndromes—cerebral hemispheres

1. Cortical stroke syndromes

a. Branch cortical artery syndromes

b. Watershed syndromes

2. Subcortical stroke syndromes

a. Lacunar strokes

b. Striatocapsular infarctions

c. Multiple lacunar infarcts

3. Major hemispheric syndromes

a. Internal carotid artery occlusion

b. Middle cerebral, anterior cerebral, or posterior cerebral artery

4. Behavioral and cognitive impairments following stroke

5. Bi-hemispheric stroke, including hypotensive events

6. Multifocal or diffuse disease

E. Ischemic stroke syndromes—brainstem and cerebellum

1. Basilar artery occlusion

a. Locked-in syndrome

b. Major brainstem strokes

2. Vertebral artery occlusion

3. Branch brainstem stroke syndromes

4. Syndromes from cerebellar arteries (brainstem/cerebellum)

5. Top-of-the-basilar syndromes

6. Thalamic syndromes

F. Ischemic stroke syndromes of the spinal cord

G. Vascular dementia (vascular cognitive impairment) and vascular cognitive

syndromes

1. Multi-infarction (multiple subcortical infarctions)

2. White matter disease (leukoaraiosis, Binswanger subcortical

leukoencephalopathy)

H. Features differentiating hemorrhagic or ischemic stroke

I. Intracerebral hemorrhage

1. Hypertension

2. Cerebral amyloid angiopathy

3. Coagulopathy/bleeding diatheses

4. Locations

a. Putamen

b. Thalamus

c. Lobar and white matter

d. Brainstem

e. Cerebellum

J. Subarachnoid hemorrhage

1. Saccular aneurysms

2. Other aneurysms

3. Unruptured aneurysm

4. Trauma

K. Vascular malformations

1. Hemorrhage

2. Other presentations

L. Primary intraventricular hemorrhage

M. Subdural or epidural hematoma

N. Venous thrombosis

1. Cavernous sinus

2. Superior sagittal sinus

3. Other sinus

4. Cortical thrombophlebitis

5. Deep cerebral veins

O. Carotid cavernous or dural fistulas

P. Pituitary apoplexy

Q. Hypertensive encephalopathy and eclampsia

R. Clinical presentations of primary and multisystem vasculitides

S. Hypoxia-ischemia

1. Cardiac arrest

2. Carbon monoxide poisoning

3. Cortical laminar necrosis

4. Other

T. Brain death

U. MELAS and metabolic disorders causing neurologic symptoms

V. Nonstroke presentations of vascular disease

W. Cardiovascular diseases

1. Heart disease, including coronary artery disease

2. Cardiac complications of stroke

3. Peripheral arterial disease

4. Aortic disease

5. Venous disease

X. Vascular presentations of other diseases of the central nervous system

Y. Infectious diseases and stroke

Z. Migraine

04. Evaluation of the patient with cerebrovascular disease

A. Evaluation of the brain and spinal cord

1. Computed tomography of brain

a. Acute changes of ischemic stroke

b. Acute changes of hemorrhagic stroke

c. Chronic changes of stroke

d. Complications of stroke

e. Vascular imaging by CT

f. Differential diagnosis by CT

g. CT perfusion

h. MR perfusion

2. Computed tomography of spine and spinal cord

3. Magnetic resonance imaging of brain

a. MRI sequences—T1, T2, FLAIR, DWI, PWI, gradient echo

b. MR spectroscopy

c. Acute changes of ischemic stroke

d. Acute changes of hemorrhagic stroke

i. Changes affected by time

e. Functional MRI

f. Vascular imaging by CT

g. Vascular imaging by MRI

4. PET and SPECT

5. EEG and evoked potentials—stroke

a. Changes in stroke

b. Complications of stroke

c. Monitoring

6. exam of the CSF

7. ICP monitoring

B. Evaluation of the vasculature—occlusive or non-occlusive

1. Arteriography and venography

a. Cerebral

b. Spinal cord

2. Extracranial ultrasonography

a. Duplex and other imaging

b. Collateral flow challenges

c. Monitoring

3. Intracranial ultrasonography

a. Collateral flow changes

b. Contrast enhancement

c. Monitoring

4. CT angiography and CT venography

5. MR angiography and MR venography

C. Evaluation of the heart and great vessels

1. Electrocardiography

a. Monitoring

b. Holter and event monitors

2. TTE and TEE

a. Contrast-enhanced studies

3. Other chest imaging studies

a. Chest x-ray

b. Chest CT

c. Chest MRI

4. Other studies

a. Blood pressure monitoring

b. Blood cultures

c. Testing for ischemic heart disease

d. Peripheral artery disease

D. Other diagnostic studies

1. Hematologic studies

a. Blood count

b. Platelet count

c. Special coagulation studies

d. Antiplatelet (aspirin, clopidogrel) resistance studies

2. Immunological studies

a. Inflammatory markers

b. Other autoimmune studies (multisystem)

c. Serologic studies

3. Biochemical studies

a. Glucose

b. Cholesterol

c. Blood gases

d. Hepatic and renal tests

4. Urine tests

5. Biopsies

6. Evaluation for the complications of stroke

7. Evaluation for the consequences of stroke

a. Swallowing

b. Orthopedic

c. Other

8. Genetic testing

05. Causes of stroke

A. Atherosclerosis—ischemic stroke

1. Evaluation of patients prior to non-cerebrovascular operations

2. Asymptomatic bruit or stenosis

3. Aortic atherosclerosis

B. Non-atherosclerotic vasculopathies—ischemic stroke

1. Non-inflammatory

a. Dissection

b. Moyamoya disease

c. Fibromuscular dysplasia

d. Trauma

e. Radiation-induced vasculopathy

f. Saccular aneurysm

g. Other

2. Infectious

a. Syphilis

b. Herpes zoster

c. AIDS

d. Cysticercosis

e. Bacterial meningitis

f. Aspergillosis

g. Mucormycosis

h. Cat-scratch disease

i. Behçet syndrome

j. Other

3. Inflammatory, non-infectious (angiitis)

a. Isolated CNS vasculitis

b. Multisystem vasculitis

c. Cogan syndrome

d. Eales disease

e. Polyarteritis nodosa

f. Wegener granulomatosis with polyangiitis

g. Eosinophilic granulomatosis with polyangiitis (Churg-Strauss

syndrome)

h. Takayasu disease

i. Systemic lupus erythematosus

j. Scleroderma

k. Rheumatoid arthritis

l. Mixed connective tissue disease

m. Ulcerative colitis and regional enteritis

n. Sarcoidosis

o. Other

C. Migraine

D. Other causes of ischemic stroke

1. Kawasaki disease

2. Lyme disease

3. Susac syndrome

E. Genetic and metabolic causes of stroke

1. CADASIL

2. MELAS

3. Fabry-Anderson disease

4. Homocystinuria

5. Kearns-Sayre syndrome

6. Myoclonus epilepsy with ragged red fibers

7. Ehlers-Danlos syndrome, type IV

8. Marfan syndrome

9. CARASIL

10. Other monogenetic small vessel brain diseases

11. Other

F. Drugs that cause stroke, including drugs of abuse

G. Cerebral amyloid angiopathy—infarction or hemorrhage

H. Cardioembolic causes of stroke

1. Atrial fibrillation

2. Cardiovascular procedures and operations

3. Acute myocardial infarction

4. Dilated cardiomyopathy

5. Rheumatic mitral or aortic stenosis

6. Infective endocarditis

7. Libman-Sacks endocarditis

8. Non-bacterial thrombotic endocarditis

9. Mechanical or bioprosthetic valves

10. Atrial myxoma

11. Sick sinus syndrome

12. Mitral valve prolapse

13. Patent foramen ovale, including atrial septal aneurysm

14. Congenital heart diseases, including cyanotic heart disease

15. Other

I. Prothrombotic causes of stroke

1. Inherited

a. Sickle cell disease

b. Factor V Leiden—activated protein C resistance

c. Prothrombin gene mutation

d. Protein S, C, antithrombin

e. Thalassemia

f. Iron deficiency anemia

g. Others

2. Acquired

a. Pregnancy

b. Cancer

c. Dehydration

d. Thrombocytosis

e. Thrombotic thrombocytopenic purpura

f. Heparin-induced thrombocytopenia and thrombosis (HITT)

g. Leukemia

h. Disseminated intravascular coagulation

i. Nephrotic syndrome

j. Hemolytic uremic syndrome

k. Sepsis and inflammation

l. Other

3. Autoimmune causes of thrombosis

a. Lupus and lupus anticoagulant, Sneddon syndrome and

antiphospholipid antibodies

b. Others

4. Iatrogenic/drugs/toxins

a. Antineoplastic

b. Prothrombotic agents

c. Others

J. Bleeding diatheses

1. Inherited

a. Hemophilia

b. Sickle cell disease

c. Thalassemia

d. von Willebrands disease

e. Others

2. Acquired

a. Leukemia

b. Thrombocytopenia

c. Disseminated intravascular coagulation

d. Others

3. Systemic diseases

4. Iatrogenic/drugs/toxins

a. Anticoagulants

b. Antiplatelet aggregating agents

c. Thrombolytic agents

d. Drugs of abuse

e. Others

K. Aneurysms

1. Saccular

2. Infected

3. Traumatic

4. Neoplastic

5. Dolichoectatic

6. Dissecting

L. Vascular malformations

1. Arteriovenous

2. Developmental venous anomaly

3. Cavernous

4. Telangiectasia

5. Dural arteriovenous fistula

M. Trauma and intracranial bleeding

N. Moyamoya disease and syndrome

O. Hypertensive hemorrhage

P. Other causes of hemorrhage

1. Vasculitis

2. Tumors

a. Primary

b. Metastatic

3. Iatrogenic

Q. Genetic diseases causing hemorrhagic stroke

06. Complications of stroke

A. Early neurologic complications

1. Brain edema, increased ICP, and herniation

2. Hydrocephalus

3. Seizures

4. Hemorrhagic transformation

5. Recurrent infarction

6. Recurrent hemorrhage

7. Other

B. Early medical complications

1. Cardiac

2. Gastrointestinal

3. Pulmonary

4. Electrolyte

5. Other

C. Chronic neurologic sequelae

D. Chronic medical sequelae

07. Treatment of patients with stroke

A. Outpatient management

1. Patient educational materials

B. Medical therapies to prevent stroke

1. Antiplatelet agents

a. Aspirin

b. Clopidogrel

c. Ticlodipine

d. Dipyridamole

e. Cilostazol

f. Prasugrel

g. Ticagrelor

h. Others

2. Anticoagulant agents

a. Warfarin

b. Heparin

c. LMW heparins

d. Direct thrombin inhibitors

e. Factor X inhibitors

3. Thrombolytic agents

4. Neuroprotective agents and other acute treatments

5. Cardioactive agents

6. Medications to prevent stroke by treating risk factors

a. Hyperlipidemia

b. Diabetes mellitus

c. Hypertension

d. Smoking

e. Hyperhomocysteinemia

f. Antiinflammatory

g. Alcohol dependence and detoxification

7. Medications to treat autoimmune diseases and vasculitis

8. Medications to treat complications of stroke

a. Anticonvulsants

b. Antidepressants

c. Brain edema and increased ICP

i. Hypertonic saline

ii. Mannitol

9. Medications to Boost or restore neurologic function or to

augment rehabilitation

10. Medications to prevent rebleeding or vasospasm following a

hemorrhage

a. Aminocaproic acid

b. Tranexamic acid

c. Nimodipine

11. Antimigraine medications

12. Vitamins

13. Interactions between medications

C. Hyperacute treatment of ischemic stroke

1. Emergency department

a. Intravenous thrombolytics

b. Intra-arterial thrombolytics

c. Mechanical thrombectomy

d. Anticoagulants and antiplatelet agents

e. Antihypertensives

f. Anticonvulsants

g. Other

2. Hospitalization – general management

a. Prevention of recurrent stroke

b. Prevention of deep vein thrombosis and pulmonary

embolism

c. Blood pressure management

d. Treatment of complications

e. Treatment of comorbid diseases

f. Treatment of risk factors for stroke

g. Other

3. Intensive care unit

a. Osmotic agents

b. Steroids

c. Sedation

d. Blood products

e. Anti-vasospasm therapy

f. Management of ventriculostomy

g. Temperature control

h. Antiarrhythmics

i. Ventilator management

j. Pressors

k. Antibiotics

l. Other

4. Neurosurgical management

a. Hemorrhage

i. Evacuation

ii. Ventriculostomy

b. Ruptured aneurysms

i. Management of vasospasm

c. Vascular malformations

d. Surgical treatment of brain edema – decompressive

craniectomy

e. Other

D. Chronic care

1. Antidepressants

2. Sedatives

3. Stimulants

E. Treatment of venous thrombosis

F. Treatment of spinal cord vascular disease

G. Treatment of pituitary apoplexy

H. Professionalism, ethics, systems-based practice

1. Palliative care

2. End-of-life decisions

3. Advanced directives, informed consent, regulations

4. Other

08. Recovery, regenerative approaches, and rehabilitation

A. Functional exam

B. Regeneration and plasticity

C. Predicting outcomes

D. Pharmacologic effects on recovery

E. Rehabilitation principles

F. Emerging approaches



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a way to become A Midwife: A Step-by means of-Step ebook | Killexams.com Resources

Editorial word: We earn a commission from companion hyperlinks on Forbes consultant. Commissions don't have an effect on our editors' opinions or opinions.

Midwives play an important role within the birthing technique, proposing information and care throughout pregnancies and after childbirth. Aspiring midwives might also take a variety of pathways towards this profession in terms of education and credentials.

This e book provides a step-by way of-step strategy to fitting a midwife. individuals questioning a way to turn into a midwife can use our research to notify their experience from student to medical professional.

what's a Midwife?

Midwives are medical professionals who supply care to sufferers before, all through and after they supply start. together with without delay managing the birthing method and recommending other care capabilities, these healthcare employees train people on reproductive fitness.

An aspiring midwife can observe a couple of avenues to this profession. talents titles encompass licensed midwife (CM), direct-entry midwife, lay midwife, certified knowledgeable midwife (CPM) and certified nurse-midwife (CNM). Some certifications are consistent across the U.S., while others range among states. CNM certification is considered the trade usual for nurse-midwifery.

role and obligations

before childbirth, midwives teach pregnant individuals on alternatives for their birth technique to set a concrete plan for the day of the beginning. A midwife offers actual tests all through a patient’s pregnancy while monitoring the fetus’s fitness and boom system.

Midwives may also assist in inducing labor or providing pain relief after labor starts. These healthcare workers also collaborate with physicians and docs as vital all the way through pregnancy and childbirth.

After start and beyond, midwives proceed to supply education and training in areas like self-care, postpartum care and breastfeeding. counting on their certification stage, midwives in some states can also work without supervision in unbiased practices, where they could write prescriptions and order lab exams.

Midwives do not administer epidurals. even though midwives may order epidurals for individuals in labor, these pain aid strategies are delivered via anesthesiologists or nurse anesthetists. Midwives additionally do not operate C-sections or supply care to individuals with high-possibility pregnancies.

Work environment

Midwives customarily work in hospitals, birthing centers and healthcare clinics. Given the unpredictable nature of childbirth, these professionals may also work unusual shifts and ought to be on name throughout nights, weekends and vacations.

how to develop into a certified Nurse-Midwife

CNMs require extra training and certification than other midwife authorities. here part explores the necessities to turn into a midwife with certification.

Earn a B.S.N. degree

potential CNMs can beginning their adventure through pursuing a Bachelor of Science in nursing (B.S.N.). Midwifery concentrations usually seem at the grasp’s and doctoral ranges. nevertheless, aspiring licensed midwives can use their B.S.N. electives to focal point their undergraduate stories on areas like human anatomy, physiology, chemistry and microbiology. These classes may additionally meet the prerequisites for graduate-level midwife classes.

A B.S.N. diploma usually takes four years to comprehensive. college students who already dangle associate levels in nursing or registered nurse (RN) licensure may additionally pursue RN-to-B.S.N. bridge programs, that are always shorter—just one to 2 years.

achieve a Nursing License

All CNM candidates should cling RN licensure, which they might also earn earlier than or after their B.S.N. We recommend incomes a B.S.N. first considering many RN employers now require nursing candidates to cling bachelor’s degrees.

becoming an RN entails passing the national Council Licensure exam for Registered Nurses (NCLEX-RN).

benefit event as a Nurse

Graduate classes in nurse-midwifery customarily require applicants to have achieved some knowledgeable nursing event to qualify for admission. This allows for potential CNMs to gain fingers-on experience with foundational nursing practices.

Aspiring midwives who're gaining RN journey may also agree with working as OB-GYN nurses to become everyday with the specialization.

attain an advanced Nursing degree

To become a licensed nurse-midwife, you should earn a graduate-level nursing diploma authorised by the Accreditation commission for Midwifery schooling. This diploma can be a master of Science in nursing (M.S.N.) or a physician of Nursing pPractice (D.N.P.) with a attention in nurse-midwifery. master’s in nursing classes always take about 18 to 24 months to complete, even though B.S.N.-to-M.S.N. bridge courses may be sooner. A D.N.P. diploma might also take three to 4 years.

Earn CNM Certification

The subsequent step in fitting a certified Nurse-Midwife is acquiring the formal credential. The American Midwifery Certification Board (AMCB) administers the CNM designation, which comprises a certification examination. Candidates should move the CNM exam inside 24 months of finishing their graduate software, and AMCB recommends taking the examination as soon as viable after graduation.

Many healthcare associations require working towards midwives to be CNMs.

become an superior apply Registered Nurse (APRN)

Most states classify midwives as APRNs and require APRNs to are seeking particular state licensure. Many states require aspiring midwives to gain CNM certification before they can qualify for APRN licensure. other usual stipulations for APRN licensure consist of RN licensure and a graduate-degree nursing diploma, which CNM certification already requires.

other Midwife Certifications

although the CNM certification is the trade common for midwives, different midwife credentials—such as the CM and the CPM—also exist and follow distinctive necessities.

as an instance, AMCB additionally administers the CM designation, which doesn't require RN licensure. CM candidates ought to still finished a graduate degree and move a certification exam. youngsters, handiest 10 jurisdictions at present admire the CM certification.

CPM certification doesn't require an academic degree however does mandate the completion of an permitted midwifery application. on the other hand, the North American Registry of Midwives can grant the credential through a portfolio evaluate. This status best applies in 35 states and Washington, D.C. CPMs customarily support in home births and work in dedicated birthing centers.

revenue and Job Outlook for Midwives

The U.S. Bureau of Labor data (BLS) reports that CNMs earn a median annual income of $a hundred twenty five,900—about $eighty,000 more than the country wide median for all occupations. The BLS initiatives a gentle employment increase cost of 6% for nurse midwives from 2022 to 2032.

generally requested Questions (FAQs) About develop into a Midwife What potential do midwives want?

Midwives must wait and see, caring people with observational potential and a strong feel of empathy. Their work may additionally contain disturbing situations, requiring them to continue to be calm for themselves and their sufferers.

am i able to turn into a midwife without being a nurse?

yes—reckoning on the class and stage of midwife you intention to become. licensed nurse-midwives must have RN licensure. licensed midwives will not have nursing licensure, however they can't follow in lots of states. other midwife roles may no longer require RN licensure and even have a comparatively narrow scope of observe.

How lengthy does it take to become a midwife?

certified nurse-midwives can predict to spend seven to 9 years completing the necessary education and earning the fundamental credentials.


 

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