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Exam Number : ABFM
Exam Name : Family Medicine Board Certification Exam
Vendor Name : Certification-Board
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ABFM test Format | ABFM Course Contents | ABFM Course Outline | ABFM test Syllabus | ABFM test Objectives

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. Exercise 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
1. Multi-infarction (multiple subcortical infarctions)
2. White matter disease (leukoaraiosis, Binswanger subcortical
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. Examination 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
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
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
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
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 Excellerate or restore neurologic function or to
augment rehabilitation
10. Medications to prevent rebleeding or vasospasm following a
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
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
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 assessment
B. Regeneration and plasticity
C. Predicting outcomes
D. Pharmacologic effects on recovery
E. Rehabilitation principles
F. Emerging approaches

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the way to delivery a enterprise Bringing americans Backpacking | ABFM real questions and PDF Questions

The backpacking company permeates the vacation, company and judicial arenas. Nature lovers will sign in to be guided on vacations through the mountains. companies use backpacking weekends to bring their groups closer collectively and juvenile courts throughout america send unruly teenagers to backpacking boot camps so that they can profit self confidence and find out how to work with others. With careful planning, backpacking experience and a data of a couple of lengthy backpacking trails, that you can run a lucrative backpacking e book company.

choose a corporate structure. A sole proprietorship is the least cumbersome formula, although, leaves you in my view dependable in the experience of a lawsuit. an organization has many suggestions and laws in regards to checklist maintaining and board participants, despite the fact, individual owners are protected from dropping their personal assets within the event of a lawsuit or fiscal destruction.

Get a business license via your city or county government offices. You have to provide the business identify, handle and get in touch with advice and pay a nominal payment. consult with your state enterprise workplace and taxing authority and agree to any registration or license necessities.

turn into CPR licensed. while your clients will signal free up kinds before happening a trip, you are going to need to be licensed in case of emergencies out on the trails.

choose a couple of routes of various lengths and difficulties. offering a lot of excursions ensures your potential to draw a bigger customer base. select backpacking trails that will also be achieved in a day, a weekend, a couple of days and per week. increase routes that contain the least number of property possession changes to make permissions much less advanced.

Request permission from public and private landowners to use the land to your excursions. Draw up a contract denoting which elements of the land you can also use, that you'll anticipate liability whereas on the land and no matter if or no longer a charge might be paid to the landowner for the permission to hike during the land.

Set your costs. Checking with local rivals offering features similar to yours will let you know what the market at present bears. Undercut the competition with the aid of 10 % whereas constructing your preliminary customer base.

Backpack through each and every chosen route a number of times. Take notes on each travel noting aspects of pastime, capabilities hazards and areas to stop and camp for in a single day journeys. examine meet-up areas for every travel. whether you appoint an workplace and let valued clientele leave their vehicles when you transport them to the route beginning factor, or cozy permission for purchasers to depart vehicles on a homeowner's website for the duration of the travel. encompass in your contract that you are usually not answerable for the car or its contents all over the commute.

opt for meal stopping points alongside every route. decide how nutrients can be performed on every route. Will hikers carry personally packaged foods or will you supply the nutrients? if so, how will or not it's transported and what's going to it can charge?

Get assurance. Your insurance agent will e book you on attainable and cautioned limits. make certain you're correctly coated for all viable liabilities. Offset the charge of insurance premiums by way of constructing them into the fee of the service you supply to customers.

Design your contract. The liability of possessing a backpacking e-book provider may still be treated with appreciate. Have an attorney, regular with contract legislation, determine your contract and ebook you to any changes which are mandatory for superior coverage. minimum gadgets include identify and phone of customer, expense of day trip, what happens in inclement climate that cancels the go back and forth, your non-liability for customer automobiles, and a clause that the customer assumes full accountability for his defense inside the limits of your state laws.

come to a decision about inventory. selling backpacking device along with your emblem on it is first rate promoting, however can be time-consuming to control. Contact companies and deploy normal beginning of backpacks, canteens, compasses and different backpacking machine together with your emblem and contact quantity pre-printed on it. one more alternative is to order stickers with your guidance printed on them and place the stickers on prevalent equipment that you simply sell.

rent an administrative assistant and assistant backpacking courses. assess the background of each and every worker and require CPR certification for all assistant guides.

Design a website or appoint a design business to do it for you. devoid of an precise storefront, your site could be your leading contact for shoppers. consist of upcoming backpacking journeys, images from past movements and tips to your enterprise. encompass a column that changes per week to supply shoppers and advantage shoppers a rationale to maintain coming returned to your web page. Make a web page to your web page on a social networking web site and invite individuals to add a hyperlink to the page on their social networking website pages.

Market your company. in addition to promoting via typical media sources, present free or discounted journeys to various organizations for notice of mouth promoting. as an example, ship a free shuttle coupon to each and every organisation for your area and ask them to make use of it as a reward inside their business for whatever. That one grownup signs up for a visit and goes lower back to tell everybody in his enterprise how a whole lot enjoyable it turned into. Then ship a corporate kit electronic mail to the corporation offering group services.



  • learn as an awful lot as that you may in regards to the areas you'll take your customers.
  • Take photos on journeys and ask customer permission to use them in future advertising equipment.
  • Warnings

  • Have each and every customer signal a fitness waiver verifying good health and no general clinical issues.
  • For valued clientele with clinical issues, require a doctor's certificate of fitness to sign up for a visit.This protects you in the experience of a problem all over the day trip.
  • author Bio

    Candace Webb has been writing professionally because 1989. She has labored as a full-time journalist as well as contributed to metropolitan newspapers including the "Tennessean." She has also labored on group of workers as an affiliate editor at the "Nashville dad or mum" journal. Webb holds a Bachelor of Arts in journalism with a minor in company from San Jose State college.

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