Vascular Surgery Practice Questions

Q: Sympathectomy is effective in all of the following conditions except one?

Intermittent claudication. **Explanation:** Sympathectomy involves the surgical interruption of sympathetic nerve pathways to induce vasodilation and abolish sweating in a specific distribution. **Why Intermittent Claudication is the Correct Answer:** Intermittent claudication is caused by **macrovascular** atherosclerotic obstruction in the large arteries. During exercise, the metabolic demand of the muscles increases significantly. Sympathectomy primarily affects the **cutaneous (skin) circulation** rather than the deep intramuscular vessels. Furthermore, in patients with fixed arterial stenosis, the distal vessels are already maximally dilated due to local metabolites. Therefore, sympathectomy fails to increase blood flow to the exercising muscles and does not improve walking distance. **Analysis of Other Options:** * **Hyperhidrosis:** This is a primary indication for sympathectomy (e.g., Thoracic T2-T3). It eliminates the cholinergic sympathetic supply to eccrine sweat glands, providing a permanent cure. * **Raynaud’s Disease:** Sympathectomy is used in severe, refractory cases to reduce vasospasm and improve digital skin blood flow by removing sympathetic vasoconstrictor tone. * **Causalgia (Complex Regional Pain Syndrome Type II):** Sympathectomy is highly effective for "sympathetically maintained pain." It interrupts the pain-spasm-pain cycle and provides significant symptomatic relief. **High-Yield Clinical Pearls for NEET-PG:** * **Lumbar Sympathectomy:** The chain is usually removed from **L2 to L4**. L1 is preserved in males to prevent **loss of ejaculation**. * **Best Indication in PVD:** Sympathectomy is most effective for **rest pain** and **distal ischemic ulcers** (skin involvement) rather than claudication (muscle involvement). * **Buerger’s Disease:** It is often used as a palliative measure to improve skin vascularity and promote ulcer healing.

Q: What is the most common site of subclavian artery obstruction in subclavian steal syndrome?

First part. **Explanation:** **Subclavian Steal Syndrome (SSS)** occurs due to a high-grade stenosis or total occlusion of the subclavian artery **proximal** to the origin of the **vertebral artery**. 1. **Why the First Part is Correct:** The subclavian artery is divided into three parts by the scalenus anterior muscle. The **first part** (medial to the muscle) is the segment from which the vertebral artery originates. For "steal" to occur, the obstruction must be proximal to this takeoff. When the first part is blocked, the pressure in the distal subclavian artery drops. During exercise of the ipsilateral arm, blood is "stolen" from the contralateral vertebral artery; it flows retrogradely down the ipsilateral vertebral artery to supply the arm, leading to vertebrobasilar insufficiency (dizziness, syncope). 2. **Why Other Options are Incorrect:** * **Second Part:** This lies posterior to the scalenus anterior. Obstruction here is distal to the vertebral artery origin; therefore, it would cause limb ischemia but **not** retrograde vertebral flow (no "steal"). * **Third Part:** This lies lateral to the scalenus anterior. Similar to the second part, it is distal to the vertebral origin. * **Fourth Part:** Anatomically, the subclavian artery only has three parts. **Clinical Pearls for NEET-PG:** * **Most common side:** Left side (due to direct aortic origin and sharper angulation). * **Clinical Sign:** A significant difference in blood pressure between the two arms (usually >20 mmHg). * **Diagnosis:** Duplex Ultrasonography is the initial screening tool (shows retrograde flow); Digital Subtraction Angiography (DSA) is the gold standard. * **Association:** Often associated with atherosclerosis (elderly) or Takayasu arteritis (younger females).

Q: Three days after undergoing an operation for an abdominal aortic aneurysm, a patient has moderate fever, abdominal pain, and rectal bleeding. What is the most helpful investigation?

Sigmoidoscopy. **Explanation:** The clinical presentation of fever, abdominal pain, and rectal bleeding following an abdominal aortic aneurysm (AAA) repair is highly suggestive of **Ischemic Colitis**. This is a known complication occurring in 1–2% of elective cases and up to 10% of emergency repairs for ruptured aneurysms. **Why Sigmoidoscopy is the Correct Answer:** The most common site affected is the **sigmoid colon** because the **Inferior Mesenteric Artery (IMA)** is frequently ligated during AAA repair. While collateral circulation usually suffices, inadequate flow leads to ischemia. **Sigmoidoscopy** (flexible or rigid) is the investigation of choice because it allows direct visualization of the colonic mucosa to identify signs of ischemia, such as cyanosis, friability, or ulceration. It is performed without bowel preparation to avoid increasing intraluminal pressure. **Why Other Options are Incorrect:** * **Angiography (A):** Ischemic colitis is usually a low-flow state or due to ligation, not necessarily an acute arterial occlusion that requires mapping. It is invasive and delays diagnosis. * **Upper GI Endoscopy (B):** Rectal bleeding and lower abdominal pain point toward a pathology distal to the ligament of Treitz; UGI endoscopy would not reach the site of ischemia. * **Abdominal Ultrasound (C):** It is non-specific and cannot reliably evaluate mucosal integrity or diagnose early bowel ischemia. **NEET-PG High-Yield Pearls:** * **Watershed Areas:** The most vulnerable areas for colonic ischemia are **Griffith’s point** (splenic flexure) and **Sudek’s point** (rectosigmoid junction). * **IMA Ligation:** The risk of ischemia increases if the Internal Iliac arteries are also compromised. * **Management:** Mild cases are managed conservatively (NPO, antibiotics); full-thickness gangrene requires laparotomy and resection (Hartmann’s procedure).

Q: What is true about lymphangioma?

It is a congenital sequestration of lymphatic channels.. **Explanation:** **Lymphangiomas** are benign malformations of the lymphatic system, rather than true neoplasms. 1. **Why Option B is correct:** Lymphangiomas arise due to the **congenital sequestration of lymphatic channels**. During embryonic development, certain lymphatic buds fail to establish a connection with the main lymphatic system. These sequestered primitive lymphatic sacs continue to produce lymph but lack drainage, leading to the formation of cystic or cavernous spaces. They are most commonly found in the neck (Cystic Hygroma). 2. **Why other options are incorrect:** * **Option A:** Lymphangiomas are strictly **benign** lesions. They do not metastasize, though they can be locally infiltrative and cross anatomical planes. * **Option C:** While lasers (like CO2 or Nd:YAG) are sometimes used for superficial mucosal lymphangiomas, **surgical excision** (complete removal) remains the gold standard for definitive treatment. Laser is not the primary "excision" modality for deep-seated cystic hygromas. * **Option D:** While sclerotherapy (using agents like OK-432, Bleomycin, or Doxycycline) is an emerging treatment, it is primarily effective for **macrocystic** types. However, in the context of standard surgical teaching and classical MCQ patterns, the **pathological definition** (Option B) is considered the "most true" fundamental fact about the disease. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Posterior triangle of the neck (Cystic Hygroma). * **Clinical Sign:** They are brilliantly **transilluminant** because they contain clear lymph. * **Classification:** Capillary (simple), Cavernous, and Cystic (Cystic Hygroma). * **Complications:** Sudden increase in size usually indicates hemorrhage into the cyst or secondary infection. * **Association:** Often associated with chromosomal abnormalities like **Turner syndrome** and Down syndrome.

Q: Which drug is used for Buerger's disease?

Xanthinol nicotinate. **Explanation:** **Buerger’s Disease (Thromboangiitis Obliterans - TAO)** is a non-atherosclerotic, segmental, inflammatory disease that primarily affects small and medium-sized arteries and veins of the extremities. It is strongly associated with heavy tobacco use. **Why Xanthinol Nicotinate is correct:** Xanthinol nicotinate is a peripheral vasodilator. It acts by causing direct relaxation of the vascular smooth muscles and improving peripheral blood flow. In Buerger’s disease, where there is significant ischemia due to vessel narrowing, vasodilators are used as adjuvant therapy to improve distal perfusion and relieve rest pain. Other drugs used in TAO include **Iloprost** (a prostacyclin analogue) and **Cilostazol** (a PDE3 inhibitor). **Why the other options are incorrect:** * **Propranolol:** This is a non-selective beta-blocker. It is generally **contraindicated** in peripheral vascular diseases like Buerger’s because blocking beta-2 receptors leads to unopposed alpha-adrenergic activity, causing further vasoconstriction and worsening ischemia. * **Glyceryl Trinitrate (GTN):** While GTN is a potent vasodilator, it acts primarily on the venous system and coronary arteries. It is not a standard or effective treatment for the chronic, segmental arterial inflammation seen in Buerger’s disease. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Treatment:** The only definitive way to stop disease progression is **absolute smoking cessation**. * **Classic Presentation:** Young male smoker with a triad of distal ischemia (claudication/ulcers), Raynaud’s phenomenon, and **migratory superficial thrombophlebitis**. * **Angiographic Finding:** "Corkscrew collaterals" (Martorell’s sign). * **Surgical Option:** Lumbar Sympathectomy (to relieve pain and improve skin perfusion) or Omental Transposition.

Q: Lehriche syndrome is characterized by the presence of arterial insufficiency in which of the following arteries?

Aorto-iliac artery. **Explanation:** **Leriche Syndrome** (also known as Aortoiliac Occlusive Disease) is a clinical triad caused by the chronic atherosclerotic occlusion of the **distal abdominal aorta** and/or the **common iliac arteries**. **1. Why Option A is Correct:** The pathophysiology involves a blockage at the aortic bifurcation. This leads to a classic clinical triad: * **Intermittent Claudication:** Pain in the buttocks, hips, or thighs (due to ischemia of the proximal muscle groups). * **Erectile Dysfunction:** Impotence occurs due to decreased blood flow in the internal iliac (hypogastric) arteries. * **Absent or Diminished Femoral Pulses:** Since the occlusion is proximal to the inguinal ligament. **2. Why the Other Options are Incorrect:** * **B. Superficial Femoral Artery:** Occlusion here leads to calf claudication (the most common site for peripheral arterial disease) but does not cause the proximal symptoms or impotence seen in Leriche syndrome. * **C. Temporal Artery:** This is associated with Giant Cell Arteritis (Temporal Arteritis), characterized by headaches and jaw claudication, not lower limb ischemia. * **D. Brachial Artery:** Involvement of the upper limb arteries is seen in conditions like Takayasu Arteritis or Thoracic Outlet Syndrome, not Leriche syndrome. **High-Yield Clinical Pearls for NEET-PG:** * **Risk Factors:** Strongly associated with smoking, hyperlipidemia, and hypertension. * **Diagnosis:** The gold standard for anatomical mapping is **CT Angiography** or Digital Subtraction Angiography (DSA). * **Management:** Lifestyle modification and statins are first-line. Surgical intervention includes **Aortobifemoral bypass** (gold standard for extensive disease) or endovascular stenting for focal lesions. * **Key Differentiator:** If a question mentions "buttock claudication + impotence," always think Leriche Syndrome.

Q: Which of the following is NOT a side effect of sclerotherapy in the treatment of varicose veins?

Anesthetic complications. **Explanation:** Sclerotherapy is a minimally invasive procedure used to treat varicose veins and telangiectasias. It involves the injection of a sclerosing agent (e.g., Sodium Tetradecyl Sulfate or Polidocanol) directly into the vein to cause endothelial damage, fibrosis, and eventual occlusion. **Why "Anesthetic complications" is the correct answer:** Sclerotherapy is typically performed as an outpatient procedure **without the need for general or regional anesthesia**. Since no anesthetic agents are required for the procedure itself, anesthetic complications (such as malignant hyperthermia or respiratory depression) are not considered side effects of sclerotherapy. **Analysis of incorrect options:** * **Skin necrosis:** This occurs if the sclerosant is accidentally injected extravascularly (into the surrounding tissue) or into a small cutaneous artery, leading to localized tissue ischemia. * **Thrombophlebitis:** A common side effect where the inflammatory response intended to close the vein causes localized pain, redness, and a palpable cord-like structure. * **Anaphylaxis:** Although rare, patients can develop severe allergic reactions or anaphylactic shock to the chemical sclerosing agents used. **High-Yield Clinical Pearls for NEET-PG:** * **Standard Sclerosant:** Sodium Tetradecyl Sulfate (STS) is the most commonly used agent. * **Fegan’s Technique:** A specific method of sclerotherapy involving injection into "empty" veins followed by immediate compression. * **Contraindications:** Pregnancy, acute Deep Vein Thrombosis (DVT), and severe systemic illness. * **Complication to watch:** Deep Vein Thrombosis (DVT) can occur if the sclerosant migrates into the deep venous system.

Question 1

Sympathectomy is effective in all of the following conditions except one?

Accepted Answer

Intermittent claudication

Answer

Hyperhydrosis

Answer

Raynaud's disease

Answer

Causalgia

Question 2

A drug abuser developed a pseudoaneurysm. Which of the following should be included in the treatment modalities?

Accepted Answer

Ligation of the involved vessel and wide surgical debridement

Answer

Exposure and ligation with subsequent revascularization

Answer

Direct interposition graft with synthetic material in the groin for revascularization

Answer

Direct interposition graft with autogenous graft

Question 3

In Buerger disease, which is the site of pain?

Accepted Answer

Calf pain

Answer

Foot pain

Answer

Hand pain

Answer

Thigh pain

Question 4

What is the most common site of subclavian artery obstruction in subclavian steal syndrome?

Accepted Answer

First part

Answer

Second part

Answer

Third part

Answer

Fourth part

Question 5

Three days after undergoing an operation for an abdominal aortic aneurysm, a patient has moderate fever, abdominal pain, and rectal bleeding. What is the most helpful investigation?

Accepted Answer

Sigmoidoscopy

Answer

Angiography

Answer

Upper GI endoscopy

Answer

Abdominal ultrasound

Question 6

What is true about lymphangioma?

Accepted Answer

It is a congenital sequestration of lymphatic channels.

Answer

It is a malignant tumor.

Answer

Laser excision is a treatment modality.

Answer

Sclerotherapy is a commonly employed treatment.

Question 7

Which drug is used for Buerger's disease?

Accepted Answer

Xanthinol nicotinate

Answer

Propranolol

Answer

Glyceryl trinitrate

Answer

All the above

Question 8

Pain in varicose veins is due to all EXCEPT:

Accepted Answer

Increased capillary permeability

Answer

Increased venous wall tension

Answer

Hyperviscosity of RBCs

Answer

Hypoxia of tunica media of venous wall

Question 9

Lehriche syndrome is characterized by the presence of arterial insufficiency in which of the following arteries?

Accepted Answer

Aorto-iliac artery

Answer

Superficial femoral artery

Answer

Temporal artery

Answer

Brachial artery

Question 10

Which of the following is NOT a side effect of sclerotherapy in the treatment of varicose veins?

Accepted Answer

Anesthetic complications

Answer

Skin necrosis

Answer

Thrombophlebitis

Answer

Anaphylaxis

Vascular Surgery — MCQs

Vascular Surgery — MCQs

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