Vascular Surgery Practice Questions

Q: Which of the following are components of "Klippel-Trenaunay syndrome" ? 1. Cutaneous Naevus 2. Subcutaneous Lipomas 3. Varicose veins 4. Soft tissue hypertrophy Select the correct answer using the code given below :

1, 3 and 4. ***1, 3 and 4*** - Klippel-Trenaunay syndrome is characterized by a triad of **capillary malformations (cutaneous naevus)**, **venous malformations (varicose veins)**, and **limb overgrowth (soft tissue hypertrophy)**. - These features are typically present at birth and often affect a single limb or a region of the body. *1, 2 and 3* - This option incorrectly includes **subcutaneous lipomas** as a core component of Klippel-Trenaunay syndrome, which are not typically associated with the condition. - While capillary malformations and varicose veins are characteristic, the inclusion of lipomas makes this option incorrect. *2, 3 and 4* - This option incorrectly includes **subcutaneous lipomas** and omits the essential feature of **cutaneous naevus (capillary malformation)**. - The absence of cutaneous naevus, a hallmark of the syndrome, makes this selection inaccurate. *1, 2 and 4* - This option incorrectly includes **subcutaneous lipomas** and omits **varicose veins**, a key component of the syndrome. - The presence of capillary malformations and soft tissue hypertrophy are correct, but the missing varicose veins and incorrect inclusion of lipomas render this option incorrect.

Q: A 48-year-old smoker presents to the OPD with complaints of cramping pain in both the calves on walking to about 100-150 metres. The pain is relieved on taking rest for about 2-3 minutes and the patient is able to walk for some more distance again before the pain appears. This presentation is suggestive of

intermittent claudication. ***intermittent claudication*** - The classic presentation of **cramping pain in the calves** that occurs with exertion, particularly walking a specific distance, and is **relieved by rest** within a few minutes, is highly characteristic of **intermittent claudication** [1]. - This condition is a hallmark symptom of **peripheral artery disease (PAD)**, where narrowed arteries reduce blood flow to the limbs, and is exacerbated by risk factors such as **smoking** [1]. *osteoarthritis of the knee* - While osteoarthritis causes pain with activity, it typically describes a **mechanical joint pain worsened by movement** and often associated with stiffness, crepitus, and swelling [2]. - The pain from osteoarthritis is usually **localized to the joint** and less likely to be described as cramping in the calves or to have such a clear, immediate resolution with rest as seen in claudication [2]. *muscular fatigue* - Muscular fatigue can cause pain and discomfort with exertion, but it typically does not present with the **consistent, reproducible pattern** of pain onset at a specific distance and rapid relief with a short rest as described. - Fatigue-related pain is generally more diffuse and gradually improves with prolonged rest, rather than the quick resolution characteristic of claudication. *neurogenic claudication* - Neurogenic claudication also causes **leg pain with walking** but is typically associated with **spinal stenosis** and is often described as numbness, tingling, or weakness, rather than pure cramping. - Crucially, neurogenic claudication is often relieved by **bending forward or sitting**, rather than just standing still, and is less directly tied to the specific walking distance that defines intermittent claudication.

Q: Which of the following statements are correct regarding Buerger's disease? 1. It involves small to medium arteries. 2. It is common in smokers. 3. It commonly involves lower limb vessels. 4. Cessation of smoking reverses the disease process.

1, 2 and 3. ***1, 2 and 3*** - Buerger's disease, or **thromboangiitis obliterans**, primarily affects **small to medium-sized arteries and veins** in the upper and lower extremities. - It is **strongly associated with tobacco use** and commonly affects the **distal arteries** of the limbs, leading to ischemia and potential gangrene. *1, 3 and 4* - While Buerger's disease involves small to medium arteries and commonly affects lower limb vessels, **cessation of smoking does not reverse the disease process** but rather stops its progression. - The damage caused to the vessels by inflammation and thrombosis is largely irreversible. *1, 2 and 4* - This option incorrectly states that cessation of smoking reverses the disease process, which is not true. - While smoking cessation is crucial for preventing progression, existing vascular damage is permanent. *2, 3 and 4* - This option misses that Buerger's disease involves **small to medium arteries**, which is a key characteristic of the condition. - Additionally, it incorrectly suggests that smoking cessation reverses the disease.

Q: Which one of the following statements is not correct regarding thoracic outlet syndrome?

Radial nerve is involved. ***Radial nerve is involved*** - Thoracic outlet syndrome (TOS) primarily involves compression of the **brachial plexus** (specifically the lower trunk C8-T1), subclavian artery, or subclavian vein. - The **radial nerve** is derived from the posterior cord (C5-T1) of the brachial plexus, but the classic presentation of TOS does not typically involve isolated or predominant radial nerve symptoms. Instead, TOS symptoms more commonly affect the **ulnar nerve distribution** (C8-T1) due to compression of the lower trunk of the brachial plexus. *Resection of First rib is effective treatment* - **First rib resection** is a well-established surgical treatment option for thoracic outlet syndrome, aiming to decompress the neurovascular structures. - This procedure alleviates pressure on the **brachial plexus** and **subclavian vessels**, leading to symptom improvement in many patients. *It is associated with Horner's syndrome* - **Horner's syndrome** can be associated with thoracic outlet pathology, particularly tumors like **Pancoast tumors**, which can compress the sympathetic chain at the thoracic outlet. - While not a direct feature of typical TOS, conditions affecting the thoracic outlet region can impact the **cervical sympathetic ganglion** leading to Horner's syndrome (ptosis, miosis, anhidrosis). *It is a rare condition* - Thoracic outlet syndrome is generally considered a **relatively rare condition**, although its true incidence might be underestimated due to diagnostic challenges. - It is often a diagnosis of exclusion, requiring careful clinical evaluation and imaging to rule out other causes of **neck, shoulder, and arm pain**.

Q: Which one of the following investigations is considered to be "Gold standard" technique for diagnosis of arterial occlusive disease ?

Digital Subtraction Angiography (DSA). ***Digital Subtraction Angiography (DSA)*** - **DSA** remains the gold standard for diagnosing arterial occlusive disease as it provides **high-resolution images** of the arterial lumen, accurately depicting stenoses and occlusions [1]. - It allows for precise localization and quantification of arterial lesions, which is crucial for treatment planning, especially for **interventional procedures** [1]. *Duplex imaging* - While useful for screening and follow-up, **duplex ultrasound** is operator-dependent and may not always provide the detailed anatomical information required for definitive diagnosis or pre-procedural planning, especially in complex cases. - It assesses blood flow and vessel patency but can be limited by factors such as patient body habitus, calcification, and bowel gas. *Doppler ultrasound blood flow detection* - **Doppler ultrasound** is an excellent tool for assessing blood flow characteristics and detecting changes indicative of arterial disease, but it provides less anatomical detail compared to angiography. - It is often used for **screening** and monitoring, but it does not offer the precise visualization of the arterial lumen needed to be a gold standard for diagnosis. *Treadmill* - A **treadmill test** (exercise stress test) is used to assess the functional impact of arterial occlusive disease, particularly **intermittent claudication**, by measuring the ankle-brachial index (ABI) after exertion. - It is a physiological test that indicates the presence and severity of flow-limiting lesions, but it does not provide anatomical information about the location or nature of the arterial occlusion.

Q: Lympho-venous anastomosis is done for

Filarial lymphoedema. ***Filarial lymphoedema*** - **Lympho-venous anastomosis (LVA)** is a microsurgical technique used to bypass damaged lymphatic vessels and directly connect lymphatic channels to small veins. This procedure is primarily effective in treating **lymphedema due to lymphatic obstruction**, such as that caused by filarial infection. - In **filarial lymphoedema**, the lymphatic obstruction leads to accumulation of lymph fluid. LVA helps to restore lymphatic drainage, reducing limb swelling and improving symptoms, particularly in the early stages of the disease. *Cystic hygroma* - A **cystic hygroma** is a congenital lymphatic malformation, typically treated by surgical excision, sclerotherapy, or laser ablation. - It involves abnormally dilated lymphatic spaces and doesn't usually benefit from LVA, as the primary issue is malformation rather than obstruction requiring a bypass. *Malignant lymphoedema* - **Malignant lymphoedema** (secondary to cancer or its treatment) is often complicated by active tumor burden, radiation fibrosis, or extensive nodal involvement. - While LVA might be considered in carefully selected cases, its efficacy can be limited due to underlying cancer and the diffuse nature of the lymphatic damage, making it a less common primary indication compared to filarial lymphedema. *Lymphoid cyst* - A **lymphoid cyst** is a localized collection of lymph, often treated by aspiration, sclerotherapy, or surgical excision. - It is not a widespread lymphatic drainage disorder that would necessitate a bypass procedure like lympho-venous anastomosis.

Q: Treatment of choice for acute femoral artery embolism is :

Immediate embolectomy. ***Immediate embolectomy*** - **Acute femoral artery embolism** is a medical emergency that requires prompt intervention to restore blood flow and prevent limb ischemia. - **Early surgical embolectomy** is the treatment of choice to physically remove the clot and immediately re-establish perfusion. *Warfarin* - **Warfarin** is an anticoagulant used for *long-term prevention* of future embolic events, but it is not effective for acute clot removal. - Its therapeutic effect is delayed, making it unsuitable for the immediate treatment of an acute embolism. *Embolectomy after rest for few days* - Delaying embolectomy for several days would lead to **irreversible tissue damage** and potential limb loss due to prolonged ischemia. - Time is critical in acute arterial occlusions, and immediate intervention is paramount. *Heparin* - **Heparin** is an anticoagulant used to *prevent further clot propagation* and reduce the risk of re-embolization. - While it can be initiated as an adjunct, it does not dissolve the existing embolus quickly enough to be the sole treatment for an acute limb-threatening obstruction.

Q: In which one of the following is Branham's sign positive?

Arteriovenous fistula. ***Arteriovenous fistula*** - **Branham's sign**, also known as Nicoladoni-Branham's sign, is characterized by a **sudden decrease in heart rate** upon compression of an arteriovenous fistula. - This occurs because *compression of the fistula increases systemic vascular resistance, leading to improved venous return and a reflex bradycardia* via vagal stimulation. *Arterial stenosis* - **Arterial stenosis** involves narrowing of an artery and does not typically present with Branham's sign. - While it may cause a **bruit** or **reduced pulse**, compressing the stenotic vessel would not lead to an immediate change in heart rate. *Deep vein thrombosis* - **Deep vein thrombosis (DVT)** is a blood clot in a deep vein, causing pain and swelling, but it is not associated with Branham's sign. - Compression in the area of a DVT would likely worsen pain or dislodge the clot, not alter heart rate in this manner. *Arterial aneurysm* - An **arterial aneurysm** is a localized bulging of an artery wall, which can pulsate but generally does not elicit Branham's sign upon compression. - Compressing an aneurysm could be dangerous and would not result in the reflex bradycardia seen with an arteriovenous fistula.

Q: The following are the indications for carrying out a sympathectomy except

Venous ulcer of leg. ***Venous ulcer of leg*** - Sympathectomy aims to reduce **vasoconstriction** and improve blood flow, but venous ulcers are primarily caused by **venous insufficiency** and stasis, not arterial spasm. - While improved microcirculation might be a minor benefit, it is not a primary indication for sympathectomy, as the underlying problem is venous, requiring different treatments like compression and elevation. *Causalgia* - **Causalgia (Complex Regional Pain Syndrome type II)** is characterized by severe burning pain, hyperalgesia, and allodynia, often with vasomotor dysfunction. - Sympathectomy can relieve the pain by interrupting the **sympathetic efferent nerves** that contribute to the pain and vasomotor changes. *Hyperhidrosis* - **Hyperhidrosis** is a condition of excessive sweating, mostly localized to the hands, feet, or axillae. - Sympathectomy, particularly **endoscopic thoracic sympathectomy (ETS)**, is an effective treatment for severe localized hyperhidrosis by disrupting the sympathetic nerve supply to the sweat glands. *Raynaud's disease* - **Raynaud's disease** involves episodic digital ischemia due to exaggerated vasoconstriction of peripheral arteries, often triggered by cold or stress. - Sympathectomy can reduce the frequency and severity of vasospastic attacks by interrupting the **vasoconstrictor sympathetic fibers** to the affected digits.

Q: In a 30-year-old male smoker, the commonest cause of dry gangrene of foot will be

Buerger's disease. Buerger's disease - **Buerger's disease** (**thromboangiitis obliterans**) is strongly associated with **heavy smoking** and typically affects young to middle-aged adult males, leading to dry gangrene in the extremities. - It involves **inflammation and thrombosis** of small and medium-sized arteries and veins, predominantly in the limbs, often manifesting as **ischemic pain**, ulcerations, and gangrene. *Diabetes mellitus* - While **diabetes** can cause dry gangrene due to **peripheral artery disease** and small vessel disease, it is more commonly associated with **wet gangrene** due to increased infection risk, and the age and smoking history point away from it being the *commonest* cause in this specific demographic for dry gangrene [1]. - Diabetic neuropathy can also mask symptoms, leading to delayed presentation and worsening tissue damage [1]. *Embolism* - An **embolic event** would typically present with **sudden onset** severe pain, pallor, pulselessness, paresthesia, and paralysis (the "6 Ps"), leading to acute limb ischemia rather than the progressive dry gangrene described implied in the question. - While it can cause tissue necrosis, it's usually an acute event rather than a chronic process leading to gradual gangrene. *Atherosclerosis* - While **atherosclerosis** is a significant cause of peripheral artery disease and gangrene, especially in smokers, it typically affects an **older population** than the 30-year-old male described [2]. - In younger smokers with gangrene, **Buerger's disease** is a more specific and common diagnosis, as atherosclerosis tends to manifest later in life unless other significant risk factors are present [2].

Question 1

Which of the following are components of "Klippel-Trenaunay syndrome" ?

1. Cutaneous Naevus
2. Subcutaneous Lipomas
3. Varicose veins
4. Soft tissue hypertrophy

Select the correct answer using the code given below :

Accepted Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 2 and 4

Question 2

A 48-year-old smoker presents to the OPD with complaints of cramping pain in both the calves on walking to about 100-150 metres. The pain is relieved on taking rest for about 2-3 minutes and the patient is able to walk for some more distance again before the pain appears. This presentation is suggestive of

Accepted Answer

intermittent claudication

Answer

osteoarthritis of the knee

Answer

muscular fatigue

Answer

neurogenic claudication

Question 3

Which of the following statements are correct regarding Buerger's disease?

1. It involves small to medium arteries.
2. It is common in smokers.
3. It commonly involves lower limb vessels.
4. Cessation of smoking reverses the disease process.

Accepted Answer

1, 2 and 3

Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

2, 3 and 4

Question 4

Which one of the following statements is not correct regarding thoracic outlet syndrome?

Accepted Answer

Radial nerve is involved

Answer

Resection of First rib is effective treatment

Answer

It is associated with Horner's syndrome

Answer

It is a rare condition

Question 5

Which one of the following investigations is considered to be "Gold standard" technique for diagnosis of arterial occlusive disease ?

Accepted Answer

Digital Subtraction Angiography (DSA)

Answer

Duplex imaging

Answer

Doppler ultrasound blood flow detection

Answer

Treadmill

Question 6

Lympho-venous anastomosis is done for

Accepted Answer

Filarial lymphoedema

Answer

Cystic hygroma

Answer

Malignant lymphoedema

Answer

Lymphoid cyst

Question 7

Treatment of choice for acute femoral artery embolism is :

Accepted Answer

Immediate embolectomy

Answer

Warfarin

Answer

Embolectomy after rest for few days

Answer

Heparin

Question 8

In which one of the following is Branham's sign positive?

Accepted Answer

Arteriovenous fistula

Answer

Arterial stenosis

Answer

Deep vein thrombosis

Answer

Arterial aneurysm

Question 9

The following are the indications for carrying out a sympathectomy except

Accepted Answer

Venous ulcer of leg

Answer

Causalgia

Answer

Hyperhidrosis

Answer

Raynaud's disease

Question 10

In a 30-year-old male smoker, the commonest cause of dry gangrene of foot will be

Accepted Answer

Buerger's disease

Answer

Diabetes mellitus

Answer

Embolism

Answer

Atherosclerosis

Vascular Surgery — MCQs

Vascular Surgery — MCQs

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