Vascular Surgery Practice Questions

Q: Which one of the following is an example of a chemodectoma ?

Carotid body tumour. ***Carotid body tumour*** - A **carotid body tumour** is a rare, usually benign, neuroendocrine tumour that arises from the **chemoreceptor cells (paraganglia)** of the carotid body. - These tumours are also known as **paragangliomas** and are classic examples of chemodectomas. *Cock's peculiar tumour* - **Cock's peculiar tumour** is a historical term for a **sebaceous cyst** that has undergone inflammation and potential infection, often presenting as a chronic, indurated lesion. - It is a benign adnexal tumour of the skin and does not arise from chemoreceptor cells. *Cystosarcoma phylloides* - **Cystosarcoma phylloides** (Phyllodes tumour) is a rare fibroepithelial tumour of the breast, characterized by both epithelial and stromal components arranged in leaf-like patterns. - It varies in its malignant potential but is distinct from neuroendocrine tumours. *Keratoacanthoma* - A **keratoacanthoma** is a rapidly growing, usually benign, cutaneous tumour that mimics squamous cell carcinoma. - It originates from the hair follicle epithelium and is characterized by a central keratin plug, not neuroendocrine tissue.

Q: Trendelenburg's operation is done for

primary varicose veins. ***primary varicose veins*** - **Trendelenburg's operation** is the classical surgical procedure for **primary varicose veins of the lower limb** - It involves **high ligation of the long saphenous vein** at the saphenofemoral junction - Named after Friedrich Trendelenburg (1844-1924), this was historically the standard treatment for varicose veins - Modern variations include **flush ligation** and stripping of the saphenous vein - Now often replaced by minimally invasive techniques like **endovenous laser ablation (EVLA)** and **radiofrequency ablation (RFA)** *varicocele* - **Varicocele** is treated by operations like **Ivanissevich procedure**, **Palomo's operation**, or **laparoscopic varicocelectomy** - These involve ligation of the **testicular/gonadal veins**, not the saphenous vein - There is no established surgical technique for varicocele called "Trendelenburg's operation" - The confusion may arise from Trendelenburg's contributions to various surgical fields *deep vein thrombosis with varicose veins* - **Deep vein thrombosis (DVT)** is an acute condition requiring **anticoagulation therapy**, not surgical intervention like Trendelenburg's operation - Management focuses on preventing **pulmonary embolism** and post-thrombotic syndrome - Varicose veins may coexist but are addressed separately after DVT treatment *arteriovenous fistula* - **Arteriovenous fistula** represents an abnormal connection between artery and vein - Treatment involves **surgical repair**, **embolization**, or observation depending on etiology - This is unrelated to Trendelenburg's operation for venous insufficiency

Q: Which of the following is NOT a symptom of atherosclerotic occlusive disease at the bifurcation of aorta (Leriche syndrome)?

Claudication of the calf. ***Claudication of the calf*** - In Leriche syndrome, the occlusion is at the **aortic bifurcation**, affecting blood flow to the iliac arteries and their branches, typically presenting with **buttock and thigh claudication** [1]. - **Calf claudication** alone is usually indicative of more distal occlusive disease, such as in the popliteal or tibial arteries, and not typically the primary or most characteristic symptom of Leriche syndrome [1]. *Sexual impotence* - **Atherosclerotic occlusive disease** at the aortic bifurcation often reduces blood flow to the internal iliac arteries, which supply the penile arteries. - This results in **erectile dysfunction** due to insufficient blood supply during erection, making sexual impotence a characteristic symptom of Leriche syndrome. *Claudication of the buttock and thigh* - The partial or complete blockage of the **aortic bifurcation** impairs blood flow to both common iliac arteries, leading to ischemia in the major muscle groups of the buttocks and thighs [1]. - This **ischemia** manifests as pain, cramping, or fatigue during exercise, which is relieved by rest, making it a classic symptom of Leriche syndrome [1]. *Gangrene localised to the feet* - Severe and chronic **ischemia** resulting from significant atherosclerotic occlusion at the aortic bifurcation can lead to critical limb ischemia, especially in the lower extremities [1]. - Reduced blood flow to the feet can cause tissue necrosis, ultimately leading to **gangrene**, particularly in advanced stages of Leriche syndrome [1].

Q: A 56-year-old male comes with history of claudication pain in both buttocks, thighs and calves. He also gives history of impotence. The probable site of arterial occlusion is:

Aortoiliac occlusion. ***Aortoiliac occlusion*** - The combination of **claudication** in the buttocks, thighs, and calves, along with **impotence**, is characteristic of **Leriche syndrome**, which results from **aortoiliac occlusion**. - **Aortoiliac occlusion** affects blood flow to both lower extremities and the internal iliac arteries, which supply the pelvic organs, including those responsible for erectile function. *Iliac obstruction* - While iliac obstruction can cause claudication in the buttocks and thighs, it generally does not explain calf claudication as prominently. - Isolated iliac obstruction may contribute to impotence, but the widespread lower limb claudication points to a more proximal and extensive occlusion. *Proximal femoral artery occlusion* - **Proximal femoral artery occlusion** would primarily cause claudication in the thigh and calf, but typically spares the buttocks. - It would not usually be associated with impotence, as blood supply to the pelvis would be preserved via the internal iliac arteries. *Distal femoral artery occlusion* - **Distal femoral artery occlusion** typically causes claudication in the calf and foot, as it is located further down the leg. - This type of occlusion would not cause claudication in the buttocks or thighs, nor would it lead to impotence.

Q: A 75 year old lady came with an incidentally diagnosed splenic artery aneurysm which, after radiological investigation, was confirmed to be calcified. She should be offered:

Observation. ***Observation*** - A **calcified splenic artery aneurysm** in an asymptomatic 75-year-old typically indicates a **stable, chronic aneurysm** with a low risk of rupture. - Given the patient's age and the benign nature of calcified aneurysms, the risks associated with intervention often outweigh the benefits, making **watchful waiting** the most appropriate course. *Endovascular stenting* - **Endovascular stenting** is generally reserved for **symptomatic** or **rapidly enlarging aneurysms**, or those with a higher risk of rupture, which is not the case here. - The presence of **calcification** can make stent placement challenging and potentially increase the procedural risks. *Embolisation* - **Embolization** is typically indicated for **symptomatic aneurysms**, those with a high risk of rupture (e.g., non-calcified, large size, rapid growth), or in patients unsuitable for open surgery. - For a **calcified, asymptomatic aneurysm** in an elderly patient, the risk-benefit profile usually favors observation over intervention. *Laparoscopic splenic artery ligation and splenectomy* - **Laparoscopic splenic artery ligation and splenectomy** is an **invasive surgical procedure** with significant risks and is generally reserved for **ruptured aneurysms** or those with a high immediate risk of rupture and clear symptoms. - Performing such a major intervention on an **asymptomatic, calcified aneurysm** in an elderly patient carries a high morbidity without significant clinical benefit.

Q: Allen's test is used in cardiac surgery for:

When radial artery harvest is planned. ***When radial artery harvest is planned*** - **Allen's test** is performed to assess the patency of the **ulnar artery** and ensure adequate collateral circulation to the hand before harvesting the radial artery. - A positive test (indicating good collateral flow) is crucial to prevent **hand ischemia** if the radial artery is removed. *To select finger prick for blood glucose estimation* - Finger prick sites for **blood glucose estimation** are chosen based on adequate capillary blood flow and patient comfort, not by Allen's test. - Allen's test is specifically for evaluating **arterial patency** and collateral circulation, which is irrelevant for routine fingersticks. *To check warmth of hands* - Checking the **warmth of hands** is a basic clinical assessment for peripheral perfusion but does not involve Allen's test. - Allen's test is a dynamic test of **vascular competence**, not a static thermal assessment. *For evaluation of AV fistula* - **AV fistula evaluation** involves assessing patency, thrill, and bruit, and is typically done using physical examination and Doppler ultrasound. - Allen's test is not used for this purpose, as it assesses **collateral arterial flow** to a digit, not the patency of an arteriovenous connection.

Q: Indication of Coronary artery bypass grafting (CABG) is:

Triple vessel disease. ***Triple vessel disease*** - **Triple vessel disease** (significant stenosis in all three major coronary arteries: LAD, LCx, and RCA) is a **Class I indication for CABG** with the highest level of evidence. - CABG provides **superior long-term outcomes** compared to PCI in triple vessel disease, with better survival rates, reduced need for repeat revascularization, and more complete revascularization. - This is particularly true in patients with **diabetes** or **reduced LV function**. *More than 70% stenosis of proximal left anterior interventricular artery* - While **proximal LAD stenosis >70%** can be treated with CABG (Class IIa indication), it is often managed successfully with **PCI** (drug-eluting stents). - The choice between CABG and PCI for isolated proximal LAD disease depends on anatomy, patient comorbidities, and surgical risk factors. *More than 50% stenosis of critical left main stem* - **Left main coronary artery stenosis >50%** is actually a **Class I indication for CABG** per ACC/AHA and ESC/EACTS guidelines. - However, in the context of this question comparing multiple scenarios, **triple vessel disease** represents a more universally accepted and broader indication with the strongest evidence base for CABG superiority over PCI. - Modern guidelines do allow PCI for selected left main cases (low SYNTAX score, ostial/shaft lesions), whereas triple vessel disease more consistently favors CABG. *Deranged Stress Echocardiography report* - A **positive stress echocardiography** indicates inducible myocardial ischemia but is a **diagnostic finding**, not a specific indication for the revascularization method. - Further evaluation with **coronary angiography** is required to determine the anatomical extent of CAD and guide the choice between CABG, PCI, or medical management.

Q: On second day following femoral embolectomy, the leg is found to be tender, tense and dusky with feeble dorsalis pedis pulse. The most appropriate management would be:

Fasciotomy. ***Fasciotomy*** - The symptoms (tender, tense, dusky leg with feeble dorsalis pedis pulse) occurring after revascularization strongly suggest developing **compartment syndrome**. - **Fasciotomy** is the most appropriate management to relieve pressure, restore blood flow, and prevent irreversible muscle and nerve damage. *Dye studies* - While imaging like angiography (dye studies) can assess vascular patency, they are not the immediate solution for suspected **compartment syndrome**. - Delaying definitive treatment for compartment syndrome for imaging can lead to **irreversible tissue damage**. *Doing re-embolectomy* - The problem is unlikely to be a persistent or recurrent embolus given the prior embolectomy and the presentation suggesting **compartment syndrome**, not ongoing arterial occlusion. - Repeating the procedure without addressing the underlying compartment pressure would be ineffective and potentially harmful. *Anticoagulant therapy* - Anticoagulation is crucial for preventing new clots or re-thrombosis but does not resolve the acute mechanical compression and ischemia of **compartment syndrome**. - It's part of the overall management but not the primary intervention for the immediate life-threatening limb condition described.

Q: Bisgaard treatment refers to that of:

Venous ulcer. ***Venous ulcer*** - **Bisgaard treatment** is a historical surgical technique specifically developed for the management of **chronic venous ulcers**. - This treatment aims to improve venous return and reduce venous hypertension by surgically addressing incompetent perforator veins and superficial venous reflux. *An ischaemic ulcer* - **Ischaemic ulcers** are caused by arterial insufficiency and require interventions to improve arterial blood flow, such as revascularization. - Bisgaard treatment is not appropriate for ischaemic ulcers as it does not address the underlying **arterial occlusive disease**. *An in-growing toe nail* - An **ingrown toenail** is a common podiatric condition typically treated with local procedures like nail avulsion or matrixectomy. - Bisgaard treatment is a complex vascular surgical procedure and bears no relevance to the treatment of an ingrown toenail. *Ruptured tendo achillis* - A **ruptured Achilles tendon** is an orthopaedic injury that requires surgical repair or conservative management involving immobilization. - Bisgaard treatment is exclusively for venous ulcer disease and has no role in the management of tendon injuries.

Q: In India, the commonest cause of unilateral lymphoedema of lower limb is:

Filariasis. ***Filariasis (Correct Answer)*** - **Filariasis**, particularly caused by *Wuchereria bancrofti*, is endemic in many parts of India and is the leading cause of **secondary lymphedema** worldwide. - The parasitic worms block the lymphatic vessels, leading to chronic swelling, thickening of the skin, and can cause grotesque enlargement of limbs, often unilaterally. - In India, filariasis accounts for the vast majority of acquired unilateral lower limb lymphedema cases. *Tubercular lymphadenopathy (Incorrect)* - While **tubercular lymphadenopathy** is common in India, it primarily causes swelling of lymph nodes, often in the neck or axilla. - It typically does not lead to diffuse, unilateral lymphedema of the entire lower limb. *Carcinoma of penis (Incorrect)* - **Carcinoma of the penis** can cause inguinal lymph node metastasis, which might lead to lymphedema if the nodes are extensively involved or surgically removed. - However, it is not the most common cause of unilateral lower limb lymphedema in the general population of India. *Lymphoedema tarda (Incorrect)* - **Lymphedema tarda** is a form of primary lymphedema that typically presents after the age of 35, often without an identifiable cause. - While it can occur in India, it is a congenital or developmental disorder of the lymphatic system and is far less common than filariasis as a cause of acquired lymphedema.

Question 1

Which one of the following is an example of a chemodectoma ?

Accepted Answer

Carotid body tumour

Answer

Cock's peculiar tumour

Answer

Cystosarcoma phylloides

Answer

Keratoacanthoma

Question 2

Trendelenburg's operation is done for

Accepted Answer

primary varicose veins

Answer

deep vein thrombosis with varicose veins

Answer

varicocele

Answer

arteriovenous fistula

Question 3

Which of the following is NOT a symptom of atherosclerotic occlusive disease at the bifurcation of aorta (Leriche syndrome)?

Accepted Answer

Claudication of the calf

Answer

Sexual impotence

Answer

Claudication of the buttock and thigh

Answer

Gangrene localised to the feet

Question 4

A 56-year-old male comes with history of claudication pain in both buttocks, thighs and calves. He also gives history of impotence. The probable site of arterial occlusion is:

Accepted Answer

Aortoiliac occlusion

Answer

Iliac obstruction

Answer

Proximal femoral artery occlusion

Answer

Distal femoral artery occlusion

Question 5

A 75 year old lady came with an incidentally diagnosed splenic artery aneurysm which, after radiological investigation, was confirmed to be calcified. She should be offered:

Accepted Answer

Observation

Answer

Endovascular stenting

Answer

Embolisation

Answer

Laparoscopic splenic artery ligation and splenectomy

Question 6

Allen's test is used in cardiac surgery for:

Accepted Answer

When radial artery harvest is planned

Answer

To select finger prick for blood glucose estimation

Answer

To check warmth of hands

Answer

For evaluation of AV fistula

Question 7

Indication of Coronary artery bypass grafting (CABG) is:

Accepted Answer

Triple vessel disease

Answer

More than 70% stenosis of proximal left anterior interventricular artery

Answer

More than 50% stenosis of critical left main stem

Answer

Deranged Stress Echocardiography report

Question 8

On second day following femoral embolectomy, the leg is found to be tender, tense and dusky with feeble dorsalis pedis pulse. The most appropriate management would be:

Accepted Answer

Fasciotomy

Answer

Dye studies

Answer

Doing re-embolectomy

Answer

Anticoagulant therapy

Question 9

Bisgaard treatment refers to that of:

Accepted Answer

Venous ulcer

Answer

An ischaemic ulcer

Answer

An in-growing toe nail

Answer

Ruptured tendo achillis

Question 10

In India, the commonest cause of unilateral lymphoedema of lower limb is:

Accepted Answer

Filariasis

Answer

Tubercular lymphadenopathy

Answer

Carcinoma of penis

Answer

Lymphoedema tarda

Vascular Surgery — MCQs

Vascular Surgery — MCQs

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