Vascular Surgery Practice Questions

Q: An asymptomatic old patient presents with bruit in the carotid artery. Which of the following is the investigation of choice?

Doppler ultrasonography. ***Doppler ultrasonography*** - **Doppler ultrasonography** is a non-invasive, quick, and accurate method for assessing the degree of stenosis in the carotid arteries. - It provides information on **blood flow velocity** and plaque morphology, which is crucial for determining the need for intervention in **asymptomatic carotid bruits**. *Internal carotid angiography* - **Internal carotid angiography** is an invasive procedure with a risk of complications such as stroke. - It is typically reserved for cases where non-invasive imaging is inconclusive or as a preliminary step to endovascular intervention, not as a primary diagnostic tool for an **asymptomatic patient**. *Aortic arch angiography* - **Aortic arch angiography** is also an invasive procedure primarily used to visualize the great vessels originating from the aortic arch. - While it can show the proximal carotid arteries, it is not the initial investigation of choice for focusing specifically on **carotid stenosis**. *Spiral CT angiography* - **Spiral CT angiography** involves radiation exposure and intravenous contrast material, making it less suitable as a first-line screening tool. - While it provides detailed anatomical information, **Doppler ultrasonography** is preferred as the initial investigation due to its safety, lack of radiation, and effectiveness for **asymptomatic carotid disease**.

Q: All of the following are true with respect to ligation of internal iliac artery except -

Bleeding is always controlled with it. ***Bleeding is always controlled with it*** - Ligation of the internal iliac artery reduces **pulse pressure** and **blood flow** to the pelvic organs but does not guarantee complete cessation of bleeding. - Significant **collateral circulation** within the pelvis can maintain bleeding, especially from multiple sites or larger vessels. *Collateral circulation is established later between middle sacral and lateral sacral arteries* - This statement is true; these vessels are part of the vast **collateral network** that can supply the pelvic organs after internal iliac artery ligation. - The **middle sacral artery** (a branch of the aorta) and **lateral sacral arteries** (branches of the internal iliac) form anastomoses that become more prominent over time. *The artery should be ligated and not transected* - This is true because ligation (tying off) reduces blood flow without disrupting the vessel wall, preserving **vascular integrity**. - **Transecting** the artery would create two open ends, potentially leading to immediate or delayed hemorrhage and making subsequent control more challenging. *For hemostasis, anterior division is to be ligated* - This is true because the **anterior division** of the internal iliac artery supplies most of the pelvic organs implicated in obstetric and gynecological hemorrhage. - Ligation of the anterior division effectively reduces blood flow to the uterus, vagina, and bladder with less impact on essential structures than ligating the main trunk or posterior division.

Q: Foot ulcers secondary to arterial insufficiency are successfully treated by all of the following techniques except:

Elevation of the affected extremity. ***Elevation of the affected extremity*** - Elevating an extremity with arterial insufficiency will **further reduce arterial blood flow** to the foot, exacerbating ischemia and slowing ulcer healing. - This intervention decreases the **hydrostatic pressure**, which is already compromised due to inadequate arterial supply, making it detrimental. *Antibiotic administration* - Foot ulcers, especially those with impaired circulation, are highly susceptible to **infection**, which necessitates antibiotic treatment. - Antibiotics help to **control bacterial growth** in the ulcer, preventing systemic infection and facilitating the healing process. *Bed rest* - **Reducing weight-bearing** and overall activity through bed rest can decrease metabolic demands on the ischemic limb. - This allows the limited blood supply to be more effectively utilized for **tissue repair and healing**, rather than supporting activity. *Debridement of devitalized tissue* - **Necrotic tissue** in an ulcer provides a medium for bacterial growth and impedes wound healing. - Debridement involves removing non-viable tissue **to promote a clean wound bed**, making it more amenable to healing and reducing infection risk.

Q: Features of Raynaud's disease are all except

Commonly unilateral. ***Commonly unilateral*** - Raynaud's **disease** (primary Raynaud's) typically presents with **bilateral and symmetrical** involvement of the digits. - **Unilateral** or asymmetric involvement is more characteristic of **Raynaud's phenomenon** (secondary Raynaud's), which is associated with underlying conditions like scleroderma. *Repeated attacks occur* - Raynaud's disease is defined by **recurrent, episodic attacks** of vasospasm in response to cold or stress. - These attacks are a hallmark of the condition, distinguishing it from transient episodes. *Peripheral pulses are normally felt* - In primary Raynaud's disease, the underlying arterial structure is healthy, so **large vessel peripheral pulses** remain palpable between attacks. - Absence of peripheral pulses would suggest an **obstructive arterial disease** or secondary Raynaud's phenomenon. *Common in young females* - Raynaud's disease primarily affects **young women**, with onset typically occurring between the ages of 15 and 30. - This demographic predisposition is a well-established epidemiological feature of the condition.

Q: Allen's test is for the patency of:

Radial and ulnar artery. ***Radial and ulnar artery*** - **Allen's test** assesses the patency of the **radial** and **ulnar arteries** and the adequacy of collateral circulation to the hand. - It involves occluding both arteries and then releasing one to see if the hand reperfuses, indicating good blood flow. *Vertebral artery* - The **vertebral arteries** supply blood to the posterior part of the brain and are typically assessed through dynamic neurological exams or imaging studies. - Their patency is not evaluated by **Allen's test**. *Subclavian artery* - The **subclavian arteries** supply blood to the head, neck, and upper limbs; their patency is assessed by palpation of pulses and imaging. - **Allen's test** does not directly evaluate the subclavian artery. *Internal carotid artery* - The **internal carotid arteries** supply blood to the anterior and middle parts of the brain. - Their patency is assessed by listening for bruits or through imaging techniques, not **Allen's test**.

Q: Buerger's disease affects all except -

Multiparity. ***Multiparity*** - **Multiparity** (having given birth multiple times) has no known association with **Buerger's disease**. - Buerger's disease is strongly linked to **smoking** and affects blood vessels, not reproductive states. [1] *Small veins* - **Buerger's disease** is a **thromboangiitis obliterans** that affects small and medium-sized arteries and veins. - Inflammation and thrombosis can be found in small veins, though arterial involvement is more prominent. [1] *Small arteries* - The disease primarily involves **inflammatory changes** and **thrombosis** of the **small and medium-sized arteries**. [1] - This leads to **ischemia** and potential **gangrene** in the affected extremities. *Medium-sized arteries* - **Medium-sized arteries** are characteristic sites of involvement, particularly in the **distal extremities**. - These vessels become occluded, causing pain, ulcers, and tissue loss.

Q: A 65-year-old woman, two days after knee implant surgery, complains of calf pain and swelling in her leg. She later develops breathlessness and dies suddenly in the ward. What is the most probable cause?

Pulmonary embolism. ***Pulmonary embolism*** - The combination of **calf pain** and **swelling** post-surgery indicates a probable **deep vein thrombosis (DVT)**, which can dislodge and travel to the lungs. - The sudden onset of **breathlessness** and death is characteristic of a **massive pulmonary embolism**, where a large clot obstructs blood flow to the lungs and heart. *Stroke* - A stroke typically presents with **focal neurological deficits**, such as sudden weakness, numbness, or speech difficulties, which are not described here. - While post-operative stroke is possible, sudden death with preceding calf pain and swelling is not typical for its presentation. *Myocardial infarction* - A **myocardial infarction** (heart attack) would likely involve chest pain, radiating pain, and EKG changes, though silent MIs can occur. - While a life-threatening event, the preceding DVT symptoms and breathlessness point more towards a pulmonary cause of sudden death, especially in a post-surgical patient. *ARDS* - **Acute Respiratory Distress Syndrome (ARDS)** is characterized by widespread inflammation in the lungs leading to severe hypoxemia, often developing over hours to days. - While it causes severe breathlessness, the rapid onset of death and the clear indicators of a preceding DVT make ARDS less likely as the immediate cause of sudden demise.

Q: According to Boyd's classification, when the pain continues but the patient can still walk with effort is:

Pain persists but walking is possible with effort. ***Pain persists but walking is possible with effort*** - This description aligns precisely with Boyd's classification for **intermittent claudication** where the patient experiences pain during ambulation but can continue to walk, albeit with notable effort. - It represents a specific grade in the severity continuum of claudication, indicating a functional limitation that is not yet incapacitating. *Pain necessitating rest* - This stage implies a more severe level of claudication where pain becomes **intolerable** during walking and requires the patient to stop and rest for recovery. - It indicates a greater compromise in blood supply to the muscles compared to just pain with effort. *Pain disappears with walking* - This statement is contradictory to the nature of claudication, which is defined by pain brought on or worsened by ambulation. - Pain that disappears with walking would suggest a different underlying pathology, not **vascular claudication**. *Severe pain preventing any movement* - This describes a state of **critical limb ischemia** or rest pain, a much more advanced and serious condition than intermittent claudication. - In this scenario, the pain is so severe that it prevents any movement, often indicating impending tissue loss.

Q: True about carotid body tumor is all except:

First-bite syndrome is a known complication. ***Correct Answer: First-bite syndrome is NOT a known complication*** - **First-bite syndrome** is classically associated with **parotid gland surgery**, not carotid body tumor surgery - It occurs due to **sympathetic denervation** following parotid surgery, causing severe pain with the first bite of each meal - Carotid body tumor surgery has different complications: **cranial nerve injuries** (vagus, hypoglossal, glossopharyngeal), **vascular injury**, and **stroke** - This is the EXCEPTION - it is NOT true about carotid body tumors *Hereditary predisposition - TRUE* - **10-35% of carotid body tumors** have a familial/hereditary pattern - Associated with mutations in **succinate dehydrogenase (SDH) genes** (SDH-B, SDH-C, SDH-D) - Hereditary cases tend to be **bilateral** and present at a younger age - While most are sporadic, hereditary predisposition is a well-recognized feature *Lyre sign on angiography - TRUE* - The **"lyre sign"** is a classic angiographic finding - Represents **splaying of the carotid bifurcation** as the tumor grows between the internal and external carotid arteries - This widening of the carotid angle resembles the shape of a lyre (ancient musical instrument) - Highly characteristic of carotid body tumors *Benign - TRUE* - Carotid body tumors are typically **benign paragangliomas** - Slow-growing and usually do not metastasize - Only **5-10% are malignant** with metastatic potential - However, they can be locally aggressive and cause complications due to their location

Question 1

An asymptomatic old patient presents with bruit in the carotid artery. Which of the following is the investigation of choice?

Accepted Answer

Doppler ultrasonography

Answer

Internal carotid angiography

Answer

Aortic arch angiography

Answer

Spiral CT angiography

Question 2

All of the following are true with respect to ligation of internal iliac artery except -

Accepted Answer

Bleeding is always controlled with it

Answer

Collateral circulation is established later between middle sacral and lateral sacral arteries

Answer

The artery should be ligated and not transected

Answer

For hemostasis, anterior division is to be ligated

Question 3

Foot ulcers secondary to arterial insufficiency are successfully treated by all of the following techniques except:

Accepted Answer

Elevation of the affected extremity

Answer

Antibiotic administration

Answer

Bed rest

Answer

Debridement of devitalized tissue

Question 4

Features of Raynaud's disease are all except

Accepted Answer

Commonly unilateral

Answer

Repeated attacks occur

Answer

Peripheral pulses are normally felt

Answer

Common in young females

Question 5

A young man following RTA presented with proptosis and pain in the right eye after four days. On examination, there is periorbital ecchymosis on the forehead and right eye. What is the diagnosis -

Accepted Answer

Carotico-cavernous fistula

Answer

Internal carotid artery aneurysm

Answer

Fracture of sphenoid

Answer

Cavernous sinus thrombosis

Question 6

Allen's test is for the patency of:

Accepted Answer

Radial and ulnar artery

Answer

Vertebral artery

Answer

Subclavian artery

Answer

Internal carotid artery

Question 7

Buerger's disease affects all except -

Accepted Answer

Multiparity

Answer

Small veins

Answer

Small arteries

Answer

Medium-sized arteries

Question 8

A 65-year-old woman, two days after knee implant surgery, complains of calf pain and swelling in her leg. She later develops breathlessness and dies suddenly in the ward. What is the most probable cause?

Accepted Answer

Pulmonary embolism

Answer

Stroke

Answer

Myocardial infarction

Answer

ARDS

Question 9

According to Boyd's classification, when the pain continues but the patient can still walk with effort is:

Accepted Answer

Pain persists but walking is possible with effort

Answer

Pain necessitating rest

Answer

Pain disappears with walking

Answer

Severe pain preventing any movement

Question 10

True about carotid body tumor is all except:

Accepted Answer

First-bite syndrome is a known complication

Answer

Lyre sign on angiography

Answer

Hereditary predisposition

Answer

Benign

Vascular Surgery — MCQs

Vascular Surgery — MCQs

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