Vascular Surgery Practice Questions

Q: What is the primary cause of varicose veins?

Incompetent valve perforators. **Explanation:** Varicose veins are dilated, tortuous, and elongated superficial veins, most commonly occurring in the lower limbs. **Why Option A is Correct:** The physiological movement of blood in the lower limbs depends on the flow from the superficial system to the deep system via **perforating veins**. These perforators contain valves that prevent backflow. The **primary cause** (pathophysiology) of varicose veins is **valvular incompetence** at the saphenofemoral junction, saphenopopliteal junction, or within the perforators themselves. When these valves fail, high-pressure blood from the deep venous system leaks into the low-pressure superficial system (venous reflux), leading to dilation and varicosity. **Analysis of Incorrect Options:** * **Option B & D:** While intrinsic structural abnormalities and changes in the collagen/elastin ratio (Type III vs. Type I collagen) are observed in the vein walls of affected patients, these are generally considered **contributory factors** or secondary changes rather than the primary mechanical trigger for the disease. * **Option C:** **Venous hypertension** is the *result* of valvular incompetence and the *mechanism* by which skin changes (like lipodermatosclerosis) occur, but it is not the primary cause of the varicosities themselves. **Clinical Pearls for NEET-PG:** * **Trendelenburg Test:** Used to differentiate between saphenofemoral incompetence and perforator incompetence. * **Perthes Test:** Used to assess the patency of the **deep venous system** (crucial before surgery). * **Gold Standard Investigation:** Duplex Ultrasound (Color Doppler) is the investigation of choice. * **CEAP Classification:** Used for clinical grading (C0 to C6), where C2 represents varicose veins and C6 represents active venous ulcers.

Q: What is the most common cause of acquired arteriovenous fistula?

Penetrating trauma. ### Explanation **Correct Answer: D. Penetrating Trauma** An **arteriovenous fistula (AVF)** is an abnormal communication between an artery and a vein, bypassing the capillary bed. In the acquired category, **penetrating trauma** (such as stab wounds, gunshot wounds, or accidental punctures) is the most common cause. When an artery and its adjacent vein are simultaneously injured within a confined tissue space, the high-pressure arterial blood creates a tract into the low-pressure venous system as the hematoma organizes. **Analysis of Incorrect Options:** * **A & B (Bacterial/Fungal Infections):** While infections can cause "mycotic aneurysms" that may erode into adjacent vessels, this is a rare mechanism for AVF formation compared to direct mechanical trauma. * **C (Blunt Trauma):** Blunt trauma more commonly results in vessel contusion, thrombosis, or intimal flaps. While it can theoretically cause an AVF (e.g., via a bone fracture fragment), it is significantly less frequent than penetrating injuries where the sharp mechanism directly tracks through both vessels. **Clinical Pearls for NEET-PG:** * **Iatrogenic Causes:** A major subset of penetrating trauma is iatrogenic (e.g., femoral artery catheterization for angiography or internal jugular vein cannulation). * **Clinical Triad:** Look for a **pulsatile mass**, a **palpable thrill**, and a **continuous "machinery" murmur** on auscultation. * **Nicoladoni-Branham Sign:** Bradycardia occurs upon manual compression of the feeding artery (due to a sudden increase in peripheral resistance and vagal reflex). * **Systemic Effects:** Large, long-standing AVFs can lead to **high-output heart failure** due to increased venous return and decreased systemic vascular resistance. * **Investigation of Choice:** Duplex Ultrasonography is the initial screening tool; **Digital Subtraction Angiography (DSA)** remains the gold standard for anatomical mapping.

Q: Bisgaard regimen is used in the treatment of which condition?

Varicose ulcer. **Explanation:** The **Bisgaard regimen** (also known as the "Method of Bisgaard") is a specialized conservative treatment protocol specifically designed for the management of **Varicose ulcers** (venous ulcers) and the chronic venous insufficiency that precedes them. **Why the correct answer is right:** The regimen is based on the principle of reducing venous hypertension and improving calf muscle pump function. It consists of four main components: 1. **Massage:** To reduce edema and soften indurated tissue. 2. **Exercises:** Specifically active movements of the ankle joint to activate the "peripheral heart" (calf muscles). 3. **Compression:** Using inelastic bandages or stockings to support venous return. 4. **Elevation:** Elevating the limb to facilitate gravity-assisted venous drainage. **Why the incorrect options are wrong:** * **Trophic ulcer:** These are typically neurotrophic (e.g., in Diabetes or Leprosy) caused by repetitive trauma to insensitive skin. Treatment focuses on offloading and debridement, not venous drainage exercises. * **Malignant ulcer:** These (e.g., Marjolin’s ulcer) require surgical excision with wide margins or radiotherapy. Massage is contraindicated as it may promote metastasis. * **Ischaemic ulcer:** Caused by arterial insufficiency (PAD). Compression (a key part of Bisgaard) is strictly contraindicated in severe arterial disease as it further compromises blood flow. **High-Yield Clinical Pearls for NEET-PG:** * **Cockett and Elving’s operation:** A surgical procedure for venous ulcers involving subfascial ligation of incompetent perforators. * **Marjolin’s Ulcer:** A squamous cell carcinoma arising in a chronic venous ulcer or burn scar. * **Trendelenburg Test:** Used to differentiate between saphenofemoral incompetence and perforator incompetence. * **Gold Standard for Diagnosis:** Venous Duplex Ultrasound is the investigation of choice for varicose veins/ulcers.

Q: Buerger’s Disease is:

All of the above. **Explanation:** Buerger’s Disease, medically termed **Thromboangiitis Obliterans (TAO)**, is a non-atherosclerotic, segmental inflammatory disease that predominantly affects the small and medium-sized arteries and veins of the extremities. * **Option A is correct:** TAO is the formal medical name for Buerger’s disease. It is characterized by highly cellular, "organized" thrombi with relative sparing of the blood vessel wall. * **Option B is correct:** The disease is **segmental**, meaning diseased sections of the vessel are separated by healthy "skip areas." It is an inflammatory process, though unlike systemic vasculitis, it does not typically show a positive ANA or ANCA. * **Option C is correct:** It primarily involves the distal vessels (e.g., radial, ulnar, tibial, and peroneal arteries). While it most commonly starts in the lower limbs, upper extremity involvement is a classic hallmark that helps distinguish it from peripheral arterial disease (PAD). Since all individual statements are accurate descriptions of the pathology, **Option D** is the correct answer. **High-Yield Clinical Pearls for NEET-PG:** * **Strongest Risk Factor:** Heavy tobacco use (smoking or chewing). Smoking cessation is the only treatment that prevents disease progression. * **Classic Triad:** Claudication (often of the arch of the foot), Raynaud’s phenomenon, and Migratory Superficial Thrombophlebitis. * **Angiographic Sign:** "Corkscrew collaterals" (Martorell’s sign) around areas of occlusion. * **Allen’s Test:** Often positive, indicating involvement of the radial or ulnar arteries. * **Demographics:** Typically affects young males (<45 years) who are heavy smokers.

Q: In Mondor's disease, there is swelling and hardening of which structures?

Veins. **Explanation:** **Mondor’s disease** is a clinical condition characterized by **superficial thrombophlebitis** (inflammation and clotting) of the subcutaneous veins. It most commonly affects the chest wall, specifically involving the **lateral thoracic, thoracoepigastric, or superior epigastric veins**. 1. **Why Veins are correct:** The underlying pathology is the formation of a blood clot within a superficial vein, followed by inflammation and subsequent fibrosis. This leads to the classic clinical presentation of a **palpable, tender, "cord-like" structure** under the skin, which becomes more prominent when the arm is abducted or the breast is elevated. 2. **Why other options are incorrect:** * **Lymphatics:** While lymphangitis can cause red streaks, it does not typically present as a persistent, hard, thrombosed cord. * **Arteries:** Arterial thrombosis leads to ischemia (pallor, pulselessness, pain), not superficial subcutaneous cords. * **Nerves:** Nerve pathologies (like neuromas) present with sensory or motor deficits rather than visible, superficial vascular hardening. **High-Yield Clinical Pearls for NEET-PG:** * **Presentation:** A "string-like" or "iron-wire" cord on the breast or chest wall. * **Etiology:** Usually idiopathic, but can be triggered by trauma, vigorous exercise, or breast surgery. * **Association:** While usually benign and self-limiting, it can rarely be a marker of underlying **breast malignancy**; therefore, a mammogram is often recommended to rule out occult cancer. * **Management:** Reassurance and NSAIDs for pain relief. It typically resolves spontaneously within 4–8 weeks.

Q: Which of the following does NOT describe critical limb ischemia?

Ankle Systolic Blood Pressure (SBP) > 30 mmHg. **Explanation:** Critical Limb Ischemia (CLI) is the most severe stage of Peripheral Arterial Disease (PAD), characterized by chronic ischemic rest pain, ulcers, or gangrene. It represents a state where blood flow is insufficient to maintain tissue viability. **Why Option D is the Correct Answer:** The diagnostic criteria for CLI are strictly defined by objective hemodynamic measurements. For a diagnosis of CLI, the **Ankle Systolic Blood Pressure (SBP) must be 30 mmHg (which could be 40 or 45 mmHg) still falls within the range of CLI. The option is technically incorrect as a "description" because the threshold for CLI is specifically **less than 50 mmHg**, not just greater than 30 mmHg. In the context of this question, it is the only value that does not align with the standard diagnostic cutoff. **Analysis of Incorrect Options:** * **Option A (ABPI = 0.3):** An ABPI of **≤ 0.4** is a classic diagnostic criterion for CLI. A value of 0.3 indicates severe ischemia. * **Option B (Ankle SBP < 50 mmHg):** This is the standard threshold for CLI in patients with rest pain or tissue loss. * **Option C (Toe SBP < 30 mmHg):** Toe pressure is often more reliable in diabetics (due to calcified, non-compressible ankle arteries). A Toe SBP **< 30 mmHg** is a definitive criterion for CLI. **High-Yield Clinical Pearls for NEET-PG:** * **Fontaine Classification:** CLI corresponds to Stage III (Rest pain) and Stage IV (Ulceration/Gangrene). * **Rutherford Classification:** CLI corresponds to Categories 4, 5, and 6. * **The "6 Ps"** (Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia) refer to **Acute** Limb Ischemia, which is a surgical emergency, unlike the chronic nature of CLI. * **Management:** The primary goal in CLI is urgent revascularization (Endovascular or Bypass) to prevent amputation.

Q: Nicoladoni sign is also known as what?

Branham sign. **Explanation:** **Nicoladoni sign**, also known as the **Branham sign**, is a classic clinical finding associated with large, long-standing **Arteriovenous Fistulas (AVFs)**. When digital pressure is applied to the artery proximal to the AV fistula, the shunt is temporarily abolished. This leads to a sudden increase in peripheral resistance and an increase in effective circulating blood volume. The body compensates via the baroreceptor reflex, resulting in **reflex bradycardia** and a rise in systolic blood pressure. This sign is a strong clinical indicator of a high-flow fistula that may be placing a significant burden on the heart (potentially leading to high-output cardiac failure). **Analysis of Incorrect Options:** * **Murray sign:** This is not a standard vascular sign. (Note: Not to be confused with Murphy’s sign for cholecystitis). * **Frei's sign:** This is not a recognized vascular eponym. (Note: Frey’s syndrome refers to gustatory sweating). * **Darrier's sign:** A dermatological sign where rubbing a lesion (usually in mastocytosis) leads to localized urticaria and erythema due to histamine release from mast cells. **High-Yield Clinical Pearls for NEET-PG:** * **Machinery Murmur:** AV fistulas are characterized by a continuous "bruit" or "thrill" that persists throughout systole and diastole. * **Proximal Dilatation:** The artery proximal to a chronic AVF often becomes dilated and tortuous (cirsoid aneurysm). * **Management:** Large symptomatic AVFs are typically managed via surgical excision or endovascular embolization/stenting.

Q: Etiopathogenesis of diabetic foot includes the following except:

Myelopathy. The etiopathogenesis of diabetic foot is a multifactorial process primarily driven by the "triad" of neuropathy, ischemia, and infection. **Explanation of the Correct Answer:** * **A. Myelopathy:** This refers to pathology of the spinal cord. While diabetes can cause various neurological issues, it primarily affects the peripheral nervous system (**Peripheral Neuropathy**), not the spinal cord. Therefore, myelopathy is not a standard component of diabetic foot pathogenesis. **Explanation of Incorrect Options:** * **B. Osteoarthropathy:** Specifically **Charcot’s Arthropathy**, this results from motor and sensory neuropathy. Loss of proprioception and repetitive microtrauma lead to joint destruction, bone fragmentation, and the classic "rocker-bottom" foot deformity. * **C. Microangiopathy:** Chronic hyperglycemia leads to basement membrane thickening in capillaries and arterioles. While macroangiopathy (atherosclerosis) causes large vessel ischemia, microangiopathy impairs nutrient exchange and wound healing at the cellular level. * **D. Infection:** Hyperglycemia impairs leukocyte function (chemotaxis and phagocytosis). Combined with a lack of protective sensation (sensory neuropathy) and poor blood supply (ischemia), minor injuries quickly escalate into deep-seated infections and gangrene. **High-Yield Clinical Pearls for NEET-PG:** * **The Diabetic Triad:** Neuropathy (Sensory, Motor, and Autonomic), Ischemia, and Infection. * **Sensory Neuropathy:** Leads to "painless" trauma (the most common initiating factor). * **Autonomic Neuropathy:** Causes anhidrosis (dry, cracked skin) and arteriovenous shunting, which bypasses capillary beds. * **Motor Neuropathy:** Leads to atrophy of intrinsic foot muscles, causing claw toes and abnormal pressure distribution. * **Wagner’s Classification:** Used to grade the severity of diabetic foot ulcers (Grade 0 to 5).

Question 1

What is the primary cause of varicose veins?

Accepted Answer

Incompetent valve perforators

Answer

Intrinsic abnormality of the venous wall

Answer

Venous hypertension

Answer

Decrease in collagen in the venous wall

Question 2

What is a characteristic of a knitted Dacron artery graft?

Accepted Answer

It can be easily incised and the opening resutured.

Answer

It is not porous.

Answer

It is eventually dissolved by tissue reaction.

Answer

It never gets infected.

Question 3

What is the most common cause of acquired arteriovenous fistula?

Accepted Answer

Penetrating trauma

Answer

Bacterial infection

Answer

Fungal infection

Answer

Blunt trauma

Question 4

Bisgaard regimen is used in the treatment of which condition?

Accepted Answer

Varicose ulcer

Answer

Trophic ulcer

Answer

Malignant ulcer

Answer

Ischaemic ulcer

Question 5

Buerger’s Disease is:

Accepted Answer

All of the above

Answer

Also known as Thromboangitis Obliterans

Answer

A segmental inflammatory disease

Answer

Affects small and medium arteries in upper and lower extremities

Question 6

In Mondor's disease, there is swelling and hardening of which structures?

Accepted Answer

Veins

Answer

Lymphatics

Answer

Arteries

Answer

Nerves

Question 7

Which of the following does NOT describe critical limb ischemia?

Accepted Answer

Ankle Systolic Blood Pressure (SBP) > 30 mmHg

Answer

Ankle-Brachial Pulse Index (ABPI) = 0.3

Answer

Ankle Systolic Blood Pressure (SBP) < 50 mmHg

Answer

Toe Systolic Blood Pressure (SBP) < 30 mmHg

Question 8

Nicoladoni sign is also known as what?

Accepted Answer

Branham sign

Answer

Murray sign

Answer

Frei's sign

Answer

Darrier's sign

Question 9

Etiopathogenesis of diabetic foot includes the following except:

Accepted Answer

Myelopathy

Answer

Osteoarthropathy

Answer

Microangiopathy

Answer

Infection

Question 10

Which is the most common part of the subclavian artery to be affected by stenosis?

Accepted Answer

First part

Answer

Second part

Answer

Third part

Answer

Equally affected

Vascular Surgery — MCQs

Vascular Surgery — MCQs

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