Vascular Surgery Practice Questions

Q: Which of the following types of dissecting aneurysm does NOT involve the ascending aorta?

Stanford type B. Aortic dissection is classified based on the anatomical location of the intimal tear and the extent of the dissection. The two primary systems used are the **Stanford** and **DeBakey** classifications. ### **Explanation of the Correct Answer** **A. Stanford type B:** This classification is based solely on whether the **ascending aorta** is involved. * **Stanford Type A:** Involves the ascending aorta (regardless of the site of the primary tear). * **Stanford Type B:** Involves only the descending aorta (distal to the left subclavian artery) and **spares the ascending aorta**. Therefore, Type B is the correct answer. ### **Explanation of Incorrect Options** * **B. Stanford type A:** By definition, this involves the ascending aorta. It is a surgical emergency due to the risk of coronary artery occlusion, aortic regurgitation, and cardiac tamponade. * **C. DeBakey type I:** This involves the **ascending aorta**, the arch, and extends into the descending aorta. * **D. DeBakey type II:** This is confined strictly to the **ascending aorta**. ### **High-Yield NEET-PG Pearls** * **Gold Standard Investigation:** CT Angiography (CTA) is the investigation of choice for diagnosis. * **Management Rule:** * **Stanford Type A (DeBakey I & II):** Requires urgent **Surgical** repair. * **Stanford Type B (DeBakey III):** Primarily managed **Medically** (blood pressure control using Beta-blockers like Labetalol) unless complications like ischemia or rupture occur. * **Risk Factors:** Hypertension (most common), Marfan Syndrome, and Bicuspid aortic valve. * **Clinical Sign:** "Tearing" chest pain radiating to the back with a blood pressure discrepancy between arms.

Q: Stemmer's sign and buffalo hump are features of which condition?

Lymphoedema. **Explanation:** The correct answer is **Lymphoedema**. This condition results from the accumulation of protein-rich fluid in the interstitial space due to defective lymphatic drainage. * **Stemmer’s Sign:** This is a pathognomonic clinical sign of chronic lymphoedema. It is considered positive when the skin on the dorsal surface of the second toe or finger cannot be pinched or lifted due to thickening and fibrosis of the subcutaneous tissue. * **Buffalo Hump (in Lymphoedema):** While commonly associated with endocrine disorders, a "buffalo hump" appearance can occur in **primary lymphoedema** (specifically Milroy’s disease or Meige’s disease) due to the accumulation of lymph and adipose tissue in the cervicodorsal region. **Analysis of Incorrect Options:** * **Cushing’s Disease:** While a "buffalo hump" (supraclavicular/cervicodorsal fat pad) is a classic feature due to hypercortisolism, **Stemmer’s sign is absent**. * **Hypothyroidism:** Can cause non-pitting edema (myxedema), but it lacks the specific fibrotic skin changes required for a positive Stemmer’s sign. * **Carcinoid Tumour:** Characterized by flushing, diarrhea, and right-sided heart failure; it does not present with these localized physical signs. **NEET-PG High-Yield Pearls:** * **Stages of Lymphoedema:** Stemmer’s sign typically becomes positive in **Stage II** (spontaneously irreversible) and **Stage III** (lymphostatic elephantiasis). * **Milroy’s Disease:** Congenital primary lymphoedema (VEGFR-3 mutation). * **Gold Standard Investigation:** Lymphoscintigraphy is the investigation of choice for diagnosing lymphoedema. * **Treatment:** The mainstay is Complex Decongestive Therapy (CDT). Surgical options like Lymphaticovenular Anastomosis (LVA) are reserved for refractory cases.

Q: Unna boot is used for the treatment of which condition?

Varicose ulcers. **Explanation:** The **Unna boot** is a specialized compression dressing used primarily for the management of **venous stasis ulcers (varicose ulcers)**. It consists of a zinc oxide-impregnated gauze wrap, often containing calamine and glycerin, which provides inelastic compression. **Why it is the correct answer:** Venous ulcers occur due to chronic venous insufficiency and ambulatory venous hypertension. The Unna boot works by providing **high-pressure compression during muscle contraction** (walking) and low pressure at rest. This "semi-rigid" cast enhances the calf muscle pump function, reduces edema, and promotes venous return, creating an optimal environment for the ulcer to heal. The zinc oxide also helps soothe the skin and manage dermatitis. **Analysis of incorrect options:** * **Diabetic foot ulcer:** These are primarily neuropathic or ischemic. Compression is often contraindicated if there is associated Peripheral Arterial Disease (PAD), as it can worsen ischemia. * **Ankle instability:** This requires stabilization via ligaments repair or rigid bracing (like an Aircast), not a medicated compression wrap. * **Calcaneum fracture:** This requires immobilization (Plaster of Paris cast) or surgical fixation (ORIF), depending on the displacement. **Clinical Pearls for NEET-PG:** * **Contraindication:** Do not use an Unna boot in patients with severe **Peripheral Arterial Disease (ABI < 0.5)**, as compression can cause tissue necrosis. * **Application:** It is applied from the base of the toes to just below the knee. * **Gold Standard:** While the Unna boot is classic, **multi-layer compression bandages** (e.g., Profore) are now often considered the gold standard for venous ulcers.

Q: The angiogram depicted below is most typical of a patient whose history includes:

Cigarette smoking. ***Cigarette smoking*** - The angiogram shows characteristic **corkscrew collateral vessels** and **segmental occlusions** typical of **Buerger's disease (Thromboangiitis Obliterans)**, which is strongly associated with cigarette smoking. - **Skip lesions** with normal intervening segments and prominent collateral circulation are pathognomonic findings in young smokers with peripheral vascular disease. *Alcoholism* - Alcoholism primarily causes **cardiomyopathy** and **hepatic cirrhosis** rather than the specific vascular changes seen in this angiogram. - Does not typically produce the characteristic **segmental arterial occlusions** and **corkscrew collaterals** shown in the image. *Hypertension* - Hypertensive vascular disease typically shows **diffuse arterial narrowing** and **smooth tapering** rather than segmental occlusions. - The angiographic pattern would demonstrate **generalized atherosclerotic changes** without the distinctive collateral vessel formation seen here. *Diabetes* - Diabetic vascular disease commonly affects **small vessels (microangiopathy)** and shows **diffuse atherosclerotic narrowing**. - The pattern typically involves **calcified vessels** and **diffuse stenosis** rather than the segmental occlusions and prominent collaterals characteristic of Buerger's disease.

Q: Which of the following statements regarding carotid body tumors is correct?

May metastasize. **Explanation:** **Carotid Body Tumors (CBTs)**, also known as **Chemodectomas** or **Paragangliomas**, are rare, highly vascular neuroendocrine tumors arising from the paraganglion cells (chemoreceptors) located at the bifurcation of the common carotid artery. 1. **Why Option D is Correct:** While most carotid body tumors are benign, approximately **5% to 10% are malignant**. Malignancy cannot be determined by histology alone (as benign and malignant cells look identical); it is defined clinically by the presence of **metastasis** to regional lymph nodes or distant organs (lungs, bones). 2. **Why Incorrect Options are Wrong:** * **Option A & B:** CBTs originate from **Type I (Chief) cells**, which are derived from the **neural crest**. They do not arise from endothelial cells (vascular origin) or Schwann cells (nerve sheath origin). * **Option C:** The treatment of choice is **surgical excision**. Radiation therapy is generally reserved for elderly patients, non-surgical candidates, or unresectable/recurrent tumors to achieve local control, but it is not the primary modality. **High-Yield Clinical Pearls for NEET-PG:** * **Fontaine’s Sign:** The tumor is mobile horizontally but fixed vertically (due to its attachment within the carotid bifurcation). * **Lyre Sign:** On angiography, the tumor causes widening/splaying of the carotid bifurcation (displacement of internal and external carotid arteries). * **Shamblin Classification:** Used to grade the tumor based on its involvement/encasement of the carotid vessels. * **Inheritance:** Most are sporadic, but 10–35% are familial (associated with *SDH* gene mutations). Familial cases are more likely to be bilateral.

Q: A patient presents with occasional pain over her middle finger. The surgeon identifies a black spot. Pressing around the black spot does not elicit pain, while pain is sensed on pressing the spot itself. What is the most likely diagnosis?

Glomus tumour. **Explanation:** The clinical presentation described is classic for a **Glomus Tumour**. These are benign vascular hamartomas arising from the glomus body, a specialized neuromyovascular apparatus involved in thermoregulation. **Why it is the correct answer:** The hallmark of a glomus tumour is the **triad of severe paroxysmal pain, localized tenderness, and cold hypersensitivity**. The description of pain elicited specifically by pressing the "black spot" (the tumour itself) while surrounding areas remain painless is known as **Love’s Test**. The "black spot" or bluish discoloration represents the vascular mass seen through the skin or nail plate. These tumours are most commonly found in the subungual region of the fingers. **Why other options are incorrect:** * **Haemangioma:** While vascular, these are typically painless and present as soft, compressible masses without the exquisite point tenderness seen here. * **Arteriovenous (AV) Fistula:** These usually present with a palpable thrill, an audible bruit, and regional swelling rather than a localized, exquisitely painful spot. * **Melanoma:** Subungual melanoma presents as a dark streak (Hutchinson’s sign) or enlarging pigmented lesion. While it can be serious, it is generally not associated with the intense, localized paroxysmal pain triggered by pressure. **High-Yield Clinical Pearls for NEET-PG:** * **Love’s Test:** Positive when localized pressure with a pinhead or probe elicits excruciating pain. * **Hildreth’s Sign:** Disappearance of pain after inflating a blood pressure cuff (ischaemia) proximal to the lesion. * **Transillumination:** Glomus tumours often transilluminate due to their vascular nature. * **Treatment:** Complete surgical excision is the definitive management.

Q: What is the most common vessel affected in acute limb ischemia?

Superficial femoral artery. **Explanation:** Acute limb ischemia (ALI) is a surgical emergency characterized by a sudden decrease in limb perfusion. The most common cause of ALI is **arterial embolism**, followed by **thrombosis in situ**. **1. Why Superficial Femoral Artery (SFA) is correct:** The SFA is the most common site for both atherosclerotic occlusion and embolic lodgment. In the case of emboli (most commonly originating from the heart due to Atrial Fibrillation), the clot tends to lodge where the vessel caliber narrows or at bifurcations. The **SFA at the level of the Adductor (Hunter’s) Canal** is the most frequent site of occlusion because it is a long, relatively narrow segment where the vessel is subjected to mechanical stress. **2. Analysis of Incorrect Options:** * **B. Iliac artery:** While a common site for chronic atherosclerotic disease (Aorto-iliac disease), it is less common than the SFA for acute embolic events because of its larger diameter. * **C. Popliteal artery:** This is the second most common site for embolic lodgment. It is also the most common site for peripheral arterial aneurysms, which can lead to acute thrombosis, but statistically, it occurs less frequently than SFA involvement. * **D. Tibial artery:** These are smaller "run-off" vessels. While they can be affected by "trash foot" (microemboli) or distal propagation of a proximal clot, they are not the primary site of major acute limb-threatening ischemia compared to the SFA. **Clinical Pearls for NEET-PG:** * **The 6 P’s of ALI:** Pain, Pallor, Pulselessness, Paresthesia, Paralysis, and Poikilothermia (coldness). * **Gold Standard Investigation:** Digital Subtraction Angiography (DSA). * **Initial Management:** Immediate anticoagulation with IV Unfractionated Heparin to prevent clot propagation. * **Most common source of emboli:** Left Atrium (secondary to Atrial Fibrillation). * **Fogarty Catheter:** Used for surgical embolectomy.

Question 1

Which of the following types of dissecting aneurysm does NOT involve the ascending aorta?

Accepted Answer

Stanford type B

Answer

Stanford type A

Answer

DeBakey type I

Answer

DeBakey type II

Question 2

Stemmer's sign and buffalo hump are features of which condition?

Accepted Answer

Lymphoedema

Answer

Cushing's disease

Answer

Hypothyroidism

Answer

Carcinoid tumour

Question 3

What is the best graft material for aortic dissection?

Accepted Answer

Dacron

Answer

Autologous vein

Answer

Autologous artery

Answer

PTFE

Question 4

A 67-year-old man with a history of hypertension, hyperlipidemia, and tobacco use has been diagnosed with an infra-renal aortic aneurysm of size 3 x 3.5 cm. Which management strategy is best suited for this patient?

Accepted Answer

Serial follow-up with MRI; initiate statins, and the major determinant of surgery being size greater than 5.5 cm

Answer

Endovascular stenting of the aneurysm

Answer

Serial follow-up with MRI; major determinant of surgery being renal artery involvement

Answer

Serial follow-up with MRI; initiate statins and operate only in case of acute anginal pain

Question 5

Unna boot is used for the treatment of which condition?

Accepted Answer

Varicose ulcers

Answer

Diabetic foot ulcer

Answer

Ankle instability

Answer

Calcaneum fracture

Question 6

The angiogram depicted below is most typical of a patient whose history includes:

Accepted Answer

Cigarette smoking

Answer

Alcoholism

Answer

Hypertension

Answer

Diabetes

Question 7

Which of the following statements regarding carotid body tumors is correct?

Accepted Answer

May metastasize

Answer

Arises from the endothelial cells

Answer

Originates from the Schwann cells

Answer

Radiation therapy is the treatment of choice

Question 8

A patient presents with occasional pain over her middle finger. The surgeon identifies a black spot. Pressing around the black spot does not elicit pain, while pain is sensed on pressing the spot itself. What is the most likely diagnosis?

Accepted Answer

Glomus tumour

Answer

Haemangioma

Answer

Arteriovenous fistula

Answer

Melanoma

Question 9

What is the most common vessel affected in acute limb ischemia?

Accepted Answer

Superficial femoral artery

Answer

Iliac artery

Answer

Popliteal artery

Answer

Tibial artery

Question 10

All of the following are true about varicose veins except:

Accepted Answer

The Trendelenburg operation is the gold standard treatment for varicose veins.

Answer

The most common symptom is dull aching pain in the veins at the end of the day, after prolonged standing.

Answer

Duplex ultrasound is the investigation of choice for the diagnosis of varicose veins.

Answer

Bisgaard's regimen is used for venous ulcers.

Vascular Surgery — MCQs

Vascular Surgery — MCQs

On this page

Practice by Chapter

Want unlimited practice?