Vascular Surgery Practice Questions

Q: Thoracic outlet syndrome is primarily diagnosed by which method?

Clinical Evaluation. **Explanation:** Thoracic Outlet Syndrome (TOS) is a constellation of symptoms caused by the compression of neurovascular structures (brachial plexus, subclavian artery, or subclavian vein) as they pass through the superior thoracic aperture. **Why Clinical Evaluation is the Correct Answer:** TOS is fundamentally a **clinical diagnosis**. The diagnosis is primarily based on a detailed patient history and a thorough physical examination. Since most cases (95%) are neurogenic, imaging often fails to show structural abnormalities. Clinicians rely on provocative maneuvers that narrow the thoracic outlet to reproduce symptoms. Key tests include the **Adson’s test**, **Roos test (Elevated Arm Stress Test)**, and **Wright’s test**. **Why Other Options are Incorrect:** * **CT Scan & MRI:** These are adjunct modalities used to rule out differential diagnoses (like cervical discs or tumors) or to identify anatomical predispositions (like a cervical rib or fibrous bands). They are not diagnostic of the syndrome itself. * **Angiography:** This is reserved for suspected **Vascular TOS** (arterial or venous). While it can demonstrate stenosis or occlusion, it is an invasive procedure and is not the primary method for diagnosing the more common neurogenic variety. **High-Yield Clinical Pearls for NEET-PG:** * **Most Common Type:** Neurogenic TOS (95%), involving the brachial plexus (usually lower trunk, C8-T1). * **Most Common Anatomical Cause:** Cervical rib (though many people with cervical ribs remain asymptomatic). * **Paget-Schroetter Syndrome:** Also known as "effort thrombosis," it is the spontaneous thrombosis of the subclavian vein due to venous TOS. * **Adson’s Test:** Loss of radial pulse when the patient rotates their head toward the affected side and extends the neck during deep inspiration.

Q: Lisker's sign is seen in which condition?

Deep Vein Thrombosis (DVT). **Explanation:** **Lisker's sign** is a clinical sign used in the diagnosis of **Deep Vein Thrombosis (DVT)**. It is characterized by **tenderness elicited upon percussion of the anterior surface of the tibia**. The underlying medical concept is that the vibration or pressure from percussion irritates the inflamed deep veins (specifically the posterior tibial veins) lying in close proximity to the bone, causing localized pain. **Analysis of Options:** * **Deep Vein Thrombosis (Correct):** Along with Lisker’s sign, DVT is associated with several eponymous signs resulting from venous inflammation and calf muscle compression. * **Buerger’s Disease (Thromboangiitis Obliterans):** This is an inflammatory vasculitis of small and medium-sized arteries. It is characterized by the **Adson’s test** (for thoracic outlet) or **Allen’s test**, but not Lisker's sign. * **Coarctation of the Aorta:** This presents with radio-femoral delay and rib notching. * **Arteriovenous (AV) Fistula:** This is associated with **Nicoladoni-Branham sign** (bradycardia upon compression of the fistula), not percussion tenderness. **High-Yield Clinical Pearls for NEET-PG:** In the context of DVT, remember these other eponymous signs frequently tested: 1. **Homan’s Sign:** Pain in the calf on dorsiflexion of the foot (most famous but least specific). 2. **Moses’ Sign:** Pain on squeezing the calf muscles from side to side (anteroposteriorly). 3. **Lowenberg’s Sign:** Pain elicited when a blood pressure cuff wrapped around the calf is inflated to 80–100 mmHg. 4. **Pratt’s Sign:** Presence of prominent "sentinel" veins over the pretibial area.

Q: Which of the following is included in the definition of critical limb ischemia?

Rest pain. **Explanation:** Critical Limb Ischemia (CLI) represents the end-stage of peripheral arterial disease (PAD), where the blood supply is insufficient to meet the metabolic demands of the tissue at rest. **Why the correct answer is right:** According to the **Fontaine Classification (Stage III and IV)** and the **Rutherford Classification (Categories 4, 5, and 6)**, CLI is defined by the presence of chronic ischemic **rest pain** (typically requiring opiate analgesia for >2 weeks) or tissue loss (ulceration or gangrene). It is objectively confirmed by hemodynamic parameters showing severely reduced perfusion, specifically an **ankle pressure 50 mm Hg:** This is incorrect because the diagnostic threshold for CLI is an ankle pressure **less than** 50 mm Hg. Pressures above this level generally suggest compensated ischemia. * **C. Intermittent claudication:** This represents Fontaine Stage II. While it indicates PAD, it is not "critical" because the blood supply is adequate at rest and only becomes insufficient during exercise. * **D. Well preserved tissues:** CLI is characterized by the breakdown of tissue (Fontaine Stage IV), leading to non-healing ischemic ulcers or gangrene. **High-Yield Clinical Pearls for NEET-PG:** * **The "6 Ps"** (Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia) refer to **Acute** Limb Ischemia, which is a surgical emergency, whereas CLI is a **chronic** condition. * **Buerger’s Test:** A positive test (elevation pallor and dependent rubor) is a classic clinical sign of CLI. * **Management:** The primary goal in CLI is urgent revascularization (endovascular or bypass) to prevent limb loss (amputation).

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: What is the treatment of choice for acute lymphadenitis?

Antibiotics and rest. **Explanation:** **Acute lymphadenitis** is the inflammation and infection of one or more lymph nodes, most commonly occurring secondary to a primary pyogenic infection (usually *Staphylococcus aureus* or *Streptococcus pyogenes*) in the drainage area of the node. **Why Option A is Correct:** The mainstay of management for acute lymphadenitis is **medical therapy**. Since the underlying cause is typically a bacterial infection, **systemic antibiotics** are essential to eradicate the pathogen. **Rest** and elevation of the affected part help reduce lymphatic flow and decrease regional congestion, thereby alleviating pain and preventing the further spread of infection. **Why Other Options are Incorrect:** * **B. Lymphangiography:** This is a diagnostic imaging modality used to visualize lymphatic vessels. It has no therapeutic role in acute infection and is contraindicated in the acute phase as it can worsen the spread of bacteria. * **C. Excision:** Surgical excision is generally avoided in the acute inflammatory phase. Surgery is only indicated if the lymphadenitis progresses to an **abscess**, in which case **Incision and Drainage (I&D)** is performed, not excision. * **D. No treatment needed:** Untreated acute lymphadenitis can progress to suppuration (abscess formation), cellulitis, or systemic sepsis. **NEET-PG Clinical Pearls:** * **Most common cause:** Skin or soft tissue infection in the distal drainage area. * **Clinical Sign:** Nodes are enlarged, tender, warm, and the overlying skin may be erythematous. * **Key Distinction:** If the node becomes fluctuant, it indicates **suppuration**, and the treatment shifts from antibiotics alone to **Incision and Drainage**. * **Chronic Lymphadenitis:** If nodes are painless and persistent, consider Tuberculosis (Cold Abscess) or Malignancy.

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.

Question 1

Thoracic outlet syndrome is primarily diagnosed by which method?

Accepted Answer

Clinical Evaluation

Answer

CT scan

Answer

MRI

Answer

Angiography

Question 2

Lisker's sign is seen in which condition?

Accepted Answer

Deep Vein Thrombosis (DVT)

Answer

Berger's disease

Answer

Coarctation of the aorta

Answer

Arteriovenous fistula

Question 3

Which of the following is included in the definition of critical limb ischemia?

Accepted Answer

Rest pain

Answer

Ankle blood pressure >50 mm Hg

Answer

Intermittent claudication

Answer

Well preserved tissues

Question 4

What is the first treatment for rupture of varicose veins at the ankle?

Accepted Answer

Direct pressure and elevation

Answer

Rest in a prone position

Answer

Application of a tourniquet proximally

Answer

Application of a tourniquet distally

Question 5

What is the most common cause of acute arterial occlusion?

Accepted Answer

Emboli from atrial fibrillation

Answer

Pulmonary emboli

Answer

Atherosclerosis plaque

Answer

Thrombosis of an aneurysm

Question 6

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 7

What is the treatment of choice for acute lymphadenitis?

Accepted Answer

Antibiotics and rest

Answer

Lymphangiography

Answer

Excision

Answer

No treatment needed

Question 8

What is the best graft material for aortic dissection?

Accepted Answer

Dacron

Answer

Autologous vein

Answer

Autologous artery

Answer

PTFE

Question 9

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 10

Unna boot is used for the treatment of which condition?

Accepted Answer

Varicose ulcers

Answer

Diabetic foot ulcer

Answer

Ankle instability

Answer

Calcaneum fracture

Vascular Surgery — MCQs

Vascular Surgery — MCQs

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