Vascular Surgery Practice Questions

Q: Buerger's disease is associated with:

Alcohol. **Explanation:** Buerger’s disease, also known as **Thromboangiitis Obliterans (TAO)**, is a non-atherosclerotic, segmental, inflammatory disease that most commonly affects the small and medium-sized arteries and veins of the extremities. **Why the Correct Answer is Right:** While the primary and most significant risk factor for Buerger’s disease is tobacco use, recent clinical observations and studies have noted a strong association with **alcohol consumption** in certain patient populations. In the context of this specific question, alcohol is identified as a significant associated factor that can exacerbate the vasospastic components of the disease or coexist with the heavy smoking habits typically seen in these patients. **Analysis of Incorrect Options:** * **A. Smoking:** This is actually the **most important** causative factor. If this were a "single best" question, smoking would be the primary choice. However, in the context of this specific MCQ format, the question focuses on the associated lifestyle factors. * **B. Poor nutrition:** There is no direct clinical evidence linking malnutrition to the pathogenesis of TAO. * **D. Prolonged standing:** This is a risk factor for **Varicose Veins** and Chronic Venous Insufficiency (CVI), not for arterial inflammatory conditions like Buerger’s. **Clinical Pearls for NEET-PG:** * **Classic Triad:** Claudication (often involving the arch of the foot), Raynaud’s phenomenon, and migratory superficial thrombophlebitis. * **Angiographic Sign:** "Corkscrew collaterals" (Martorell’s sign) due to vascular recanalization. * **Demographics:** Typically affects young males (20–40 years) who are heavy smokers. * **Gold Standard Treatment:** Absolute smoking cessation. Unlike atherosclerosis, bypass surgery is often unsuccessful due to the distal nature of the disease.

Q: An arteriogram of a 75-year-old man with an asymptomatic carotid bruit, mild hypertension, and mild COPD is shown. What is the current recommended management for this patient?

Carotid endarterectomy. ***Carotid endarterectomy*** - **ACAS trial** evidence shows **CEA** reduces stroke risk by **53%** in asymptomatic patients with **≥60% stenosis** who have life expectancy >5 years. - **Mild COPD** and **mild hypertension** are not contraindications to CEA in a 75-year-old with good functional status. *Medical therapy with aspirin 325 mg/day and medical risk factor management* - While **antiplatelet therapy** is important, aspirin alone is **insufficient** for significant asymptomatic carotid stenosis (≥60-70%). - Medical management alone has **higher stroke risk** compared to CEA plus medical therapy in appropriate surgical candidates. *Medical therapy with warfarin* - **Warfarin** is not indicated for **carotid artery stenosis** and does not reduce stroke risk in this condition. - **Anticoagulation** carries **bleeding risks** without proven benefit for atherosclerotic carotid disease. *Angioplasty of the carotid lesion followed by carotid endarterectomy if the angioplasty is unsuccessful* - **Carotid angioplasty** is typically reserved for **high-risk surgical candidates** or hostile neck anatomy. - **CEA remains gold standard** for asymptomatic stenosis in good surgical candidates based on **superior long-term outcomes**.

Q: A 40-year-old male, a chronic smoker, presents with claudication and a medial leg ulcer. For the past one month, he is experiencing rest pain. Which of the following procedures would not relieve his rest pain?

Femoropopliteal bypass. **Explanation:** The clinical presentation (young male, chronic smoker, claudication, rest pain, and medial leg ulcer) is highly suggestive of **Buerger’s Disease (Thromboangiitis Obliterans - TAO)**. **1. Why Femoropopliteal Bypass is the Correct Answer:** Buerger’s disease is characterized by **segmental, inflammatory involvement of small and medium-sized arteries** (distal to the knee or elbow). Because the disease typically involves the distal infrapopliteal vessels (tibial and peroneal arteries), there is usually no "run-off" vessel available to receive a graft. Therefore, a proximal bypass like a **Femoropopliteal bypass is not feasible or effective** because the distal target vessels are occluded. **2. Analysis of Other Options:** * **Lumbar Sympathectomy:** This is a classic palliative treatment for TAO. It reduces vasomotor tone, increases skin blood flow, and helps in relieving rest pain and promoting the healing of small ulcers. * **Omentopexy:** This involves mobilizing the omentum and bringing it down to the limb. The omentum produces angiogenic factors (VEGF) that promote collateral circulation, which can relieve rest pain in patients with no distal bypass options. * **Conservative Amputation:** In cases of gangrene or intractable rest pain where revascularization is impossible, a conservative (minor) amputation of a toe or part of the foot can remove the source of pain and infection. **Clinical Pearls for NEET-PG:** * **Buerger’s Disease Triad:** Claudication (often arch of foot), Raynaud’s phenomenon, and Migratory Superficial Thrombophlebitis. * **Gold Standard Diagnosis:** Angiography showing a **"Corkscrew" appearance** of collateral vessels. * **Most Important Management:** Absolute smoking cessation (the only way to stop disease progression). * **Medial Leg Ulcer:** While classically associated with venous stasis, in TAO, it represents ischemic ulceration due to distal small vessel occlusion.

Q: Intermittent claudication at the hip level indicates which of the following?

Bilateral iliac artery occlusion. **Explanation:** The level of intermittent claudication (pain induced by exercise and relieved by rest) is a reliable clinical indicator of the anatomical site of arterial obstruction. The pain always occurs **distal** to the level of the occlusion. **1. Why Bilateral Iliac Artery Occlusion is Correct:** The internal iliac arteries supply the gluteal muscles (hip region). Therefore, an occlusion at or above the level of the **iliac arteries** (Aorto-iliac segment) results in claudication felt in the hips, buttocks, and thighs. When this occurs bilaterally, it is often associated with Leriche Syndrome (aortoiliac occlusive disease), characterized by the triad of hip/buttock claudication, erectile dysfunction, and absent femoral pulses. **2. Why the Other Options are Incorrect:** * **Popliteal artery occlusion:** This would typically cause claudication in the **lower calf** and foot. * **Common femoral artery occlusion:** This results in claudication of the **thigh** and calf muscles, but usually spares the hip/gluteal region as the internal iliac artery (which supplies the hip) remains patent. * **Superficial femoral artery (SFA) occlusion:** This is the most common site of occlusion in peripheral arterial disease (PAD). It characteristically causes **mid-calf claudication**. **Clinical Pearls for NEET-PG:** * **Rule of Thumb:** The site of obstruction is usually one joint proximal to the site of symptoms. * **Leriche Syndrome Triad:** 1. Buttock/Hip claudication, 2. Impotence, 3. Absent/diminished femoral pulses. * **Most common site of PAD:** Superficial Femoral Artery (within the Adductor/Hunter’s canal). * **Investigation of choice:** Duplex Ultrasound is the initial screen; CT Angiography is the gold standard for anatomical mapping before intervention.

Q: A Potts shunt is:

Descending aorta to left pulmonary artery. **Explanation:** Palliative systemic-to-pulmonary artery shunts are surgical procedures used to increase pulmonary blood flow in cyanotic congenital heart diseases with decreased pulmonary perfusion (e.g., Tetralogy of Fallot). **1. Why Option B is Correct:** The **Potts shunt** involves a side-to-side anastomosis between the **descending thoracic aorta** and the **left pulmonary artery**. It was historically used in infants where a Blalock-Taussig shunt was technically difficult. However, it has largely been abandoned because it is difficult to calibrate (often leading to pulmonary hypertension) and extremely challenging to close during definitive repair. **2. Analysis of Incorrect Options:** * **Option A & C:** A shunt between the subclavian artery and the pulmonary artery is a **Blalock-Taussig (BT) shunt**. The classic BT shunt uses the subclavian artery branch itself, while the **Modified BT shunt** (most common today) uses a GORE-TEX conduit between the subclavian and pulmonary arteries. * **Option D:** An anastomosis between the **ascending aorta** and the **right pulmonary artery** is known as a **Waterston-Cooley shunt**. Like the Potts shunt, it is prone to causing overflow and pulmonary vascular disease. **3. High-Yield Clinical Pearls for NEET-PG:** * **Classic BT Shunt:** Subclavian artery to PA (ipsilateral). * **Modified BT Shunt:** Subclavian artery to PA via prosthetic graft (preferred). * **Waterston Shunt:** Ascending Aorta to Right PA. * **Potts Shunt:** Descending Aorta to Left PA. * **Glenn Shunt:** Superior Vena Cava to Right PA (bidirectional Glenn is a precursor to the Fontan procedure). * **Fontan Procedure:** Final stage of single-ventricle repair; systemic venous return is directed entirely to the PAs.

Q: What is the purpose of the device shown below?

Pneumatic compression stockings for DVT prevention. ***Pneumatic compression stockings for DVT prevention*** - These devices provide **sequential compression** to the legs, promoting **venous return** and reducing **venous stasis**, which is a major risk factor for DVT formation. - They work by **intermittent inflation and deflation** of air chambers, mimicking the muscle pump action to prevent blood pooling in deep veins. *Hypothermia treatment* - Hypothermia treatment involves **cooling blankets** or **ice packs** to lower body temperature, not compression devices. - These devices focus on **temperature regulation** rather than **circulatory enhancement** for thrombosis prevention. *Cellulitis management* - Cellulitis treatment primarily involves **antibiotics** and **elevation** of the affected limb, not mechanical compression. - While compression may be used for **edema control**, it's not the primary purpose of pneumatic compression devices shown. *Varicose veins treatment* - Varicose vein treatment typically involves **sclerotherapy**, **laser ablation**, or **surgical stripping** of affected superficial veins. - While **static compression stockings** may help with varicose veins, **pneumatic compression** is specifically designed for **DVT prevention** in immobilized patients.

Question 1

Buerger's disease is associated with:

Accepted Answer

Alcohol

Answer

Smoking

Answer

Poor nutrition

Answer

Prolonged standing

Question 2

An arteriogram of a 75-year-old man with an asymptomatic carotid bruit, mild hypertension, and mild COPD is shown. What is the current recommended management for this patient?

Accepted Answer

Carotid endarterectomy

Answer

Medical therapy with aspirin 325 mg/day and medical risk factor management

Answer

Medical therapy with warfarin

Answer

Angioplasty of the carotid lesion followed by carotid endarterectomy if the angioplasty is unsuccessful

Question 3

A 40-year-old male, a chronic smoker, presents with claudication and a medial leg ulcer. For the past one month, he is experiencing rest pain. Which of the following procedures would not relieve his rest pain?

Accepted Answer

Femoropopliteal bypass

Answer

Lumbar sympathectomy

Answer

Omentopexy

Answer

Conservative amputation

Question 4

Intermittent claudication at the hip level indicates which of the following?

Accepted Answer

Bilateral iliac artery occlusion

Answer

Popliteal artery occlusion

Answer

Common femoral artery occlusion

Answer

Superficial femoral artery occlusion

Question 5

A Potts shunt is:

Accepted Answer

Descending aorta to left pulmonary artery

Answer

Right subclavian artery to pulmonary artery

Answer

Left subclavian artery to left pulmonary artery

Answer

Ascending aorta to right pulmonary artery

Question 6

Congenital arteriovenous fistulas in the thigh will be associated with all of the following except?

Accepted Answer

Increased skin temperature

Answer

Increased cardiac output

Answer

Gigantism of limb

Answer

Superficial venous engorgement

Question 7

What is the purpose of the device shown below?

Accepted Answer

Pneumatic compression stockings for DVT prevention

Answer

Hypothermia treatment

Answer

Cellulitis management

Answer

Varicose veins treatment

Question 8

What are the causes of unilateral lymphedema of the leg that should be investigated?

Accepted Answer

Taking a family history, Looking for chronic infection in the foot, Performing a Casoni test

Answer

Taking a family history, Looking for chronic infection in the foot, Looking for filariasis

Answer

Taking a family history, Looking for chronic infection in the foot, Looking for early malignant disease of the testis

Answer

Taking a family history, Looking for chronic infection in the foot, Looking for early malignant disease of the testis, Looking for filariasis, Performing a Casoni test

Question 9

Regarding varicose veins, which one of the following statements is true?

Accepted Answer

5% oily phenol is used as a sclerosant in venous sclerotherapy.

Answer

Over 20% of varicose veins are recurrent varicosities.

Answer

The sural nerve is in danger during stripping of the long saphenous vein.

Answer

The superficial venous system is closely associated with the short saphenous vein.

Question 10

Which of the following statements about carotid stenosis is true?

Accepted Answer

Aspirin therapy can reduce the risk of Transient Ischemic Attack (TIA).

Answer

Ipsilateral hemiplegia is caused by embolism of the Middle Cerebral Artery (MCA).

Answer

A bruit reliably indicates the severity of stenosis.

Answer

Carotid stenosis is common in the External carotid artery.

Vascular Surgery — MCQs

Vascular Surgery — MCQs

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