Vascular Surgery Practice Questions

Q: Which among the following is not a feature of peripheral arterial occlusion?

Shock. **Explanation:** Acute peripheral arterial occlusion is a surgical emergency characterized by the sudden cessation of blood flow to a limb. The diagnosis is primarily clinical, based on the classic **"6 Ps"** of acute limb ischemia. **1. Why "Shock" is the correct answer:** Shock is a systemic state of circulatory collapse leading to inadequate tissue perfusion across multiple organ systems. While peripheral arterial occlusion causes localized ischemia to a specific limb, it does not typically cause systemic hypotension or shock unless it is a secondary complication of a massive underlying event (like a large Myocardial Infarction causing a saddle embolus). Therefore, shock is not a diagnostic feature of the arterial occlusion itself. **2. Analysis of Incorrect Options (The 6 Ps):** * **Pain:** Usually the earliest and most common symptom. It is sudden, severe, and located distal to the site of occlusion. * **Pallor:** The affected limb appears "waxy white" due to the lack of erythrocyte-filled capillaries. * **Pulselessness:** A hallmark sign; pulses are absent distal to the level of the occlusion. * *Note: The remaining 3 Ps are Paresthesia (loss of sensory function), Paralysis (loss of motor function—a late sign), and Poikilothermia (limb takes on the ambient temperature).* **Clinical Pearls for NEET-PG:** * **Golden Period:** Revascularization should ideally be performed within **6 hours** to prevent irreversible muscle necrosis and "Rigor Mortis" of the limb. * **Most Common Site of Embolism:** The **Femoral artery bifurcation** is the most frequent site for peripheral embolic lodgment. * **Most Common Source:** The heart (Atrial Fibrillation) is the source of emboli in over 80% of cases. * **Management:** Immediate anticoagulation with **IV Heparin** is the first step to prevent clot propagation, followed by surgical embolectomy (using a **Fogarty catheter**).

Q: What is the most common site for venous thrombosis?

Soleal vein. **Explanation:** The **soleal veins** (located within the soleus muscle in the calf) are the most common site for the initiation of venous thrombosis. These veins are large, thin-walled, valveless sinusoids that act as a reservoir for blood. During periods of immobility, the "calf muscle pump" fails, leading to significant stasis in these sinuses. According to Virchow’s Triad, stasis is a primary driver of thrombus formation, making the soleal veins the most frequent nidus for Deep Vein Thrombosis (DVT). **Analysis of Options:** * **B. Soleal vein (Correct):** Most DVTs originate here. While many remain asymptomatic and undergo spontaneous lysis, they can propagate proximally to involve the popliteal and femoral veins. * **A. Popliteal vein:** This is a common site for *extension* of a calf thrombus, but it is not the most common site of primary origin. * **C. Femoral vein:** Though clinically significant due to a higher risk of pulmonary embolism (PE) when involved, primary thrombosis here is less common than in the calf sinuses. * **D. Internal iliac vein:** Thrombosis here is rare compared to the lower limb and is usually associated with pelvic surgery, trauma, or malignancy. **NEET-PG High-Yield Pearls:** * **Most common site for DVT:** Soleal veins (Calf sinusoids). * **Most common source of clinically significant Pulmonary Embolism:** Iliofemoral veins (proximal DVT). * **Gold Standard Investigation for DVT:** Contrast Venography (rarely used now). * **Investigation of Choice (IOC):** Color Doppler (Duplex) Ultrasonography. * **Homan’s Sign:** Pain in the calf on dorsiflexion of the foot (low sensitivity and specificity).

Q: What is the most common cause of an abdominal aneurysm?

Atherosclerosis. **Explanation:** **1. Why Atherosclerosis is Correct:** Atherosclerosis is the leading cause of Abdominal Aortic Aneurysms (AAA). The pathophysiology involves the chronic inflammation of the arterial wall, leading to the degradation of elastin and collagen by matrix metalloproteinases (MMPs). This weakens the tunica media, causing the vessel to dilate under arterial pressure. Risk factors like smoking, hypertension, and male gender further accelerate this atherosclerotic degeneration. **2. Why Other Options are Incorrect:** * **Trauma:** While trauma can cause "pseudoaneurysms" (false aneurysms) due to arterial wall injury, it is a rare cause of true abdominal aneurysms. * **Marfan’s Syndrome:** This is a connective tissue disorder (fibrillin-1 mutation) that typically leads to **cystic medial necrosis**. While it causes aneurysms, it most commonly affects the **ascending thoracic aorta**, not the abdominal aorta. * **Congenital:** Congenital aneurysms are extremely rare in the abdominal aorta; they are more commonly associated with cerebral circulation (e.g., Berry aneurysms in the Circle of Willis). **3. High-Yield Clinical Pearls for NEET-PG:** * **Location:** Most AAAs are **infra-renal** (90%), occurring between the renal arteries and the aortic bifurcation. * **Screening:** Ultrasonography is the investigation of choice for screening. * **Surgical Threshold:** Surgery (EVAR or Open Repair) is generally indicated when the diameter is **>5.5 cm in men** or **>5.0 cm in women**, or if it grows >0.5 cm in 6 months. * **Triad of Rupture:** Hypotension, pulsatile abdominal mass, and back/abdominal pain. * **Syphilis:** Classically causes aneurysms of the **ascending aorta/arch** (Tree-bark appearance), not the abdominal aorta.

Q: Visceral aneurysm is most commonly seen in which of the following locations?

Splenic. **Explanation:** Visceral artery aneurysms (VAAs) are rare but clinically significant due to their risk of rupture. Among all visceral locations, the **Splenic artery** is the most common site, accounting for approximately **60%** of all visceral aneurysms. **1. Why Splenic Artery is Correct:** The splenic artery is the most frequent site for VAAs. They are more common in females (4:1 ratio) and are strongly associated with conditions that increase splenic blood flow or weaken the arterial wall, such as **pregnancy** (due to hormonal changes and portal congestion) and **portal hypertension/cirrhosis**. Most are saccular and located in the distal third of the artery. **2. Analysis of Incorrect Options:** * **Renal Artery (B):** This is the second most common site (approx. 20-25%). They are often associated with fibromuscular dysplasia and hypertension. * **Hepatic Artery (C):** These account for about 20% of VAAs. They are more common in males and are often associated with trauma, infection, or vasculitis. * **Coronary Artery (D):** While serious, coronary aneurysms are not classified as "visceral" aneurysms in the standard surgical context and are significantly rarer than splenic aneurysms. **Clinical Pearls for NEET-PG:** * **The "Double Rupture" Phenomenon:** Splenic aneurysms can rupture first into the lesser sac (contained) and then into the general peritoneal cavity (free rupture). * **Indications for Surgery:** Treatment is generally indicated if the aneurysm is **>2 cm**, in **pregnant women**, or in women of childbearing age (due to high mortality risk during pregnancy). * **Most common cause:** Medial degeneration/atherosclerosis.

Question 1

Intermittent claudication is caused by?

Accepted Answer

Arterial insufficiency

Answer

Venous occlusion

Answer

Neural compression

Answer

Muscular dystrophy

Question 2

Which of the following is NOT a bypass procedure used in the surgical management of lymphedema?

Accepted Answer

Homan's operation

Answer

Handley's operation

Answer

Kinmonth operation

Answer

Gillies operation

Question 3

Which among the following is not a feature of peripheral arterial occlusion?

Accepted Answer

Shock

Answer

Pallor

Answer

Pain

Answer

Pulselessness

Question 4

The following are true regarding intermittent claudication, except:

Accepted Answer

Affected by body position

Answer

Cramping pain typically in calf muscles

Answer

Occurs usually after a similar degree of activity

Answer

Relieved by rest quickly

Question 5

What is the most common site for venous thrombosis?

Accepted Answer

Soleal vein

Answer

Popliteal vein

Answer

Femoral vein

Answer

Internal iliac vein

Question 6

Which of the following is a contraindication for surgical intervention in varicose veins?

Accepted Answer

Deep venous thrombosis

Answer

Symptoms refractory to conservative therapy

Answer

Bleeding from a varix

Answer

Venous stasis ulcer

Question 7

Which of the following is used for the prophylaxis of deep vein thrombosis?

Accepted Answer

Heparin

Answer

Warfarin

Answer

Pneumatic compression devices

Answer

Graded compression stockings

Question 8

What is the most common cause of an abdominal aneurysm?

Accepted Answer

Atherosclerosis

Answer

Trauma

Answer

Marfan's syndrome

Answer

Congenital

Question 9

Visceral aneurysm is most commonly seen in which of the following locations?

Accepted Answer

Splenic

Answer

Renal

Answer

Hepatic

Answer

Coronary

Question 10

Which test is NOT used to demonstrate the presence of collateral circulation of the hand?

Accepted Answer

Allen's test

Answer

Kety Schmidt test

Answer

Sellick's test

Answer

Swan Ganz test

Vascular Surgery — MCQs

Vascular Surgery — MCQs

On this page

Practice by Chapter

Want unlimited practice?