Vascular Surgery Practice Questions

Q: Which site is most commonly affected by diabetic foot ulcers?

Heel. **Explanation:** Diabetic foot ulcers are primarily a result of **peripheral neuropathy** (loss of protective sensation) and **peripheral arterial disease**. While pressure-related ulcers frequently occur at the metatarsal heads due to biomechanical changes, the **heel** is the most common site for ulcers leading to significant morbidity and hospitalization in diabetic patients. The heel is particularly vulnerable because it bears the maximum weight during the initial contact phase of the gait cycle. In a diabetic patient, the combination of **fat pad atrophy**, dry skin (due to autonomic neuropathy), and constant pressure makes the heel the primary site for deep tissue injury and ulceration. **Analysis of Options:** * **Heel (Correct):** Statistically the most frequent site for diabetic ulcers, especially those associated with prolonged pressure and high weight-bearing. * **Head of Metatarsal (Incorrect):** This is the most common site for **neuropathic (perforating) ulcers** or "Malperforans." While very common, in the context of overall diabetic foot presentations, the heel remains the leading site. * **Medial & Lateral Malleoli (Incorrect):** These are classic sites for **venous ulcers** (medial) and **hypertensive/ischemic ulcers** (lateral). They are not the primary sites for diabetic foot pathology unless associated with direct trauma or ill-fitting footwear. **Clinical Pearls for NEET-PG:** * **Wagner’s Classification:** Used to grade diabetic foot ulcers (Grade 0: Pre-ulcerative; Grade 1: Superficial; Grade 2: Deep to tendon/bone; Grade 3: Osteomyelitis/Abscess; Grade 4: Forefoot gangrene; Grade 5: Whole foot gangrene). * **Monofilament Test:** The 10g Semmes-Weinstein monofilament is the gold standard for screening loss of protective sensation. * **Charcot’s Arthropathy:** Characterized by "rocker-bottom deformity," often triggered by minor trauma in a neuropathic foot.

Q: Which of the following is NOT true regarding Milroy's disease?

It typically involves unilateral upper and lower limbs.. **Explanation:** Milroy’s disease is a specific type of **Primary Congenital Lymphedema** caused by a mutation in the **FLT4 gene**, which encodes the **VEGFR-3** (Vascular Endothelial Growth Factor Receptor 3). This mutation leads to the failure of lymphatic vessel development. **Why Option B is the correct answer (False statement):** Milroy’s disease characteristically presents as **bilateral** swelling of the **lower limbs** only. It is present at birth or develops within the first year of life. Involvement of the upper limbs is extremely rare, and unilateral presentation is not the classic clinical picture. **Analysis of other options:** * **Option A (Autosomal Dominant):** This is true. It follows an autosomal dominant inheritance pattern with variable expressivity. * **Option C (Face involvement):** While rare, Milroy’s disease can occasionally be associated with facial edema, hydrocele, or prominent veins. * **Option D (Congenital Lymphedema):** This is true. By definition, Milroy’s is "Lymphedema Praecox" (specifically the congenital subtype), as it is present at birth. **High-Yield Clinical Pearls for NEET-PG:** * **Classification by Age:** * **Milroy’s Disease:** Congenital (at birth). * **Meige’s Disease:** Lymphedema Praecox (at puberty/most common primary type). * **Lymphedema Tarda:** Occurs after age 35. * **Stemmer’s Sign:** Inability to pinch the skin on the dorsal surface of the base of the second toe; a pathognomonic sign of lymphedema. * **Imaging:** **Lymphoscintigraphy** is the gold standard investigation for confirming the diagnosis and assessing lymphatic flow.

Q: Which of the following structures is NOT involved in Berger's disease?

Lymphatics. **Explanation:** **Buerger’s Disease**, also known as **Thromboangiitis Obliterans (TAO)**, is a non-atherosclerotic, segmental, inflammatory disease that primarily affects small and medium-sized vessels of the extremities. **1. Why Lymphatics is the Correct Answer:** Buerger’s disease is characterized by a highly cellular, "soft" inflammatory thrombus that involves the **neurovascular bundle**. While it affects arteries, veins, and nerves, it characteristically **spares the lymphatics**. Therefore, lymphatic involvement is not a feature of this pathology. **2. Analysis of Incorrect Options:** * **Artery (A):** This is the primary site of involvement. It causes segmental occlusive lesions leading to distal ischemia, claudication, and gangrene. * **Veins (B):** Approximately 40-50% of patients exhibit **Migratory Superficial Thrombophlebitis**, where inflammation affects the superficial veins. * **Nerve (C):** The inflammatory process extends from the vessels to the adjacent sheath, involving the nerves within the neurovascular bundle. This often results in severe neuropathic pain and is a hallmark of the disease. **3. High-Yield Clinical Pearls for NEET-PG:** * **Strongest Risk Factor:** Heavy tobacco use (smoking or chewing). Smoking cessation is the only way to halt disease progression. * **Demographics:** Classically seen in young males (<45 years). * **Angiographic Sign:** "Corkscrew collaterals" (Martorell’s sign) due to recanalization of the vessels. * **Pathology:** Presence of **Microabscesses** (of Smith) within the thrombus, surrounded by multinucleated giant cells. * **Allen’s Test:** Often positive, indicating involvement of the radial or ulnar arteries.

Q: Which of the following are features of Klippel-Trenaunay syndrome?

All features are true.. **Explanation:** **Klippel-Trenaunay Syndrome (KTS)** is a rare congenital vascular disorder characterized by a classic triad of clinical features. Understanding the pathophysiology is crucial for NEET-PG, as management differs significantly from standard venous disease. 1. **Why Option D is Correct:** All listed features are characteristic of KTS: * **Cutaneous Hemangioma:** Specifically, a "Port-wine stain" (capillary malformation) is usually the first sign. * **Varicose Veins:** Often presenting as a large lateral venous channel (Servelle-Martorell vein). * **Limb Hypertrophy:** Soft tissue and bony overgrowth of the affected extremity. * **Anomalous Deep Veins:** Patients frequently have hypoplastic or absent deep venous systems. * **Hazardous Saphenous Stripping:** Because the deep venous system is often absent or incompetent, the superficial varicose veins act as the **primary drainage** for the limb. Stripping these veins can lead to severe venous congestion and limb-threatening ischemia. 2. **Why Other Options are Incorrect:** Options A, B, and C are incorrect because they categorize one or more of these essential diagnostic or management features as "false." In KTS, the presence of deep vein anomalies and the contraindication to traditional vein stripping are defining clinical principles. **High-Yield Clinical Pearls for NEET-PG:** * **Parkes-Weber Syndrome:** Often confused with KTS; it includes the KTS triad plus **clinically significant Arteriovenous (AV) fistulas**. * **Diagnosis:** Duplex ultrasonography is the initial investigation, but **MR Venography** is the gold standard to assess the deep venous system. * **Management:** Primarily conservative (compression stockings). Surgery is reserved for complications and only after confirming a patent deep venous system.

Q: A 45-year-old male with a history of chronic smoking presents with pain in his lower limb due to blockage of the femoral artery. What is the most likely diagnosis?

Atherosclerosis. **Explanation:** **Atherosclerosis** is the most common cause of chronic arterial occlusive disease in the lower limbs, especially in patients over 40 with a history of smoking. It is a systemic inflammatory process where lipid-rich plaques accumulate in the tunica intima, leading to progressive narrowing (stenosis) or complete occlusion of large and medium-sized arteries like the femoral artery. Smoking is the most potent modifiable risk factor, accelerating plaque formation and peripheral arterial disease (PAD). **Why other options are incorrect:** * **Thromboangiitis obliterans (Buerger’s Disease):** While strongly associated with smoking, it typically affects **small and medium-sized distal arteries** (radial, tibial, plantar) in younger males (<40 years). It is an inflammatory vasculitis, not a primary blockage of the proximal femoral artery. * **Embolism:** This usually presents as an **acute** event (the "6 Ps": Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia) rather than a chronic presentation. The source is often the heart (atrial fibrillation). * **Arteritis:** This refers to inflammatory conditions (like Takayasu’s). While they cause blockages, they are less common than atherosclerosis in a 45-year-old male smoker and usually involve the aorta or its primary branches. **NEET-PG High-Yield Pearls:** * **Most common site of atherosclerosis in the lower limb:** The **Adductor (Hunter’s) canal**, where the superficial femoral artery is most vulnerable. * **Leriche Syndrome:** A triad of claudication (buttock/thigh), impotence, and absent femoral pulses due to aortoiliac occlusion. * **Ankle-Brachial Index (ABI):** The best initial screening test for PAD. A value **<0.9** is diagnostic; **<0.4** indicates critical limb ischemia. * **Management:** Smoking cessation is the single most important step to prevent disease progression.

Q: What does a Potts shunt connect?

Descending aorta to left pulmonary artery. ### Explanation The **Potts shunt** is a palliative systemic-to-pulmonary shunt historically 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 designed to provide a reliable source of pulmonary blood flow; however, it is rarely performed today because it is technically difficult to take down during definitive repair and carries a high risk of causing pulmonary hypertension due to excessive flow. **2. Analysis of Incorrect Options:** * **Option A & C:** A shunt between the **subclavian artery** and the **pulmonary artery** is known as a **Blalock-Taussig (BT) shunt**. The "Classic" BT shunt uses the subclavian artery branch itself, while the "Modified" BT shunt uses a GORE-TEX conduit. * **Option D:** A shunt 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 heart failure and pulmonary vascular disease. **3. High-Yield Clinical Pearls for NEET-PG:** * **Blalock-Taussig Shunt:** Subclavian artery to Pulmonary artery (Most commonly tested). * **Waterston Shunt:** Ascending Aorta to Right Pulmonary artery. * **Potts Shunt:** Descending Aorta to Left Pulmonary artery. * **Glenn Shunt:** Superior Vena Cava (SVC) to Right Pulmonary artery (A cavopulmonary shunt). * **Fontan Procedure:** Total cavopulmonary connection (IVC and SVC to Pulmonary artery).

Question 1

Which site is most commonly affected by diabetic foot ulcers?

Accepted Answer

Heel

Answer

Medial malleolus

Answer

Lateral malleolus

Answer

Head of metatarsal

Question 2

Which of the following is NOT true regarding Milroy's disease?

Accepted Answer

It typically involves unilateral upper and lower limbs.

Answer

It is autosomal dominant.

Answer

The face may be involved.

Answer

It is a form of congenital lymphedema.

Question 3

Which of the following structures is NOT involved in Berger's disease?

Accepted Answer

Lymphatics

Answer

Artery

Answer

Veins

Answer

Nerve

Question 4

Which of the following are features of Klippel-Trenaunay syndrome?

Accepted Answer

All features are true.

Answer

Varicose veins, cutaneous hemangioma, limb hypertrophy, and anomalous deep veins are true, while saphenous vein stripping is hazardous is false.

Answer

Varicose veins, cutaneous hemangioma, limb hypertrophy, and saphenous vein stripping being hazardous are true, while anomalous deep veins is false.

Answer

Varicose veins and limb hypertrophy and saphenous vein stripping being hazardous are true, while cutaneous hemangioma and anomalous deep veins are false.

Question 5

True about coarctation of aorta?

Accepted Answer

Most common site is distal to the origin of the left subclavian artery

Answer

Most common age of presentation is at 15–20 years

Answer

Upper rib notching is due to erosion by dilated collateral vessels

Answer

Right ventricular hypertrophy

Question 6

Which of the following describes the Nicoladoni-Branham sign?

Accepted Answer

Bradycardia caused by compression

Answer

Tachycardia caused by compression

Answer

Hypotension

Answer

Systolic filling

Question 7

What is the most common bacterial infection associated with lymphedema?

Accepted Answer

Streptococcus

Answer

Staphylococcus

Answer

E. coli

Answer

Pseudomonas

Question 8

A 45-year-old male with a history of chronic smoking presents with pain in his lower limb due to blockage of the femoral artery. What is the most likely diagnosis?

Accepted Answer

Atherosclerosis

Answer

Thromboangiitis obliterans

Answer

Embolism

Answer

Arteritis

Question 9

Which of the following drugs is NOT used for sclerotherapy of varicose veins?

Accepted Answer

Ethanol

Answer

Ethanolamine oleate

Answer

Polidocanol

Answer

Sodium tetradecyl sulfate

Question 10

What does a Potts shunt connect?

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

Vascular Surgery — MCQs

Vascular Surgery — MCQs

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