Vascular Surgery Practice Questions

Q: Bilateral pulseless disease in upper limbs is caused by which of the following conditions?

Takayasu arteritis. **Explanation:** **Takayasu Arteritis (Correct Answer):** Takayasu arteritis is a chronic, large-vessel vasculitis that primarily involves the **aorta and its main branches** (such as the subclavian, carotid, and renal arteries). It is most common in young females. The inflammation leads to segmental stenosis, occlusion, or aneurysmal dilation. When the **subclavian arteries** are bilaterally involved, it results in the characteristic clinical finding of absent or diminished pulses in the upper limbs, earning it the moniker **"Pulseless Disease."** **Analysis of Incorrect Options:** * **Coarctation of Aorta:** Typically involves narrowing distal to the origin of the left subclavian artery. This results in hypertension and strong pulses in the upper limbs, but weak/delayed pulses in the lower limbs (radio-femoral delay). * **Fibromuscular Dysplasia (FMD):** A non-inflammatory, non-atherosclerotic angiopathy that primarily affects medium-sized arteries, most commonly the **renal and internal carotid arteries**. It rarely causes bilateral upper limb pulselessness. * **Buerger’s Disease (Thromboangiitis Obliterans):** An inflammatory condition strongly associated with smoking that affects **small and medium-sized vessels** of the distal extremities (hands and feet). While it causes ischemia, it does not typically present as a proximal "pulseless disease" of the entire upper limb. **High-Yield Clinical Pearls for NEET-PG:** * **Demographics:** Most common in females 10 mmHg between arms is a diagnostic criterion. * **Treatment:** Glucocorticoids are the first-line medical management; bypass surgery or angioplasty is reserved for irreversible stenosis.

Q: Buerger's disease usually affects all of the following except:

Large arteries. **Explanation:** **Buerger’s Disease**, also known as **Thromboangiitis Obliterans (TAO)**, is a non-atherosclerotic, segmental, inflammatory disease that primarily affects the distal vasculature of the extremities. **Why "Large Arteries" is the correct answer:** Buerger’s disease is characteristically a disease of the **small and medium-sized** vessels. It typically starts in the distal arteries of the hands and feet (e.g., digital, tibial, and radial arteries) and progresses proximally. It **spares large-sized arteries** (like the aorta or iliac arteries), which is a key diagnostic differentiator from atherosclerosis. **Analysis of other options:** * **Small and Medium-sized arteries (Options A & D):** These are the primary targets of the disease. The pathology involves a highly cellular "soft" thrombus that occludes these vessels, leading to ischemia, claudication, and gangrene. * **Deep veins (Option C):** While primarily an arterial disease, Buerger’s is unique because it also involves veins and nerves. Approximately 40% of patients experience **migratory superficial thrombophlebitis**, and involvement of deep veins is a recognized component of the pan-vasculitis seen in this condition. **NEET-PG High-Yield Pearls:** * **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) around areas of occlusion. * **Pathology:** Characterized by **microabscesses** within the thrombus, surrounded by multinucleated giant cells. * **Allen’s Test:** Often positive, indicating involvement of the radial or ulnar arteries.

Q: What is the commonest site of thromboangiitis obliterans?

None of the above. **Explanation:** **Thromboangiitis Obliterans (TAO)**, also known as **Buerger’s Disease**, is a non-atherosclerotic, segmental, inflammatory disease that primarily affects the **small and medium-sized arteries and veins** of the distal extremities. **Why "None of the above" is correct:** The hallmark of TAO is its predilection for **distal vessels**. The most common sites of involvement are the **infrapopliteal arteries** (specifically the **Anterior Tibial, Posterior Tibial, and Peroneal arteries**) in the lower limbs, and the **Radial and Ulnar arteries** in the upper limbs. Since the options provided (Femoral, Popliteal, and Iliac) are all large, proximal arteries, they are typically spared in the early and middle stages of the disease. **Analysis of Incorrect Options:** * **A, B, and C (Femoral, Popliteal, and Iliac):** These are large-caliber, proximal elastic/muscular arteries. These vessels are the classic sites for **Atherosclerosis Obliterans (ASO)**, not Buerger’s disease. In TAO, the proximal pulses (Femoral and Popliteal) are characteristically preserved, while distal pulses (Dorsalis Pedis and Posterior Tibial) are absent. **High-Yield Clinical Pearls for NEET-PG:** * **Strongest Risk Factor:** Heavy tobacco consumption (smoking or chewing). * **Classic Triad:** Distal ischemia (claudication/gangrene), Raynaud’s phenomenon, and Migratory Superficial Thrombophlebitis. * **Angiographic Sign:** "Corkscrew collaterals" (Martorell’s sign) due to recanalization of the thrombus. * **Pathology:** Characterized by a "highly cellular thrombus" with microabscesses, but the internal elastic lamina remains intact (unlike atherosclerosis). * **Treatment:** Absolute smoking cessation is the only way to halt disease progression. Sympathectomy may be used for symptomatic relief.

Q: Milroy's disease is characterized by which of the following?

Congenital lymphedema. **Explanation:** Milroy’s disease is a specific form of **Primary Lymphedema**, classified as **Lymphedema Congenita**. It is an autosomal dominant condition typically caused by a mutation in the **FLT4 gene**, which encodes the Vascular Endothelial Growth Factor Receptor-3 (VEGFR-3). This mutation leads to the hypoplasia or failure of development of lymphatic vessels. **Why the correct answer is right:** * **Option C:** Milroy’s disease is defined by the presence of lymphedema at birth or within the first year of life. It typically presents as bilateral, non-pitting edema of the lower limbs and is the classic example of congenital primary lymphedema. **Why the other options are wrong:** * **Option A & B:** These represent **Secondary Lymphedema**. Filariasis (caused by *Wuchereria bancrofti*) is the most common cause of secondary lymphedema worldwide, while post-cellulitic edema occurs due to lymphatic destruction following recurrent infections. * **Option D:** This is also a form of secondary lymphedema, commonly seen after radical lymph node dissections (e.g., post-mastectomy lymphedema). **High-Yield Clinical Pearls for NEET-PG:** * **Classification by Age of Onset:** * **Lymphedema Congenita:** Present at birth (e.g., Milroy’s Disease). * **Lymphedema Praecox:** Most common primary type; appears during puberty/before age 35 (e.g., **Meige’s Disease**). * **Lymphedema Tarda:** Appears after age 35. * **Stemmer’s Sign:** Inability to pinch the skin on the dorsal surface of the base of the second toe; a pathognomonic clinical sign for lymphedema. * **Imaging:** **Lymphoscintigraphy** is the gold standard investigation for evaluating the lymphatic system.

Q: What is the most common site of lymphangiosarcoma?

Post-mastectomy edema of arm. **Explanation:** **Lymphangiosarcoma** is a rare, highly aggressive malignant tumor arising from the endothelial lining of lymphatic vessels. **Why Option C is correct:** The most common clinical setting for lymphangiosarcoma is chronic, long-standing lymphedema. Specifically, it is most frequently associated with **Stewart-Treves Syndrome**. This syndrome refers to the development of lymphangiosarcoma in an arm affected by chronic lymphedema following a radical mastectomy with axillary lymph node dissection (usually for breast cancer). The tumor typically appears 10–20 years after the initial surgery as persistent cutaneous nodules or purple-red patches. **Why other options are incorrect:** * **A & B (Liver and Spleen):** While primary angiosarcomas can occur in the liver (often associated with vinyl chloride or thorotrast exposure) and the spleen, these are blood vessel malignancies (hemangiosarcomas), not primary lymphangiosarcomas. * **D (Retroperitoneum):** This is a common site for other sarcomas (like liposarcoma or leiomyosarcoma), but it is an extremely rare site for primary lymphangiosarcoma. **High-Yield Clinical Pearls for NEET-PG:** * **Stewart-Treves Syndrome:** Classic triad = Post-mastectomy + Chronic Lymphedema + Lymphangiosarcoma. * **Latent Period:** Usually occurs **10 years** or more after surgery. * **Clinical Presentation:** Look for "bruise-like" lesions or purple subcutaneous nodules on a lymphedematous limb that do not resolve. * **Prognosis:** Extremely poor due to early hematogenous metastasis (most commonly to the lungs). * **Treatment:** Radical amputation of the limb is often required, but survival rates remain low.

Q: Sympathectomy is effective in all of the following conditions except one?

Intermittent claudication. **Explanation:** Sympathectomy involves the surgical interruption of sympathetic nerve pathways to induce vasodilation and abolish sweating in a specific distribution. **Why Intermittent Claudication is the Correct Answer:** Intermittent claudication is caused by **macrovascular** atherosclerotic obstruction in the large arteries. During exercise, the metabolic demand of the muscles increases significantly. Sympathectomy primarily affects the **cutaneous (skin) circulation** rather than the deep intramuscular vessels. Furthermore, in patients with fixed arterial stenosis, the distal vessels are already maximally dilated due to local metabolites. Therefore, sympathectomy fails to increase blood flow to the exercising muscles and does not improve walking distance. **Analysis of Other Options:** * **Hyperhidrosis:** This is a primary indication for sympathectomy (e.g., Thoracic T2-T3). It eliminates the cholinergic sympathetic supply to eccrine sweat glands, providing a permanent cure. * **Raynaud’s Disease:** Sympathectomy is used in severe, refractory cases to reduce vasospasm and improve digital skin blood flow by removing sympathetic vasoconstrictor tone. * **Causalgia (Complex Regional Pain Syndrome Type II):** Sympathectomy is highly effective for "sympathetically maintained pain." It interrupts the pain-spasm-pain cycle and provides significant symptomatic relief. **High-Yield Clinical Pearls for NEET-PG:** * **Lumbar Sympathectomy:** The chain is usually removed from **L2 to L4**. L1 is preserved in males to prevent **loss of ejaculation**. * **Best Indication in PVD:** Sympathectomy is most effective for **rest pain** and **distal ischemic ulcers** (skin involvement) rather than claudication (muscle involvement). * **Buerger’s Disease:** It is often used as a palliative measure to improve skin vascularity and promote ulcer healing.

Question 1

Which one of the following does not cause deep vein thrombosis?

Accepted Answer

Sickle cell Anemia

Answer

Estrogen

Answer

Thrombocytosis

Answer

Venous stasis

Question 2

Bilateral pulseless disease in upper limbs is caused by which of the following conditions?

Accepted Answer

Takayasu arteritis

Answer

Coarctation of aorta

Answer

Fibromuscular dysplasia

Answer

Buerger's disease

Question 3

Buerger's disease usually affects all of the following except:

Accepted Answer

Large arteries

Answer

Medium sized arteries

Answer

Deep veins

Answer

Small sized arteries

Question 4

Which of the following does NOT cause lymphoedema?

Accepted Answer

Lymphogranuloma venereum

Answer

Syphilis

Answer

Tuberculosis

Answer

Filariasis

Question 5

A 30-year-old male, a labourer and chronic smoker and alcoholic, presents with acute chest pain, severe back pain radiating to the interscapular area. What is the most likely diagnosis?

Accepted Answer

Ruptured aortic aneurysm

Answer

Pericarditis

Answer

Tension pneumothorax

Answer

Myocardial infarction

Question 6

A 55-year-old man suffers from an acute myocardial infarction after occlusion of the left anterior descending coronary artery. The patient undergoes coronary bypass surgery 3 days later. Which of the following is the most frequent cause of saphenous vein graft failure several years following coronary bypass surgery?

Accepted Answer

Atherosclerosis

Answer

Acute inflammation

Answer

Graft-versus-host disease

Answer

Metastatic calcification

Question 7

What is the commonest site of thromboangiitis obliterans?

Accepted Answer

None of the above

Answer

Femoral artery

Answer

Popliteal artery

Answer

Iliac artery

Question 8

Milroy's disease is characterized by which of the following?

Accepted Answer

Congenital lymphedema

Answer

Edema due to filariasis

Answer

Post-cellulitic lymphedema

Answer

Lymphedema following surgery

Question 9

What is the most common site of lymphangiosarcoma?

Accepted Answer

Post-mastectomy edema of arm

Answer

Liver

Answer

Spleen

Answer

Retroperitoneum

Question 10

Sympathectomy is effective in all of the following conditions except one?

Accepted Answer

Intermittent claudication

Answer

Hyperhydrosis

Answer

Raynaud's disease

Answer

Causalgia

Vascular Surgery — MCQs

Vascular Surgery — MCQs

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