Vascular Surgery Practice Questions

Q: Lehriche syndrome is characterized by the presence of arterial insufficiency in which of the following arteries?

Aorto-iliac artery. **Explanation:** **Leriche Syndrome** (also known as Aortoiliac Occlusive Disease) is a clinical triad caused by the chronic atherosclerotic occlusion of the **distal abdominal aorta** and/or the **common iliac arteries**. **1. Why Option A is Correct:** The pathophysiology involves a blockage at the aortic bifurcation. This leads to a classic clinical triad: * **Intermittent Claudication:** Pain in the buttocks, hips, or thighs (due to ischemia of the proximal muscle groups). * **Erectile Dysfunction:** Impotence occurs due to decreased blood flow in the internal iliac (hypogastric) arteries. * **Absent or Diminished Femoral Pulses:** Since the occlusion is proximal to the inguinal ligament. **2. Why the Other Options are Incorrect:** * **B. Superficial Femoral Artery:** Occlusion here leads to calf claudication (the most common site for peripheral arterial disease) but does not cause the proximal symptoms or impotence seen in Leriche syndrome. * **C. Temporal Artery:** This is associated with Giant Cell Arteritis (Temporal Arteritis), characterized by headaches and jaw claudication, not lower limb ischemia. * **D. Brachial Artery:** Involvement of the upper limb arteries is seen in conditions like Takayasu Arteritis or Thoracic Outlet Syndrome, not Leriche syndrome. **High-Yield Clinical Pearls for NEET-PG:** * **Risk Factors:** Strongly associated with smoking, hyperlipidemia, and hypertension. * **Diagnosis:** The gold standard for anatomical mapping is **CT Angiography** or Digital Subtraction Angiography (DSA). * **Management:** Lifestyle modification and statins are first-line. Surgical intervention includes **Aortobifemoral bypass** (gold standard for extensive disease) or endovascular stenting for focal lesions. * **Key Differentiator:** If a question mentions "buttock claudication + impotence," always think Leriche Syndrome.

Q: Which of the following is NOT a side effect of sclerotherapy in the treatment of varicose veins?

Anesthetic complications. **Explanation:** Sclerotherapy is a minimally invasive procedure used to treat varicose veins and telangiectasias. It involves the injection of a sclerosing agent (e.g., Sodium Tetradecyl Sulfate or Polidocanol) directly into the vein to cause endothelial damage, fibrosis, and eventual occlusion. **Why "Anesthetic complications" is the correct answer:** Sclerotherapy is typically performed as an outpatient procedure **without the need for general or regional anesthesia**. Since no anesthetic agents are required for the procedure itself, anesthetic complications (such as malignant hyperthermia or respiratory depression) are not considered side effects of sclerotherapy. **Analysis of incorrect options:** * **Skin necrosis:** This occurs if the sclerosant is accidentally injected extravascularly (into the surrounding tissue) or into a small cutaneous artery, leading to localized tissue ischemia. * **Thrombophlebitis:** A common side effect where the inflammatory response intended to close the vein causes localized pain, redness, and a palpable cord-like structure. * **Anaphylaxis:** Although rare, patients can develop severe allergic reactions or anaphylactic shock to the chemical sclerosing agents used. **High-Yield Clinical Pearls for NEET-PG:** * **Standard Sclerosant:** Sodium Tetradecyl Sulfate (STS) is the most commonly used agent. * **Fegan’s Technique:** A specific method of sclerotherapy involving injection into "empty" veins followed by immediate compression. * **Contraindications:** Pregnancy, acute Deep Vein Thrombosis (DVT), and severe systemic illness. * **Complication to watch:** Deep Vein Thrombosis (DVT) can occur if the sclerosant migrates into the deep venous system.

Q: What is the most common site of deep vein thrombosis?

Pelvic veins. **Explanation:** The correct answer is **Pelvic veins**. While clinical symptoms of Deep Vein Thrombosis (DVT) are most frequently observed in the calf and thigh, extensive autopsy studies and radioisotope scanning (such as $^{125}$I-fibrinogen tests) have demonstrated that the **pelvic veins** (specifically the internal iliac and periprostatic/perivaginal plexuses) are the most frequent site of origin for thrombi, particularly in postoperative and bedridden patients. **Analysis of Options:** * **Pelvic Veins (Correct):** These are the most common anatomical sites for the initiation of thrombus formation, though they often remain clinically silent until they propagate or embolize. * **Tibial Veins (Incorrect):** While "calf muscle sinusoids" (soleal sinuses) are a very common site for the *initiation* of small thrombi, the pelvic veins are statistically cited as the most frequent overall site in the context of major surgical or systemic risk factors. * **Femoral and Popliteal Veins (Incorrect):** These are common sites for *clinically significant* DVT and are the most frequent sources of major pulmonary emboli. However, thrombi here often represent a propagation of a clot that started more distally or in the pelvic tributaries. **NEET-PG High-Yield Pearls:** * **Virchow’s Triad:** Stasis, endothelial injury, and hypercoagulability are the three pillars of DVT pathogenesis. * **Most common site for Pulmonary Embolism (PE) source:** The **Iliofemoral veins** (proximal DVT) are the most common source of life-threatening PE. * **Gold Standard Investigation:** Contrast Venography (though Duplex Ultrasound is the initial investigation of choice). * **Cockett’s Syndrome (May-Thurner):** Compression of the left common iliac vein by the right common iliac artery, leading to left-sided pelvic/iliofemoral DVT.

Q: The great saphenous vein is typically cannulated at which anatomical location?

Anterior to the medial malleolus. The **Great Saphenous Vein (GSV)** is the longest vein in the body and is a frequent site for venous cutdown, especially in emergency trauma situations when peripheral intravenous access cannot be established. ### **Explanation of the Correct Answer** **A. Anterior to the medial malleolus:** This is the most consistent anatomical location of the GSV. At the ankle, the vein passes approximately **1 to 2 cm anterior and superior to the medial malleolus**. Because its position here is constant and predictable across individuals, it is the preferred site for surgical cannulation (venous cutdown). ### **Analysis of Incorrect Options** * **B. At the fossa ovalis:** While the GSV terminates here by joining the femoral vein (the saphenofemoral junction), it lies deep to the cribriform fascia. Cannulation here is technically difficult and carries a high risk of injuring the femoral artery or nerve. * **C. Above the popliteal fossa:** The GSV runs along the medial aspect of the knee, not the popliteal fossa. The **Small Saphenous Vein** is the structure associated with the popliteal fossa, as it pierces the deep fascia to join the popliteal vein. ### **High-Yield Clinical Pearls for NEET-PG** * **Nerve Injury:** During a venous cutdown at the medial malleolus, the **saphenous nerve** (a branch of the femoral nerve) is at risk of injury because it runs immediately adjacent to the vein. Injury leads to numbness along the medial aspect of the foot. * **Course:** The GSV originates from the medial end of the dorsal venous arch of the foot, ascends anterior to the medial malleolus, passes a handbreadth behind the medial border of the patella, and ends at the saphenofemoral junction. * **Valves:** It contains approximately 10–12 valves, with the most proximal one (subterminal valve) located just before it joins the femoral vein.

Q: Which statement is NOT true regarding Buerger's disease?

Veins and nerves are never involved. **Explanation:** Buerger’s disease, also known as **Thromboangiitis Obliterans (TAO)**, is a non-atherosclerotic, segmental, inflammatory disease that affects small and medium-sized arteries and veins of the extremities. **Why Option D is the correct answer (The False Statement):** Contrary to the statement, Buerger’s disease is characterized by **panangiitis**, meaning it involves the entire neurovascular bundle. It affects not only the arteries but also the **veins** (presenting as migratory superficial thrombophlebitis in 40% of cases) and the **nerves** (leading to severe ischemic pain and paresthesia). The inflammation often leads to perivascular fibrosis, binding the artery, vein, and nerve together. **Analysis of Incorrect Options (True Statements):** * **Option A & B:** TAO typically affects **young males** (though incidence in females is rising) usually **below the age of 45-50**. * **Option C:** **Tobacco use** (smoking or chewing) is the most critical predisposing and aggravating factor. The disease progression is directly linked to continued tobacco exposure, and smoking cessation is the only way to halt the disease. **NEET-PG High-Yield Pearls:** * **Angiographic Finding:** "Corkscrew collaterals" (Martorell’s sign) due to vascular recanalization. * **Pathology:** Characterized by a "highly cellular thrombus" with microabscesses, but the internal elastic lamina remains intact (unlike atherosclerosis). * **Clinical Triad:** Distal ischemia (claudication/ulcers), Raynaud’s phenomenon, and Migratory superficial thrombophlebitis. * **Allen’s Test:** Often positive, indicating involvement of the radial or ulnar arteries.

Q: Artificially high readings of Ankle-Brachial Pressure Index (ABPI) can be caused by which of the following conditions?

Arteriosclerosis with calcified arteries. ### Explanation **1. Why Option A is Correct:** The Ankle-Brachial Pressure Index (ABPI) is calculated by dividing the systolic blood pressure at the ankle by the systolic blood pressure at the arm. In patients with **Arteriosclerosis with calcified arteries** (commonly seen in **Diabetes Mellitus** and **Chronic Kidney Disease**), the tunica media of the arterial wall becomes stiff and non-compressible. This is known as **Mönckeberg’s medial calcific sclerosis**. During ABPI measurement, the blood pressure cuff cannot easily compress these "pipe-stem" arteries. Consequently, an abnormally high pressure is required to occlude the vessel, leading to a falsely elevated ABPI reading (typically **>1.3 or 1.4**), which does not accurately reflect the actual perfusion pressure. **2. Why Other Options are Incorrect:** * **B & C (Ischemic Ulcers & Intermittent Claudication):** These are clinical manifestations of Peripheral Arterial Disease (PAD). In these conditions, arterial narrowing typically leads to a **decrease** in ankle systolic pressure, resulting in a **low ABPI** (usually <0.9). * **D (Deep Vein Thrombosis):** DVT is a pathology of the venous system. ABPI is a diagnostic tool specifically designed to evaluate the arterial system; DVT does not directly cause arterial wall calcification or falsely high arterial pressure readings. **3. Clinical Pearls for NEET-PG:** * **Normal ABPI Range:** 0.9 – 1.2. * **Critical Limb Ischemia:** Usually associated with an ABPI ** 1.3) due to calcification, the next best step is to perform a **Toe-Brachial Index (TBI)**, as digital arteries are less prone to medial calcification. * **High-Yield Association:** Falsely high ABPI = Diabetes Mellitus = Mönckeberg’s sclerosis.

Q: What is the earliest sign of deep vein thrombosis?

Calf tenderness. **Explanation:** Deep Vein Thrombosis (DVT) typically originates in the calf veins. Understanding the chronological progression of its clinical features is crucial for NEET-PG. **Why Calf Tenderness is the Correct Answer:** **Calf tenderness** is recognized as the **earliest clinical sign** of DVT. It occurs due to the acute inflammatory response triggered by the formation of a thrombus within the deep venous system. This inflammation irritates the surrounding tissues and vessel walls, leading to localized pain and tenderness upon palpation, often before significant venous obstruction or systemic symptoms develop. **Analysis of Incorrect Options:** * **Rise in temperature:** This is a systemic or localized inflammatory response that usually occurs after the initial thrombus formation and localized tenderness have manifested. * **Swelling of calf muscle:** Swelling (edema) is a result of significant venous outflow obstruction. It typically follows tenderness as the clot propagates or causes enough resistance to increase hydrostatic pressure. * **Homan’s sign:** Defined as pain in the calf on dorsiflexion of the foot. While classic, it is **neither sensitive nor specific** and is often a later finding. It is now discouraged in clinical practice as it may theoretically dislodge a clot, leading to pulmonary embolism. **Clinical Pearls for NEET-PG:** * **Moses Sign:** Pain on squeezing the calf muscles from side to side (earlier than Homan’s). * **Neuhof’s Sign:** Tenderness and "thickness" or lack of mobility of the calf muscles. * **Gold Standard Investigation:** Contrast Venography (rarely used now). * **Investigation of Choice:** Duplex Ultrasound (Color Doppler). * **Wells Criteria:** Used clinically to determine the pre-test probability of DVT.

Q: A Potts shunt is:

Descending aorta to left pulmonary artery. ### Explanation A **Potts shunt** is a palliative systemic-to-pulmonary shunt used in congenital cyanotic heart diseases (like Tetralogy of Fallot) to increase pulmonary blood flow. It involves a side-to-side anastomosis between the **descending thoracic aorta and the left pulmonary artery**. #### Why Option B is Correct: The Potts shunt was designed to provide a reliable source of pulmonary blood flow by connecting the high-pressure descending aorta directly to the left pulmonary artery. While effective, it is rarely performed today because it is difficult to calibrate (often leading to pulmonary hypertension) and extremely challenging to take down during definitive surgical repair. #### Analysis of Incorrect Options: * **Option A (Right subclavian to PA):** This describes a **Classic Blalock-Taussig (BT) shunt**. If a prosthetic graft is used between the subclavian and PA, it is a **Modified BT shunt** (the current gold standard). * **Option C (Left subclavian to left PA):** This is also a variation of the **Blalock-Taussig shunt** (specifically the left-sided version). * **Option D (Ascending aorta to right PA):** This describes a **Waterston-Cooley shunt**. Like the Potts shunt, it is largely historical due to the high risk of heart failure and pulmonary vascular disease. #### NEET-PG Clinical Pearls: * **Blalock-Taussig Shunt:** Subclavian artery to Pulmonary artery (Most common/preferred). * **Waterston Shunt:** Ascending Aorta to Right Pulmonary artery. * **Potts Shunt:** Descending Aorta to Left Pulmonary artery. * **Glenn Shunt:** Superior Vena Cava to Right Pulmonary artery (Cavopulmonary anastomosis). * **Fontan Procedure:** Final stage of single-ventricle repair; systemic venous return is directed entirely to the pulmonary arteries.

Question 1

Lehriche syndrome is characterized by the presence of arterial insufficiency in which of the following arteries?

Accepted Answer

Aorto-iliac artery

Answer

Superficial femoral artery

Answer

Temporal artery

Answer

Brachial artery

Question 2

Which of the following is NOT a side effect of sclerotherapy in the treatment of varicose veins?

Accepted Answer

Anesthetic complications

Answer

Skin necrosis

Answer

Thrombophlebitis

Answer

Anaphylaxis

Question 3

What is the most common site of deep vein thrombosis?

Accepted Answer

Pelvic veins

Answer

Femoral veins

Answer

Popliteal veins

Answer

Tibial veins

Question 4

Stenosis of which of the following vessels is associated with the highest patency rates following angioplasty or stenting?

Accepted Answer

Iliac artery

Answer

Medial circumflex artery

Answer

Superficial femoral artery

Answer

Popliteal artery

Question 5

The great saphenous vein is typically cannulated at which anatomical location?

Accepted Answer

Anterior to the medial malleolus

Answer

At the fossa ovalis

Answer

Above the popliteal fossa

Answer

None of the above

Question 6

Which statement is NOT true regarding Buerger's disease?

Accepted Answer

Veins and nerves are never involved

Answer

Men are usually involved

Answer

Occurs below 50 years of age

Answer

Smoking is a predisposing factor

Question 7

Deep vein thrombosis is seen in all except one?

Accepted Answer

Subungual melanoma

Answer

Prolonged immobilization

Answer

Pregnancy

Answer

Major surgical operation

Question 8

Artificially high readings of Ankle-Brachial Pressure Index (ABPI) can be caused by which of the following conditions?

Accepted Answer

Arteriosclerosis with calcified arteries

Answer

Ischemic ulcers

Answer

Intermittent claudication

Answer

Deep Vein Thrombosis

Question 9

What is the earliest sign of deep vein thrombosis?

Accepted Answer

Calf tenderness

Answer

Rise in temperature

Answer

Swelling of calf muscle

Answer

Homan's sign

Question 10

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

Vascular Surgery — MCQs

Vascular Surgery — MCQs

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