Vascular Surgery Practice Questions

Q: A 70-year-old man presents with severe pain in his right lower limb. Upon examination, the limb is cold, pale, and pulseless. What is the most likely diagnosis?

Acute limb ischemia. ***Acute limb ischemia*** - The classic symptoms of **acute limb ischemia** are the "6 Ps": **pain, pallor, pulselessness, paresthesias, paralysis, and poikilothermia (coldness)**. This patient exhibits multiple of these, indicating a sudden loss of blood flow. - This condition requires urgent intervention to prevent **tissue necrosis** and limb loss, as the limb is severely compromised due to lack of oxygen and nutrients. *Deep vein thrombosis* - **Deep vein thrombosis (DVT)** typically presents with **swelling, warmth, redness**, and tenderness in the affected limb, rather than coldness and pallor. - Although it can cause pain, DVT would not result in a **pulseless limb** as arterial flow is preserved. *Peripheral neuropathy* - **Peripheral neuropathy** involves nerve damage, leading to **numbness, tingling, weakness**, and sometimes burning pain, but generally does not cause acute changes in limb temperature, color, or pulse. - It's a chronic condition with sensory and motor deficits, not an acute vascular emergency causing **limb ischemia**. *Compartment syndrome* - **Compartment syndrome** results from increased pressure within a closed fascial compartment, often due to trauma, leading to severe pain and muscle ischemia. - While it can cause pain and paresthesias, it does not typically lead to a **pulseless** and **pale** limb unless the pressure is extremely high and prolonged, causing arterial compression.

Q: Which complication is most commonly associated with untreated varicose veins?

Venous ulcers. ***Venous ulcers*** - Chronic **venous insufficiency** due to varicose veins leads to increased pressure in superficial veins, causing fluid leakage and skin changes [1]. - This persistent inflammation and impaired tissue perfusion eventually result in **skin breakdown** and the formation of painful, slow-healing ulcers, primarily around the ankles [1]. *Pulmonary embolism* - While **deep vein thrombosis (DVT)** can lead to pulmonary embolism, varicose veins themselves are primarily a superficial venous issue and are not a direct or common cause of PE [2]. - PE is a more serious complication typically arising from a clot in the **deep venous system** dislodging and traveling to the lungs [2]. *Arterial thrombosis* - **Arterial thrombosis** involves clot formation in arteries, usually due to atherosclerosis, and is unrelated to varicose veins, which affect the venous system. - The pathophysiology, risk factors, and clinical manifestations of arterial thrombosis are distinct from venous conditions. *Deep vein thrombosis* - Although more advanced varicose veins may slightly increase the risk of **DVT**, it is not the most common complication and is generally less directly associated than venous ulcers [1]. - DVT primarily affects the deeper veins, whereas varicose veins involve the **superficial venous system**.

Q: A 50-year-old woman complains of pain in her right lower limb. The pain worsens with walking and improves with rest. This condition is most likely due to obstruction in which artery?

Femoral artery. ***Femoral artery*** - Pain in the **right lower limb** that worsens with walking and improves with rest is a classic symptom of **intermittent claudication**, indicating peripheral artery disease (PAD) [1]. - The **femoral artery** is the most common site of obstruction causing claudication in the thigh and calf due to its prominent role in supplying blood to the lower limb [1]. *Popliteal artery* - Obstruction of the **popliteal artery** would typically cause claudication specifically in the **calf muscle**, as this artery is distal to the femoral artery and supplies the lower leg directly [1]. - While it can cause claudication, it is less common as the primary site of obstruction for general lower limb pain compared to the femoral artery in broad presentations. *Anterior tibial artery* - Obstruction of the **anterior tibial artery** would primarily affect blood flow to the **anterior compartment of the lower leg** and the dorsum of the foot. - This would result in claudication felt more specifically in the **shin** or foot rather than the entire lower limb. *Posterior tibial artery* - Obstruction of the **posterior tibial artery** would largely impact the **posterior compartment of the lower leg** and the plantar aspect of the foot. - Symptoms would manifest as pain in the **calf or sole of the foot**, and less likely as generalized lower limb pain.

Question 1

In a patient with chronic thromboembolic pulmonary hypertension, what is the rationale for choosing pulmonary thromboendarterectomy (PTE) over medical management?

Accepted Answer

PTE directly removes the obstructing clots, potentially curing the condition

Answer

Medical therapy only provides symptomatic relief without hemodynamic improvement

Answer

Medical management may not address the underlying obstruction effectively.

Answer

PTE has lower long-term mortality than lifelong anticoagulation alone

Question 2

In a patient with carotid artery stenosis, how should the decision for carotid endarterectomy be determined?

Accepted Answer

Based on the degree of stenosis, symptomatology, and overall stroke risk factors, including the patient's clinical context.

Answer

Always perform surgery if any stenosis is present

Answer

Only if the patient experiences symptoms

Answer

Based solely on patient age

Question 3

A 70-year-old man presents with severe pain in his right lower limb. Upon examination, the limb is cold, pale, and pulseless. What is the most likely diagnosis?

Accepted Answer

Acute limb ischemia

Answer

Deep vein thrombosis

Answer

Peripheral neuropathy

Answer

Compartment syndrome

Question 4

A 62-year-old man with a history of hypertension and diabetes presents with chest pain radiating to the back, a blood pressure of 220/110 mmHg, ST depression in leads V4-V6 on ECG, and a chest X-ray showing a wide mediastinum. He then develops left-sided weakness and slurred speech, with his blood pressure dropping to 90/60 mmHg. What is the diagnosis and the next step in management?

Accepted Answer

Aortic dissection with stroke; urgent surgery

Answer

Acute myocardial infarction; thrombolysis

Answer

Hypertensive crisis; blood pressure management

Answer

Aortic dissection with neurological deficits; urgent surgical intervention

Question 5

Which complication is most commonly associated with untreated varicose veins?

Accepted Answer

Venous ulcers

Answer

Pulmonary embolism

Answer

Arterial thrombosis

Answer

Deep vein thrombosis

Question 6

In a patient with acute limb ischemia and evidence of thrombotic occlusion, what is the treatment of choice?

Accepted Answer

Surgical thrombectomy

Answer

Long-term anticoagulation

Answer

Immediate limb amputation

Answer

Percutaneous angioplasty

Question 7

A 65-year-old male, diabetic and a smoker, presents with a non-healing ulcer and absent pulses in the right foot, with a TcPO2 of 20 mmHg. The left foot shows claudication and an ABI of 0.6. An angiogram reveals right SFA occlusion and left SFA 70% stenosis. What is the best surgical approach?

Accepted Answer

R fem-pop bypass, L angioplasty

Answer

Bilateral fem-pop bypass

Answer

R fem-pop bypass, L conservative management

Answer

R BKA, L angioplasty

Question 8

A 68-year-old male with type 2 diabetes mellitus presents with severe lower extremity pain, pallor, and pulselessness. Examination reveals a cool extremity and absent femoral pulses, with an ankle-brachial index (ABI) of less than 0.5. Evaluate and select the optimal treatment approach.

Accepted Answer

Urgent surgical revascularization with embolectomy or bypass

Answer

Conservative management with observation

Answer

Anticoagulation with heparin only

Answer

Endovascular intervention with thrombolysis

Question 9

A 50-year-old woman complains of pain in her right lower limb. The pain worsens with walking and improves with rest. This condition is most likely due to obstruction in which artery?

Accepted Answer

Femoral artery

Answer

Popliteal artery

Answer

Anterior tibial artery

Answer

Posterior tibial artery

Question 10

A 60-year-old male with a history of smoking presents with severe abdominal pain and a pulsatile abdominal mass. What is the most appropriate next step in managing this patient?

Accepted Answer

CT angiography

Answer

Immediate surgery

Answer

Ultrasound of the abdomen

Answer

Observation

Vascular Surgery — MCQs

Vascular Surgery — MCQs

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