Vascular Surgery Practice Questions

Q: According to the Spetzler-Martin grading system for arteriovenous malformations, which of the following scores corresponds to an arteriovenous malformation of size 3-6 cm with deep venous drainage and location near the internal capsule?

4. ***4*** - This score aligns with the sum of the points assigned for each feature: 2 points for a **size of 3-6 cm**, 1 point for **deep venous drainage**, and 1 point for **location near the internal capsule**. - The Spetzler-Martin grade is calculated by summing points for size (small 6 cm = 3 pts), venous drainage (superficial = 0 pts, deep = 1 pt), and eloquence of adjacent brain (non-eloquent = 0 pts, eloquent = 1 pt). *2* - A score of 2 would correspond to, for example, a medium-sized AVM (2 points) with superficial venous drainage (0 points) in a non-eloquent area (0 points), or a small AVM (1 point) with deep venous drainage (1 point) in another non-eloquent area. - This score does not account for all three high-risk factors described in the question (medium size, deep drainage, eloquent location). *3* - A score of 3 could be generated, for instance, by a large AVM (>6 cm = 3 points) with superficial drainage (0 points) in a non-eloquent area (0 points). - It could also be a medium AVM (2 points) with deep venous drainage (1 point) but in a non-eloquent brain region. *5* - A score of 5 would represent an extremely high-risk AVM, such as a large AVM (>6 cm = 3 points) with deep venous drainage (1 point) and an eloquent location (1 point). - This score would exceed the sum calculated from the specific characteristics given in the question (2 + 1 + 1 = 4).

Q: Success of revascularization therapy in acute limb ischemia is mainly dependent on:

Time to intervention. ***Time to intervention*** - The most critical factor for successful revascularization in acute limb ischemia is the **time from symptom onset to restoration of blood flow**. - Following the principle **"time is tissue"**, irreversible muscle and nerve damage occurs after 6-8 hours of complete ischemia. - Early revascularization (within 6 hours) significantly improves limb salvage rates and functional outcomes. - Delayed intervention leads to reperfusion injury, compartment syndrome, and increased risk of amputation. *Quality of distal runoff vessels* - While important for long-term patency of revascularization, the quality of distal vessels is a secondary factor compared to timing. - Good runoff improves graft patency but cannot reverse already necrotic tissue from delayed intervention. *Patient's comorbidities* - Comorbidities like diabetes and smoking affect long-term outcomes and wound healing. - However, even patients with multiple comorbidities can have successful acute revascularization if performed in time. - Comorbidities influence perioperative risk but are not the primary determinant of revascularization success. *Extent of collateral circulation* - Collateral circulation may delay the onset of irreversible ischemia and provide some protection. - However, in acute limb ischemia, collaterals are often insufficient to prevent tissue damage. - The presence of collaterals cannot compensate for prolonged ischemia time.

Q: Sclerotherapy for varicose veins is contraindicated in the following condition:

Deep vein Thrombosis. ***Deep vein Thrombosis*** - **Sclerotherapy** involves injecting a solution that irritates and scars the vein, causing it to close. If **deep vein thrombosis (DVT)** is present, this procedure could dislodge a **thrombus**, leading to a potentially fatal **pulmonary embolism**. - Additionally, DVT indicates a compromised deep venous system, and treating superficial veins with sclerotherapy when the deep system is inadequate can lead to **worsened venous insufficiency** and complications. *Varicose ulcers* - **Varicose ulcers** are often a complication of **venous insufficiency**, and **sclerotherapy** can sometimes be used cautiously, in conjunction with compression therapy, to treat the underlying insufficient veins that contribute to ulcer formation. - While it's not a universal treatment for all ulcers, the presence of an ulcer itself is not an absolute **contraindication** if the underlying venous pathology can be safely addressed. *Pigmentation Over limb* - **Pigmentation over the limb** (often **hyperpigmentation**) is a common sign of **chronic venous insufficiency** and a cosmetic concern associated with **varicose veins**. - It is not a contraindication to **sclerotherapy**; in fact, successful treatment of the underlying varicose veins can sometimes lead to an improvement in or prevention of further pigmentation. *Hemorrhoids* - **Hemorrhoids** are essentially **varicose veins** of the **anorectal region**. While **sclerotherapy** can be used to treat hemorrhoids (a procedure called sclerotherapy for hemorrhoids), they are distinct from **lower limb varicose veins**. - The presence of hemorrhoids does not contraindicate **sclerotherapy** for leg varicose veins, as they are separate vascular systems and pathologies.

Q: All of the following may be acceptable operative approaches to the management of thoracic outlet syndrome, except:

Thoracoplasty. ***Thoracoplasty*** - **Thoracoplasty** is a surgical procedure that involves **removing ribs** to *reduce the size of the thoracic cavity*, primarily used for lung collapse therapy in tuberculosis or to manage chronic empyema. - It is **not a treatment for thoracic outlet syndrome (TOS)**, as TOS involves compression of neurovascular structures in the thoracic outlet, not a need for lung volume reduction. *Scalenectomy* - A **scalenectomy**, involving the partial or complete removal of the **anterior and/or middle scalene muscles**, is a common surgical approach for TOS. - These muscles can **compress the brachial plexus** and subclavian artery, and their removal helps decompress the neurovascular bundle. *Excision of a cervical rib* - A **cervical rib** is a congenital anomaly that can **compress the brachial plexus** and subclavian artery, leading to TOS symptoms. - Its surgical **excision is a direct and effective** treatment for TOS caused by this anatomical variant. *First rib resection* - **First rib resection**, performed via various approaches (transaxillary, supraclavicular, infraclavicular), is a **primary surgical treatment for TOS**. - The first rib can **compress the subclavian artery, subclavian vein, or brachial plexus**, and its removal creates more space in the thoracic outlet.

Q: Which condition is primarily associated with Letessier-Meige disease?

Lymphedema. ***Lymphedema*** - **Letessier-Meige disease**, also known as **primary lymphedema type I** or **Meige disease**, is a congenital form of lymphedema. - It is caused by **hypoplasia** or malformation of the lymphatic vessels, leading to chronic swelling, typically in the lower limbs. *A-V malformations* - **Arteriovenous malformations** are abnormal connections between arteries and veins, bypassing the capillary system. - They are distinct from lymphatic system disorders and can cause symptoms related to shunting blood, such as bleeding or heart failure. *Abdominal aortic aneurysm* - An **abdominal aortic aneurysm** is a localized dilation of the abdominal aorta due to weakening of the vessel wall. - This condition is a vascular disease involving arteries, with no direct association with lymphatic system dysfunction. *Chronic venous insufficiency* - **Chronic venous insufficiency** results from incompetent venous valves, leading to blood pooling in the veins, particularly in the lower extremities. - While it can cause leg swelling, it is a disorder of the venous system rather than the lymphatic system, which is affected in Letessier-Meige disease.

Q: The combination of rest pain, color changes, edema, and hyperesthesia is characteristic of:

Early ischemic changes. **Early ischemic changes** - **Rest pain**, **color changes** (pallor, rubor), **edema**, and **hyperesthesia** are classic signs of **acute limb ischemia**, reflecting tissue hypoxia before irreversible damage. - These symptoms indicate a critical reduction in blood flow, prompting medical intervention to prevent progression to more severe stages. *Gangrenous changes* - **Gangrene** represents **tissue necrosis** due to severe ischemia, typically presenting with black discoloration, foul odor, and often a clear line of demarcation. - While it follows ischemia, the described symptoms (rest pain, edema, hyperesthesia) are characteristic of an earlier, *reversible* stage, not irreversible tissue death. *Localized tissue death* - **Localized tissue death** (necrosis) is a general term for dead tissue, which can be caused by various factors, not exclusively ischemia. - It does not specifically encompass the *combination* of rest pain, color changes, edema, and hyperesthesia, which are specific indicators of compromised blood flow. *Inflammation of blood vessels* - **Inflammation of blood vessels (vasculitis)** can cause symptoms like pain and color changes due to impaired blood flow or vessel damage. - However, the specific combination of **rest pain**, **edema**, and **hyperesthesia** is more directly indicative of **ischemia** than just inflammation itself, which might have broader and more varied clinical presentations.

Q: Allen's test is useful in evaluating

Integrity of the palmar arch. ***Assessment of the integrity of the palmar arch.*** - Allen's test assesses the **patency of the radial and ulnar arteries** to ensure adequate blood flow to the hand, particularly before procedures like **arterial line insertion** or **radial artery harvesting**. - It specifically evaluates the integrity of the **palmar arches** (superficial and deep) and their ability to provide collateral circulation if one of the main arteries (radial or ulnar) is occluded. *Thoracic outlet syndrome affects blood flow.* - Thoracic outlet syndrome involves **compression of neurovascular structures** (brachial plexus, subclavian artery/vein) in the thoracic outlet. - While it affects blood flow to the limb, Allen's test is not the primary diagnostic tool; other tests like **Adson's maneuver** or **Wright's test** are more appropriate. *Presence of a cervical rib can affect blood flow.* - A cervical rib can cause **compression of the subclavian artery**, leading to symptoms of vascular compromise in the upper extremity. - However, Allen's test is used for evaluating **hand arterial patency**, not directly for diagnosing a cervical rib. *Assessment of digital blood flow.* - While digital blood flow is ultimately assessed indirectly, the primary purpose of Allen's test is to evaluate the **collateral circulation** via the palmar arch, ensuring the radial or ulnar artery can be safely utilized. - More direct assessments of digital blood flow might involve techniques like **pulse oximetry** or **Doppler ultrasound** over the digits.

Q: What does Harvey's sign indicate?

Indicates venous filling after emptying a vein. ***Indicates venous filling after emptying a vein*** - **Harvey's sign**, also known as the **Trendelenburg test (modified)** or **Brodie-Trendelenburg test**, assesses the competence of venous valves in the legs [1]. - It involves emptying the superficial veins by elevating the leg and then observing for rapid venous filling after the patient stands, indicating **venous reflux** due to incompetent valves [1]. *Transmitted pressure wave on coughing in an artery* - This description typically relates to signs of a **patent ductus arteriosus** (a thrill or murmur) or **aneurysms**, where a cough can transmit a palpable impulse. - It is not associated with Harvey's sign or the assessment of venous valve competency [1]. *Loss of hair from eyebrows* - **Madarosis**, specifically loss of hair from the outer third of the eyebrows, is a classic sign of **hypothyroidism** (also known as Hertoghe's sign). - This symptom is entirely unrelated to Harvey's sign, which is a clinical maneuver for evaluating venous function. *None of the options* - This option is incorrect because the second option accurately describes Harvey's sign (or a related clinical maneuver for assessing venous competence).

Q: Adson's test is positive in which of the following conditions?

Cervical rib. ***Cervical rib*** - A **cervical rib** can compress the **subclavian artery** or brachial plexus as they pass through the **thoracic outlet**, leading to **vascular symptoms**. - **Adson's test** is positive when the radial pulse diminishes or disappears upon specific maneuvers (extension, external rotation of the arm, and head rotation towards the affected side), indicating compression, often due to a cervical rib. *Cervical spine fracture* - A cervical spine fracture primarily involves **bony integrity** and can lead to **spinal cord compression** or nerve root injury, resulting in neurological deficits, not direct subclavian artery compression detectable by Adson's test. - While there may be pain and instability, it does not typically cause the specific neurovascular compromise Adson's test evaluates. *Cervical spondylosis* - **Cervical spondylosis** is a degenerative condition of the cervical spine that primarily causes **neck pain**, stiffness, and sometimes **nerve root or spinal cord compression** (myelopathy or radiculopathy). - It does not directly involve compression of the **subclavian artery** or its associated neurovascular bundle in the thoracic outlet. *Cervical dislocation* - **Cervical dislocation** is a severe injury involving displacement of vertebral bodies, leading to **spinal cord injury** with significant neurological deficits. - It is an acute traumatic event affecting the spinal column itself rather than causing chronic compression of vessels or nerves in the **thoracic outlet** in a manner assessed by Adson's test.

Q: Brodie-Trendelenburg test demonstrates?

Sapheno-femoral incompetence. ***Sapheno-femoral incompetence*** - The **Brodie-Trendelenburg test** is specifically designed to assess the competence of the **sapheno-femoral valve** and the presence of ascending reflux in varicose veins. - It involves emptying the veins and observing their refilling pattern after releasing proximal compression, indicating incompetent valves if rapid filling occurs from above. *Mid-thigh perforation* - While the test can indirectly suggest involvement of perforators, it does not directly demonstrate **mid-thigh perforator** incompetence as its primary objective. - Other tests or observations of varices would be more specific for individual perforating veins. *Deep vein thrombosis* - The Brodie-Trendelenburg test is not used to diagnose **deep vein thrombosis (DVT)**. - **DVT** diagnosis typically involves clinical assessment, D-dimer testing, and imaging like duplex ultrasonography. *Calf perforators* - The test can give clues about **calf perforator** incompetence if varices refill from below, but it's not the primary focus or a direct diagnostic for them. - Proper assessment of calf perforators often requires more detailed physical examination and duplex ultrasound.

Question 1

According to the Spetzler-Martin grading system for arteriovenous malformations, which of the following scores corresponds to an arteriovenous malformation of size 3-6 cm with deep venous drainage and location near the internal capsule?

Accepted Answer

4

Answer

3

Answer

5

Answer

2

Question 2

Success of revascularization therapy in acute limb ischemia is mainly dependent on:

Accepted Answer

Time to intervention

Answer

Extent of collateral circulation

Answer

Patient's comorbidities

Answer

Quality of distal runoff vessels

Question 3

Sclerotherapy for varicose veins is contraindicated in the following condition:

Accepted Answer

Deep vein Thrombosis

Answer

Varicose ulcers

Answer

Pigmentation Over limb

Answer

Hemorrhoids

Question 4

All of the following may be acceptable operative approaches to the management of thoracic outlet syndrome, except:

Accepted Answer

Thoracoplasty

Answer

Excision of a cervical rib

Answer

First rib resection

Answer

Scalenectomy

Question 5

Which condition is primarily associated with Letessier-Meige disease?

Accepted Answer

Lymphedema

Answer

A-V malformations

Answer

Chronic venous insufficiency

Answer

Abdominal aortic aneurysm

Question 6

The combination of rest pain, color changes, edema, and hyperesthesia is characteristic of:

Accepted Answer

Early ischemic changes

Answer

Gangrenous changes

Answer

Localized tissue death

Answer

Inflammation of blood vessels

Question 7

Allen's test is useful in evaluating

Accepted Answer

Integrity of the palmar arch

Answer

Thoracic outlet syndrome

Answer

Presence of cervical rib

Answer

Digital blood flow

Question 8

What does Harvey's sign indicate?

Accepted Answer

Indicates venous filling after emptying a vein

Answer

Transmitted pressure wave on coughing in an artery

Answer

Loss of hair from eyebrows

Answer

None of the options

Question 9

Adson's test is positive in which of the following conditions?

Accepted Answer

Cervical rib

Answer

Cervical spine fracture

Answer

Cervical spondylosis

Answer

Cervical dislocation

Question 10

Brodie-Trendelenburg test demonstrates?

Accepted Answer

Sapheno-femoral incompetence

Answer

Mid-thigh perforation

Answer

Deep vein thrombosis

Answer

Calf perforators

Vascular Surgery — MCQs

Vascular Surgery — MCQs

On this page

Practice by Chapter

Want unlimited practice?