Vascular Surgery Practice Questions

Q: Lympho-venous anastomosis is done for

Filarial lymphoedema. ***Filarial lymphoedema*** - **Lympho-venous anastomosis (LVA)** is a microsurgical technique used to bypass damaged lymphatic vessels and directly connect lymphatic channels to small veins. This procedure is primarily effective in treating **lymphedema due to lymphatic obstruction**, such as that caused by filarial infection. - In **filarial lymphoedema**, the lymphatic obstruction leads to accumulation of lymph fluid. LVA helps to restore lymphatic drainage, reducing limb swelling and improving symptoms, particularly in the early stages of the disease. *Cystic hygroma* - A **cystic hygroma** is a congenital lymphatic malformation, typically treated by surgical excision, sclerotherapy, or laser ablation. - It involves abnormally dilated lymphatic spaces and doesn't usually benefit from LVA, as the primary issue is malformation rather than obstruction requiring a bypass. *Malignant lymphoedema* - **Malignant lymphoedema** (secondary to cancer or its treatment) is often complicated by active tumor burden, radiation fibrosis, or extensive nodal involvement. - While LVA might be considered in carefully selected cases, its efficacy can be limited due to underlying cancer and the diffuse nature of the lymphatic damage, making it a less common primary indication compared to filarial lymphedema. *Lymphoid cyst* - A **lymphoid cyst** is a localized collection of lymph, often treated by aspiration, sclerotherapy, or surgical excision. - It is not a widespread lymphatic drainage disorder that would necessitate a bypass procedure like lympho-venous anastomosis.

Q: Treatment of choice for acute femoral artery embolism is :

Immediate embolectomy. ***Immediate embolectomy*** - **Acute femoral artery embolism** is a medical emergency that requires prompt intervention to restore blood flow and prevent limb ischemia. - **Early surgical embolectomy** is the treatment of choice to physically remove the clot and immediately re-establish perfusion. *Warfarin* - **Warfarin** is an anticoagulant used for *long-term prevention* of future embolic events, but it is not effective for acute clot removal. - Its therapeutic effect is delayed, making it unsuitable for the immediate treatment of an acute embolism. *Embolectomy after rest for few days* - Delaying embolectomy for several days would lead to **irreversible tissue damage** and potential limb loss due to prolonged ischemia. - Time is critical in acute arterial occlusions, and immediate intervention is paramount. *Heparin* - **Heparin** is an anticoagulant used to *prevent further clot propagation* and reduce the risk of re-embolization. - While it can be initiated as an adjunct, it does not dissolve the existing embolus quickly enough to be the sole treatment for an acute limb-threatening obstruction.

Q: In which one of the following is Branham's sign positive?

Arteriovenous fistula. ***Arteriovenous fistula*** - **Branham's sign**, also known as Nicoladoni-Branham's sign, is characterized by a **sudden decrease in heart rate** upon compression of an arteriovenous fistula. - This occurs because *compression of the fistula increases systemic vascular resistance, leading to improved venous return and a reflex bradycardia* via vagal stimulation. *Arterial stenosis* - **Arterial stenosis** involves narrowing of an artery and does not typically present with Branham's sign. - While it may cause a **bruit** or **reduced pulse**, compressing the stenotic vessel would not lead to an immediate change in heart rate. *Deep vein thrombosis* - **Deep vein thrombosis (DVT)** is a blood clot in a deep vein, causing pain and swelling, but it is not associated with Branham's sign. - Compression in the area of a DVT would likely worsen pain or dislodge the clot, not alter heart rate in this manner. *Arterial aneurysm* - An **arterial aneurysm** is a localized bulging of an artery wall, which can pulsate but generally does not elicit Branham's sign upon compression. - Compressing an aneurysm could be dangerous and would not result in the reflex bradycardia seen with an arteriovenous fistula.

Q: The following are the indications for carrying out a sympathectomy except

Venous ulcer of leg. ***Venous ulcer of leg*** - Sympathectomy aims to reduce **vasoconstriction** and improve blood flow, but venous ulcers are primarily caused by **venous insufficiency** and stasis, not arterial spasm. - While improved microcirculation might be a minor benefit, it is not a primary indication for sympathectomy, as the underlying problem is venous, requiring different treatments like compression and elevation. *Causalgia* - **Causalgia (Complex Regional Pain Syndrome type II)** is characterized by severe burning pain, hyperalgesia, and allodynia, often with vasomotor dysfunction. - Sympathectomy can relieve the pain by interrupting the **sympathetic efferent nerves** that contribute to the pain and vasomotor changes. *Hyperhidrosis* - **Hyperhidrosis** is a condition of excessive sweating, mostly localized to the hands, feet, or axillae. - Sympathectomy, particularly **endoscopic thoracic sympathectomy (ETS)**, is an effective treatment for severe localized hyperhidrosis by disrupting the sympathetic nerve supply to the sweat glands. *Raynaud's disease* - **Raynaud's disease** involves episodic digital ischemia due to exaggerated vasoconstriction of peripheral arteries, often triggered by cold or stress. - Sympathectomy can reduce the frequency and severity of vasospastic attacks by interrupting the **vasoconstrictor sympathetic fibers** to the affected digits.

Q: Which one of the following is an example of a chemodectoma ?

Carotid body tumour. ***Carotid body tumour*** - A **carotid body tumour** is a rare, usually benign, neuroendocrine tumour that arises from the **chemoreceptor cells (paraganglia)** of the carotid body. - These tumours are also known as **paragangliomas** and are classic examples of chemodectomas. *Cock's peculiar tumour* - **Cock's peculiar tumour** is a historical term for a **sebaceous cyst** that has undergone inflammation and potential infection, often presenting as a chronic, indurated lesion. - It is a benign adnexal tumour of the skin and does not arise from chemoreceptor cells. *Cystosarcoma phylloides* - **Cystosarcoma phylloides** (Phyllodes tumour) is a rare fibroepithelial tumour of the breast, characterized by both epithelial and stromal components arranged in leaf-like patterns. - It varies in its malignant potential but is distinct from neuroendocrine tumours. *Keratoacanthoma* - A **keratoacanthoma** is a rapidly growing, usually benign, cutaneous tumour that mimics squamous cell carcinoma. - It originates from the hair follicle epithelium and is characterized by a central keratin plug, not neuroendocrine tissue.

Q: Trendelenburg's operation is done for

primary varicose veins. ***primary varicose veins*** - **Trendelenburg's operation** is the classical surgical procedure for **primary varicose veins of the lower limb** - It involves **high ligation of the long saphenous vein** at the saphenofemoral junction - Named after Friedrich Trendelenburg (1844-1924), this was historically the standard treatment for varicose veins - Modern variations include **flush ligation** and stripping of the saphenous vein - Now often replaced by minimally invasive techniques like **endovenous laser ablation (EVLA)** and **radiofrequency ablation (RFA)** *varicocele* - **Varicocele** is treated by operations like **Ivanissevich procedure**, **Palomo's operation**, or **laparoscopic varicocelectomy** - These involve ligation of the **testicular/gonadal veins**, not the saphenous vein - There is no established surgical technique for varicocele called "Trendelenburg's operation" - The confusion may arise from Trendelenburg's contributions to various surgical fields *deep vein thrombosis with varicose veins* - **Deep vein thrombosis (DVT)** is an acute condition requiring **anticoagulation therapy**, not surgical intervention like Trendelenburg's operation - Management focuses on preventing **pulmonary embolism** and post-thrombotic syndrome - Varicose veins may coexist but are addressed separately after DVT treatment *arteriovenous fistula* - **Arteriovenous fistula** represents an abnormal connection between artery and vein - Treatment involves **surgical repair**, **embolization**, or observation depending on etiology - This is unrelated to Trendelenburg's operation for venous insufficiency

Q: Which of these is a palliative shunt procedure created between the left subclavian artery and pulmonary artery to treat cyanotic congenital heart disease?

Blalock-Taussig shunt. **Blalock-Taussig shunt** - This procedure creates a **systemic-to-pulmonary artery shunt** by anastomosing a systemic artery (often the **subclavian artery**) to the pulmonary artery, increasing **pulmonary blood flow**. - It is a palliative measure for **cyanotic congenital heart diseases** where there is reduced pulmonary blood flow, such as **Tetralogy of Fallot**. *Waterston's shunt* - This is an older, no longer commonly used palliative shunt connecting the **ascending aorta to the right pulmonary artery**. - It was associated with a high incidence of complications, including **pulmonary overcirculation** and **pulmonary vascular disease**. *Lieno renal shunt* - This refers to a shunt created between the **splenic vein (lienal vein)** and the **left renal vein**. - It is primarily used to treat **portal hypertension** by decompressing the portal venous system, not congenital heart disease. *Gott's shunt* - This involves a **temporary bypass shunt** often used during **thoracic aortic surgery** to protect the spinal cord from ischemia. - It maintains blood flow to the distal aorta during aortic clamping and is not related to congenital heart disease palliation.

Q: A 56-year-old male comes with history of claudication pain in both buttocks, thighs and calves. He also gives history of impotence. The probable site of arterial occlusion is:

Aortoiliac occlusion. ***Aortoiliac occlusion*** - The combination of **claudication** in the buttocks, thighs, and calves, along with **impotence**, is characteristic of **Leriche syndrome**, which results from **aortoiliac occlusion**. - **Aortoiliac occlusion** affects blood flow to both lower extremities and the internal iliac arteries, which supply the pelvic organs, including those responsible for erectile function. *Iliac obstruction* - While iliac obstruction can cause claudication in the buttocks and thighs, it generally does not explain calf claudication as prominently. - Isolated iliac obstruction may contribute to impotence, but the widespread lower limb claudication points to a more proximal and extensive occlusion. *Proximal femoral artery occlusion* - **Proximal femoral artery occlusion** would primarily cause claudication in the thigh and calf, but typically spares the buttocks. - It would not usually be associated with impotence, as blood supply to the pelvis would be preserved via the internal iliac arteries. *Distal femoral artery occlusion* - **Distal femoral artery occlusion** typically causes claudication in the calf and foot, as it is located further down the leg. - This type of occlusion would not cause claudication in the buttocks or thighs, nor would it lead to impotence.

Q: A 75 year old lady came with an incidentally diagnosed splenic artery aneurysm which, after radiological investigation, was confirmed to be calcified. She should be offered:

Observation. ***Observation*** - A **calcified splenic artery aneurysm** in an asymptomatic 75-year-old typically indicates a **stable, chronic aneurysm** with a low risk of rupture. - Given the patient's age and the benign nature of calcified aneurysms, the risks associated with intervention often outweigh the benefits, making **watchful waiting** the most appropriate course. *Endovascular stenting* - **Endovascular stenting** is generally reserved for **symptomatic** or **rapidly enlarging aneurysms**, or those with a higher risk of rupture, which is not the case here. - The presence of **calcification** can make stent placement challenging and potentially increase the procedural risks. *Embolisation* - **Embolization** is typically indicated for **symptomatic aneurysms**, those with a high risk of rupture (e.g., non-calcified, large size, rapid growth), or in patients unsuitable for open surgery. - For a **calcified, asymptomatic aneurysm** in an elderly patient, the risk-benefit profile usually favors observation over intervention. *Laparoscopic splenic artery ligation and splenectomy* - **Laparoscopic splenic artery ligation and splenectomy** is an **invasive surgical procedure** with significant risks and is generally reserved for **ruptured aneurysms** or those with a high immediate risk of rupture and clear symptoms. - Performing such a major intervention on an **asymptomatic, calcified aneurysm** in an elderly patient carries a high morbidity without significant clinical benefit.

Q: Allen's test is used in cardiac surgery for:

When radial artery harvest is planned. ***When radial artery harvest is planned*** - **Allen's test** is performed to assess the patency of the **ulnar artery** and ensure adequate collateral circulation to the hand before harvesting the radial artery. - A positive test (indicating good collateral flow) is crucial to prevent **hand ischemia** if the radial artery is removed. *To select finger prick for blood glucose estimation* - Finger prick sites for **blood glucose estimation** are chosen based on adequate capillary blood flow and patient comfort, not by Allen's test. - Allen's test is specifically for evaluating **arterial patency** and collateral circulation, which is irrelevant for routine fingersticks. *To check warmth of hands* - Checking the **warmth of hands** is a basic clinical assessment for peripheral perfusion but does not involve Allen's test. - Allen's test is a dynamic test of **vascular competence**, not a static thermal assessment. *For evaluation of AV fistula* - **AV fistula evaluation** involves assessing patency, thrill, and bruit, and is typically done using physical examination and Doppler ultrasound. - Allen's test is not used for this purpose, as it assesses **collateral arterial flow** to a digit, not the patency of an arteriovenous connection.

Question 1

Lympho-venous anastomosis is done for

Accepted Answer

Filarial lymphoedema

Answer

Cystic hygroma

Answer

Malignant lymphoedema

Answer

Lymphoid cyst

Question 2

Treatment of choice for acute femoral artery embolism is :

Accepted Answer

Immediate embolectomy

Answer

Warfarin

Answer

Embolectomy after rest for few days

Answer

Heparin

Question 3

In which one of the following is Branham's sign positive?

Accepted Answer

Arteriovenous fistula

Answer

Arterial stenosis

Answer

Deep vein thrombosis

Answer

Arterial aneurysm

Question 4

The following are the indications for carrying out a sympathectomy except

Accepted Answer

Venous ulcer of leg

Answer

Causalgia

Answer

Hyperhidrosis

Answer

Raynaud's disease

Question 5

Which one of the following is an example of a chemodectoma ?

Accepted Answer

Carotid body tumour

Answer

Cock's peculiar tumour

Answer

Cystosarcoma phylloides

Answer

Keratoacanthoma

Question 6

Trendelenburg's operation is done for

Accepted Answer

primary varicose veins

Answer

deep vein thrombosis with varicose veins

Answer

varicocele

Answer

arteriovenous fistula

Question 7

Which of these is a palliative shunt procedure created between the left subclavian artery and pulmonary artery to treat cyanotic congenital heart disease?

Accepted Answer

Blalock-Taussig shunt

Answer

Waterston's shunt

Answer

Lieno renal shunt

Answer

Gott’s shunt

Question 8

A 56-year-old male comes with history of claudication pain in both buttocks, thighs and calves. He also gives history of impotence. The probable site of arterial occlusion is:

Accepted Answer

Aortoiliac occlusion

Answer

Iliac obstruction

Answer

Proximal femoral artery occlusion

Answer

Distal femoral artery occlusion

Question 9

A 75 year old lady came with an incidentally diagnosed splenic artery aneurysm which, after radiological investigation, was confirmed to be calcified. She should be offered:

Accepted Answer

Observation

Answer

Endovascular stenting

Answer

Embolisation

Answer

Laparoscopic splenic artery ligation and splenectomy

Question 10

Allen's test is used in cardiac surgery for:

Accepted Answer

When radial artery harvest is planned

Answer

To select finger prick for blood glucose estimation

Answer

To check warmth of hands

Answer

For evaluation of AV fistula

Vascular Surgery — MCQs

Vascular Surgery — MCQs

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