Vascular Surgery — MCQs

Vascular Surgery Indian Medical PG Practice Questions and MCQs

Question 431: Lympho-venous anastomosis is done for

A. Cystic hygroma
B. Malignant lymphoedema
C. Lymphoid cyst
D. Filarial lymphoedema (Correct Answer)

Explanation: ***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.

Question 432: Treatment of choice for acute femoral artery embolism is :

A. Immediate embolectomy (Correct Answer)
B. Warfarin
C. Embolectomy after rest for few days
D. Heparin

Explanation: ***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.

Question 433: In which one of the following is Branham's sign positive?

A. Arterial stenosis
B. Arteriovenous fistula (Correct Answer)
C. Deep vein thrombosis
D. Arterial aneurysm

Explanation: ***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.

Question 434: The following are the indications for carrying out a sympathectomy except

A. Causalgia
B. Hyperhidrosis
C. Venous ulcer of leg (Correct Answer)
D. Raynaud's disease

Explanation: ***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.

Question 435: Which one of the following is an example of a chemodectoma ?

A. Cock's peculiar tumour
B. Cystosarcoma phylloides
C. Keratoacanthoma
D. Carotid body tumour (Correct Answer)

Explanation: ***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.

Question 436: Trendelenburg's operation is done for

A. primary varicose veins (Correct Answer)
B. deep vein thrombosis with varicose veins
C. varicocele
D. arteriovenous fistula

Explanation: ***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

Question 437: Which of these is a palliative shunt procedure created between the left subclavian artery and pulmonary artery to treat cyanotic congenital heart disease?

A. Waterston's shunt
B. Lieno renal shunt
C. Gott’s shunt
D. Blalock-Taussig shunt (Correct Answer)

Explanation: **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.

Question 438: 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:

A. Iliac obstruction
B. Aortoiliac occlusion (Correct Answer)
C. Proximal femoral artery occlusion
D. Distal femoral artery occlusion

Explanation: ***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.

Question 439: 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:

A. Endovascular stenting
B. Embolisation
C. Observation (Correct Answer)
D. Laparoscopic splenic artery ligation and splenectomy

Explanation: ***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.

Question 440: Allen's test is used in cardiac surgery for:

A. To select finger prick for blood glucose estimation
B. To check warmth of hands
C. When radial artery harvest is planned (Correct Answer)
D. For evaluation of AV fistula

Explanation: ***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.

Practice by Chapter

Atherosclerotic Disease

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Aortic Aneurysms

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Peripheral Arterial Disease

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Carotid Artery Disease

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Venous Thromboembolism

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Chronic Venous Insufficiency

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Mesenteric Vascular Disease

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Vascular Trauma

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Vascular Access for Hemodialysis

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Endovascular Techniques

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Diabetic Foot Vascular Disease

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Vasculitis

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