Vascular Surgery Practice Questions

Q: Which of the following is the best management for radiation induced occlusive disease of carotid artery?

Carotid angioplasty and stenting. ***Carotid angioplasty and stenting*** - **Radiation-induced carotid artery disease** often involves the distal part of the carotid artery, making it less amenable to surgical endarterectomy. - **Angioplasty and stenting** offer a less invasive approach with good technical success in these challenging cases, especially given the increased fragility and fibrosis of radiated tissues. *Carotid endarterectomy* - **Carotid endarterectomy** in previously radiated fields is associated with a significantly higher risk of complications, including **cranial nerve injury**, **wound infection**, and **carotid artery rupture**, due to tissue fibrosis and scarring. - The disease often extends beyond the easily accessible segment for endarterectomy in radiation-induced cases. *Low dose aspirin* - **Low-dose aspirin** is an important component of medical therapy for **atherosclerotic disease** and **stroke prevention**, but it is insufficient as a sole treatment for symptomatic or high-grade occlusive disease of the carotid artery. - It helps manage the underlying **atherosclerotic process** but does not directly address the severe stenosis or occlusion. *Carotid bypass procedure* - **Carotid bypass procedures** are complex surgical interventions usually reserved for cases of **carotid artery occlusion** or **recurrent stenosis** after previous interventions where endarterectomy or stenting is not feasible. - While an option, it is more invasive and technically demanding than angioplasty and stenting, particularly in already radiated tissues with compromised vascular integrity.

Q: All are absolute indications for amputation except,

Frost bite. ***Frost bite*** - While severe **frostbite** can lead to amputation, it is not an absolute indication as initial management often involves **rapid rewarming**, observation, and conservative measures to preserve tissue. - Amputation is typically considered only after the full extent of tissue damage is clear, and conservative treatments have failed or severe infection develops. *Buerger's gangrene* - **Buerger's disease (thromboangiitis obliterans)** is a progressive inflammatory obliterative disease of small and medium-sized arteries and veins, mainly affecting the limbs. - **Gangrene** in Buerger's disease is often severe and progressive, frequently leading to **autoamputation** or surgical amputation to prevent spread and manage pain. *Gas gangrene* - **Gas gangrene** is a rapidly progressive and life-threatening infection caused by Clostridium species, which produces toxins and gas in tissues. - It necessitates urgent and aggressive treatment, including **radical débridement** or **amputation** to remove infected tissue and prevent sepsis. *Diabetic gangrene* - **Diabetic gangrene** arises from severe peripheral artery disease and neuropathy in diabetic patients, compromising blood supply and sensation. - The compromised blood flow and presence of infection often result in tissue necrosis requiring **amputation** to prevent further spread of infection and systemic complications.

Q: All of the following are true with respect to ligation of internal iliac artery except -

Bleeding is always controlled with it. ***Bleeding is always controlled with it*** - Ligation of the internal iliac artery reduces **pulse pressure** and **blood flow** to the pelvic organs but does not guarantee complete cessation of bleeding. - Significant **collateral circulation** within the pelvis can maintain bleeding, especially from multiple sites or larger vessels. *Collateral circulation is established later between middle sacral and lateral sacral arteries* - This statement is true; these vessels are part of the vast **collateral network** that can supply the pelvic organs after internal iliac artery ligation. - The **middle sacral artery** (a branch of the aorta) and **lateral sacral arteries** (branches of the internal iliac) form anastomoses that become more prominent over time. *The artery should be ligated and not transected* - This is true because ligation (tying off) reduces blood flow without disrupting the vessel wall, preserving **vascular integrity**. - **Transecting** the artery would create two open ends, potentially leading to immediate or delayed hemorrhage and making subsequent control more challenging. *For hemostasis, anterior division is to be ligated* - This is true because the **anterior division** of the internal iliac artery supplies most of the pelvic organs implicated in obstetric and gynecological hemorrhage. - Ligation of the anterior division effectively reduces blood flow to the uterus, vagina, and bladder with less impact on essential structures than ligating the main trunk or posterior division.

Q: Foot ulcers secondary to arterial insufficiency are successfully treated by all of the following techniques except:

Elevation of the affected extremity. ***Elevation of the affected extremity*** - Elevating an extremity with arterial insufficiency will **further reduce arterial blood flow** to the foot, exacerbating ischemia and slowing ulcer healing. - This intervention decreases the **hydrostatic pressure**, which is already compromised due to inadequate arterial supply, making it detrimental. *Antibiotic administration* - Foot ulcers, especially those with impaired circulation, are highly susceptible to **infection**, which necessitates antibiotic treatment. - Antibiotics help to **control bacterial growth** in the ulcer, preventing systemic infection and facilitating the healing process. *Bed rest* - **Reducing weight-bearing** and overall activity through bed rest can decrease metabolic demands on the ischemic limb. - This allows the limited blood supply to be more effectively utilized for **tissue repair and healing**, rather than supporting activity. *Debridement of devitalized tissue* - **Necrotic tissue** in an ulcer provides a medium for bacterial growth and impedes wound healing. - Debridement involves removing non-viable tissue **to promote a clean wound bed**, making it more amenable to healing and reducing infection risk.

Q: A 40-year-old male with a history of accident 2 days back presented to the ER with complaints of redness of eye, diplopia, decreased vision, and facial pain in the distribution of ophthalmic division of trigeminal nerve. On examination: Bruit was heard over the eyes, Proptosis, Ocular pulsations, Exposure keratopathy, Pulsating exophthalmos. MRI brain was done. The artery involved in the above condition passes through which of the following structures?

Cavernous sinus. ***Cavernous sinus*** - The symptoms described (redness, diplopia, decreased vision, facial pain in the ophthalmic division of the trigeminal nerve, bruit over eyes, proptosis, ocular pulsations, pulsating exophthalmos after trauma) are highly suggestive of a **carotid-cavernous fistula**. - In a carotid-cavernous fistula, the **internal carotid artery** (or one of its branches) tears within the **cavernous sinus**, establishing an abnormal communication that shunts high-pressure arterial blood into the venous system of the orbit. *Optic canal* - The **optic canal** primarily transmits the **optic nerve** (cranial nerve II) and the **ophthalmic artery**. - While it's closely related to orbital structures, the internal carotid artery does not pass through the optic canal itself in a way that would lead to a carotid-cavernous fistula within this structure. *Superior orbital fissure* - The **superior orbital fissure** is a passageway for several nerves (**oculomotor III, trochlear IV, ophthalmic V1, abducens VI**) and the **superior ophthalmic vein**. - Although these structures are affected by a carotid-cavernous fistula, the internal carotid artery itself does not traverse this fissure. *Foramen rotundum* - The **foramen rotundum** transmits the **maxillary nerve** (V2), the second division of the trigeminal nerve. - This structure is not involved in the direct pathology of a carotid-cavernous fistula, nor does the internal carotid artery pass through it.

Q: Balloon valvotomy is successful in all of the following cases except –

Calcified mitral stenosis. ***Calcified mitral stenosis*** - **Heavily calcified valves** are generally considered a contraindication for balloon valvotomy due to the high risk of **valve tearing**, embolism, and suboptimal results. - The rigid, non-compliant nature of heavily calcified valves prevents effective leaflet separation, reducing the chances of a successful procedure and increasing the risk of adverse events. *Congenital pulmonary stenosis* - **Balloon pulmonary valvotomy** is the treatment of choice for most cases of symptomatic congenital pulmonary stenosis with a significant gradient. - It effectively dilates the stenotic valve, leading to a good prognosis and long-term results. *Congenital aortic stenosis* - **Balloon aortic valvotomy** is often performed for severe congenital aortic stenosis, especially in infants and young children, to relieve obstruction. - While it can be associated with some risk of aortic regurgitation, it is a viable option to improve hemodynamics. *Mitral stenosis in pregnancy* - **Balloon mitral valvotomy** is a safe and effective treatment for symptomatic severe mitral stenosis during pregnancy, especially if medical management fails. - It can significantly improve maternal and fetal outcomes by reducing pulmonary congestion and improving cardiac output.

Q: Butcher's thigh is?

Accidental injury to major vessels in thigh or groin. ***Accidental injury to major vessels in thigh or groin*** - **Butcher's thigh** refers to a significant traumatic injury that involves the major blood vessels and nerves in the thigh or groin region. - This type of injury can lead to severe **hemorrhage** and neurological deficits, often requiring immediate surgical intervention. *Subcutaneous lipodermatosclerosis* - **Lipodermatosclerosis** is a condition characterized by **skin hardening** and pigmentation, typically in the lower legs, often associated with chronic venous insufficiency. - It does not describe an acute traumatic vascular injury to the thigh. *Bursa in adductor canal* - A **bursa** is a fluid-filled sac that reduces friction between tissues; while bursae can develop in various locations, a bursa in the adductor canal is uncommon and not referred to as "butcher's thigh". - This condition would typically present as a localized swelling or pain, not as an acute, severe vascular injury. *Vastus lateral rupture* - A **vastus lateralis rupture** is a tear in one of the quadriceps muscles located on the lateral side of the thigh. - This is a muscular injury, not a vascular injury, and would present with pain, swelling, and loss of function specific to the muscle.

Q: Allen's test is for the patency of:

Radial and ulnar artery. ***Radial and ulnar artery*** - **Allen's test** assesses the patency of the **radial** and **ulnar arteries** and the adequacy of collateral circulation to the hand. - It involves occluding both arteries and then releasing one to see if the hand reperfuses, indicating good blood flow. *Vertebral artery* - The **vertebral arteries** supply blood to the posterior part of the brain and are typically assessed through dynamic neurological exams or imaging studies. - Their patency is not evaluated by **Allen's test**. *Subclavian artery* - The **subclavian arteries** supply blood to the head, neck, and upper limbs; their patency is assessed by palpation of pulses and imaging. - **Allen's test** does not directly evaluate the subclavian artery. *Internal carotid artery* - The **internal carotid arteries** supply blood to the anterior and middle parts of the brain. - Their patency is assessed by listening for bruits or through imaging techniques, not **Allen's test**.

Question 1

Which of the following is the best management for radiation induced occlusive disease of carotid artery?

Accepted Answer

Carotid angioplasty and stenting

Answer

Carotid endarterectomy

Answer

Low dose aspirin

Answer

Carotid bypass procedure

Question 2

All are absolute indications for amputation except,

Accepted Answer

Frost bite

Answer

Buerger's gangrene

Answer

Gas gangrene

Answer

Diabetic gangrene

Question 3

All of the following are true with respect to ligation of internal iliac artery except -

Accepted Answer

Bleeding is always controlled with it

Answer

Collateral circulation is established later between middle sacral and lateral sacral arteries

Answer

The artery should be ligated and not transected

Answer

For hemostasis, anterior division is to be ligated

Question 4

Foot ulcers secondary to arterial insufficiency are successfully treated by all of the following techniques except:

Accepted Answer

Elevation of the affected extremity

Answer

Antibiotic administration

Answer

Bed rest

Answer

Debridement of devitalized tissue

Question 5

A 40-year-old male with a history of accident 2 days back presented to the ER with complaints of redness of eye, diplopia, decreased vision, and facial pain in the distribution of ophthalmic division of trigeminal nerve. On examination: Bruit was heard over the eyes, Proptosis, Ocular pulsations, Exposure keratopathy, Pulsating exophthalmos. MRI brain was done. The artery involved in the above condition passes through which of the following structures?

Accepted Answer

Cavernous sinus

Answer

Optic canal

Answer

Superior orbital fissure

Answer

Foramen rotundum

Question 6

Balloon valvotomy is successful in all of the following cases except –

Accepted Answer

Calcified mitral stenosis

Answer

Congenital pulmonary stenosis

Answer

Congenital aortic stenosis

Answer

Mitral stenosis in pregnancy

Question 7

Bullet wounds near major blood vessels should be explored only if -

Accepted Answer

There are hard signs of vascular injury (active hemorrhage, expanding hematoma, absent distal pulses, palpable thrill/bruit)

Answer

The wound is in close proximity to a major blood vessel

Answer

There is any suspicion of possible vascular involvement

Answer

Routine exploration is indicated for all penetrating wounds near vessels

Question 8

Butcher's thigh is?

Accepted Answer

Accidental injury to major vessels in thigh or groin

Answer

Subcutaneous lipodermatosclerosis

Answer

Bursa in adductor canal

Answer

Vastus lateralis rupture

Question 9

A young man following RTA presented with proptosis and pain in the right eye after four days. On examination, there is periorbital ecchymosis on the forehead and right eye. What is the diagnosis -

Accepted Answer

Carotico-cavernous fistula

Answer

Internal carotid artery aneurysm

Answer

Fracture of sphenoid

Answer

Cavernous sinus thrombosis

Question 10

Allen's test is for the patency of:

Accepted Answer

Radial and ulnar artery

Answer

Vertebral artery

Answer

Subclavian artery

Answer

Internal carotid artery

Vascular Surgery — MCQs

Vascular Surgery — MCQs

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