Vascular Surgery — MCQs

Vascular Surgery Indian Medical PG Practice Questions and MCQs

Question 471: Allen's test is for the patency of:

A. Vertebral artery
B. Subclavian artery
C. Radial and ulnar artery (Correct Answer)
D. Internal carotid artery

Explanation: ***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 472: Tobey-Ayer test is positive in which of the following conditions?

A. Lateral sinus thrombosis (Correct Answer)
B. Subarachnoid haemorrhage
C. Petrositis
D. Cerebral abscess

Explanation: ***Lateral sinus thrombosis*** - The **Tobey-Ayer test** (or Queckenstedt's maneuver) assesses the patency of the **internal jugular vein** by observing changes in CSF pressure during compression. - In **lateral sinus thrombosis**, compression of the unaffected internal jugular vein leads to a rise in CSF pressure, but compression of the affected side yields **no or a blunted rise**, indicating obstruction. *Subarachnoid haemorrhage* - This condition involves bleeding into the subarachnoid space, which can elevate **intracranial pressure (ICP)**, but it isn't directly diagnosed by a differential CSF pressure response to jugular compression. - The primary diagnostic methods are **CT scans** and **lumbar puncture** showing xanthochromia. *Petrositis* - Also known as Gradenigo's syndrome, petrositis is an infection of the **petrous apex** of the temporal bone, often presenting with ear discharge, facial pain, and abducens nerve palsy. - While it's a complication of otitis media, it does not typically involve obstruction of the internal jugular vein or present with a positive Tobey-Ayer test. *Cerebral abscess* - A cerebral abscess is a localized collection of pus within the brain parenchyma, which can cause **localized neurological deficits** and increased ICP. - The Tobey-Ayer test would not specifically diagnose a cerebral abscess, as it assesses venous outflow from the brain rather than focal brain lesions.

Question 473: Deep vein thrombosis is MOST common after which of the following procedures?

A. Neurosurgery
B. Total hip replacement (Correct Answer)
C. Gastrectomy
D. Prostatic operation

Explanation: ***Total hip replacement*** - **Total hip replacement surgery** is a significant risk factor for DVT due to extensive tissue trauma, prolonged immobility, and potential damage to venous endothelium during the procedure. - The incidence of **postoperative DVT** can be as high as 40-60% without prophylaxis, earning it a classification as a **very high-risk procedure** for VTE. *Neurosurgery* - While neurosurgery carries a risk of DVT, it is generally **lower compared to major orthopedic surgeries** like total hip replacement. - The focus in neurosurgery often revolves around avoiding **intracranial bleeding**, which can limit the intensity of anticoagulant prophylaxis. *Gastrectomy* - Gastrectomy, a major abdominal surgery, does increase the risk of DVT, but typically **less profoundly than total hip replacement**. - Risk factors like **anesthesia duration** and degree of inflammation contribute to DVT risk, but not to the same extent as direct trauma to large veins in the lower extremities. *Prostatic operation* - **Prostatic operations**, such as prostatectomy, carry a moderate risk of DVT, but this risk is generally **lower than that associated with major orthopedic procedures**. - The risk is influenced by factors such as **surgical time**, patient age, and the presence of malignancy, but the extent of venous stasis and damage is typically less severe.

Question 474: Classical indication of gamma knife amongst the following is:

A. Hepatocellular carcinoma
B. Tuberculoma
C. Arterio-venous malformation (Correct Answer)
D. Glioblastoma

Explanation: ***Arterio-venous malformation*** - Gamma Knife radiosurgery is a well-established and highly effective treatment for **intracranial arterio-venous malformations (AVMs)**, particularly those that are small to medium-sized and surgically inaccessible. - It works by delivering a highly focused dose of radiation to the abnormal blood vessels, causing them to gradually scar and occlude over time. *Hepatocellular carcinoma* - Gamma Knife radiosurgery is primarily designed and used for treating **intracranial lesions**, not peripheral solid organ tumors like hepatocellular carcinoma. - Treatment for hepatocellular carcinoma typically involves systemic therapies, surgical resection, or other localized interventions like transarterial chemoembolization (TACE) or radiofrequency ablation. *Tuberculoma* - Tuberculoma is an infectious granulomatous lesion, usually managed with **anti-tubercular drug therapy**. - Radiosurgery is not the primary treatment for infectious processes unless there's a specific indication for mass effect not responding to medical therapy, which is rare. *Glioblastoma* - While radiation therapy is a cornerstone of glioblastoma treatment, **Gamma Knife radiosurgery** is generally not a primary treatment for diffuse, infiltrative tumors like glioblastoma, especially at initial diagnosis. - It may be considered as an adjuvant or salvage therapy for small, recurrent lesions or focal recurrences, but its role is limited due to the infiltrative nature of the disease.

Question 475: Tobey-Ayer test and Crowe-Beck test are used for?

A. Lateral sinus thrombosis (Correct Answer)
B. Subarachnoid hemorrhage
C. Petrositis
D. Cerebral abscess

Explanation: ***Lateral sinus thrombosis*** - The **Tobey-Ayer test** and **Crowe-Beck test** are classical methods used to diagnose **lateral sinus thrombosis**. - These tests rely on observing changes in **cerebrospinal fluid (CSF) pressure** upon compression of the jugular veins, which will be altered in the presence of a thrombus. *Subarachnoid hemorrhage* - Diagnosed primarily by **CT scan of the head** and analysis of **CSF for xanthochromia**. - While CSF is involved, these specific tests are not used for its diagnosis. *Petrositis* - This is an inflammation of the **petrous apex** of the temporal bone, often diagnosed with **CT or MRI** imaging. - The Tobey-Ayer and Crowe-Beck tests are not relevant to its diagnosis. *Cerebral abscess* - A localized collection of pus within the brain, diagnosed with **contrast-enhanced CT or MRI** of the brain. - These specific tests are irrelevant for the diagnostic workup of a cerebral abscess.

Question 476: A 65-year-old woman, two days after knee implant surgery, complains of calf pain and swelling in her leg. She later develops breathlessness and dies suddenly in the ward. What is the most probable cause?

A. Pulmonary embolism (Correct Answer)
B. Stroke
C. Myocardial infarction
D. ARDS

Explanation: ***Pulmonary embolism*** - The combination of **calf pain** and **swelling** post-surgery indicates a probable **deep vein thrombosis (DVT)**, which can dislodge and travel to the lungs. - The sudden onset of **breathlessness** and death is characteristic of a **massive pulmonary embolism**, where a large clot obstructs blood flow to the lungs and heart. *Stroke* - A stroke typically presents with **focal neurological deficits**, such as sudden weakness, numbness, or speech difficulties, which are not described here. - While post-operative stroke is possible, sudden death with preceding calf pain and swelling is not typical for its presentation. *Myocardial infarction* - A **myocardial infarction** (heart attack) would likely involve chest pain, radiating pain, and EKG changes, though silent MIs can occur. - While a life-threatening event, the preceding DVT symptoms and breathlessness point more towards a pulmonary cause of sudden death, especially in a post-surgical patient. *ARDS* - **Acute Respiratory Distress Syndrome (ARDS)** is characterized by widespread inflammation in the lungs leading to severe hypoxemia, often developing over hours to days. - While it causes severe breathlessness, the rapid onset of death and the clear indicators of a preceding DVT make ARDS less likely as the immediate cause of sudden demise.

Question 477: The ideal synthetic material used for femoropopliteal bypass when autologous vein is unavailable is:

A. Dacron
B. Xenograft
C. Saphenous vein
D. PTFE (non-expanded)
E. Cryopreserved vein graft
F. ePTFE (Correct Answer)
. Polyethylene terephthalate (PET)
. Allograft

Explanation: ***ePTFE (Expanded Polytetrafluoroethylene)*** - **ePTFE** is the preferred synthetic graft for femoropopliteal bypass when autologous vein is unavailable - Offers good **biocompatibility** and relative resistance to **thrombosis** - Provides superior patency rates in above-knee femoropopliteal bypasses compared to other synthetic materials (5-year patency ~50-60%) - The expanded structure allows tissue ingrowth and better integration *Dacron (Polyethylene terephthalate)* - Generally used for **larger diameter vessels** (e.g., aortoiliac grafts) - Has **inferior patency rates** in smaller diameter femoropopliteal position compared to ePTFE - More prone to kinking and associated with higher rates of intimal hyperplasia in peripheral circulation *Saphenous vein* - The autologous saphenous vein is the **gold standard** for femoropopliteal bypass with superior long-term patency (5-year patency ~70-80%) - However, this question specifically asks for synthetic material when vein is unavailable or unsuitable - Not always available or of adequate quality in all patients *PTFE (non-expanded)* - **Non-expanded PTFE** lacks the porous structure of ePTFE - Not used for vascular grafts due to absence of tissue ingrowth capability - The **expanded** form is specifically engineered for vascular applications

Question 478: A patient is on follow-up for recurrent abdominal pain. USG reveals an aortic aneurysm of 40 mm. What should be the next immediate step?

A. Establish surveillance protocol with repeat imaging in 6-12 months. (Correct Answer)
B. Initiate medical management with beta-blockers.
C. Perform surgical intervention immediately.
D. Start antihypertensive therapy immediately.

Explanation: ***Establish surveillance protocol with repeat imaging in 6-12 months.*** - A **40mm abdominal aortic aneurysm (AAA)** is below the threshold for elective surgical repair (typically **55mm for men, 50mm for women**). - The **immediate next step** is to establish a **surveillance protocol** with repeat imaging at appropriate intervals (every **6-12 months** for 40-44mm AAAs). - Surveillance allows monitoring of aneurysm growth rate and timely intervention if it expands to surgical threshold or becomes symptomatic. - **Risk factor modification** (smoking cessation, BP control, statin therapy) should accompany surveillance but is secondary to establishing the monitoring plan. *Initiate medical management with beta-blockers.* - **Beta-blockers are NOT recommended** for AAA management and may actually be harmful by reducing aortic wall stress detection. - Current guidelines do not support routine pharmacological therapy specifically to prevent AAA expansion, though **statins** may have some benefit. *Perform surgical intervention immediately.* - A **40mm AAA is well below surgical threshold** and does not require immediate intervention. - Surgery is considered when AAA reaches **≥55mm (men) or ≥50mm (women)**, growth rate **>10mm/year**, or when **symptomatic/ruptured**. *Start antihypertensive therapy immediately.* - While **blood pressure control is important** in AAA management, it is not the immediate next step without first establishing a surveillance protocol. - Antihypertensive therapy should be part of overall cardiovascular risk management but assumes the patient is hypertensive (not specified in the question).

Question 479: Following endarterectomy on the right common carotid, a patient is found to be blind in the right eye. It appears that a small thrombus embolized during surgery and lodged in the artery supplying the retina. Which artery would be blocked?

A. Nasociliary artery
B. Infraorbital artery
C. Lacrimal artery
D. Central artery of the retina (Correct Answer)

Explanation: ***Central artery of the retina*** - The **central artery of the retina** is a branch of the **ophthalmic artery** that supplies blood to the inner two-thirds of the retina, including the **photoreceptors** and **ganglion cells**. - Its occlusion, often due to an **embolus** like in this scenario, leads to sudden, **painless monocular vision loss**, often described as a "curtain" coming down, which aligns with **blindness in the right eye**. *Nasociliary artery* - The **nasociliary artery** supplies structures like the **ethmoid sinuses**, **dura mater**, and part of the **nasal cavity**. - It does not directly supply the **optic nerve** or the **retina** and its occlusion would not cause blindness. *Infraorbital artery* - The **infraorbital artery** supplies structures in the **maxilla**, **lower eyelid**, and part of the **cheek**. - Its occlusion would primarily affect these areas and would not result in **blindness**. *Lacrimal artery* - The **lacrimal artery** primarily supplies the **lacrimal gland**, which produces tears, as well as parts of the **eyelids** and **conjunctiva**. - While it's a branch of the ophthalmic artery, its occlusion would not directly cause **blindness** by affecting the retina or optic nerve.

Question 480: Primary vascular access of choice in chronic kidney disease is:

A. Radio-cephalic fistula (Correct Answer)
B. PTFE graft
C. Brachio-cephalic fistula
D. Permcath

Explanation: ***Radio-cephalic fistula*** - The **radio-cephalic fistula** is the preferred primary vascular access in **chronic kidney disease** patients because it has the longest patency rates and lowest complication rates. - It is often created at the **wrist** and involves an anastomosis between the **radial artery** and the **cephalic vein**. *PTFE graft* - **PTFE grafts** are typically used when autologous veins are unsuitable for fistula creation due to poor quality or prior failures. - They tend to have **lower patency rates** and **higher infection rates** compared to native fistulas. *Brachio-cephalic fistula* - A **brachio-cephalic fistula** is usually considered a secondary option when a radio-cephalic fistula is not feasible. - It is created in the **upper arm** and generally has a **shorter lifespan** and potentially more complications than a wrist fistula. *Permcath* - A **Permcath** (tunneled central venous catheter) is a temporary or short-term access option, often used for immediate dialysis needs or when no other vascular access is possible. - It carries a **high risk of infection** and central venous stenosis, making it unsuitable for long-term primary vascular access.

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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