Vascular Surgery Practice Questions

Q: What is the indication for surgery in asymptomatic patients with abdominal aortic aneurysm?

Transverse diameter > 5.5 cm. **Explanation:** The management of an Abdominal Aortic Aneurysm (AAA) is based on balancing the risk of spontaneous rupture against the risks associated with surgical repair (EVAR or open surgery). 1. **Why Option B is Correct:** In asymptomatic patients, the threshold for elective surgical intervention is a **transverse diameter of ≥ 5.5 cm in men** and **≥ 5.0 cm in women**. Large-scale clinical trials (like the UKSAT and ADAM trials) demonstrated that for aneurysms smaller than 5.5 cm, the risk of rupture is lower than the operative mortality risk, making surveillance the preferred strategy. Once the diameter exceeds 5.5 cm, the risk of rupture increases exponentially. 2. **Why Other Options are Incorrect:** * **Option A (> 3 cm):** A diameter of > 3.0 cm is the diagnostic criteria for an AAA, but it is not an indication for surgery. These patients require serial ultrasound surveillance. * **Option C (> 7.5 cm):** This is dangerously high. The risk of rupture for an aneurysm > 7.0 cm is approximately 30% per year; surgery should have been performed much earlier. * **Option D:** Waiting for symptoms (pain, tenderness) is incorrect because the first "symptom" of an AAA is often fatal rupture. **High-Yield Clinical Pearls for NEET-PG:** * **Expansion Rate:** Regardless of size, an expansion of **> 0.5 cm in 6 months** or **> 1 cm in 1 year** is an absolute indication for surgery. * **Symptomatic AAA:** Any symptomatic aneurysm (back/abdominal pain or tenderness) requires **urgent/emergent repair** regardless of the diameter. * **Investigation of Choice:** **Ultrasound** is used for screening and surveillance; **Contrast-Enhanced CT (CECT)** is the gold standard for preoperative planning. * **Most Common Site:** Infra-renal (below the origin of renal arteries).

Q: What is the investigation of choice for detecting small para-aortic lymph nodes?

CT scan. **Explanation:** The **CT scan (Computed Tomography)** is the investigation of choice for detecting small para-aortic lymph nodes due to its superior spatial resolution and ability to visualize the retroperitoneum clearly. It allows for the precise measurement of node size (typically considered significant if >10 mm in the short axis) and assessment of their relationship with major vessels like the aorta and IVC. Contrast-enhanced CT (CECT) further helps differentiate nodes from vascular structures. **Analysis of Options:** * **Ultrasound (A):** While useful for screening, it is often limited by overlying bowel gas and patient habitus, making it unreliable for detecting "small" nodes deep in the retroperitoneum. * **Lymphangiography (C):** Historically used to visualize lymphatic architecture, it is an invasive, technically demanding procedure that has been almost entirely replaced by non-invasive cross-sectional imaging (CT/MRI). * **Arteriography (D):** This is used to visualize the lumen of arteries. It does not visualize lymph nodes unless they are large enough to displace major vessels, which would not apply to "small" nodes. **Clinical Pearls for NEET-PG:** * **Gold Standard for Staging:** CT is the standard for staging most intra-abdominal malignancies (e.g., Testicular tumors, Renal Cell Carcinoma) to check for para-aortic involvement. * **PET-CT:** While CT detects size, PET-CT is superior for detecting metastasis in normal-sized nodes by assessing metabolic activity. * **MRI:** Equivalent to CT in accuracy but usually reserved for patients with contrast allergies or for specific pelvic nodal staging.

Q: Surgical treatment (ligation or stripping) is preferred for GSV diameter equal to or greater than what measurement?

2 cm. ### Explanation The management of varicose veins has evolved significantly with the advent of endovenous thermal ablation (EVLA/RFA). However, the diameter of the **Great Saphenous Vein (GSV)** remains a critical factor in determining the surgical approach. **Why 2 cm is the correct answer:** Standard endovenous techniques (Laser or Radiofrequency ablation) are highly effective for moderate venous diameters. However, when the GSV diameter at the saphenofemoral junction (SFJ) or the proximal thigh exceeds **2 cm (20 mm)**, the risk of failure with thermal ablation increases significantly. Large diameters are associated with higher rates of **recanalization** and technical difficulty in achieving a complete "seal" of the vessel. In such cases, traditional **High Ligation and Stripping (HL/S)** is preferred to ensure definitive closure and reduce the risk of recurrence. **Analysis of Incorrect Options:** * **3 cm, 4 cm, and 5 cm:** While these diameters certainly necessitate surgical intervention, they are far beyond the established threshold. A vein measuring 2 cm is already considered "giant" or "aneurysmal" in the context of venous reflux; waiting for it to reach 3–5 cm would lead to severe chronic venous insufficiency (CVI) and skin changes (lipodermatosclerosis). **Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Duplex Ultrasound is the investigation of choice for varicose veins. * **CEAP Classification:** Used to grade chronic venous disorders (C0: No signs, C2: Varicose veins, C6: Active ulcer). * **Trendelenburg Test:** Used clinically to differentiate between SFJ incompetence and perforator incompetence. * **Complication of Stripping:** Injury to the **Saphenous nerve** (sensory loss on the medial aspect of the leg/foot) is a high-yield surgical complication.

Q: What is the commonest cause of arteriovenous fistulae?

Congenital. **Explanation:** Arteriovenous (AV) fistulae are abnormal communications between an artery and a vein that bypass the capillary bed. **Why Congenital is the Correct Answer:** Congenital AV fistulae are the **most common** type overall. They result from the failure of the embryonic vascular plexus to differentiate into distinct arteries and veins during the third to fourth week of development. These are often multiple, small, and diffuse, frequently involving an entire limb or organ (e.g., Klippel-Trenaunay Syndrome). Because they are developmental anomalies present from birth (though they may manifest later), they represent the largest statistical group of AV communications. **Analysis of Incorrect Options:** * **Traumatic:** This is the most common cause of **acquired** AV fistulae. They typically result from penetrating injuries (stab or gunshot wounds) where an adjacent artery and vein are damaged simultaneously. * **Surgical creation:** These are iatrogenic fistulae (e.g., Brescia-Cimino fistula) created intentionally for hemodialysis access. While common in renal wards, they do not surpass congenital cases in the general population. * **Tumor erosion:** This is a rare cause where a malignant tumor (e.g., renal cell carcinoma) erodes through the walls of adjacent vessels. **High-Yield Clinical Pearls for NEET-PG:** * **Nicoladoni-Branham Sign:** Pressure applied to the artery proximal to an AV fistula leads to a decrease in heart rate (bradycardia). This is due to the sudden increase in peripheral resistance and subsequent vagal stimulation. * **Hemodynamic Effects:** AV fistulae lead to **increased cardiac output** and can eventually cause high-output heart failure. * **Physical Exam:** A continuous "machinery" murmur and a palpable thrill are classic findings over the site of the fistula.

Q: Which of the following is NOT true about abdominal aortic aneurysm?

It most commonly arises from the infrarenal aorta.. **Explanation:** The question asks for the statement that is **NOT true** regarding Abdominal Aortic Aneurysm (AAA). However, based on surgical facts, **Option B is actually a true statement**, making the question technically flawed or suggesting a typo in the provided key. In standard surgical teaching, over 90% of AAAs are infrarenal. **1. Analysis of Options:** * **Option A (True):** Atherosclerosis is the most common etiology. It leads to the degradation of elastin and collagen in the tunica media, weakening the arterial wall. * **Option B (True):** The infrarenal aorta is the most common site for AAA. This is due to a lower density of vasa vasorum and a higher proportion of elastic fiber breakdown in this segment. * **Option C (True):** The standard threshold for elective surgical intervention in asymptomatic males is **>5.5 cm**. For females, the threshold is often lower (**>5.0 cm**) due to a higher risk of rupture at smaller diameters. * **Option D (True):** Endovascular Aneurysm Repair (EVAR) using a stent-graft is a standard minimally invasive alternative to open surgery, provided the anatomical criteria (like a suitable "neck") are met. **2. Clinical Pearls for NEET-PG:** * **Risk Factors:** Smoking is the strongest risk factor; male gender and family history are also significant. * **Screening:** A one-time USG is recommended for men aged 65–75 who have ever smoked. * **Indications for Surgery:** 1. Diameter >5.5 cm (Men) / >5.0 cm (Women). 2. Rapid expansion (>0.5 cm in 6 months or >1 cm in 1 year). 3. Any symptomatic aneurysm (pain/tenderness) regardless of size. * **Classic Triad of Rupture:** Hypotension, pulsatile abdominal mass, and back/abdominal pain.

Question 1

Syndrome of internal iliac artery occlusion is manifested by?

Accepted Answer

Absent pulse at the dorsalis pedis artery

Answer

Pain in calf

Answer

Intermittent claudication

Answer

Gangrene

Question 2

Which of the following statements is true regarding fat embolism?

Accepted Answer

Most patients with major trauma involving long bones have urinary fat globules.

Answer

All patients with urinary fat globules develop fat embolism.

Answer

Peak incidence of respiratory insufficiency for pulmonary fat embolism is around day 7 after injury.

Answer

Heparin as an anticoagulant decreases mortality and morbidity in fat embolism syndrome.

Question 3

What is the indication for surgery in asymptomatic patients with abdominal aortic aneurysm?

Accepted Answer

Transverse diameter > 5.5 cm

Answer

Transverse diameter > 3 cm

Answer

Transverse diameter > 7.5 cm

Answer

No need for surgery unless symptomatic

Question 4

Lumbar sympathectomy is the treatment for which of the following conditions?

Accepted Answer

Distal ischemia affecting the skin of the toes with rest pain

Answer

Trophic ulcer

Answer

Arteriovenous fistula

Answer

Diabetic neuropathy

Question 5

What is the investigation of choice for detecting small para-aortic lymph nodes?

Accepted Answer

CT scan

Answer

Ultrasound scan

Answer

Lymphangiography

Answer

Aeriography

Question 6

Surgical treatment (ligation or stripping) is preferred for GSV diameter equal to or greater than what measurement?

Accepted Answer

2 cm

Answer

3 cm

Answer

4 cm

Answer

5 cm

Question 7

Lymphangiography of the leg is performed by?

Accepted Answer

Dissecting lymphatics through an incision on the dorsum of the foot

Answer

An injection of sodium diatrizoate subcutaneously between the toes

Answer

Injecting sodium diatrizoate retrogradely under pressure into a small vein on the dorsum of the foot

Answer

The use of an infusion pump

Question 8

Boyd's classification is with regard to what condition?

Accepted Answer

Arterial stenosis

Answer

Limb ischemia

Answer

Claudication

Answer

AV fistula

Question 9

What is the commonest cause of arteriovenous fistulae?

Accepted Answer

Congenital

Answer

Traumatic

Answer

Surgical creation

Answer

Tumor erosion

Question 10

Which of the following is NOT true about abdominal aortic aneurysm?

Accepted Answer

It most commonly arises from the infrarenal aorta.

Answer

Atherosclerosis is the commonest cause.

Answer

For asymptomatic aneurysms, repair is indicated if the diameter is >5.5 cm.

Answer

Endovascular placement of an aortic stent is used for repair.

Vascular Surgery — MCQs

Vascular Surgery — MCQs

On this page

Practice by Chapter

Want unlimited practice?