Vascular Surgery Practice Questions

Q: CEAP score indicates-

Venous disorder. ***Venous disorder*** - The **CEAP classification** is a widely recognized system used to categorize and describe chronic venous disorders. The acronym stands for **Clinical, Etiological, Anatomical, and Pathophysiological** factors. - It provides a standardized framework for clinicians to classify the severity and characteristics of **venous disease**, ranging from spider veins to active ulcers. *Atrial disorders* - **Atrial disorders** refer to conditions affecting the atria of the heart, such as **atrial fibrillation** or **atrial flutter**. - These are cardiovascular conditions distinct from venous disorders, which involve the veins (blood vessels returning blood to the heart). *Neurological disorder* - A **neurological disorder** is a condition affecting the **nervous system**, including the brain, spinal cord, and nerves. - The CEAP classification is specifically designed for vascular conditions and has no direct relevance to neurological diseases. *Trauma disorder* - A **trauma disorder** is a condition resulting from a **physically or psychologically traumatic event**. - While trauma can sometimes lead to venous issues (e.g., deep vein thrombosis from immobilization), the CEAP score itself is a classification system for chronic venous disease, not for traumatic conditions in general.

Q: Percutaneous chemical lumbar sympathectomy is practised using -

Phenol. ***Phenol*** - **Phenol** is a commonly used neurolytic agent for percutaneous chemical sympathectomy due to its ability to induce a **long-lasting chemical denervation**. - It works by causing **protein denaturation** and nerve fiber destruction, thereby interrupting sympathetic nerve transmission. *Ethanol* - **Ethanol** (absolute alcohol) is also often used as a neurolytic agent for chemical sympathectomy, but phenol is specifically mentioned in the context of longer-lasting and more controlled effects for lumbar sympathectomies. - While effective, ethanol's spread can be less predictable, and it can cause significant **local pain** during injection. *Formalin* - **Formalin** is primarily used as a fixative for tissue samples in histology. - It is **not a standard neurolytic agent** for chemical sympathectomy due to its high toxicity and unpredictable effects in vivo. *Acetic acid* - **Acetic acid** is generally not used as a neurolytic agent for chemical sympathectomy. - Its neurolytic action is less potent and predictable compared to phenol or ethanol, and its use is limited in such procedures.

Q: Which of the following lumbar vertebrae is typically spared in a lumbar sympathectomy?

L1. ***L1*** - The **L1 sympathetic ganglion** is typically spared during a lumbar sympathectomy primarily to **prevent retrograde ejaculation** and maintain ejaculatory function in males. - L1 fibers contribute to the **hypogastric plexus**, which controls seminal emission and ejaculation. - Additionally, its fibers ascend to supply the kidneys and adrenal glands, and disruption can lead to complications like **renal denervation** and **adrenal dysfunction**. *L2* - The **L2 sympathetic ganglion** is commonly targeted in a lumbar sympathectomy to achieve adequate denervation for conditions affecting the lower limbs. - Its interruption effectively blocks sympathetic outflow to the legs. *L3* - The **L3 sympathetic ganglion** is often removed or ablated during a lumbar sympathectomy to enhance the sympathetic blockade to the lower extremities. - Its removal contributes significantly to the therapeutic effect of the procedure. *L4* - The **L4 sympathetic ganglion** is frequently included in a lumbar sympathectomy to achieve the most extensive sympathetic denervation of the lower limbs. - Denervation at this level is crucial for treating severe conditions like **peripheral arterial disease** and **severe hyperhidrosis**.

Q: Dysphagia lusoria is due to?

Compression by aberrant blood vessel. ***Compression by aberrant blood vessel*** - **Dysphagia lusoria** is a condition caused by the compression of the esophagus by an **aberrant right subclavian artery** (ARSA) that usually arises from the descending aorta and passes posterior to the esophagus. - The term "lusoria" refers to the **"aberrant" or "mistake of nature"** nature of the vessel, which is a congenital anomaly. *Esophageal diverticulum* - An **esophageal diverticulum** is an outpouching or sac-like protrusion of the esophageal wall. - While it can cause dysphagia, it is a structural abnormality *of* the esophagus, not an extrinsic compression *on* it. *Aneurysm of aorta* - An **aneurysm of the aorta**, particularly a descending thoracic aortic aneurysm, can compress the esophagus and cause dysphagia. - However, **dysphagia lusoria specifically refers to compression by an aberrant subclavian artery**, not typically by a generalized aortic aneurysm unless it is in a position to cause similar compression. *Esophageal web* - An **esophageal web** is a thin, shelflike protrusion of mucosal and submucosal tissue into the esophageal lumen. - It primarily causes dysphagia due to **intrinsic narrowing of the esophageal lumen**, rather than extrinsic compression.

Q: Claudication due to superficial femoral artery occlusion is primarily seen in

Calf pain during exercise. ***Calf pain during exercise*** - **Claudication** due to superficial femoral artery occlusion (peripheral artery disease) typically manifests as pain in the **calf muscles** during exercise. - This is because the **superficial femoral artery** supplies the popliteal artery and subsequently the calf, and its occlusion leads to insufficient blood flow to these muscles during increased demand. *Thigh pain during exercise* - **Thigh pain** during exercise usually indicates stenosis or occlusion higher up in the arterial tree, such as the **common femoral** or **iliac arteries**. - While related to peripheral artery disease, it is not the primary symptom of superficial femoral artery occlusion. *Buttock pain during exercise* - **Buttock claudication** is characteristic of significant stenosis or occlusion in the **aortoiliac segment**, affecting blood supply to the gluteal muscles. - This is distinct from superficial femoral artery occlusion, which affects distal circulation. *Foot pain during exercise* - **Foot pain** during exercise can indicate more severe, distal occlusive disease affecting the **tibial** or **pedal arteries**. - While peripheral artery disease can affect the foot, classic claudication from superficial femoral artery occlusion is predominantly felt in the calf.

Q: What is the cutoff for surgery in an abdominal aortic aneurysm in asymptomatic patients?

5.5cm. ***5.5cm*** - For **asymptomatic patients**, an abdominal aortic aneurysm (AAA) measuring **5.5 cm or larger** is generally considered the threshold for surgical repair. - This cutoff is based on studies showing that the risk of rupture significantly increases beyond this size, outweighing the risks of elective repair. *6.5cm* - While a 6.5 cm AAA would certainly warrant repair, the **standard cutoff for elective repair is 5.5 cm** to prevent rupture. - Delaying repair until this size would expose the patient to an unnecessarily higher risk of complications. *7.5cm* - An aneurysm of 7.5 cm carries a **very high risk of rupture**, making emergency repair almost inevitable if it is not addressed proactively. - This size is well beyond the recommended threshold for elective intervention. *8.5cm* - An 8.5 cm AAA has an **extremely high and imminent risk of rupture**, which would be a life-threatening event. - Surgical intervention would be considered urgent in this scenario, as it is far past the ideal window for elective repair.

Q: Which of the following is the preferred graft material for femoropopliteal bypass?

Reversed saphenous. ***Reversed saphenous*** - The **autologous reversed saphenous vein** is considered the **gold standard** for femoropopliteal bypass due to its superior patency rates and resistance to infection. - The vein's valves are bypassed by reversing its orientation, ensuring unidirectional blood flow. *Dacron* - **Dacron (polyethylene terephthalate)** grafts are synthetic and commonly used for large-diameter arterial bypasses, such as in the aorta, but have **inferior patency in infrainguinal bypasses** compared to autologous vein. - **Higher rates of thrombosis and infection** are observed with Dacron in smaller leg vessels due to compliance mismatch and increased anastomotic intimal hyperplasia. *PTFE* - **Polytetrafluoroethylene (PTFE)** grafts are synthetic and are an option when autologous vein is unavailable, particularly for above-knee femoropopliteal bypasses. - However, PTFE generally has **lower long-term patency rates** and a higher risk of complications like **graft thrombosis and infection** compared to autologous vein grafts. *None of the options* - This option is incorrect because the **reversed saphenous vein** is indeed a preferred and highly effective graft material for femoropopliteal bypass. - The clinical evidence strongly supports its use over synthetic alternatives when available.

Question 1

CEAP score indicates-

Accepted Answer

Venous disorder

Answer

Atrial disorders

Answer

Trauma disorder

Answer

Neurological disorder

Question 2

Percutaneous chemical lumbar sympathectomy is practised using -

Accepted Answer

Phenol

Answer

Formalin

Answer

Ethanol

Answer

Acetic acid

Question 3

Which of the following lumbar vertebrae is typically spared in a lumbar sympathectomy?

Accepted Answer

L1

Answer

L2

Answer

L3

Answer

L4

Question 4

Which of the following statements is MOST accurate regarding the use of grafts in vascular surgery?

Accepted Answer

Autologous saphenous vein achieves superior patency rates to prosthetic materials especially in femorodistal bypass

Answer

In the absence of specific contraindications aspirin should be prescribed for all the patients of peripheral vascular disease

Answer

Doppler ultrasound assessment is the method of choice for quality assurance on completion of operative procedure

Answer

The patency of the PTFE grafts may be improved by interposition of a vein cuff at proximal anastomosis

Question 5

Which of the following is the MOST IMPORTANT initial management approach for venous ulcers of the lower limb?

Accepted Answer

Initial treatment involves conservative measures such as compression therapy.

Answer

Biological dressings can improve healing by providing a scaffold for new tissue growth.

Answer

Antibiotics are not routinely used to speed up ulcer healing.

Answer

Compression dressings should ideally be applied more frequently than twice weekly.

Question 6

Dysphagia lusoria is due to?

Accepted Answer

Compression by aberrant blood vessel

Answer

Esophageal diverticulum

Answer

Aneurysm of aorta

Answer

Esophageal web

Question 7

Claudication due to superficial femoral artery occlusion is primarily seen in

Accepted Answer

Calf pain during exercise

Answer

Thigh pain during exercise

Answer

Buttock pain during exercise

Answer

Foot pain during exercise

Question 8

A 68-year-old asymptomatic male is found to have an abdominal aortic aneurysm (AAA) measuring 4.5 cm on routine ultrasound screening. What is the most appropriate management?

Accepted Answer

Monitor regularly and consider surgery if size reaches 55mm or symptomatic

Answer

Ultrasound monitoring until size exceeds 70mm

Answer

No treatment unless symptomatic

Answer

Immediate surgical repair for all diagnosed aneurysms regardless of size

Question 9

What is the cutoff for surgery in an abdominal aortic aneurysm in asymptomatic patients?

Accepted Answer

5.5cm

Answer

6.5cm

Answer

7.5cm

Answer

8.5cm

Question 10

Which of the following is the preferred graft material for femoropopliteal bypass?

Accepted Answer

Reversed saphenous

Answer

PTFE

Answer

Dacron

Answer

None of the options

Vascular Surgery — MCQs

Vascular Surgery — MCQs

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