Vascular Surgery — MCQs

Vascular Surgery Indian Medical PG Practice Questions and MCQs

Question 501: What is the appropriate management strategy for an asymptomatic abdominal aortic aneurysm (AAA)?

A. Regular ultrasound monitoring for asymptomatic aneurysms.
B. No treatment for small aneurysms.
C. Surgical intervention for aneurysms 55mm or larger.
D. Monitor small aneurysms (<55mm) with regular surveillance and perform surgical intervention when they reach 55mm or larger. (Correct Answer)

Explanation: ***Monitor small aneurysms (<55mm) with regular surveillance and perform surgical intervention when they reach 55mm or larger.*** - This option correctly outlines the **two-pronged approach** for AAA management: surveillance for smaller aneurysms to monitor growth and intervention for those reaching the size threshold for increased rupture risk. - Aneurysms 55mm or larger in asymptomatic men have a significantly higher risk of rupture, making **surgical intervention** safer than continued observation. *Regular ultrasound monitoring for asymptomatic aneurysms.* - While **regular ultrasound monitoring** is a component of appropriate management for smaller aneurysms, this option is incomplete as it doesn't address the management of aneurysms that reach a critical size. - This alone is not sufficient if the aneurysm grows to a size that warrants intervention. *No treatment for small aneurysms.* - This statement is inaccurate because "no treatment" implies a lack of surveillance, which is a crucial part of managing **small abdominal aortic aneurysms**. - Small aneurysms still require **regular monitoring** to detect growth and assess the need for future intervention, rather than being completely untreated. *Surgical intervention for aneurysms 55mm or larger.* - This statement is partially correct but incomplete as it only addresses intervention for larger aneurysms and fails to include the appropriate management for **smaller aneurysms**, which involves surveillance. - Focusing solely on surgical intervention without mentioning initial watchful waiting for smaller aneurysms does not represent the full spectrum of appropriate management.

Question 502: CEAP score indicates-

A. Atrial disorders
B. Venous disorder (Correct Answer)
C. Trauma disorder
D. Neurological disorder

Explanation: ***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.

Question 503: Which of the following lumbar vertebrae is typically spared in a lumbar sympathectomy?

A. L1 (Correct Answer)
B. L2
C. L3
D. L4

Explanation: ***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**.

Question 504: Percutaneous chemical lumbar sympathectomy is practised using -

A. Phenol (Correct Answer)
B. Formalin
C. Ethanol
D. Acetic acid

Explanation: ***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.

Question 505: Which of the following statements is MOST accurate regarding the use of grafts in vascular surgery?

A. In the absence of specific contraindications aspirin should be prescribed for all the patients of peripheral vascular disease
B. Doppler ultrasound assessment is the method of choice for quality assurance on completion of operative procedure
C. The patency of the PTFE grafts may be improved by interposition of a vein cuff at proximal anastomosis
D. Autologous saphenous vein achieves superior patency rates to prosthetic materials especially in femorodistal bypass (Correct Answer)

Explanation: ***Autologous saphenous vein achieves superior patency rates to prosthetic materials especially in femorodistal bypass*** - **Autologous saphenous vein** is considered the **gold standard conduit** for femorodistal bypasses due to its excellent long-term patency, biological compatibility, and resistance to infection. - Its superior patency rates are attributed to the preservation of endothelium, which minimizes **thrombogenicity** and promotes laminar flow. *The patency of the PTFE grafts may be improved by interposition of a vein cuff at proximal anastomosis* - While **vein cuffs** (e.g., Taylor patch, Miller cuff) can improve patency of **PTFE grafts**, they are typically placed at the **distal anastomosis**, not the proximal. - The purpose of a vein cuff at the distal anastomosis is to create a more compliant and larger outflow tract, reducing **anastomotic neointimal hyperplasia** and turbulence. *Doppler ultrasound assessment is the method of choice for quality assurance on completion of operative procedure* - While **Doppler ultrasound** is a valuable tool, **intraoperative angiography** or **duplex ultrasound** are more commonly considered the methods of choice for definitive quality assurance immediately after vascular surgery. - These methods provide detailed anatomical and hemodynamic information, allowing for the detection of technical errors like stenoses, intimal flaps, or thromboses that might require immediate correction. *In the absence of specific contraindications aspirin should be prescribed for all the patients of peripheral vascular disease* - **Aspirin** is recommended for patients with **symptomatic peripheral artery disease (PAD)** to reduce the risk of cardiovascular events, but it is not indicated for all patients, especially those with asymptomatic PAD or specific contraindications like bleeding disorders. - The decision to prescribe antiplatelet therapy such as aspirin should be made based on individual patient risk assessment and current clinical guidelines.

Question 506: Which of the following is the MOST IMPORTANT initial management approach for venous ulcers of the lower limb?

A. Initial treatment involves conservative measures such as compression therapy. (Correct Answer)
B. Biological dressings can improve healing by providing a scaffold for new tissue growth.
C. Antibiotics are not routinely used to speed up ulcer healing.
D. Compression dressings should ideally be applied more frequently than twice weekly.

Explanation: ***Initial treatment involves conservative measures such as compression therapy.*** * **Compression therapy** is the **cornerstone and first-line treatment** of venous leg ulcers, reducing edema and improving venous return. * It is crucial for healing and preventing recurrence by counteracting the effects of **venous hypertension**. * Compression is the **most important initial management** with healing rates of 50-60% at 12 weeks when properly applied. *Antibiotics are not routinely used to speed up ulcer healing.* * While this statement is true, antibiotics are only indicated for **clinically infected ulcers**, not as routine initial management. * They do not speed healing of uninfected venous ulcers and their use should be targeted, not routine. * This is not the **most important** initial approach compared to compression. *Biological dressings can improve healing by providing a scaffold for new tissue growth.* * While biological dressings can be beneficial, they are **not first-line initial management**. * They are typically considered for **complex, non-healing ulcers** after conservative measures have been attempted. * **Compression therapy remains more important** as the initial management approach. *Compression dressings should ideally be applied more frequently than twice weekly.* * This is **incorrect** - compression dressings are typically changed **once or twice weekly**, depending on exudate levels. * More frequent changes are only necessary for highly exudative wounds or compromised dressings. * Standard practice is 1-2 times per week for optimal healing and cost-effectiveness.

Question 507: Dysphagia lusoria is due to?

A. Esophageal diverticulum
B. Aneurysm of aorta
C. Esophageal web
D. Compression by aberrant blood vessel (Correct Answer)

Explanation: ***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.

Question 508: 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?

A. Ultrasound monitoring until size exceeds 70mm
B. No treatment unless symptomatic
C. Monitor regularly and consider surgery if size reaches 55mm or symptomatic (Correct Answer)
D. Immediate surgical repair for all diagnosed aneurysms regardless of size

Explanation: ***Monitor regularly and consider surgery if size reaches 55mm or symptomatic*** - For **asymptomatic abdominal aortic aneurysms (AAA)** measuring less than 5.5 cm, **regular surveillance** with imaging (ultrasound or CT) is the appropriate management. - Elective surgical intervention (open repair or EVAR) is recommended when the aneurysm reaches **≥5.5 cm diameter** in men or **≥5.0 cm in women**, or if the patient becomes **symptomatic** (abdominal/back pain, tenderness). - Growth rate >1 cm/year is also an indication for repair. - The **55mm threshold** balances rupture risk against surgical mortality risk based on large randomized trials (UKSAT, ADAM). *Immediate surgical repair for all diagnosed aneurysms regardless of size* - This approach is **too aggressive** and not evidence-based. - Small AAAs (<5.5 cm) have low annual rupture rates (<1% for AAAs <5 cm), making elective surgery unjustified given operative mortality (2-5%). - Randomized trials showed **no survival benefit** from early repair of small AAAs. *Ultrasound monitoring until size exceeds 70mm* - The threshold of **70mm (7 cm) is dangerously high** and significantly increases rupture risk. - AAAs ≥5.5 cm have annual rupture rates of 3-15%, with mortality from rupture exceeding 80%. - The standard threshold for elective repair is **5.5 cm**, not 7 cm. *No treatment unless symptomatic* - This approach ignores **aneurysm size**, which is the primary predictor of rupture risk in asymptomatic patients. - Elective repair of large asymptomatic AAAs (≥5.5 cm) prevents rupture and improves survival compared to watchful waiting. - Any **symptomatic AAA** requires urgent evaluation regardless of size, as symptoms suggest impending rupture.

Question 509: Claudication due to superficial femoral artery occlusion is primarily seen in

A. Thigh pain during exercise
B. Calf pain during exercise (Correct Answer)
C. Buttock pain during exercise
D. Foot pain during exercise

Explanation: ***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.

Question 510: Which of the following is the preferred graft material for femoropopliteal bypass?

A. PTFE
B. Dacron
C. Reversed saphenous (Correct Answer)
D. None of the options

Explanation: ***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.

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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