Vascular Trauma — MCQs

10 questions

A 19 year old girl sustained blunt abdominal trauma. She was diagnosed of having splenic rupture. Her pulse is 110/min and BP is normal. She is tachypneic with respiratory rate of 22/min and she is anxious. Her approximate blood loss is -

A young adult presents with proptosis and pain in eye after 4 days of trauma to eye. Chemosis, conjunctival congestion and extraocular muscle palsy with inability to move eye are seen.Investigation of choice -

Butcher's thigh is?

Which one of the following investigations is considered to be "Gold standard" technique for diagnosis of arterial occlusive disease –

What is the Investigation of Choice (IOC) for Acute Aortic Dissection?

What is the best procedure to control external hemorrhage in an event of accidental injury?

What is the treatment for most cases of blunt trauma to the kidney?

Which of the following does not cause deep venous thrombosis (DVT)?

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

Q10

In which condition is the Adson test positive?

Vascular Trauma Indian Medical PG Practice Questions and MCQs

Question 1: A 19 year old girl sustained blunt abdominal trauma. She was diagnosed of having splenic rupture. Her pulse is 110/min and BP is normal. She is tachypneic with respiratory rate of 22/min and she is anxious. Her approximate blood loss is -

A. 1500 - 2000ml
B. < 750 ml
C. 750 - 1500ml (Correct Answer)
D. > 2000ml

Explanation: ***750 - 1500ml*** - The patient's **pulse of 110/min**, **normal blood pressure**, tachypnea (22/min), and anxiety are indicative of **Class II hemorrhage**, which typically involves a blood loss of 750-1500 ml. - In Class II hemorrhage, the body's compensatory mechanisms maintain blood pressure, but **tachycardia** (pulse >100 bpm) is a primary sign, often accompanied by **anxiety** and increased respiratory rate. *1500 - 2000ml* - A blood loss of 1500-2000 ml (Class III hemorrhage) would typically present with **significant hypotension** (systolic BP <90 mmHg), marked tachycardia (>120 bpm), and altered mental status. - The patient's **normal blood pressure** rules out this extent of blood loss. *< 750 ml* - A blood loss of less than 750 ml (Class I hemorrhage) would typically present with **minimal or no changes** in vital signs, and the patient would likely not exhibit significant anxiety or a pulse of 110/min. - The patient's **tachycardia** (110/min) indicates more significant blood loss than Class I. *> 2000ml* - A blood loss of more than 2000 ml (Class IV hemorrhage) is a life-threatening condition presenting with **profound hypovolemic shock**, including severe hypotension, marked tachycardia (>140 bpm), and usually unresponsiveness. - The patient's **normal blood pressure** and only moderate tachycardia do not align with this massive blood loss.

Question 2: A young adult presents with proptosis and pain in eye after 4 days of trauma to eye. Chemosis, conjunctival congestion and extraocular muscle palsy with inability to move eye are seen.Investigation of choice -

A. MR angiography
B. CT
C. MRI
D. Digital subtraction angiography (Correct Answer)

Explanation: ***Digital subtraction angiography*** - The combination of **proptosis**, **pain**, **chemosis**, **conjunctival congestion**, and **extraocular muscle palsy** following trauma strongly suggests a **carotid-cavernous fistula (CCF)**. - **Digital subtraction angiography (DSA)** is the **gold standard** for diagnosing and characterizing CCFs, providing detailed visualization of arterial and venous flow. *MR angiography* - While MRA can provide information about vascular structures, it is less sensitive and specific than DSA for detecting and characterizing subtle shunts in **carotid-cavernous fistulas**. - It might miss smaller fistulas or provide insufficient detail for therapeutic planning. *CT* - **Computed tomography (CT)** is useful for assessing orbital bony structures, but it offers limited information regarding the dynamic blood flow and shunt characteristics crucial for diagnosing **carotid-cavernous fistulas**. - **CT angiography** can provide some vascular detail, but it is generally less comprehensive than DSA for this specific condition. *MRI* - **Magnetic Resonance Imaging (MRI)** can show orbital soft tissue changes and identify potential vascular abnormalities, but it lacks the real-time, high-resolution vascular detail of DSA, especially for depicting the exact location and flow dynamics of an **arteriovenous shunt**. - It is often used as a preliminary imaging modality but is not the definitive diagnostic tool for **carotid-cavernous fistulas**.

Question 3: Butcher's thigh is?

A. Accidental injury to major vessels in thigh or groin (Correct Answer)
B. Subcutaneous lipodermatosclerosis
C. Bursa in adductor canal
D. Vastus lateralis rupture

Explanation: ***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.

Question 4: Which one of the following investigations is considered to be "Gold standard" technique for diagnosis of arterial occlusive disease –

A. Doppler ultrasound blood flow detection
B. Treadmill
C. Duplex imaging
D. Digital subtraction angiography (DSA) (Correct Answer)

Explanation: ***Digital subtraction angiography (DSA)*** - **DSA** is considered the **gold standard** because it provides highly detailed, real-time images of arterial anatomy and blood flow within the vessels. - It allows for precise localization and characterization of **stenosis**, **occlusions**, and other vascular abnormalities, which is crucial for treatment planning. *Doppler ultrasound blood flow detection* - While useful for measuring blood flow velocities and identifying areas of stenosis, **Doppler ultrasound** is operator-dependent and less accurate than DSA for detailed anatomical mapping. - It provides functional information but lacks the comprehensive anatomical detail necessary to be the gold standard. *Treadmill* - A **treadmill test** is a functional assessment used to evaluate exercise-induced symptoms and the physiological impact of arterial occlusive disease. - It does not directly visualize the arterial pathology but rather assesses the patient's functional capacity and symptom response to exertion. *Duplex imaging* - **Duplex imaging** combines B-mode ultrasound (for anatomical visualization) with Doppler ultrasound (for blood flow assessment). - It is a very good non-invasive screening tool, but it is not as precise or comprehensive as DSA, particularly for complex anatomies or smaller vessels, and can be limited by factors such as obesity or bowel gas.

Question 5: What is the Investigation of Choice (IOC) for Acute Aortic Dissection?

A. USG
B. Doppler
C. CT-Angio (Correct Answer)
D. MR-Angio

Explanation: ***CT-angio*** - **Computed tomography angiography (CTA)** is considered the **gold standard** imaging modality for diagnosing acute aortic dissection due to its rapid acquisition, wide availability, and excellent visualization of the aorta and its branches. - It precisely demonstrates the **intimal flap**, true and false lumens, and assesses the extent of the dissection and involvement of major branch vessels. *Usg* - **Ultrasound (USG)**, specifically **transesophageal echocardiography (TEE)**, is highly sensitive and specific for proximal aortic dissections. - However, its utility is operator-dependent and it has limitations in visualizing the entire aorta, especially the distal descending aorta. *Doppler* - **Doppler ultrasound** is used to assess blood flow velocity and patterns within vessels. - While it can detect flow disturbances, it is not the primary imaging modality for diagnosing the anatomical extent and characteristics of an aortic dissection flap. *Mr-Angio* - **Magnetic resonance angiography (MRA)** provides excellent soft tissue contrast, no radiation exposure, and detailed anatomical information for aortic dissection. - However, it is often less accessible, time-consuming, and contraindicated in patients with certain metallic implants or claustrophobia, making it less ideal for an acute emergency setting compared to CTA.

Question 6: What is the best procedure to control external hemorrhage in an event of accidental injury?

A. Proximal tourniquet
B. Artery forceps
C. Elevation
D. Direct pressure (Correct Answer)

Explanation: ***Direct pressure*** - **Direct pressure** is the most immediate and effective first-aid measure for controlling external bleeding by compressing the injured vessel. - Applying firm, direct pressure with a clean cloth or hand helps to promote **hemostasis** and allow for clot formation at the site of injury. *Proximal tourniquet* - A **tourniquet** is a last resort for severe, life-threatening hemorrhage that cannot be controlled by direct pressure, as it can cause **tissue damage** and ischemia. - It should be applied proximal to the injury, but its prolonged use carries risks of **nerve damage** and limb loss. *Artery forceps* - **Artery forceps** are surgical instruments used to clamp individual blood vessels during a surgical procedure, not for initial control of external hemorrhage in an emergency. - Their use requires expertise and carries risks of further injury if not applied correctly by trained medical personnel. *Elevation* - **Elevation** of the injured limb above the level of the heart can help reduce blood flow and venous pressure, which may aid in controlling minor bleeding. - However, elevation alone is usually insufficient for significant hemorrhage and should be used in conjunction with **direct pressure**.

Question 7: What is the treatment for most cases of blunt trauma to the kidney?

A. Conservative (Correct Answer)
B. Nephrectomy
C. Nephrotomy
D. Nephroplexy

Explanation: ***Conservative*** - The majority of kidney injuries resulting from **blunt trauma** are low-grade (Grades I-III) and can be successfully managed with **conservative (non-operative) methods**. - This typically involves bed rest, careful monitoring of vital signs and urine output, hydration, and serial imaging to ensure stability and healing of the kidney. *Nephrectomy* - **Nephrectomy** (surgical removal of the kidney) is generally reserved for severe, high-grade kidney injuries (Grades IV-V) that are life-threatening or cannot be controlled by other means. - Indications include uncontrollable hemorrhage, extensive renal parenchymal destruction, or a non-viable kidney. *Nephrotomy* - **Nephrotomy** is an incision into the kidney, often performed for stone removal or to drain an abscess, but it is not a primary treatment for blunt traumatic kidney injury. - While surgical repair (nephrorrhaphy) may sometimes be indicated for high-grade injuries to preserve the kidney, a simple nephrotomy is not the standard approach. *Nephroplexy* - **Nephroplexy** is a surgical procedure to fix a prolapsed or "floating" kidney (nephroptosis), which is an entirely different condition from traumatic injury. - This procedure aims to secure the kidney in its normal anatomical position and is not indicated for kidney trauma.

Question 8: Which of the following does not cause deep venous thrombosis (DVT)?

A. Lower limb trauma
B. Subungual hematoma (Correct Answer)
C. Hip & pelvic surgeries
D. Cushing's syndrome

Explanation: ***Subungual hematoma*** - A **subungual hematoma** is a collection of blood under the fingernail or toenail, usually caused by trauma. - It is a localized injury that **does not affect systemic coagulation** or venous blood flow, thus not increasing DVT risk. *Lower limb trauma* - **Trauma to the lower limb**, especially involving fractures or significant soft tissue damage, can lead to **venous stasis** due to immobility and direct vessel injury [1]. - This immobility and vessel damage activate the **coagulation cascade**, significantly increasing the risk of DVT [1]. *Cushing's syndrome* - **Cushing's syndrome** is characterized by **hypercortisolism**, which leads to a **hypercoagulable state**. - **Elevated cortisol levels** increase circulating procoagulant factors and decrease fibrinolytic activity, predisposing patients to DVT. *Hip & pelvic surgeries* - **Major surgeries**, particularly those involving the **hip and pelvis**, frequently cause **endothelial injury**, blood stasis, and activate the coagulation system [1]. - Patients undergoing these procedures are at a **very high risk for DVT** due to prolonged immobility and surgical trauma [1].

Question 9: Which of the following is the best management for radiation induced occlusive disease of carotid artery?

A. Carotid endarterectomy
B. Low dose aspirin
C. Carotid bypass procedure
D. Carotid angioplasty and stenting (Correct Answer)

Explanation: ***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.

Question 10: In which condition is the Adson test positive?

A. Cervical rib (Correct Answer)
B. Cervical vertebra fracture
C. Superior vena cava syndrome
D. Cervical spondylosis

Explanation: ***Cervical rib*** - A **cervical rib** is an extra rib that arises from the seventh cervical vertebra, which can compress neurovascular structures in the **thoracic outlet**. - The **Adson test** assesses for **thoracic outlet syndrome** by checking for a diminished radial pulse during specific arm movements, indicating vascular compression often caused by a cervical rib. *Cervical vertebra fracture* - A **cervical vertebra fracture** is an injury to one of the bones in the neck and is primarily diagnosed with **imaging studies** like X-rays or CT scans. - While it can cause pain and neurological symptoms, the **Adson test** is not used for its diagnosis, as it does not typically involve neurovascular compression in the same manner as thoracic outlet syndrome. *Superior vena cava syndrome* - **Superior vena cava syndrome** involves obstruction of the **superior vena cava**, leading to swelling of the face, neck, and upper extremities. - It is diagnosed based on clinical presentation and **imaging** (e.g., CT venography) and is unrelated to the **thoracic outlet** or the **Adson test**. *Cervical spondylosis* - **Cervical spondylosis** is a degenerative condition of the cervical spine, leading to **neck pain** and potentially neurological deficits due to spinal cord or nerve root compression. - Diagnosis involves **imaging** (X-rays, MRI) to show degenerative changes; the **Adson test** is not a relevant diagnostic tool for this condition.

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