Vascular Surgery

Question 1

6Ps of Acute Limb Ischemia

Answer 1

Pain (sudden)
Pallor
Pulselessness
Paralysis
Paresthesia
Perishing cold

Question 2

Likely cause of acute limb ischemia if it is coupled with arterial fibrillation

Answer 2

Embolus

Question 3

Painless, pulsatile mass

Answer 3

Aneurysm

Question 4

Painless, pulsatile mass in the groin

Answer 4

Femoral artery aneurysm

Question 5

Patient with renal cell carcinoma presents with bluish, bag of worms sensation, dragging pain or painless scrotal swelling

Answer 5

Varicocele

Rx: Reassure or surgery if pain is persistent

Question 6

Patient with renal cell carcinoma presents with pitting non-tender bipedal edema, dilated veins in the lower abdomen

Answer 6

Inferior vena cava syndrome

Question 7

Ulcer on the toes or plantar surface of the foot + deep and punched out + surrounded by callous + reduced sensation
Diagnosis?
Causes?
Rx?

Answer 7

Neuropathic “diabetic” ulcer
Causes: DM, pressure points in the bottom of the feet
Rx: remove pressure, manage DM, diabetic foot care

Question 8

Ulcer on toes, feet, lateral malleolus - irregular, deep and necrotic + unilateral absent or weak pulses + very painfiul + prolonged CRT
Diagnosis?
Risk Factors?
Rx?

Answer 8

Arterial “ischemic” Ulcer

RF: peripheral arterial disease (HTN, smokin, DM)

Question 9

Young man (25-45) + smoking + extremity ischemia (intermittent claudication, rest pain, ischemic ulcer) + superficial thrombophlebitis + Raynaud’s phenomenon

Answer 9

Buerger’s disease (thromboangiitis obliterans)

Question 10

66-year old smoker and hypertensive + sudden onset weakness of the right arm + dysphasia + resolved within 24 hours
Likely diagnosis?
Next modality?

Answer 10

Transient Ischemic Attack

Carotid doppler scanning

Question 11

When to perform carotid endarterectomy?

Answer 11

For male: ICA stenosis > 50%

FOr female: ICA stenosis > 70%

Question 12

An elderly with recurrent episodes of TIA and loss of consciousness

Answer 12

Carotid artery stenosis

Question 13

42-year old man below the right clavicle with a pulsatile mass just below the right clavicle. (+) shooting pain and reduced sensation down the right arm; right hand is a bit cold and shows discoloration

Answer 13

Thoracic outlet syndrome

Question 14

X-ray finding seen in aortic dissection

Answer 14

Widening of the mediastinum

Question 15

First line investigation for peripheral arterial disease

Answer 15

Duplex ultrasound

Question 16

Initial step in management of a severely hypotensive patient who is highly suspicious for AAA

Answer 16

Fluid resuscitation (pNSS)

Question 17

Most appropriate initial investigation for AAA

Answer 17

ultrasound

Question 18

Deterioration of renal function tests after initiation of ACEi in a hypertensive patient?

Answer 18

Bilateral renal artery stenosis

Question 19

What anti-hypertensive medication is contraindicated in a patient with bilateral renal artery stenosis?

Answer 19

ACE inhibitors

Question 20

Associated with Turner’s syndrome, berry aneurysms and neurofibromatosis, patient may present with mid-systolic murmur, nosebleeds, headaches and LL pain on exertion.

Answer 20

Coarctation of the aorta

Question 21

Major cause of aortic aneurysm

Answer 21

Atherosclerosis

Question 22

Major cause of aortic dissection

Answer 22

Hypertension

Question 23

Acutely painful, pale, paralysed, pulseless in a smoker with atrial fibrillation

Answer 23

Acute limb ischemia

Question 24

Calf pain, relieved by rest with calf non-healing ulcer: cold and pulseless peripheries, with or without history of DM and HTN

Answer 24

peripheral arterial disease

Question 25

Around 40 year old (25-45) male, smoker, calf pain relieved by rest, reduced distal pulses

Answer 25

Buerger’s disease

Question 26

52-year old woman with disseminated renal carcinoma, presented with dilated abdominal veins and pitting edema of the right leg up to the groin. What’s the cause of the leg swelling?

Answer 26

IVC syndrome or IVC obstruction

Question 27

Patient developed unilateral limb swelling 6 days post-CS after prolonged obstructed labor. Left feet is cold, mottled up to the inguinal crease. Where is the occlusion?

Answer 27

Femoral artery

Question 28

Track the artery from common iliac down to the dorsalis pedis

Answer 28

Common iliac > External iliac > common femoral > superficial femoral > popliteal > posterior tibial > dorsalis pedis

Question 29

Single most appropriate treatment for a post-stroke patient with DVT

Answer 29

Percutaneous mechanical thrombectomy