MCQs Vascular surgery

Which of the following is true with regard to investigation of thoracic aortic

dissection?

Aortography remains the gold standard investigation.

CXR is normal in up to 20% of patients.

Transthoracic echocardiography is an excellent diagnostic imaging

technique.

Aortography has significantly higher accuracy than spiral CT with contrast.

Answer

A 56 yo female with chronic renal failure on haemodialysis presents with

general malaise and nausea. She is febrile with a tender right forearm
fistula. Which of the following is TRUE?

Thrombophlebitis in this setting is a leading cause of death.

Blood cultures should be taken from the fistula site as well as peripherally,
as they have a higher rate of positive culture.

Pseudomonas species are a common cause of fistula infection.

Alternative haemodialysis access is not a priority in this patients initial

management.

Answer

Regarding vascular malformations of the head and neck, which of the

following is TRUE?

Secondary rupture after treatment occurs mostly within the first 3 months.

Hypernatraemia may complicate aneurysmal recovery.

The rebleed rate after rupture is 10% per year.

85% of saccular aneurysms occur in the anterior circulation.

Answer

Which of the following is NOT a recognised cause of carotid or vertebral

artery dissection?

Ehlers-Danlos syndrome

Autosomal dominant polycystic kidneys

Atherosclerosis

1 degree relative with aortic dissection

st

Answer

With regards to ruptured abdominal aortic aneurysm, which of the following

statements is FALSE?

Ruptured AAA is initially misdiagnosed in up to 30% of presentations.

90% are atherosclerotic in origin

50% are palpable

Mortality rate of 45% for those who reach hospital alive.

Answer

Which of the following is TRUE with regard to burns

IV cannula should never be inserted into non burned tissue

Parkland formula uses N/S only

Parkland formula uses N/S and Dextrose

3ml/kg/percent burn + maintenance fluids should be administered over

24hrs

Answer

With regards to acute arterial occlusion, which of the following is FALSE?

Thrombotic arterial occlusion is often associated with other signs of

peripheral vascular disease.

90% of emboli are of cardiac origin.

Irreversible changes begin to occur within 4-6 hours after acute arterial
occlusion

Heparinisation should be administered immediately, except if the patient is

proceeding urgently to theatre.

Answer

With regards to abdominal aneurysms, all statements are true EXCEPT:

Splenic artery aneurysms are the 2

Hepatic artery aneurysms are associated with IVDU

Normovolaemia is the aim of resuscitation

Risk of rupture of AAA outweighs elective surgical risk when >5cm

nd

commonest

Answer

With regards to investigations for SAH, which statement is TRUE:

Absence of xanthochromia excludes SAH

Non contrast CT is >95% sensitive

MRI angiography is less reliable than cerebral angiography

A mild troponin rise is seen in 20%

Answer

10

With regards to sutures for wound closure

Absorbable sutures are made from either collagen or synthetic polymers

The swage of the needle is the best site for holding with the needle holder

Silk sutures have high tensile strength and tissue reactivity

Chromic gut sutures degrade over 3 to 4 weeks

Answer

11

With regards to solutions used for wound cleaning

Normal saline has a mild antiseptic action

Peroxide is bacteriocidal to aerobic bacteria only

The bacteriocidal effect of Povidone Iodine 10% occurs because of

release of free iodine into the wound

Chlorhexidine 0.1% aqueous is bacteriocidal for anaerobic bacteria

Answer

12

Re imaging in thoracic dissection, which of the following is TRUE

Aortography is more sensitive than CT

Low pre test probability and a negative CT has a 10% false negative rate

A negative CT angio excludes a dissection with a high pre test probability

Further imaging should be considered with a high pre test probability and
negative initial imaging

Answer

13

The highest likelihood ratio for a patient with suspected thoracic dissection is

Widened mediastinum on CXR

Tearing or ripping pain

Focal neurological deficit

Sudden chest pain

Answer

14

Real time CXR (ie on the floor) sensitivity for thoracic dissection is
approximately

Over 90%

80%-90%

70%-80%

Less than 60%

Answer

15

In regards to arterial occlusion in limbs

Embolic Cause most likely if prior claudication

Sensorimotor deficit is an indication for urgent management

A non palpable unilateral dorsalis pedis pulse confirms presence of

peripheral vascular disease and increased risk of acute occlusion

A pale, pulseless, paralysed limb is an indication for admission for

anticoagulation

Answer

Answers
1. B
2. E
3. E
4. C

Dunn, p866

5. C

Dunn. 75% are palpable

6. E
7. D

Dunn, Cameron.

8. C

Dunn

9. D

Dunn

10. A

Cameron et al Paediatrics p95-6

11. C

Cameron et al p 110

12. D

A F-aortography can miss intramural haematomas B F-0.2% false

negative, can exclude C F D T E F

Diagnostic accuracy of

Transoesophageal Echocardiography, Helical Computed Tomography, and

Magnetic Resonance Imaging for Suspected Thoracic Aortic Dissection.
Systematic Review and Meta-analysis. Shiga et al, Arch Intern Med 2006:
166: 1350-1356
13. C

A F-LR 2.0 B F-LR 10.8 C T-LR 33 D F-LR 1.6 E F-LR 1.6 Does This
Patient Have an Acute thoracic Dissection? Klompas et al, 2002,JAMA
287(17);2262-72

14. E

Answer-I think E after reading the papers below I think but many dont agree
One study 88.9% but flaws-43 patients, reviewed by radiologists who knew
that approximately half the patients had AD

Remaining papers sensitivity

approximately 50% to 90% but vast majority are unblinded, retrospective

reviews of patients with known dissection, not all studies looked at the same
radiographic findings, and viewed by radiologists not ED physicians
15. B

Dunn A Thrombotic cause much more likely B Needs blood restored

within 3-4 hours C Normal finding in 10% of population D Patient needs
more than anticoagulation (embolectomy, bypass or thrombolysis) E
Alternatives are angiography/plasty, thrombolysis