ALFAISAL UNIVERSITY QUESTIONS

VASCULAR SURGERY
QUESTIONS

3rd - 10th Batch

 [7X] Q1

What is the most common site for AAA?

A. Infra-renal aorta

B. Suprarenal aorta

C. Thoracic
 [7X] Q1

What is the most common site for AAA?

A. Infra-renal aorta

B. Suprarenal aorta

C. Thoracic
 [3X] Q2

What is a common visceral aneurysm?

A. Splenic aneurysm

B. Kidney aneurysm

C. Liver aneurysm
 [3X] Q2

What is a common visceral aneurysm?

A. Splenic aneurysm

B. Kidney aneurysm

C. Liver aneurysm
 [3X] Q3

Where does an aneurysm in the extremities occur most commonly?

A. Popliteal artery

B. Femoral artery

C. Radial artery
 [3X] Q3

Where does an aneurysm in the extremities occur most commonly?

A. Popliteal artery

B. Femoral artery

C. Radial artery
 [3X] Q4

Which of the following statements about popliteal artery aneurysms is/are CORRECT?

A. They are the most common site of peripheral artery aneurysms

B. For a patient with a popliteal aneurysm, risk of an abdominal aortic

aneurysm is approximately 50% x lot
only if bilateral
C. Popliteal artery aneurysms most commonly present with local
symptoms secondary to compression of the adjacent vein or nerve x
D. Arteriography is the most accurate test for the diagnosis of popliteal
artery aneurysm x
 [3X] Q4

Which of the following statements about popliteal artery aneurysms is/are CORRECT?

A. They are the most common site of peripheral artery aneurysms

B. For a patient with a popliteal aneurysm, risk of an abdominal aortic

aneurysm is approximately 50%

C. Popliteal artery aneurysms most commonly present with local

symptoms secondary to compression of the adjacent vein or nerve

D. Arteriography is the most accurate test for the diagnosis of popliteal

artery aneurysm
 [9X] Q5

Patient presenting with abdominal distention and vomiting. CT scan showed a 7 cm

abdominal aortic aneurysm (AAA) and an obstructing sigmoid colon mass. What is the
best management fort this patient?

A. Resect the colon cancer first. Then correct the aneurysm in another
procedure

B. Resect both at the same time

C. Correct the aortic aneurysm and take a biopsy of the sigmoid mass
 [9X] Q5

Patient presenting with abdominal distention and vomiting. CT scan showed a 7 cm

abdominal aortic aneurysm (AAA) and an obstructing sigmoid colon mass. What is the
best management fort this patient?

A. Resect the colon cancer first. Then correct the aneurysm in another
procedure do not mix the surgeries
B. Resect both at the same time

C. Correct the aortic aneurysm and take a biopsy of the sigmoid mass
 [10X] Q6

A 68-year-old man is brought to the emergency department with excruciating back pain that began suddenly 45
minutes ago. The pain is constant and is not exacerbated by sneezing or coughing. He is diaphoretic and has a systolic
blood pressure of sBP 90 mmHg. There is an 8-cm pulsatile mass deep in his epigastrium, above the umbilicus. A chest
x-ray film is unremarkable. Two years ago, he was diagnosed with prostatic cancer and was treated with orchiectomy
and radiation. At that time, his blood pressure was normal, and he had a 6-cm, asymptomatic abdominal aortic
aneurysm for which he declined treatment. Which of the following is the most likely diagnosis?

A. Rupturing abdominal aortic aneurysm (AAA)

B. Dissecting thoracic aortic aneurysm

C. Metastatic tumor to the lumbar spine

D. Fracture of lumbar pedicles with cord compression

E. Herniated disc

F. Metastatic Tumor
 [10X] Q6

A 68-year-old man is brought to the emergency department with excruciating back pain that began suddenly 45
minutes ago. The pain is constant and is not exacerbated by sneezing or coughing. He is diaphoretic and has a systolic
blood pressure of sBP 90 mmHg. There is an 8-cm pulsatile mass deep in his epigastrium, above the umbilicus. A chest
x-ray film is unremarkable. Two years ago, he was diagnosed with prostatic cancer and was treated with orchiectomy
and radiation. At that time, his blood pressure was normal, and he had a 6-cm, asymptomatic abdominal aortic
aneurysm for which he declined treatment. Which of the following is the most likely diagnosis?

A. Rupturing abdominal aortic aneurysm (AAA)

B. Dissecting thoracic aortic aneurysm

C. Metastatic tumor to the lumbar spine

D. Fracture of lumbar pedicles with cord compression

E. Herniated disc

F. Metastatic Tumor
 [3X] Q7

A 65-year old man had a 6 cm epigastric mass along with a prostatic cancer for which he had treated a couple of years
back. The patient now complains of pain radiating towards the back. Appropriate imaging is done that noted for an 8
cm epigastric mass. The patient is hemodynamically unstable with hypotension and tachycardia. What is the most
likely diagnosis?

A. Ruptured AAA

B. Prostate metastasis to the back

 [3X] Q7

A 65-year old man had a 6 cm epigastric mass along with a prostatic cancer for which he had treated a couple of years
back. The patient now complains of pain radiating towards the back. Appropriate imaging is done that noted for an 8
cm epigastric mass. The patient is hemodynamically unstable with hypotension and tachycardia. What is the most
likely diagnosis?

A. Ruptured AAA

B. Prostate metastasis to the back

 [7X] Q8

A history of melena and hematemesis for 1 day. He has a history of coronary artery bypass and
repaired abdominal aortic aneurysm (AAA). Endoscopy was negative. What do you do next:

A. CT with contrast

B. Colonoscopy

C. Angiography

D. RBC tichtanium
 [7X] Q8
fistula
enteric
aorto
p
A history of melena and hematemesis for 1 day. He has a history of coronary artery bypass and
repaired abdominal aortic aneurysm (AAA). Endoscopy was negative. What do you do next:

A. CT with contrast confirmatoryfor AAA or

complications
B. Colonoscopy

C. Angiography

D. RBC tichtanium
 [4X] Q9

A 75 year old man has a sudden onset of anterior chest pain radiating to his back, He has
unequal pulses in carotid, radial & femoral arteries, nonspecific ST elevation on ECG. His blood
pressure is 220/110 mmHg. A chest x-ray shows a widened mediastinum. What is the initial
management?

A. Hypertension control

B. Immediate operation

C. Consult cardiology and restrict fluid

D. IV fluid
 [4X] Q9

A 75 year old man has a sudden onset of anterior chest pain radiating to his back, He has
unequal pulses in carotid, radial & femoral arteries, nonspecific ST elevation on ECG. His blood
pressure is 220/110 mmHg. A chest x-ray shows a widened mediastinum. What is the initial
management?

A. Hypertension control

B. Immediate operation

C. Consult cardiology and restrict fluid

D. IV fluid
 [4X] Q10

A 75 year old man with sudden onset anterior chest pain radiating to neck and back, unequal
pulses, nonspecific ST elevation on ECG. High blood pressure. Was cannulated with two IV.
What is the imaging that you would perform?

A. Transesophageal echocardiogram

B. CT

C. Aortography
 [4X] Q10

A 75 year old man with sudden onset anterior chest pain radiating to neck and back, unequal
pulses, nonspecific ST elevation on ECG. High blood pressure. Was cannulated with two IV.
What is the imaging that you would perform?

A. Transesophageal echocardiogram if unstable but he

stable now
B. CT (the correct answer) always do CT in
dissection it's the Gold Standard if it's
inconclusive then do TEE)

C. Aortography
 [4X] Q11

A man presents with sudden abdominal pain, very low blood pressure, and a pulsating mass
can be felt in the abdomen. What is your management?

A. Give IV fluids in the ER, send to radiology for angiography

to locate site of aneurysm, then take to OR.

B. Send to OR immediately for IV fluids and surgery

C. Give IV fluids in the ER, send to radiology for CT contrast

to locate site of aneurysm, then send to OR

D. Give IV fluids in the ER and send to OR

E. Answer without IV fluid

 [4X] Q11

A man presents with sudden abdominal pain, very low blood pressure, and a pulsating mass
can be felt in the abdomen. What is your management?

A. Give IV fluids in the ER, send to radiology for angiography

to locate site of aneurysm, then take to OR.

B. Send to OR immediately for IV fluids and surgery

C. Give IV fluids in the ER, send to radiology for CT contrast

to locate site of aneurysm, then send to OR

D. Give IV fluids in the ER and send to OR

E. Answer without IV fluid

 [1X] Q12

A man with previous history of CABG after episodes of MI presents with sudden abdominal
pain radiates to back, very low blood pressure, and a pulsating mass can be felt in the
abdomen. What is your management?

A. Emergent CT scan then OR (Not sure could be)

B. Consult cardiology for assessment of operative

risk then immediately to OR

C. Emergent OR with concomitant resuscitation on

the way

D. IV fluids in ED then emergent OR

E. Give IV fluids to increase systolic BP to 100

mmHg then OR
 [1X] Q12

A man with previous history of CABG after episodes of MI presents with sudden abdominal
pain radiates to back, very low blood pressure, and a pulsating mass can be felt in the
abdomen. What is your management?

A. Emergent CT scan then OR (Not sure could be)

B. Consult cardiology for assessment of operative

risk then immediately to OR

C. Emergent OR with concomitant resuscitation on

the way

D. IV fluids in ED then emergent OR

E. Give IV fluids to increase systolic BP to 100

mmHg then OR
 [1X] Q13

A sickle cell patient with pulsating abdominal mass and hypotension. What’s your diagnosis?

A. Spleen infarction

B. Spleen rupture

C. Abdominal aortic aneurysm rupture

 [1X] Q13

A sickle cell patient with pulsating abdominal mass and hypotension. What’s your diagnosis?

A. Spleen infarction

B. Spleen rupture

C. Abdominal aortic aneurysm rupture

 [12X] Q

A 70-year-old man is admitted to the hospital for elective coronary artery bypass grafting
(CABG). On the day of his operation, an asymptomatic carotid bruit is found. Which of the
following is the most appropriate immediate next step in diagnosis?

A. Carotid Duplex scan of the neck (Neck Duplex)

B. CT scan of the head

C. PET scan of the brain

D. MRI of the brain

E. Cerebral angiography
 [12X] Q

A 70-year-old man is admitted to the hospital for elective coronary artery bypass grafting
(CABG). On the day of his operation, an asymptomatic carotid bruit is found. Which of the
following is the most appropriate immediate next step in diagnosis?

A. Carotid Duplex scan of the neck (Neck Duplex) ist line for
symptomatic Cas
B. CT scan of the head

C. PET scan of the brain

carotidangiogram goldstandard
CT angio confirmatory
D. MRI of the brain

E. Cerebral angiography
 [2X] Q14

A Person comes from CABG but asymptomatic carotid bruit found, then asking what to do?

A. Neck duplex

B. Cerebral angiography
 [2X] Q14

A Person comes from CABG but asymptomatic carotid bruit found, then asking what to do?

A. Neck duplex

B. Cerebral angiography
 [1X] Q15

A 65-year-old man complains of having had slurred speech and no motor function or
sensation of his right hand for 15 minutes. A left carotid bruit is heard in the neck. Which of
the following diagnostic studies should be done FIRST?

A. Electroencephalography (EEG)

B. Carotid arteriography

C. Computed tomography (CT) of the brain

D. Carotid duplex scan

 [1X] Q15

A 65-year-old man complains of having had slurred speech and no motor function or
sensation of his right hand for 15 minutes. A left carotid bruit is heard in the neck. Which of
the following diagnostic studies should be done FIRST?

A. Electroencephalography (EEG)

B. Carotid arteriography

C. Computed tomography (CT) of the brain

D. Carotid duplex scan

 [4X] Q16

Describe the appearance of an arterial (ischemic) ulcer?

A. Shallow and painful

B. Deep and painless

C. Punched out and painful

 [4X] Q16

Describe the appearance of an arterial (ischemic) ulcer?

A. Shallow and painful mild

pain venousulcer stasis
dermatitis
aboveanklemedialmalleolus
B. Deep and painless diabeticneuropathiculcer absent
pressurepointsonfoot reflexes
C. Punched out and painful sarterialulcer paleshiny
Tevere coldhairless
Initialstoes
tipsof
 [3X] Q17

A woman with ulcer near the medial malleolus, relieved by leg elevation. She has non-pitting
edema and varicose veins. What is the cause of the leg ulcer?

A. Deep venous insufficiency

B. Superficial varicosities

C. Arterial ulcer

D. Lymphatic obstruction
 [3X] Q17

A woman with ulcer near the medial malleolus, relieved by leg elevation. She has non-pitting
edema and varicose veins. What is the cause of the leg ulcer?

A. Deep venous insufficiency

B. Superficial varicosities

C. Arterial ulcer

D. Lymphatic obstruction
 [4X] Q18

Which of the following statements about thromboangiitis obliterans (Buerger's disease) are
True?

A. The usual cause is smoking

B. The disease affects only young men

C. It affects the large blood vessels of the limbs

D. Life expectancy is limited

 [4X] Q18

Which of the following statements about thromboangiitis obliterans (Buerger's disease) are
True?

A. The usual cause is smoking

B. The disease affects only young men x

elderly
C. It affects the large blood vessels of the limbs
x small
D. Life expectancy is limited
 [6X] Q19

Which of the following does NOT describe intermittent claudication?

A. Is often worse at night

B. Is elicited by reproducible amount of exercise

C. Abates promptly with rest

D. May be an indication for bypass surgery

 [6X] Q19

Which of the following does NOT describe intermittent claudication?

A. Is often worse at night

this is carpaltunnel or critical
limb ischemia
B. Is elicited by reproducible amount of exercise

C. Abates promptly with rest

D. May be an indication for bypass surgery

 [4X] Q20

A man complaining of intermittent claudication after walking for 300 meters. Duplex
ultrasound showed tight stenosis in lower extremity arteries. What is the next step in
management?

A. Advise walking program, exercise and give him

Aspirin

B. Dilatation of clogged vessels

C. Follow-up

D. Perform a bypass

E. Perform an angiogram
 [4X] Q20

A man complaining of intermittent claudication after walking for 300 meters. Duplex
ultrasound showed tight stenosis in lower extremity arteries. What is the next step in
management?
Alwaysmanage
conservatively
A. Advise walking program, exercise and give him
Aspirin

B. Dilatation of clogged vessels

C. Follow-up

D. Perform a bypass

E. Perform an angiogram
 [2X] Q21

A Patient with claudication of 300 meter with tight stenosis in SFA, what is the management:

A. Walking program and aspirin

B. Follow up in 6 months

C. Dilatation and stunting

D. Transluminal angiography

E. Femoropoplitial bypass
 [2X] Q21

A Patient with claudication of 300 meter with tight stenosis in SFA, what is the management:

A. Walking program and aspirin

B. Follow up in 6 months

C. Dilatation and stunting

D. Transluminal angiography

E. Femoropoplitial bypass
 [6X] Q22

What is the best predictor of symptoms of ischemic limb disease?

A. Early Ankle Brachial Index (ABI)

B. Initial walking distance

C. Proximal disease

D. Multiple risk factors

E. Advancing age
 [6X] Q22

What is the best predictor of symptoms of ischemic limb disease?

A. Early Ankle Brachial Index (ABI)

B. Initial walking distance

C. Proximal disease

D. Multiple risk factors

E. Advancing age
 [1X] Q23

What is the best predictor peripheral arterial disease progression?

A. Ankle Brachial Index (ABI)

B. Initial walking distance

C. Proximal disease

D. Multiple risk factors

E. Advanced age
 [1X] Q23

What is the best predictor peripheral arterial disease progression?

compartment syndrome sp's

A. Ankle Brachial Index (ABI)
1 Pain
2 Parasthesia B. Initial walking distance
3 Pallor and acapillaryrefill
4Pulselessness lastsign C. Proximal disease
s Poikilotherm a
D. Multiple risk factors
Acutelimbischemia All
1 Pain E. Advanced age
2 Parasthesia mostimp
3 Pallor a refill
4Pulselessness
S Poikilothermic
6 paralysis mostimp
 [1X] Q24

A patient who is having severe pain on his leg, it was progressive hurting him when walking
and now hurting him even when he sleeps and he makes it in a setting position to decrease the
pain, what is the patient most likely suffering from

A. Critical limb ischemia

B. Compartment syndrome

C. GBS
 [1X] Q24

A patient who is having severe pain on his leg, it was progressive hurting him when walking
and now hurting him even when he sleeps and he makes it in a setting position to decrease the
pain, what is the patient most likely suffering from

A. Critical limb ischemia

B. Compartment syndrome

C. GBS
 [1X] Q25

What is the feared sequelae of having 1 episode of DVT:

A. PE

B. Varicose veins
 [1X] Q25

What is the feared sequelae of having 1 episode of DVT:

A. PE

B. Varicose veins
 [3X] Q26

In patients who develop a documented episode of deep venous thrombosis (DVT) the most
significant long-term sequelae is?

A. Development of stasis Ulcer.

B. Claudication

C. Recurrent foot infections.

D. Pulmonary embolization (PE)

E. Diminished arterial perfusion

 [3X] Q26

In patients who develop a documented episode of deep venous thrombosis (DVT) the most
significant long-term sequelae is?

A. Development of stasis Ulcer.

A venousinsuff
B. Claudication

C. Recurrent foot infections.

D. Pulmonary embolization (PE)

E. Diminished arterial perfusion

 [3X] Q27

In DVT, the most common long term sequela is?

A. Post-thrombotic syndrome

B. Pulmonary Embolism

C. Right-sided heart failure

 [3X] Q27

In DVT, the most common long term sequela is?

A. Post-thrombotic syndrome chronic venous insufficiency

B. Pulmonary Embolism

C. Right-sided heart failure

 [3X] Q28

In a patient presented with sudden onset leg pain, it was pale, cold with no pulse. How do you
treat this patient?

A. Thromboembolectomy

B. Four compartment fasciotomy

 [3X] Q28

In a patient presented with sudden onset leg pain, it was pale, cold with no pulse. How do you
treat this patient? acute limbischemia

A. Thromboembolectomy if 6 hours
if ca hours give in Heparin
B. Four compartment fasciotomy for compartmentsyndrome
 [2X] Q30

Patient with history of chronic Atrial Fib, MI 12 months ago. He had an acute limb ischemia.
One leg was cold, pulseless. Acute limb ischemia. What is the management?

A. Thromboembolectomy

B. Arteriogram

C. Artery Bypass

D. Anticoagulation followed by streptokinase

E. Anticoagulation only
 [2X] Q30

Patient with history of chronic Atrial Fib, MI 12 months ago. He had an acute limb ischemia.
One leg was cold, pulseless. Acute limb ischemia. What is the management?

A. Thromboembolectomy

B. Arteriogram

C. Artery Bypass

D. Anticoagulation followed by streptokinase for DVT

E. Anticoagulation only
 [2X] Q31

Patient with history of chronic Atrial Fib, MI 12 months ago. He had an acute limb ischemia.
One leg was cold, pulseless. Acute limb ischemia. How to prevent reoccurrence for long term?

A. Anticoagulants

B. IVC filter

C. Exercise

D. Two other options with grafts

 [2X] Q31

Patient with history of chronic Atrial Fib, MI 12 months ago. He had an acute limb ischemia.
One leg was cold, pulseless. Acute limb ischemia. How to prevent reoccurrence for long term?

A. Anticoagulants

B. IVC filter

C. Exercise

D. Two other options with grafts

 [3X] Q32

A 65 male with history of atrial fibrillation & had myocardial infarction recently developed
sudden pain in lower extremity for 2 hours. What’s the long-term management?

A. Thromboembolectomy

B. Arteriogram

C. Artery Bypass
 [3X] Q32

A 65 male with history of atrial fibrillation & had myocardial infarction recently developed
sudden pain in lower extremity for 2 hours. What’s the long-term management?

A. Thromboembolectomy

B. Arteriogram

C. Artery Bypass
 [3X] Q33

A patient came with 2 hours of sudden lower limb pain, cold pale limb on one side, no signs of
ischemia on the contralateral side, what is the acute management?

A. Streptokinase

B. Warfarin
 [3X] Q33

A patient came with 2 hours of sudden lower limb pain, cold pale limb on one side, no signs of
ischemia on the contralateral side, what is the acute management?

A. Streptokinase or IV Heparin
B. Warfarin
 [2X] Q34

A A 65 male with history of atrial fibrillation & had myocardial infarction recently developed
sudden pain in lower extremity for 2 hours. What’s the first step of treatment?

A. Streptokinase

B. Heparin

C. Warfarin
 [2X] Q34

A A 65 male with history of atrial fibrillation & had myocardial infarction recently developed
sudden pain in lower extremity for 2 hours. What’s the first step of treatment?

A. Streptokinase

B. Heparin

C. Warfarin
 [1X] Q35

After a stroke, a lady became bed ridden, she developed a painful swelling in the leg 7 days
after, what is the diagnosis?

A. DVT

B. Compartment Syndrome
 [1X] Q35

After a stroke, a lady became bed ridden, she developed a painful swelling in the leg 7 days
after, what is the diagnosis?

A. DVT

B. Compartment Syndrome
 [1X] Q36

An 80-year-old woman presents with a painful swollen right leg 6 days after admission for a left
hemispheric stroke which has left her bed-bound?

A. DVT

B. Compartment Syndrome
 [1X] Q36

An 80-year-old woman presents with a painful swollen right leg 6 days after admission for a left
hemispheric stroke which has left her bed-bound?

A. DVT

B. Compartment Syndrome
 [3X] Q37

Following colon cancer resection, the patient begins complaining of pain around the calves
and you noticed in the lower extremity. What should you be worried about?

A. DVT

B. Compartment Syndrome
 [3X] Q37

Following colon cancer resection, the patient begins complaining of pain around the calves
and you noticed in the lower extremity. What should you be worried about?

A. DVT

B. Compartment Syndrome
 [3X] Q38

Question about an obese patient that underwent a hip replacement surgery, he felt discomfort
in his lower limb, which of these symptoms will you be concerned of?

A. Sudden chest pain

B. Leg warmth

C. Leg swelling
 [3X] Q38

Question about an obese patient that underwent a hip replacement surgery, he felt discomfort
in his lower limb, which of these symptoms will you be concerned of?

A. Sudden chest pain

B. Leg warmth

C. Leg swelling
 [7X] Q39

An 8 weeks Pregnant woman with tender swelling leg diagnosed with DVT (pain & swelling),
management?

A. Low Molecular Weight Heparin (LMWH)

B. IV Heparin

C. Observe

D. Warfarin

E. Abort pregnancy and start treatment

 [7X] Q39

0
An 8 weeks Pregnant woman with tender swelling leg diagnosed with DVT (pain & swelling),
management?

A. Low Molecular Weight Heparin (LMWH)

B. IV Heparin

C. Observe

D. Warfarin

E. Abort pregnancy and start treatment

 [2X] Q40

A case of a Pregnant lady with DVT, what do you prescribe for her?

A. LMWH

B. Warfarin
 [2X] Q40

A case of a Pregnant lady with DVT, what do you prescribe for her?

A. LMWH

B. Warfarin
 [2X] Q41

A lady with Pain in the leg that is improved on elevation, on walking and on massage:

A. Deep Venous Insufficiency

B. Claudication

C. Impotent perforator veins

 [2X] Q41

A lady with Pain in the leg that is improved on elevation, on walking and on massage:

A. Deep Venous Insufficiency

B. Claudication

C. Impotent perforator veins

 [2X] Q42

A Painless and progressive leg swelling (Unilateral) for 1 year, what is the diagnosis:

A. Lymphedema

B. Compartment syndrome

C. DVT
 [2X] Q42

A Painless and progressive leg swelling (Unilateral) for 1 year, what is the diagnosis:

A. Lymphedema

B. Compartment syndrome

C. DVT
 [2X] Q43

A 30-year-old woman presents with a 1-year history of progressive painless swelling in herleft
leg. There is no history of DVT or injury.

A. Lymphoedema

B. Calf muscle tear

C. Compartment syndrome

D. Congestive cardiac failure

 [2X] Q43

A 30-year-old woman presents with a 1-year history of progressive painless swelling in herleft
leg. There is no history of DVT or injury.

A. Lymphoedema

B. Calf muscle tear

C. Compartment syndrome

D. Congestive cardiac failure

 [2X] Q44

Which of the following statements regarding lymphoedema are True?

A. Early treatment is usually successful

B. Primary lymphoedema occurs in more than 5

per cent or the population
x
C. Early treatment includes surgical drainage x

D. Fluid is relatively low in protein in lymphoedema

x
E. Lymphoedema often involves the muscle
x
compartments
 [2X] Q44

Which of the following statements regarding lymphoedema are True?

A. Early treatment is usually successful

B. Primary lymphoedema occurs in more than 5

per cent or the population false
C. Early treatment includes surgical drainage
false
D. Fluid is relatively low in protein in lymphoedema
false
E. Lymphoedema often involves the muscle
compartments
false
 [2X] Q45

A woman came back after a laparoscopic cholecystectomy for follow up and the doctor
noticed she had a hematoma on every incisional site. She does not take any medications aside
from ibuprofen. Before her operation she was given one dose of heparin. Here platelet levels
were low. What is the cause of this?

A. Heparin induced thrombocytopenia

B. Inhibition of COX

C. Von willebrand disease

 [2X] Q45

A woman came back after a laparoscopic cholecystectomy for follow up and the doctor
noticed she had a hematoma on every incisional site. She does not take any medications aside
from ibuprofen. Before her operation she was given one dose of heparin. Here platelet levels
were low. What is the cause of this?

A. Heparin induced thrombocytopenia

B. Inhibition of COX

C. Von willebrand disease

 [2X] Q56

A 46 year-old woman post laparoscopic cholecystectomy develops hematoma at all sites of

incision within 2 hours of the procedure. She has history of DVT and was relieved of it but
does not take any medication for it. She was given LMWH and stockings before the procedure.
What is your diagnosis?

A. Less mechanical hemostasis

B. Deficiency in factor III

C. Deficiency in factor VIII

D. Deficiency in factor XII

 [2X] Q56

A 46 year-old woman post laparoscopic cholecystectomy develops hematoma at all sites of

incision within 2 hours of the procedure. She has history of DVT and was relieved of it but
does not take any medication for it. She was given LMWH and stockings before the procedure.
What is your diagnosis?

A. Less mechanical hemostasis

B. Deficiency in factor III

C. Deficiency in factor VIII

D. Deficiency in factor XII

 [2X] Q47

A Which of the following is NOT true regarding lymph vessels?

A. Has endothelium

B. Has valves

C. Has smooth muscle

D. Lymphatics have connection with arteries in the

capillary bed
 [2X] Q47

A Which of the following is NOT true regarding lymph vessels?

A. Has endothelium
they do
B. Has valves
theydo
C. Has smooth muscle
they do
D. Lymphatics have connection with arteries in the
capillary bed
 [2X] Q48

A Patient with history of chronic atrial fibrillation and MI 12 months ago, he had an acute limb
ischemia and one limb was cold and pulseless. What is the acute management for this?

A. IV Heparin

B. IV Warfarin

C. Aspirin
 [2X] Q48

A Patient with history of chronic atrial fibrillation and MI 12 months ago, he had an acute limb
ischemia and one limb was cold and pulseless. What is the acute management for this?

A. IV Heparin

B. IV Warfarin

C. Aspirin
 [1X] Q49

A man with previous of CABG, after episodes of MI presents with sudden abdominal pain that
radiates to the back, has low BP and a pulsating abdominal pass, what is your management?

A. Emergent CT scan then take to OR

B. Consult cardiology for assessment of operative risk then take to OR

C. Emergent OR

D. IV fluids in the emergency then take to OR

E. Give IV fluids to increase systolic BP to 100 mmHg then take to OR

 [1X] Q49

A man with previous of CABG, after episodes of MI presents with sudden abdominal pain that
radiates to the back, has low BP and a pulsating abdominal pass, what is your management?

A. Emergent CT scan then take to OR

B. Consult cardiology for assessment of operative risk then take to OR

C. Emergent OR

D. IV fluids in the emergency then take to OR

E. Give IV fluids to increase systolic BP to 100 mmHg then take to OR

 [1X] Q50

A 65 year old man had a 6 cm epigastric mass along with a prostatic cancer for which he had
treated a couple of years back. The patient now complains of pan radiating towards the back.
Appropriate imaging is done that noted for an 8 cm epigastric mass. The patient is
hemodynamically unstable with hypotension and tachycardia. What is the most likely
diagnosis?

A. Ruptured AAA
 [1X] Q52

A woman with ulcer near the medial malleolus, relieved by leg elevation. She has non-pitting
edema and varicose veins. What is the cause of the leg ulcer?

A. Deep venous insufficiency

B. Superficial varicosities

C. Arterial ulcer

D. Lymphatic obstruction
 [1X] Q52

A woman with ulcer near the medial malleolus, relieved by leg elevation. She has non-pitting
edema and varicose veins. What is the cause of the leg ulcer?

A. Deep venous insufficiency

B. Superficial varicosities

C. Arterial ulcer

D. Lymphatic obstruction
 [1X] Q53

An elderly patient post-op (removal of some cancer), had symptoms of P.E (SoB, chest pain)
what is the diagnostic tool for this?

A. V/Q Scan

B. CT Angiogram

C. Cardiac echo

D. ECG
 [1X] Q53

An elderly patient post-op (removal of some cancer), had symptoms of P.E (SoB, chest pain)
what is the diagnostic tool for this?

A. V/Q Scan

B. CT Angiogram

C. Cardiac echo

D. ECG
 [1X] Q54

A scenario about a man who has sickle cell disease presents with tender abdominal mass but
it’s not pulsating, what is the likely diagnosis?

A. Splenic infarction

B. Ruptured AAA

C. Splenic vein thrombosis

 [1X] Q54

A scenario about a man who has sickle cell disease presents with tender abdominal mass but
it’s not pulsating, what is the likely diagnosis?
not AAA
A. Splenic infarction

B. Ruptured AAA

C. Splenic vein thrombosis

 [1X] Q55

At which vertebral level is the bifurcation of common carotid artery?

A. C4

B. T4

C. L4

D. C3
 [1X] Q55

At which vertebral level is the bifurcation of common carotid artery?

A. C4

B. T4

C. L4

D. C3
 [1X] Q57

A 65 year old male with a known large abdominal aortic aneurysm who has regular interval
follow up presents with acute abdominal pain and altered mental status. Temperature is 37.7
C, heart rate 115, BP 88/56, Hemoglobin is 7.6, serum bicarbonate 18 and creatinine 1.3. What
is the most appropriate next step?

A. Admission to ICU for resuscitation and intubation under

anaesthesia

B. CT scan with IV contrast to delineate aneurysm anatomy

C. Placement of central lines and aggressive IV fluid

D. Transesophageal US evaluation of aneurysm

E. Urgent aneurysm repair

 [1X] Q57

A 65 year old male with a known large abdominal aortic aneurysm who has regular interval
follow up presents with acute abdominal pain and altered mental status. Temperature is 37.7
C, heart rate 115, BP 88/56, Hemoglobin is 7.6, serum bicarbonate 18 and creatinine 1.3. What
is the most appropriate next step?

A. Admission to ICU for resuscitation and intubation under

anaesthesia

B. CT scan with IV contrast to delineate aneurysm anatomy

C. Placement of central lines and aggressive IV fluid

D. Transesophageal US evaluation of aneurysm

E. Urgent aneurysm repair

 [1X] Q58

During a routine office visit, a 62-year-old male is found to have a pulsatile non-tender mass above his
umbilicus. His medical history is significant for hypertension, chronic renal insufficiency, myocardial
infarction, and peripheral vascular disease. He quit smoking 10 years ago. On physical examination, his blood
pressure is 160/90 mmHg and pulse is 76/min. Laboratory analyses reveal a serum creatinine of 2.0 mg/dL.
Which of the following is the most appropriate next step in evaluating this patient’s abdominal mass?

A. Abdominal CT scan with contrast

x
B. Abdominal MRI

C. Abdominal Ultrasound

D. Abdominal Angiogram

E. Emergency exploratory laparotomy

F. Abdominal and pelvic CT scan

G. Fecal occult blood test

 [1X] Q58

During a routine office visit, a 62-year-old male is found to have a pulsatile non-tender mass above his
umbilicus. His medical history is significant for hypertension, chronic renal insufficiency, myocardial
infarction, and peripheral vascular disease. He quit smoking 10 years ago. On physical examination, his blood
pressure is 160/90 mmHg and pulse is 76/min. Laboratory analyses reveal a serum creatinine of 2.0 mg/dL.
Which of the following is the most appropriate next step in evaluating this patient’s abdominal mass?

A. Abdominal CT scan with contrast

B. Abdominal MRI

C. Abdominal Ultrasound
things havestopped makingsense
D. Abdominal Angiogram

E. Emergency exploratory laparotomy

F. Abdominal and pelvic CT scan

G. Fecal occult blood test

 [1X] Q59

A 67-year-old woman comes to the physician because of an 8-month history of increasing bilateral calf pain with walking. She initially had
pain occasionally after a long walk, during the past 4 months, she has had pain after walking 300 feet on level ground or climbing one flight
of stairs. The pain is relieved with rest. She has hypertension and hypercholesterolemia. Current medications include hydrochlorothiazide,
metoprolol and simvastatin. She smoked one pack of cigarettes daily for 30 years but stopped 1 year ago. Her pulse is 66/min, respirations
are 14/min, and blood pressure is 132/81 mmHg. Cardiopulmonary examination shows no abnormalities. Carotid, femoral, and dorsalis pedis
pulses are decreased bilaterally. A soft femoral bruit is heard during systole bilaterally. There is no peripheral edema. Her serum electrolyte
concentrations are within the reference range. Her serum urea nitrogen concentration is 28 mg/dl, and serum creatinine concentration is
2.1mg/dL. Which of the following is the most appropriate next step in diagnosis?

A. Arteriography of the lower extremities

B. Duplex ultrasonography of the lower extremity

C. CT scan of lumbosacral spine

D. Myelography of lumbar spine

E. Determination of ankle brachial indices

 [1X] Q59

A 67-year-old woman comes to the physician because of an 8-month history of increasing bilateral calf pain with walking. She initially had
pain occasionally after a long walk, during the past 4 months, she has had pain after walking 300 feet on level ground or climbing one flight
of stairs. The pain is relieved with rest. She has hypertension and hypercholesterolemia. Current medications include hydrochlorothiazide,
metoprolol and simvastatin. She smoked one pack of cigarettes daily for 30 years but stopped 1 year ago. Her pulse is 66/min, respirations
are 14/min, and blood pressure is 132/81 mmHg. Cardiopulmonary examination shows no abnormalities. Carotid, femoral, and dorsalis pedis
pulses are decreased bilaterally. A soft femoral bruit is heard during systole bilaterally. There is no peripheral edema. Her serum electrolyte
concentrations are within the reference range. Her serum urea nitrogen concentration is 28 mg/dl, and serum creatinine concentration is
2.1mg/dL. Which of the following is the most appropriate next step in diagnosis?

A. Arteriography of the lower extremities

B. Duplex ultrasonography of the lower extremity

C. CT scan of lumbosacral spine

D. Myelography of lumbar spine

E. Determination of ankle brachial indices mostimportantforintermittent

claudication
 [1X] Q60

A 50 year old diabetic presented with 3x5cm chronic ulcer in the heel of his left foot. There
was exposed calcaneus. What is the definitive management?

A. Coverage of ulcer with a flap

B. Abx and follow up

 [1X] Q60

A 50 year old diabetic presented with 3x5cm chronic ulcer in the heel of his left foot. There
was exposed calcaneus. What is the definitive management?

A. Coverage of ulcer with a flap

B. Abx and follow up

 [1X] Q62

A Patient who had a trauma, was vitally stable and had widened mediastinum on CXR, what is
the best test to confirm this diagnosis?

A. CT with contrast

B. CT without contrast
 [1X] Q62

A Patient who had a trauma, was vitally stable and had widened mediastinum on CXR, what is
the best test to confirm this diagnosis?

A. CT with contrast aortic dissectiongoldstandard

B. CT without contrast
 [1X] Q63

Which of the choices is an indication for surgery in a patient with an abdominal aortic
aneurysm?

A. If the AAA increases by >10 mm in 12 months

B. If the AAA increases by >10 mm in 6 months

C. If the patient is a woman

D. If the AAA is 4cm

 [1X] Q63

Which of the choices is an indication for surgery in a patient with an abdominal aortic
aneurysm?

A. If the AAA increases by >10 mm in 12 months

B. If the AAA increases by >10 mm in 6 months

C. If the patient is a woman

D. If the AAA is 4cm

 [1X] Q65

What is the most significant long term complication of dvt?

A. Stasis Ulcer

B. PE
 [1X] Q65

What is the most significant long term complication of dvt?

A. Stasis Ulcer

B. PE
 [1X] Q67

A woman in the second month of pregnancy developed dvt that was confirmed by doppler.
How to manage?

A. Start her on LMWH

B. Start her on warfarin

C. She should not be anticoagulated

D. Watch and monitor

E. Terminate pregnancy and give proper anticoagulation

 [1X] Q67

A woman in the second month of pregnancy developed dvt that was confirmed by doppler.
How to manage?

A. Start her on LMWH

B. Start her on warfarin

C. She should not be anticoagulated

D. Watch and monitor

E. Terminate pregnancy and give proper anticoagulation

 [1X] Q69

Most common presentation of PE

A. Sinus tachycardia

B. Sinus bradycardia
 [1X] Q69

Most common presentation of PE

A. Sinus tachycardia

B. Sinus bradycardia