MCQs Vascular surgery1 Which of the following is true with regard to investigation of thoracic aortic dissection? A Aortography remains the gold standard investigation. B CXR is normal in up to 20% of patients. C Transthoracic echocardiography is an excellent diagnostic imaging technique. D Aortography has significantly higher accuracy than spiral CT with contrast. Answer 2 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? A Thrombophlebitis in this setting is a leading cause of death. B Blood cultures should be taken from the fistula site as well as peripherally, as they have a higher rate of positive culture. C Pseudomonas species are a common cause of fistula infection. D Alternative haemodialysis access is not a priority in this patients initial management. Answer 3 Regarding vascular malformations of the head and neck, which of the following is TRUE? A Secondary rupture after treatment occurs mostly within the first 3 months. B Hypernatraemia may complicate aneurysmal recovery. C The rebleed rate after rupture is 10% per year. D 85% of saccular aneurysms occur in the anterior circulation. Answer 4 Which of the following is NOT a recognised cause of carotid or vertebral artery dissection? A Ehlers-Danlos syndrome B Autosomal dominant polycystic kidneys C Atherosclerosis D 1 degree relative with aortic dissection st Answer 5 With regards to ruptured abdominal aortic aneurysm. B 90% are atherosclerotic in origin C 50% are palpable D Mortality rate of 45% for those who reach hospital alive. Answer 6 Which of the following is TRUE with regard to burns A IV cannula should never be inserted into non burned tissue B Parkland formula uses N/S only C Parkland formula uses N/S and Dextrose D 3ml/kg/percent burn + maintenance fluids should be administered over 24hrs Answer . which of the following statements is FALSE? A Ruptured AAA is initially misdiagnosed in up to 30% of presentations. 7 With regards to acute arterial occlusion. which of the following is FALSE? A Thrombotic arterial occlusion is often associated with other signs of peripheral vascular disease. except if the patient is proceeding urgently to theatre. C Irreversible changes begin to occur within 4-6 hours after acute arterial occlusion D Heparinisation should be administered immediately. B 90% of emboli are of cardiac origin. Answer 8 With regards to abdominal aneurysms. which statement is TRUE: A Absence of xanthochromia excludes SAH B Non contrast CT is >95% sensitive C MRI angiography is less reliable than cerebral angiography D A mild troponin rise is seen in 20% Answer . all statements are true EXCEPT: A Splenic artery aneurysms are the 2 B Hepatic artery aneurysms are associated with IVDU C Normovolaemia is the aim of resuscitation D Risk of rupture of AAA outweighs elective surgical risk when >5cm nd commonest Answer 9 With regards to investigations for SAH. 1% aqueous is bacteriocidal for anaerobic bacteria Answer 12 Re imaging in thoracic dissection. which of the following is TRUE A Aortography is more sensitive than CT B Low pre test probability and a negative CT has a 10% false negative rate C A negative CT angio excludes a dissection with a high pre test probability D 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 A Widened mediastinum on CXR B Tearing or ripping pain C Focal neurological deficit D Sudden chest pain Answer .10 With regards to sutures for wound closure A Absorbable sutures are made from either collagen or synthetic polymers B The swage of the needle is the best site for holding with the needle holder C Silk sutures have high tensile strength and tissue reactivity D Chromic gut sutures degrade over 3 to 4 weeks Answer 11 With regards to solutions used for wound cleaning A Normal saline has a mild antiseptic action B Peroxide is bacteriocidal to aerobic bacteria only C The bacteriocidal effect of Povidone – Iodine 10% occurs because of release of free iodine into the wound D Chlorhexidine 0. 14 Real time CXR (ie on the floor) sensitivity for thoracic dissection is approximately A Over 90% B 80%-90% C 70%-80% D Less than 60% Answer 15 In regards to arterial occlusion in limbs A Embolic Cause most likely if prior claudication B Sensorimotor deficit is an indication for urgent management C A non palpable unilateral dorsalis pedis pulse confirms presence of peripheral vascular disease and increased risk of acute occlusion D A pale. paralysed limb is an indication for admission for anticoagulation Answer . pulseless. Cameron. C A F-LR 2.JAMA 287(17). reviewed by radiologists who knew that approximately half the patients had AD Remaining papers sensitivity approximately 50% to 90% but vast majority are unblinded. and Magnetic Resonance Imaging for Suspected Thoracic Aortic Dissection. D A F-aortography can miss intramural haematomas B F-0. C Dunn. E 3.9% but flaws-43 patients. C Cameron et al p 110 12. Helical Computed Tomography. p866 5. and viewed by radiologists not ED physicians 15. Shiga et al.6 E F-LR 1. D Dunn 10. D Dunn. 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.6 Does This Patient Have an Acute thoracic Dissection? Klompas et al.Answers 1. E Answer-I think E after reading the papers below I think but many don’t agree One study 88. retrospective reviews of patients with known dissection. C Dunn 9. Systematic Review and Meta-analysis. C Dunn. not all studies looked at the same radiographic findings. B 2.8 C T-LR 33 D F-LR 1.0 B F-LR 10. E 4. Arch Intern Med 2006: 166: 1350-1356 13. 2002. 8. can exclude C F D T E F Diagnostic accuracy of Transoesophageal Echocardiography. A Cameron et al Paediatrics p95-6 11. E 7.2262-72 14.2% false negative. bypass or thrombolysis) E – Alternatives are angiography/plasty. 75% are palpable 6. thrombolysis .