Download Question 1 : SC

Case 401: MCQs in vascular surgery - 2
Authors and Affiliations
Peter Devitt
Department of Surgery
University of Adelaide
Case Overview
These questions contain suitable study material for those working towards end-of-year examinations.
Learning Objectives
.
Question 1 : SC
Question Information:
A 67-year-old man presents with two episodes of weakness of his left hand. He had been unable to use
the fingers of his left hand for several hours and then the power slowly returned. At the same time he
had experienced blurring of vision in his right eye. He is now symptom-free.
Question:
Which one of the following abnormalities is most likely to be present?
Choice 1: A bruit over the left carotid birfurcation Score : 0
Choice Feedback:
Incorrect.
Choice 2: A bruit over the right carotid birfucation Score : 1
Choice Feedback:
Correct.
Choice 3: An irregularly irregular pulse rate Score : 0
Choice Feedback:
Incorrect.
Choice 4: A pan systolic murmur over the precordium Score : 0
Choice Feedback:
Incorrect.
Choice 5: A mid diastolic murmur over the precordium Score : 0
Choice Feedback:
Incorrect.
Question 2 : SC
Question Information:
A 67-year-old man is being investigated for suspected atherosclerotic disease affecting the right carotid
artery.
Question:
With which one of the following symptoms did he most likely present?
Choice 1: Right amaurosis fugax or transient right handed weakness Score : 0
Choice Feedback:
Incorrect.
Choice 2: Recurrent episodes right handed weakness Score : 0
Choice Feedback:
Incorrect.
Choice 3: Transient weakness of the left hand Score : 1
Choice Feedback:
Correct.
Choice 4: Transient left eye blindness Score : 0
Choice Feedback:
Incorrect.
Choice 5: Drop attacks Score : 0
Choice Feedback:
Incorrect.
Question 3 : SC
Question Information:
A 63-year-old man presents with symptoms suggestive of transient cerebral ischaemia. He also gets
intermittent claudication at 200 metres. He has a forty-pack year smoking history and is being treated
for hypertension. On examination his blood pressure is 140/95 mm Hg and pulse 90/min. He has a soft
systolic bruit over the right carotid bifurcation. A duplex study shows an 80% stenosis at the origin of the
internal carotid artery.
Question:
Which one of the following would be the most likely underlying cause of his symptoms?
Choice 1: A reduction of the cerebral blood flow due to the arterial stenosis Score : 0
Choice Feedback:
Incorrect.
Choice 2: Thrombosis of the stenosed carotid artery followed by the formation of an adequate collateral
circulation Score : 0
Choice Feedback:
Incorrect.
Choice 3: Microembolisation from the atheromatous plaque Score : 1
Choice Feedback:
Correct.
Choice 4: Transient obstruction of the carotid artery Score : 0
Choice Feedback:
Incorrect.
Choice 5: Transient reduction in cardiac output Score : 0
Choice Feedback:
Incorrect.
Question 4 : SC
Question Information:
A 72-year-old man presents with a painless ulcer under his right first metatarsal head. He is not sure
how long the lesion has been present. He has a history of type II diabetes and intermittent claudication
affecting his right leg. He also has varicose veins with evidence of subcutaneous haemosiderin
deposition in both legs.
Question:
Which one of the following is the most likely underlying cause of the ulcer?
Choice 1: Chronic venous hypertension Score : 0
Choice Feedback:
Incorrect.
Choice 2: Arterial insufficiency Score : 0
Choice Feedback:
Incorrect.
Choice 3: Peripheral neuropathy Score : 1
Choice Feedback:
Correct.
Choice 4: Foreign body reaction Score : 0
Choice Feedback:
Incorrect.
Choice 5: Osteomyelitis Score : 0
Choice Feedback:
Incorrect.
Question 5 : SC
Question Information:
A 60-year-old man complains that after walking 80 metres he has to stop because of pain in both
buttocks, thighs and calves. The pain is relieved after three minute's rest. At the time of consultation, all
pulses in both lower limbs are readily palpable.
Question:
Which one of the following is the most likely explanation for his symptoms?
Choice 1: Venous claudication Score : 0
Choice Feedback:
Incorrect.
Choice 2: Spinal canal stenosis Score : 0
Choice Feedback:
Incorrect.
Choice 3: Femoral artery occlusion Score : 0
Choice Feedback:
Incorrect.
Choice 4: Degenerative disease of the hips Score : 0
Choice Feedback:
Incorrect.
Choice 5: Aortic insufficiency Score : 1
Choice Feedback:
Correct.
Question 6 : SC
Question Information:
A 67-year-old man presents to his general medical practitioner with pain in his left leg.
Question:
Which one of the following set of symptoms would be most suggestive of a diagnosis of vascular
occlusive disease?
Choice 1: Sudden onset of pain in the calf Score : 0
Choice Feedback:
Incorrect.
Choice 2: Gradual onset of paralysis in the calf and foot Score : 0
Choice Feedback:
Incorrect.
Choice 3: Pain in the buttocks brought on by walking Score : 0
Choice Feedback:
Incorrect.
Choice 4: Shooting pain down the posterior aspect of the thigh and leg Score : 0
Choice Feedback:
Incorrect.
Choice 5: Nocturnal rest pain partly relieved by leg dependency Score : 1
Choice Feedback:
Correct.
Question 7 : SC
Question Information:
A 64-year-old man presents with a two month history a cramp-like pain in his buttocks. This pain only
appears when he is walking and comes on after several minutes. The pain radiates down the right thigh
and disappears when he rests.
Question:
Which one of the following is the most likely diagnosis?
Choice 1: Stenosis of the right common iliac artery Score : 1
Choice Feedback:
Correct.
Choice 2: Spinal canal stenosis Score : 0
Choice Feedback:
Incorrect.
Choice 3: L4,5 disc compression Score : 0
Choice Feedback:
Incorrect.
Choice 4: Stenosis of the right superficial femoral artery Score : 0
Choice Feedback:
Incorrect.
Choice 5: Osteoarthritis of the right hip Score : 0
Choice Feedback:
Incorrect.
Question 8 : SC
Question Information:
A 63-year-old year old diabetic patient presents with a deep painless ulcer on the plantar surface of the
head of the third metatarsal. The patient is a non-smoker and is not on any medications, apart from oral
hypoglycaemic agents.
Question:
Which one of the following is the most likely cause of the ulcer?
Choice 1: Microvascular disease Score : 0
Choice Feedback:
Incorrect.
Choice 2: Atherosclerosis Score : 0
Choice Feedback:
Incorrect.
Choice 3: Infection Score : 0
Choice Feedback:
Incorrect.
Choice 4: Neuropathy Score : 1
Choice Feedback:
Correct.
Choice 5: Foreign body Score : 0
Choice Feedback:
Incorrect.
Question 9 : SC
Question Information:
A 55-year-old man presents with pain in his right calf when he walks more than 100 metres. The pain
ceases when he rests. He is overweight and has a 30 pack-year smoking history. On examination his
blood pressure is 150/100 mm Hg and his pulse rate is 90 bpm. Both lower limbs and feet are warm
and well perfused. The right femoral pulse is diminished in volume and the right pedal pulse cannot be
felt.
Question:
Which one of the following is the most appropriate initial treatment?
Choice 1: Prescribe a course of a beta blocker Score : 0
Choice Feedback:
Incorrect.
Choice 2: Encourage the patient to persist with his walking Score : 1
Choice Feedback:
Correct.
Choice 3: Start on an oral vasodilator Score : 0
Choice Feedback:
Incorrect.
Choice 4: Refer the patient for consideration of reconstructive surgery Score : 0
Choice Feedback:
Incorrect.
Choice 5: Refer the patient for a chemical lumbar sympathectomy Score : 0
Choice Feedback:
Incorrect.
Question 10 : SC
Question Information:
A 40-year-old shop assistant presents with aching in the legs which she attributes to her varicose veins.
Her symptoms are worse towards the end of the day and are getting worse. On examination she has
bilateral varicosities which appear to be secondary to incompetance of the long saphenous vein at the
sapheno-femoral junction.
Question:
Which one of the following is the most appropriate advice?
Choice 1: She should wear graded compression stockings when standing for any length of time Score : 0
Choice Feedback:
Incorrect.
Choice 2: Venography should be peformed to outline the incompetent veins Score : 0
Choice Feedback:
Incorrect.
Choice 3: Bilateral duplex ultrasound should be done to define the extent of the problem Score : 1
Choice Feedback:
Correct.
Choice 4: The ankle-brachial ratios should be measured Score : 0
Choice Feedback:
Incorrect.
Choice 5: She should take a job that does not require long periods of standing still Score : 0
Choice Feedback:
Incorrect.
Synopsis
.