Vascular Surgery 🩸💉

A 70 year old woman had two episodes of painless visual loss in the left eye and slurred speech. The episodes lasted 15 to 20 minutes and then completely resolved. Her blood pressure and cholesterol are controlled with a calcium channel blocker and statin respectively. She denies chest pain, dyspnea, weakness and numbness. On examination, the patient seems healthy and physical examination is unremarkable. ECG shows sinus rhythm without any signs of ischemia. Laboratory studies and CT scan of the head are normal. Carotid duplex ultrasound reveals internal carotid stenosis of 80% on the left. What is the best management for this patient?

A 76 year old man suddenly collapsed and died. At post mortem exam, a retroperitoneal haematoma was found due to ruptured abdominal aortic aneurysm. What is the SINGLE most likely underlying aetiology of the aortic aneurysm?

A 28 year old construction worker was admitted for pain in his right calf while at work which has been increasing over the last 3 months. There is no history of hypertension or diabetes but he is a smoker. On examination, loss of posterior tibial and dorsalis pedis pulsation was noticed along with a non-healing ulcer at the base of the right 1st metatarsophalangeal joint. What is the SINGLE most probable diagnosis?

A 31 year old woman with confirmed disseminated renal carcinoma presents with bilateral, pitting, non-tender leg swelling up to the groin. She was also found to have dilated lower abdominal veins. What is the SINGLE most likely cause for her symptoms?

A 59 year old smoker presents with an acutely painful right hand. She has noticed swelling and discolouration on the fingers. The pain started 3 days ago. She has no radial pulse. The fingers are cold and painful. A picture can be seen below:

What is the SINGLE most likely diagnosis?

A 62 year old man has a painless swelling on his groin. On examination, the mass lies below the midpoint of the right inguinal ligament and is pulsatile. What is the SINGLE most likely diagnosis?

A 27 year old man complains attends the GP surgery with complains of headaches, nose bleeds and pain in the lower limbs on exertion. A radio-femoral delay was noted on examination. His legs are cold and his femoral pulse is difficult to feel. Auscultation reveals a systolic murmur heard in the left infraclavicular area. What is the SINGLE most likely diagnosis?

A 60 year old presents with non-healing ulcers on his calves and a cramp-like pain in the calves relieved by rest. His past medical history includes hypertension, diabetes, and hypercholesterolaemia. He also smokes 15 cigarettes a day. Physical examination shows cold extremities absent distal pulses. Which SINGLE advice is unlikely to prevent disease progression?

A 36 year old man has acute back pain and central chest pain since he was hit by a car going 70 mph. He was in his driver’s seat with a seatbelt when this occurred. He was brought into the Emergency Department by the ambulance. He is sweating profusely with the pain intensity increasing. His heart rate is 99 beats/minute, respiratory rate is 29 breaths/minute and oxygen saturation is 97%. His blood pressure on his left arm is 90/61 mmHg and his right arm is 130/90 mmHg. A chest X-ray was performed and was abnormal. What clinical finding on the X-ray was likely seen?

A 49 year old man presents with a BP of 160/95 mmHg. He is otherwise asymptomatic. His renal function declined severely after starting ACE inhibitors. What is the SINGLE most likely cause of his hypertension?

A 51 year old man has cramping pain felt in his calves when he walks up the hill. The pain resolves within a few minutes of resting. This has been ongoing for the past 6 months. On examination, his popliteal and foot pulses are present but weak. There are no ulcers noticeable on his lower limbs. There is no weakness or numbness in his legs. His recent total cholesterol level shows a level of 5.0 mmol/L (normal is < 5 mmol/L). His blood pressure is 138/89 mmHg. He as a body mass index (BMI) of 24.9 kg/m2. He is a non-smoker. He has no history of known medical conditions. What is the SINGLE most appropriate advice to give him for secondary prevention of cardiovascular disease?

A 55 year old man comes to the emergency department with severe abdominal pain and lower back pain. He has a history of a pulsatile swelling in the abdomen. He has a pulse rate of 125 beats/minute and a blood pressure of 70/40 mmHg. What is the SINGLE most appropriate initial management?

A 60 year old diabetic presents with non-healing ulcers on his calves and a cramp-like pain in the calves relieved by rest. He does not smoke but has a history of hypertension which is well controlled with medication. Physical examination shows cold extremities with lack of hair around the ankles and absent distal pulses. What is the SINGLE most likely diagnosis?

A 68 year old lady is brought to the emergency department complaining of severe substernal pain which started suddenly. She is known to suffer from hypertension and diabetes. On examination, her pulse is 120 beats/minute and her blood pressure is 90/30 mmHg. Breath sounds are normal on both sides. Her pain is not responding to oral nitrates. What is the SINGLE most likely diagnosis?

A 38 year old woman presents with a blood pressure of 160/90 mmHg. She is otherwise asymptomatic. Ultrasound scan of kidneys reveal kidneys of equally reduced size with smooth borders and normal pelvicalyceal system. What is the SINGLE most likely cause of her hypertension?

A 62 year old male presented to Accident & Emergency with the complaint of sudden, severe back pain. His medical history includes hypertension and type 2 diabetes mellitus. He was found to be hypotensive with the presence of a pulsatile abdominal mass. The patient was subsequently determined to have an expanding abdominal aortic aneurysm and the decision was taken to immediately rush him for emergency surgery. Unfortunately, he died on his way to theatre due to a ruptured aneurysm. What is the SINGLE most likely underlying cause for his aneurysm?

A 65 year old presents with a cramp-like pain in the calves when walking and is relieved by rest. His symptoms are bilateral and often resolve within 5 minutes of resting. He has a 25 pack-year history of smoking. He takes medications for his hypertension. He does not have any weakness of the limbs. He denies any numbness. Physical examination shows weak distal pulses. What is the SINGLE most appropriate next action?

A 36 year old man has acute severe central chest pain which started an hour ago. There is no history of trauma. He presents to the Emergency Department sweating profusely with the pain intensity increasing. His heart rate is 130 beats/minute, respiratory rate is 35 breaths/minute and blood pressure is 100/70 mmHg. There is marked widening of the mediastinum on the chest X-ray. What is the SINGLE most likely diagnosis?

A 55 year old smoker presents to the Emergency Department with the complaint of severe left leg and foot pain that began earlier in the day. The pain spreads to the level just above the inguinal ligament. His past medical history includes hypertension. On examination, he has atrophic skin changes in his left leg and his left limb is cold to touch. He has no palpable pulses in the left lower extremity. Gross motor and sensory functions were intact in the symptomatic leg and foot. What is the SINGLE most likely occluded artery?

A 60 year old man has sudden severe chest pain radiating to both shoulders and accompanied by shortness of breath. There was no history of trauma. His medical history includes hypertension. Examination shows cold peripheries and paraplegia. What is the SINGLE most appropriate diagnosis?

A 78 year old man attends the GP surgery with an ulcer above his right medial malleolus. He has had this ulcer for the past 5 months. On examination, his posterior tibial and dorsalis pedis pulses on both feet are weak. The ulcer is 2 cm in diameter. Haemosiderin deposits are seen at the medial malleolus around the ulcer. There is mild pain on palpation of the ulcer. His medical history includes diabetes mellitus type 2. What is the SINGLE most likely diagnosis?

A 68 year old man gets repeated attacks of loss of consciousness and transient ischaemic attacks (TIA). What is the SINGLE most likely cause for his symptoms?

A 55 year old man presents to the Emergency Department after being involved in a road traffic accident. He has a fracture of his right mid femoral shaft. The dorsalis pedis, posterior tibial and popliteal pulses of his right leg cannot be felt. What is the SINGLE most likely artery that is damaged?

A 40 year old heavy smoker presents with pain in the calves relieved by rest. These symptoms have been worsening over the last few months. He has a history of hypertension which is well controlled with medication. His distal pulses are difficult to palpate. What is the SINGLE most likely diagnosis?

A 45 year old woman has had a haemorrhagic stroke 3 days ago. She develops a large swelling of her entire left leg and pitting oedema in the wards three days later. An ultrasound scan reveals a large, echolucent density in the left common femoral vein. She has no other medical problems. What is the SINGLE most appropriate treatment for her deep vein thrombosis?

A 70 year old smoker presents with an acutely painful, pale paralysed and pulseless left leg. He is noted to have atrial fibrillation which was diagnosed recently. He has a pulse rate of 105 beats/minute. What is the SINGLE most likely diagnosis?

A 78 year old man has a painless sudden collapse. His pulse is 120 beats/minute, blood pressure of 70/40 mmHg. Examination reveals a mottled skin of the lower body and a pulsatile abdominal mass. What is the SINGLE most likely diagnosis?

A 44 year old man has sudden severe crushing chest pain radiating to both shoulders and his back. The pain is accompanied by shortness of breath. He is sweating profusely. There was no history of trauma. Examination shows cold peripheries. He is noted to have disproportionately long, slender limbs and long fingers and toes. What is the SINGLE most likely diagnosis?

A 45 year old man presents to the Emergency Department with sudden excruciating pain in the right leg. On examination, his right lower limb is pale and cold. The dorsalis pedis and posterior tibial pulses are absent in the right foot. He has a pulse of 95 beats/minute with an irregular rhythm. What is the SINGLE most likely reason for his pain?

A 40 year old man has pain in the right pectoral area below the clavicle. He describes shooting pain down the right arm with a reduced sensation of his right forearm and hand on the ulnar side. He has a pulsatile mass just below the right clavicle. He has slight discolouration of his right hand and his right hand seems colder than his left. What is the most likely diagnosis?