A 45-year-old woman has symptomatic varicose veins of the left leg. Duplex shows reflux at the saphenofemoral junction and along a straight, 7 mm great saphenous vein in the thigh, with patent, competent deep veins. What is the preferred first-line treatment?

Endothermal ablation of the GSV

Sclerotherapy of all tributaries

High tie and long saphenous stripping

Vascular surgery, ulcers and varicose veins

18 NEET-PG practice questions on Vascular surgery, ulcers and varicose veins, part of General Surgery. The first 18 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Easy
A 66-year-old woman has had a venous ulcer above the left medial malleolus for 15 years. Over 3 months part of the ulcer edge has become raised, everted and indurated, with a foul discharge, and a hard inguinal node is felt. Biopsy of the edge is most likely to show which tumour?
1. ABasal cell carcinoma
2. BSquamous cell carcinoma
3. CMalignant melanoma
4. DKaposi sarcoma
Show answerHide answer
Answer: B · Squamous cell carcinoma
Malignant change in a long-standing chronic ulcer or scar (venous ulcer, burn scar, sinus of osteomyelitis) is a Marjolin ulcer, almost always a squamous cell carcinoma. Clues are a change in the edge (raised, everted, rolled), new growth, bleeding or smell in an ulcer that was stable for years. Any chronic ulcer with these changes needs a biopsy from the edge. A Marjolin ulcer itself is slow growing and painless because the scar has no nerves; once nodes are involved, they need treatment too.
- A: BCC has a rolled pearly edge, usually on the face, and rarely spreads to nodes.
- C: Melanoma is pigmented and is not the classic tumour in a chronic ulcer.
- D: Kaposi sarcoma gives purple plaques and nodules, mainly with HIV.
Question 2 · Hard
A 64-year-old man with calf claudication has these resting systolic pressures: right brachial 132 mmHg, left brachial 140 mmHg, right dorsalis pedis 84 mmHg and right posterior tibial 76 mmHg. What is the right-sided ankle-brachial index?
1. A0.54
2. B0.64
3. C0.58
4. D0.60
Show answerHide answer
Answer: D · 0.60
ABI for a leg = the higher of the two ankle pressures in that leg divided by the higher of the two brachial pressures. Here 84 / 140 = 0.60, which is moderate peripheral arterial disease consistent with claudication. Using the lower ankle pressure gives 76 / 140 = 0.54; using the right brachial pressure gives 84 / 132 = 0.64; and 76 / 132 gives 0.58. Taking the higher arm pressure matters because subclavian stenosis can lower one arm reading.
- A: Uses the lower ankle pressure (76/140).
- B: Uses the same-side (lower) brachial pressure (84/132).
- C: Uses both the lower ankle and the lower brachial pressure (76/132).
Question 3 · Medium
A 45-year-old woman has symptomatic varicose veins of the left leg. Duplex shows reflux at the saphenofemoral junction and along a straight, 7 mm great saphenous vein in the thigh, with patent, competent deep veins. What is the preferred first-line treatment?
1. ACompression stockings for life
2. BEndothermal ablation of the GSV
3. CSclerotherapy of all tributaries
4. DHigh tie and long saphenous stripping
Show answerHide answer
Answer: B · Endothermal ablation of the GSV
For symptomatic primary varicose veins with truncal GSV reflux and a normal deep system, endovenous thermal ablation (radiofrequency or laser) is now the first-line treatment. It is done under local tumescent anaesthesia as a day case, with less pain and quicker return to work than open surgery and similar long-term results. Open saphenofemoral ligation and stripping is used when endovenous treatment is unsuitable, and foam sclerotherapy is an alternative or adjunct. Compression stockings are for patients unfit for or unwilling to have intervention.
- A: Stockings ease symptoms but are only for those who cannot have intervention.
- C: Treating tributaries alone leaves the junction and truncal reflux untreated.
- D: Open surgery is now second-line where endovenous ablation is available.
Question 4 · Easy
A 32-year-old man from rural Bengal, a heavy bidi smoker, has painful ulcers on the tips of two toes, a history of migrating tender red cords along superficial leg veins, and absent pedal pulses. His sugar and lipids are normal. Which single measure most changes the course of his disease?
1. AFemoro-distal bypass grafting
2. BLumbar sympathectomy
3. CLong-term oral anticoagulation
4. DComplete cessation of tobacco
Show answerHide answer
Answer: D · Complete cessation of tobacco
Young male smoker, distal ulcers, migratory superficial thrombophlebitis and absent distal pulses with no atherosclerotic risk factors is thromboangiitis obliterans (Buerger disease). It is an inflammatory, segmental occlusion of small and medium arteries and veins, tightly linked to tobacco. Stopping tobacco completely (including smokeless forms) is the only measure that halts progression; patients who continue to smoke tend to go on to amputations. Sympathectomy, prostanoids and analgesia are only adjuncts.
- A: Distal disease leaves few target vessels; bypass is rarely possible and fails if smoking continues.
- B: Sympathectomy may ease rest pain or help ulcers heal but does not stop the disease.
- C: Anticoagulation has no proven role in this inflammatory arteritis.
Question 5 · Easy
A 40-year-old traffic policeman has dilated, tortuous veins along the medial side of the right leg and thigh, with aching by evening. He is being planned for treatment. What is the investigation of choice to map venous reflux before treatment?
1. AVenous duplex ultrasound
2. BHand-held Doppler at the groin
3. CAscending venography
4. DContrast CT venography
Show answerHide answer
Answer: A · Venous duplex ultrasound
Colour duplex ultrasound is the investigation of choice for varicose veins: it shows the anatomy, the sites of reflux (saphenofemoral or saphenopopliteal junction, perforators) and whether the deep veins are patent. It is non-invasive and guides the choice of endovenous ablation or surgery. Venography is invasive and now reserved for special situations, and a hand-held Doppler is only a quick screening tool.
- B: A hand-held Doppler hears reflux but cannot map anatomy or the deep veins.
- C: Venography is invasive and has been replaced by duplex for routine mapping.
- D: CT venography adds radiation and contrast without showing reflux well.
Question 6 · Hard
A 68-year-old woman on unfractionated heparin since a hip hemiarthroplasty 7 days ago develops a new, painful swollen left leg; duplex shows femoral vein thrombosis. Her platelet count, 2.6 lakh/µL before surgery, is now 0.9 lakh/µL, and there is no bleeding. Heparin is stopped. What is the most appropriate next step?
1. AStart argatroban infusion
2. BStart warfarin straight away
3. CTransfuse platelets
4. DSwitch to enoxaparin
Answer and explanation in LearnFree account
Question 7 · Medium
A 50-year-old woman with long-standing diabetes and peripheral neuropathy has a warm, red, swollen right midfoot without an ulcer, 3 weeks after a minor twist. She has little pain, pulses are bounding, and the foot is 3 °C warmer than the other. X-ray shows fragmentation around the tarsometatarsal joints. What is the mainstay of treatment?
1. AOff-loading in a total contact cast
2. BIncision and drainage
3. CBelow-knee amputation
4. DIV antibiotics for six weeks or more
Answer and explanation in LearnFree account
Question 8 · Medium
A 60-year-old man with diabetes has a deep ulcer on the sole of his left foot that has reached the bone, with a collection of pus around it and X-ray changes of osteomyelitis of the metatarsal. There is no gangrene. What is his Wagner grade?
1. AGrade 3
2. BGrade 2
3. CGrade 1
4. DGrade 4
Answer and explanation in LearnFree account
Question 9 · Hard
A 72-year-old man with atrial fibrillation reaches the district hospital 26 hours after sudden pain in the left leg, delayed by travel from his village. The leg is mottled with fixed, non-blanching staining up to mid-thigh, the calf muscles are hard and tender, and he has no movement or sensation in the foot. There are no Doppler signals in the foot arteries or veins. What is the most appropriate management of the limb?
1. ACatheter-directed thrombolysis
2. BFogarty embolectomy
3. CPrimary major amputation
4. DIV heparin and observation
Answer and explanation in LearnFree account
Question 10 · Medium
A 29-year-old man, a chronic smoker, is being worked up in the surgical ward for gangrene of the left little toe. The resident lists these statements about his likely diagnosis, thromboangiitis obliterans: 1. The upper limbs are typically spared. 2. It affects medium and small arteries and also veins. 3. Migratory superficial thrombophlebitis may occur. 4. Biopsy of an acute lesion shows inflammatory thrombus with relative sparing of the vessel wall. Which statements are correct?
1. A3 and 4 only
2. B1, 2 and 4 only
3. C1, 2, 3 and 4
4. D2, 3 and 4 only
Answer and explanation in LearnFree account
Question 11 · Medium
A 62-year-old woman who works long hours standing at a textile loom has a shallow, painless ulcer above the left medial malleolus, with brown pigmentation, eczema and a woody, indurated band of skin around the lower leg. Pedal pulses are hard to feel because of oedema. Before starting multilayer compression bandaging, what must be done?
1. AMeasure the ankle-brachial index
2. BSwab the ulcer for culture
3. CTake a punch biopsy of the ulcer base
4. DDo a venous duplex of the deep veins
Answer and explanation in LearnFree account
Question 12 · Medium
On day 5 after laparoscopic cholecystectomy, a 45-year-old woman develops mild swelling of the left calf. Her two-level Wells score is 0 (DVT unlikely). What is the most appropriate first investigation?
1. AAscending venography
2. BCompression duplex ultrasound
3. CCT pulmonary angiography
4. DHigh-sensitivity D-dimer
Answer and explanation in LearnFree account
Question 13 · Medium
A 55-year-old man with diabetes and a 30 pack-year smoking history has aching in both buttocks and thighs on walking, and has noticed erectile dysfunction for a year. Both femoral pulses are feeble and distal pulses are absent. Where is the arterial occlusion most likely to be?
1. APopliteal artery
2. BTibial arteries
3. CSuperficial femoral artery
4. DAorto-iliac segment
Answer and explanation in LearnFree account
Question 14 · Medium
A 54-year-old man with diabetes for 15 years has a painless ulcer under the head of the right first metatarsal for 2 months, with loss of monofilament sensation and palpable pedal pulses. A sterile metal probe passed into the ulcer touches bone. What is the most sensitive imaging test to confirm the suspected complication?
1. AMRI of the foot
2. BUltrasound of the foot
3. CPlain X-ray of the foot
4. DThree-phase bone scan
Answer and explanation in LearnFree account
Question 15 · Hard
A 58-year-old man with 20 years of type 2 diabetes and CKD has a non-healing ulcer on the right great toe for 6 weeks and rest pain at night. Pedal pulses are not palpable, yet the ABI is 1.5 on both sides, and X-ray shows linear calcification of the tibial arteries. What is the most appropriate next test of limb perfusion?
1. ASegmental limb pressures
2. BCapillary refill time
3. CRepeat ABI after exercise
4. DToe-brachial index
Answer and explanation in LearnFree account
Question 16 · Medium
A 70-year-old woman with rheumatic mitral stenosis and atrial fibrillation, not on anticoagulants, is brought to casualty 3 hours after the sudden onset of severe pain in the right leg. The leg is cold and pale below the knee, with absent popliteal and pedal pulses, mild numbness of the toes and preserved movement. The left leg has normal pulses. Besides analgesia, what is the next best step?
1. APrimary above-knee amputation
2. BElevate the leg, keep it warm and review in 24 hours
3. COral aspirin and cilostazol
4. DIV heparin and urgent Fogarty embolectomy
Answer and explanation in LearnFree account
Question 17 · Medium
A 68-year-old male smoker has a painful, punched-out ulcer on the tip of the right second toe with a pale, dry base. The pain is worse at night and eased by hanging the leg over the side of the bed. The foot is cold with absent pedal pulses. What type of ulcer is this?
1. APressure ulcer
2. BNeuropathic (trophic) ulcer
3. CVenous ulcer
4. DArterial (ischaemic) ulcer
Answer and explanation in LearnFree account
Question 18 · Easy
A 58-year-old man who smokes 20 bidis a day comes to the surgical OPD with calf pain after walking about 200 metres, relieved by a few minutes of rest. Ankle-brachial index is measured on both sides. Below which resting ABI value is peripheral arterial disease diagnosed?
1. A1.2
2. B0.3
3. C0.9
4. D0.5
Answer and explanation in LearnFree account

Vascular surgery, ulcers and varicose veins

A 66-year-old woman has had a venous ulcer above the left medial malleolus for 15 years. Over 3 months part of the ulcer edge has become raised, everted and indurated, with a foul discharge, and a hard inguinal node is felt. Biopsy of the edge is most likely to show which tumour?

A 64-year-old man with calf claudication has these resting systolic pressures: right brachial 132 mmHg, left brachial 140 mmHg, right dorsalis pedis 84 mmHg and right posterior tibial 76 mmHg. What is the right-sided ankle-brachial index?

A 45-year-old woman has symptomatic varicose veins of the left leg. Duplex shows reflux at the saphenofemoral junction and along a straight, 7 mm great saphenous vein in the thigh, with patent, competent deep veins. What is the preferred first-line treatment?

A 32-year-old man from rural Bengal, a heavy bidi smoker, has painful ulcers on the tips of two toes, a history of migrating tender red cords along superficial leg veins, and absent pedal pulses. His sugar and lipids are normal. Which single measure most changes the course of his disease?

A 40-year-old traffic policeman has dilated, tortuous veins along the medial side of the right leg and thigh, with aching by evening. He is being planned for treatment. What is the investigation of choice to map venous reflux before treatment?

A 60-year-old man with diabetes has a deep ulcer on the sole of his left foot that has reached the bone, with a collection of pus around it and X-ray changes of osteomyelitis of the metatarsal. There is no gangrene. What is his Wagner grade?

On day 5 after laparoscopic cholecystectomy, a 45-year-old woman develops mild swelling of the left calf. Her two-level Wells score is 0 (DVT unlikely). What is the most appropriate first investigation?

A 55-year-old man with diabetes and a 30 pack-year smoking history has aching in both buttocks and thighs on walking, and has noticed erectile dysfunction for a year. Both femoral pulses are feeble and distal pulses are absent. Where is the arterial occlusion most likely to be?

A 68-year-old male smoker has a painful, punched-out ulcer on the tip of the right second toe with a pale, dry base. The pain is worse at night and eased by hanging the leg over the side of the bed. The foot is cold with absent pedal pulses. What type of ulcer is this?

A 58-year-old man who smokes 20 bidis a day comes to the surgical OPD with calf pain after walking about 200 metres, relieved by a few minutes of rest. Ankle-brachial index is measured on both sides. Below which resting ABI value is peripheral arterial disease diagnosed?