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Questions and Answers
What is the gold standard diagnostic test for chronic limb ischemia?
In the management of acute limb ischemia, what is the next step after administering heparin?
Which of the following is the initial management for a patient with poorly controlled diabetes presenting with ulcers on the toes?
Which symptom is NOT part of the triad seen in Leriche syndrome?
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What is the recommended first step in the management protocol for lymphedema?
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What procedure should be performed if a patient has heart failure and an ejection fraction below 50%?
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Which type of stone is associated with sickle cell disease?
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What is the appropriate surgical intervention if the common bile duct is accidentally transected during a procedure?
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What indicates the use of laparoscopic cholecystectomy over open cholecystectomy?
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Which of the following conditions would require an open cholecystectomy?
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What is the appropriate timing for an elective laparoscopic cholecystectomy if the patient has received a drug-eluting stent?
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In a patient with Budd-Chiari syndrome, which of the following symptoms is least likely to be present?
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Which type of cholecystectomy is most commonly performed on patients with symptomatic gallstones who also have a history of recent percutaneous coronary intervention (PCI)?
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Which of the following statements regarding management of a patient with gallstones and a bare metal stent is true?
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Which of the following factors would most likely influence the decision between open and laparoscopic cholecystectomy?
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What condition is characterized by painful enlargement of the gallbladder with stones impacted in the Hartmann's pouch?
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In a patient where acute cholecystitis has persisted for more than 3 days, what is the recommended management approach?
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What condition is associated with a shrunken gallbladder and intrahepatic duct dilation but a normal CBD?
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Which management option is indicated for the presence of intramural gas in the gallbladder?
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Which of the following is a possible complication related to morphine administration in the context of gallbladder issues?
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What is the most common site of aortic injury in blunt trauma?
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Which procedure is appropriate for an extra peritoneal rectal injury?
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In the context of burns, what indicates effective resuscitation?
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What is the initial treatment for a patient with 40% carboxyhemoglobin after a burn?
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What is the first indicator of hemorrhagic shock following a 25% blood loss?
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Study Notes
Vascular Surgery
- Unilateral leg erythema is indicative of arterial insufficiency, worsening in a dependent position.
- Leriche syndrome characterized by a triad: claudication, erectile dysfunction, and decreased distal pulses; treated with aortobifemoral bypass.
- Limb ischemia diagnosis: Ankle-Brachial Index (ABI) < 0.3 and CT Angiography (CTA) showing artery occlusion > 3 cm; amputation is necessary in acute cases on top of chronic ischemia.
- Management of intermittent claudication includes smoking cessation and a supervised exercise program to improve walking distance.
- Chronic limb ischemia initial management: daily aspirin; diagnosis through ABI and Doppler ultrasonography; imaging via CTA; conventional angiography is the gold standard.
- Acute limb ischemia treatment flow:
- Next step: Heparin
- Followed by Doppler ultrasound
- Gold standard imaging: CTA
- Management by grade:
- Grade 1: No motor or sensory loss; heparin and observation.
- Grade 2A: Sensory loss without motor involvement; catheter thrombolysis.
- Grade 2B: Mild to moderate motor involvement; embolectomy.
- Grade 3: Motor and sensory loss (anesthetic/paralysis); amputation is indicated.
- Lower limb ischemia prevention strategies include aspirin for cardiac events and warfarin for systemic emboli.
- Poorly controlled diabetes with ulcers on three toes and diminished dorsalis pedis bilaterally requires lower limb duplex scan or CTA; initial management consists of diet modification and lifestyle changes, followed by debridement if necessary.
Lymphedema and Venous Disorders
- Lymphedema is characterized by non-pitting edema; consider family history; next step in evaluation: Duplex ultrasound; management includes exercise, compression, and massage.
- Spider nevus is diagnosed clinically.
- Varicose veins require a Duplex ultrasound before treatment; therapeutic options include endovascular/thermal ablation and sclerotherapy for cosmetic cases.
- Vascular malformations in the leg may necessitate surgery if congestive heart failure is present.
- Thrombophlebitis presents as a cord-like swelling; treatment involves NSAIDs.
Cholecystectomy and Gallbladder Disease
- AV fistula is typically created between the radial artery and cephalic vein.
- Budd-Chiari syndrome is indicated by RUQ pain, jaundice, and ascites; initial treatment includes heparin.
- For elective laparoscopic cholecystectomy post-percutaneous coronary intervention (PCI): wait 6 weeks for bare metal stent and 6 months for drug-eluting stent.
- If patient has heart failure or low ejection fraction (< 50%), opt for open cholecystectomy; laparoscopic is suitable for recent myocardial infarction cases.
- Accidental transection of the common bile duct (CBD) is treated with hepaticojejunostomy.
Gallbladder Pathologies
- Sickle cell disease is associated with black pigmented stones; sickle cell trait often leads to mixed stones; obesity is linked with cholesterol stones.
- Mirizzi's syndrome presents as painful gallbladder enlargement with stones in the Hartmann’s pouch; managed by open cholecystectomy and CBD exploration.
- Klatskin tumor features shrunken gallbladder and intrahepatic duct dilation with normal CBD; treated with laparoscopic cholecystectomy.
- Calcified gallbladder requires cholecystectomy; intramural gas indicates emphysematous gallbladder.
- Morphine may cause sphincter of Oddi dysfunction.
- Acute cholecystitis management differs based on time elapsed: early surgery if less than 3 days, antibiotics followed by surgery after 6 weeks if greater than 3 days.
- In neck injury with conscious patient and low oxygen saturation (82%), immediate endotracheal intubation is necessary.
Vascular and Traumatic Injuries
- Left subclavian vessel injury requires left anterior lateral thoracotomy.
- Most common sites for aortic injury include the aortic isthmus and the ligamentum arteriosum in blunt trauma.
- Distal left subclavian artery is the frequent site of thoracic injury.
- Cervical emphysema and decreased air entry can indicate tracheobronchial injury; a mediastinum widened with tracheal shift suggests thoracic aorta rupture or esophageal rupture.
- In rectal injury cases, management differs: diverting colostomy for extra-peritoneal injuries, primary repair for intra-peritoneal ones.
- For burns, assess resuscitation via urine output; lactic acid in other scenarios. Presence of black spots over nostrils and carboxyhemoglobin at 40% necessitates intubation and 100% oxygen ventilation, with hyperbaric oxygen as definitive treatment.
- Chemical burns should be managed by sweeping away powder; depth of burn is evaluated via biopsy.
- Shock defines class 3 at heart rate less than 140 and blood pressure no less than 90, marked by a decreased pulse pressure with 25% blood loss.
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Description
This quiz covers important concepts in vascular surgery, including the diagnosis and management of conditions like Leriche syndrome and limb ischemia. It also discusses treatment strategies such as aortobifemoral bypass and the role of supervised exercise programs in managing intermittent claudication.
