Acute & Chronic limb ischemia MCQs

1-Regarding the sudden loss of limb perfusion, which one is true?

A)AF being an uncommon source for thrombo-embolism
B)Early intervention may restore limb function and prevent reversible ischemic
changes
C)Amputation rather than attempts at revascularization may be an option
from the beginning
D)Anticoagulation with warfarin is indicated as soon as possible
E)Embolectomy is indicated before reversible changes appear in the affected
limb
2-The presentation of chronic limb ischemia include all of the followings
except:
A)Absent distal pulse
B)Coldness of affected limb
C)Hirsutism
D)Pain of affected limb
E)Reduced ABI
3-The clinical manifestations of acute limb ischemia include all below
except:
A)Poikilothermia
B)Feeling of numbness
C)Weakness of movement
D)Weak pulse of the affected limb
E)Mottling of skin

Note: Mottling is defined as purplish discoloration of skin due to necrosis of

blood vessels and extravasation of R.B.C.s into the interstitium and it is
considered as first sign of gangrene and is commonly seen in patients with
acute limb ischemia due to late presentation.

4-The treatment of chronic limb ischemia includes all below except:

A)Tolazoline
B)Exercise
C)Weight loss
D)Amputation
E)Pentoxifylline
5-The clinical manifestations of acute limb ischemia include all below
except:
A)Coldness of limb
B)Established gangrene
C)Feeling of numbness
D)Intact distal pulse
E)Inability of movement

6-The treatment of chronic limb ischemia includes all below except:

A)Control of hypertension and D.M.
B)Regular exercise
C)Weight loss
D)Embolectomy
E)Statins

7-The clinical manifestations of chronic limb ischemia include all of the

following except:
A)Intermittent claudication
B)Atrophy of muscles of the legs
C)Hirsutism
D)Rest pain
E)Brittle nails

8-Regarding the sudden loss of limb perfusion; all are false except:
A)Embolectomy is indicated in all patients with acute limb ischemia
B)Delay of intervention leads almost always to sepsis or acute renal failure
C)Anticoagulation with warfarin is indicated as soon as possible
D)Amputation may be an option from the beginning
E)Subacute bacterial endocarditis is the most common cause

9-The initial treatment of chronic limb ischemia includes all below except:
A)Tamsulosin
B)Exercise
C)Weight loss
D)Amputation
E)Pentoxifylline
10-Regarding the sudden loss of limb perfusion:
A)Myocardial infarction is the most common cause
B)Delay of intervention leads to development of reversible ischemic changes
C)Amputation rather than attempts at revascularization may be an option
from the beginning
D)Anticoagulation with warfarin is indicated as soon as possible
E)Embolectomy is indicated before reversible changes appear in the affected
limb

11-The treatment of chronic limb ischemia includes all below except:

A)Abstinence of smoking
B)Exercise
C)Weight loss
D)Amputation
E)Aspirin

12-The clinical manifestations of acute limb ischemia include all below

except:
A)Coldness of limb
B)Feeling of numbness
C)Weakness of movement
D)Weak distal pulse
E)Mottling of skin

13-The clinical manifestations of chronic limb ischemia include all of the

followings except:
A)Absent distal pulse
B)Coldness of affected limb
C)Hirsutism
D)Pain of affected limb
E)Gangrene of affected limb
 DVT MCQs
1-Indications for a vena cava filter in DVT of the leg are except:
A)Recurrent thromboembolism despite adequate anticoagulation
B)DVT in a patient with contraindications to anticoagulation
C)Propagating iliofemoral venous thrombus in anticoagulated patient
D)Chronic pulmonary embolism and resultant pulmonary hypertension
E)Propagating femoropopliteal venous thrombus in anticoagulated patient

2-Which one is false regarding DVT of lower limb?

A)Phlegmasia alba dolens is characterized by blanching due to arterial spasm
B)When the thrombosis extends to the collateral veins, the condition is known as
phlegmasia cerulean dolens
C)Duplex ultrasound is now the most commonly performed test for the detection
of infrainguinal DVT and has a sensitivity and specificity of > 95% in
symptomatic petients
D)LMWH results in equivalent, if not better, efficacy with significantly less
bleeding complications in comparison with unfractionated heparin and is given
in a dose of 100 I.U./Kg/12 hours
E)The goal of treatment of DVT is to decrease pain and swelling of affected
limb

3-The following are risk factors for DVT except:

A)Nephrotic syndrome
B)Varicose veins
C)Anti-thrombin deficiency
D)Protein C and S deficiency
E)Minor surgery

4-The followings are risk factors for DVT except:

A)Anti-thrombin deficiency
B)Smoking
C)Malignancy
D)Hypofibrinogenemia
E)Protein C and S deficiency
5-Which one is false regarding DVT of lower limb?
A)Phlegmasia alba dolens is characterized by blanching due to arterial spasm
B)When the thrombosis extends to the collateral veins, the condition is known as
phlegmasia cerulean dolens
C)Duplex ultrasound is now the most commonly performed test for the detection
of infrainguinal DVT and has a sensitivity and specificity of > 95% in
symptomatic petients
D)LMWH is given in a dose of 100 I.U./Kg per 24 hours
E)The goals of treatment of DVT are the prevention of pulmonary embolism and
the postphlebitic syndrome

6-Which one is false regarding DVT of lower limb?

A)Phlegmasia alba dolens is characterized by pallor of limb due to arterial spasm
B)When the thrombosis extends to the collateral veins, the condition is known as
phlegmasia cerulea dolens
C)Duplex ultrasound is now the most commonly performed test for the detection
of infrainguinal DVT and has a sensitivity and specificity of > 95% in
symptomatic petients
D)LMWH results in equivalent, if not better, efficacy with significantly less
bleeding complications in comparison with unfractionated heparin and it's
therapeutic dose is 100 I.U./Kg/24 hours
E)The goals of treatment of DVT are the prevention of pulmonary embolism and
the postphlebitic syndrome

7-The followings are risk factors for DVT except:

A)Nephrotic syndrome
B)Varicose veins
C)Anti-thrombin deficiency
D)Protein C and S deficiency
E)Hypofibrinogenemia

8-Which of the following does not describe intermittent claudication?

A. Is elicited by reproducible amount of exercise.
B. Abates promptly with rest.
C. Is often worse at night.
D. May be an indication for bypass surgery.
E. Is related to vascular occlusion
9-Thrombolytic therapy in pulmonary embolism:
A. Should precede anticoagulation.
B. Can be considered for all patients.
C. Can be considered for hemodynamically unstable patients.
D. Is indicated for the majority of patients with documented pulmonary
embolism.
E. Is given subcutaneously
 Shock MCQs
1-Severe sepsis means sepsis associated with organ dysfunction and
hypoperfusion which occurs in all of the followings except:
A)Significant hypotension with hypoxia and anaerobic metabolism of peripheral
tissues
B)>20 mmHg fall from normal systolic blood pressure
C)Metabolic acidosis
D)Oliguria
E)Agitation
2-Which one is true regarding shock?
A)Patients whose blood loss exceeds 30% of their blood volume are at imminent
risk of death
B)Compensated shock syndrome occurs if the blood loss is less than 10% of the
blood volume
C)Patients with uncompensated shock syndrome are hypotensive after acute
hemorrhage in which losses are equivalent to 15% to 30% of their blood
volume
D)Lethal exsanguination not only needs immediate massive transfusion but
also frequently requires prompt performance of a surgical procedure to
control the hemorrhage
E)Clinical features of hemorrhagic shock include hypotension (systole),
increased heart rate, absent sweating, skin pallor and decreased urine output
3-Obstructive shock can be caused by all of the followings except:
A)Tension pneumothorax
B)SVC obstruction
C)Increased intrathoracic pressure
D)Excess positive end-expiratory pressure
E)Neoplasm
4-Severe sepsis means sepsis associated with organ dysfunction and
hypoperfusion which is associated with all of the followings except:
A)Significant hypotension with hypoxia and anaerobic metabolism of peripheral
tissues
B)>10 mmHg fall from normal systolic blood pressure
C)Lactic acidosis
D)Oliguria
E)Acute mental status changes
5-Regarding hemorrhagic shock. Which is true:
A)Patients whose blood loss exceeds 20% of their blood volume are at imminent
risk of death
B)Compensated shock syndrome occurs if the blood loss is less than 40% of the
blood volume
C)Patients with uncompensated shock syndrome are hypotensive after acute
hemorrhage in which losses are equivalent to (10 – 20)% of their blood
volume
D)Lethal exsanguination not only needs immediate massive transfusion but
also frequently requires prompt performance of a surgical procedure to
control the hemorrhage
E)Clinical features of hemorrhagic shock include hypotension (systole),
increased heart rate, absent sweating, skin flushing and normal urine output

6-Obstructive shock can be caused by all of the followings except:

A)Tension pneumothorax
B)Abdominal aortic aneurysm
C)Increased intrathoracic pressure
D)Excess positive end-expiratory pressure
E)Neoplasm

7-Which is true regarding all types of shock?

A)Increased urine output
B)Bradycardia
C)Hypertension
D)Metabolic acidosis
E)Hemiplegia

8-Which is true regarding all types of shock?

A)Increased urine output
B)Dryness of skin
C)Hypertension
D)Metabolic acidosis
E)Hemiplegia
9-Regarding shock. Which is true:
A)Patients whose blood loss exceeds 30% of their blood volume are at imminent
risk of death
B)Compensated shock syndrome occurs if the blood loss is less than 5% of the
blood volume
C)Patients with uncompensated shock syndrome are hypotensive after acute
hemorrhage in which losses are equivalent to 20% to 40% of their blood
volume
D)Lethal exsanguination not only needs immediate massive transfusion but
also frequently requires prompt performance of a surgical procedure to
control the hemorrhage
E)Clinical features of hemorrhagic shock include increased heart rate, absent
sweating, skin flushing and decreased urine output

10-Which is wrong regarding septic shock?

A)It is the fourth level and the most severe category of SIRS (Systemic
Infalmmatory Response Syndrome)
B)The organ dysfunction in patients in septic shock may progress to organ failure
C)It is a vasodilatory shock due to dysfunction of the endothelium and
vasculature secondary to circulating inflammatory mediators and cells
D)Hypotension results from failure of the vascular smooth muscle to constrict
appropriately
E)Plasma catecholamine levels are not elevated, and the renin-angiotensin
system is not activated

11-Which is wrong regarding treatment of hemorrhagic shock?

A)After securing reliable IV access, the first attempts at resuscitation of the
patient are made with plasma
B)Adult patients who do not respond to 2 to 4L of balanced electrolyte solution
and remain hypotensive usually require blood transfusions
C)The surgeon must identify the potential sites of active hemorrhage in an
irreversibly hypotensive patient and decide whether a surgical intervention is
needed
D)Patients with preexisting cardiac dysfunction need continuous monitoring of
their hemodynamic status guided by measurement of central venous pressure
E)Patients with complex comorbid conditions may require pharmacologic
interventions (Heart failure, D.M., Ischemic heart disease, etc…….)
12-Which is wrong regarding resuscitation of hemorrhagic shock?
A)If large volumes of normal saline are used for resuscitation, hyperchloremic
acidemia may develop
B)Lactated Ringer's is the fluid of choice
C)Coagulopathy may develop as a complication of massive transfusion
D)Success of treatment may depend on the surgeon's ability to stop the bleeding
E)Patients are susceptible to the development of hyperthermia and alkalosis
13-Criteria of severe sepsis and multi-organ dysfunction include the
followings except:
A)Systolic blood pressure <90 mmHg
B)Oliguria
C)Acute mental status changes
D)Metabolic alkalosis
E)Elevated blood urea and serum creatinine

14-Criteria of Systemic Inflammatory Response Syndrome (SIRS) include

the followings except:
A)Temperature (core) > 38ᵒC or < 36ᵒC
B)Tachycardia
C)Hypoventilation
D)Leucocytosis
E)Leucopenia

15-Treatment of septic shock includes the followings except:

A)Intravenous infusion of fluids
B)Vasoactive agents: inotropic drugs and vasoconstrictors
C)Antimicrobial agents
D)Intravenous steroid has a role in septic shock
E)Surgical intervention is contraindicated

16-The followings are causes for cardiogenic shock except:

A)Pulmonary embolus
B)Acute myocardial infarction
C)Acute mitral regurgitation
D)Acute ventricular septal defect
E)Pericardial tamponade
17-Which is false regarding massive pulmonary embolism?
A)Clinical examination reveals distended neck veins and a tricuspid regurgitation
murmur
B)Electrocardiographic findings indicate right ventricular strain with an S1Q3T3
pattern
C)The infusion of vasoconstrictors is necessary until definite treatment is
applied
D)Echocardiography reveals acute right heart distention and strain
E)The effectiveness of thrombolytic therapy has been established

18-Severe sepsis means sepsis associated with organ dysfunction and is

characterized by all of the followings except:
A)Significant hypotension with hypoxia and anaerobic metabolism of peripheral
tissues
B)>10 mmHg fall from normal systolic blood pressure
C)Lactic acidemia
D)Oliguria
E)Acute mental status changes

19-Which is wrong regarding the three phases after resuscitation from

shock?
A)Phase 1 which starts at the time of the patient's arrival in the emergency
department and ends when the operation or procedure needed to control the
bleeding is complete
B)During Phase 1, there may be a contraction in the interstitial volume as fluids
shift to intravascular compartment to compensate for shock
C)Phase 2 starts at the end of surgery and is characterized as a period in
which less fluid needs to be infused than is lost
D)Phase 3 corresponds to recovery
E)During Phase 3, there is over-diuresis

20-Obstructive shock can be caused by all of the followings except:

A)Tension pneumothorax
B)Superior vena caval obstruction
C)Increased intrathoracic pressure
D)Excess positive end-expiratory pressure
E)Neoplasm