Download DNB 2015 Dec PVS PERIPHERAL VASCULAR SURGERY P II Question Paper

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FINAL EXAM NATIONAL BOARD OF EXAMINATIONS

DECEMBER 2015

PERIPHERAL VASCULAR SURGERY

PAPER — I

PVS/D/15/33/11

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Time : 3 hours

Max. Marks : 100

Important instructions:

• Attempt all questions in order.
• Each question carries 10 marks.

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• Read the question carefully and answer to the point neatly and legibly.
• Do not leave any blank pages between two answers.
• Indicate the question number correctly for the answer in the margin space.
• Answer all the parts of a single question together.
• Start the answer to a question on a fresh page or leave adequate space between two answers.

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• Draw table/diagrams/flowcharts wherever appropriate.

Write short notes on:

1. 1. Assessment (non-invasive) of pressure points in a diabetic foot. : 5
   2. Options to off load a fore foot diabetic foot ulcer, under the 15‘5 5 metatarsal head.

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2. Axillary hyperhydrosis:

   1. Etiology 2
   2. Assessment 2
   3. Medical management 3
   4. Surgical management 3

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3. A 35 year old, active male, presents with a pulsatile swelling in Zone II of the left side of his neck. :

   1. Differential diagnosis of above clinical presentation. 3
   2. Shamblin classification 3
   3. What complications will be mentioned in the informed consent for surgery? 4

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4. A 72 year old man presents to the emergency department with a left hemiparesis of four hours duration and is recovering. He has no other neurological deficiencies.

   1. What is your diagnosis? 1
   2. How will you investigate this patient? 4
   3. When would you offer to intervene? 3

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   4. What did the CREST trial show, comparing carotid artery stenting with surgery? : 2

5. An 18 year old boy presents with a non-healing ulcer of the arch of his left foot. A thrill is palpable around the ulcer and the foot is warm. There is no history of trauma.

   1. What is your diagnosis? 1
   2. How will you investigate this patient? 3

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   3. Mention drugs / devices that can be used for embolization. 3
   4. Advantages and disadvantages of alcohol for embolization. 3

P.T.O.

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Firstranker's choice

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FINAL EXAM NATIONAL BOARD OF EXAMINATIONS

DECEMBER 2015

PERIPHERAL VASCULAR SURGERY

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PAPER - II

6. A 30 year old male presents with acute onset (10 days) left leg swelling. Duplex shows an ileo-femoral DVT. He was on a long flight 12 days prior to this presentation to hospital.

   1. Would you offer thrombolysis & why?
   2. What thrombolytic agents are available?
   3. What was the conclusion of the CaVenT trial?

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   4. What steps would you take to prevent post-thrombotic syndrome?

7. A 62 year old male has been referred to you with CT angiogram images, diagnosing a Type II Crawford aneurysm.

   1. Advantages and disadvantages of an open surgical repair Vs total endovascular option. : 6
   2. When would you order a branched device? :

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   3. Mechanisms to prevent Spinal Cord Ischaemia. 3
8. 1. Advice you would give to a patient who has had a left brachio-cephalic fistula created by you. 3
   2. Rule of 6 for AV access fistula.
   3. Draw the DRIL procedure.

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9. A 28 year old male with varicose veins involving the left GSV/SFJ has a BMI of 40.1 and a non-healing, painless ulcer, over the gaiter area for 3 months.

   1. Draw an algorithm of your treatment plan for-him.
   2. What is the evidence for use of micronised flavonoid derivatives and pentoxifyline in venous ulcer disease?
   3. What is the level of compression offered in mm of mercury by a 4 layer compression bandage? 1

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10. A 55 year old diabetic is scheduled for a Femoro-posterior tibial artery bypass on his right leg for a critically ischaemic foot.

    1. What precautions will you take while dissecting in the groin to get proximal control? 2
    2. What would help you decide to perform an in-situ bypass?
    3. Mention one critical (important) step prior to anastamosis.

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    4. When would you consider dual antiplatelet therapy and or anticoagulation in this patient, post-operatively and for how long?