Vascular surgery: phlegmasia cerulea dolens: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

General Surgery · Vascular surgery: phlegmasia cerulea dolens

Sample item

A 45-year-old woman after pelvic surgery develops sudden massive swelling of the entire left leg that is painful and deeply blue, with blistering. Arterial pulses are faint because of oedema. What is the underlying lesion?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Massive iliofemoral venous thrombosis with outflow obstruction

Phlegmasia cerulea dolens is extensive iliofemoral thrombosis obstructing almost all venous outflow, producing severe oedema, cyanosis and pain, and can progress to venous gangrene. Management is heparin, limb elevation and catheter-directed thrombolysis or thrombectomy. Arterial embolism produces a pale, cold limb without gross swelling.

Option by option

  • A. Lymphoedema praecox

    Lymphoedema is chronic and painless, not acute and cyanotic.

  • B. Acute thromboembolic arterial occlusion

    Arterial occlusion gives a pale, cold, pulseless limb without massive swelling.

  • C. Cellulitis with abscess

    Infection causes warmth and erythema and not diffuse cyanosis after surgery.

  • D. Massive iliofemoral venous thrombosis with outflow obstruction (correct)

    Correct. Almost total venous occlusion produces the tense, blue, swollen limb.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Surgery questions

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is D, Massive iliofemoral venous thrombosis with outflow obstruction. Phlegmasia cerulea dolens is extensive iliofemoral thrombosis obstructing almost all venous outflow, producing severe oedema, cyanosis and pain, and can progress to venous gangrene.

Why is "Lymphoedema praecox" not the answer?

Lymphoedema is chronic and painless, not acute and cyanotic.

Why is "Acute thromboembolic arterial occlusion" not the answer?

Arterial occlusion gives a pale, cold, pulseless limb without massive swelling.

Why is "Cellulitis with abscess" not the answer?

Infection causes warmth and erythema and not diffuse cyanosis after surgery.

What concept does this question test?

It tests Vascular surgery: phlegmasia cerulea dolens in General Surgery. Management is heparin, limb elevation and catheter-directed thrombolysis or thrombectomy. Arterial embolism produces a pale, cold limb without gross swelling.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Vascular surgery: phlegmasia cerulea dolens?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.