Vascular surgery: splenic artery aneurysm: 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.

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General Surgery · Vascular surgery: splenic artery aneurysm

Sample item

A 30-year-old woman in the third trimester of her third pregnancy collapses with sudden epigastric pain and shock. There is initial transient improvement, then deterioration, with free intraperitoneal blood. Which lesion is the most likely cause?

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

The answer and the reasoning

D. Ruptured splenic artery aneurysm

Splenic artery aneurysm is the commonest visceral artery aneurysm and is associated with multiparity, portal hypertension and pregnancy. Rupture in pregnancy has high maternal and fetal mortality, and a classic double rupture phenomenon occurs when initial bleeding is contained in the lesser sac before free rupture. Women of childbearing age with such aneurysms should be treated electively.

Option by option

  • A. Ruptured abdominal aortic aneurysm

    Aortic aneurysm rupture is rare in a young woman.

  • B. Perforated peptic ulcer

    Perforation causes peritonitis with free air rather than haemorrhagic shock.

  • C. Acute pancreatitis

    Pancreatitis does not cause haemoperitoneum with shock in this way.

  • D. Ruptured splenic artery aneurysm (correct)

    Correct. Pregnancy-related haemodynamic and hormonal changes predispose a splenic aneurysm to rupture.

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.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is D, Ruptured splenic artery aneurysm. Splenic artery aneurysm is the commonest visceral artery aneurysm and is associated with multiparity, portal hypertension and pregnancy.

Why is "Ruptured abdominal aortic aneurysm" not the answer?

Aortic aneurysm rupture is rare in a young woman.

Why is "Perforated peptic ulcer" not the answer?

Perforation causes peritonitis with free air rather than haemorrhagic shock.

Why is "Acute pancreatitis" not the answer?

Pancreatitis does not cause haemoperitoneum with shock in this way.

What concept does this question test?

It tests Vascular surgery: splenic artery aneurysm in General Surgery. Rupture in pregnancy has high maternal and fetal mortality, and a classic double rupture phenomenon occurs when initial bleeding is contained in the lesser sac before free rupture. Women of childbearing age with such aneurysms should be treated electively.

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: splenic artery aneurysm?

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.