Vascular surgery: reperfusion compartment syndrome: 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: reperfusion compartment syndrome

Sample item

A 68-year-old man has an embolectomy for acute leg ischaemia after 9 hours. Six hours later the calf is tense and swollen with severe pain on passive dorsiflexion of the toes, although foot pulses are now palpable. What is the next step?

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

The answer and the reasoning

C. Four-compartment fasciotomy

Reperfusion of ischaemic muscle causes oedema within closed fascial compartments, raising pressure and compromising perfusion even when pulses are palpable. Severe pain on passive stretch and a tense calf are the key signs, and treatment is urgent four-compartment fasciotomy. Delay risks muscle necrosis, myoglobinuria and renal failure.

Option by option

  • A. Elevate the limb and give analgesia

    Elevation lowers arterial inflow and worsens perfusion in a compartment syndrome.

  • B. Start intravenous heparin infusion and observe

    Heparin does not relieve the pressure and increases bleeding risk after fasciotomy.

  • C. Four-compartment fasciotomy (correct)

    Correct. Decompression is urgent; pulses may remain present in compartment syndrome.

  • D. Repeat embolectomy

    Pulses are present, so re-exploration for thrombus will not relieve compartment pressure.

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 C, Four-compartment fasciotomy. Reperfusion of ischaemic muscle causes oedema within closed fascial compartments, raising pressure and compromising perfusion even when pulses are palpable.

Why is "Elevate the limb and give analgesia" not the answer?

Elevation lowers arterial inflow and worsens perfusion in a compartment syndrome.

Why is "Start intravenous heparin infusion and observe" not the answer?

Heparin does not relieve the pressure and increases bleeding risk after fasciotomy.

Why is "Repeat embolectomy" not the answer?

Pulses are present, so re-exploration for thrombus will not relieve compartment pressure.

What concept does this question test?

It tests Vascular surgery: reperfusion compartment syndrome in General Surgery. Severe pain on passive stretch and a tense calf are the key signs, and treatment is urgent four-compartment fasciotomy. Delay risks muscle necrosis, myoglobinuria and renal failure.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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: reperfusion compartment syndrome?

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.