Vascular surgery: retroperitoneal haemorrhage after femoral puncture: 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: retroperitoneal haemorrhage after femoral puncture

Sample item

A day after coronary angiography through the right femoral artery, a woman is hypotensive with right flank pain and a falling haemoglobin. The groin is soft, with no swelling or bruit, and distal pulses are present. What is the most likely cause?

AArteriovenous fistula at the puncture siteBAcute thrombosis of the femoral arteryCRetroperitoneal haemorrhage from a puncture above the inguinal ligamentDFemoral pseudoaneurysm

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

The answer and the reasoning

C. Retroperitoneal haemorrhage from a puncture above the inguinal ligament

A puncture above the inguinal ligament lets bleeding track into the retroperitoneum, where it can be concealed and produce shock, flank or back pain and a falling haemoglobin without a groin swelling. CT confirms it, and management is resuscitation, with endovascular or open repair if bleeding continues.

Option by option

A. Arteriovenous fistula at the puncture site
An arteriovenous fistula gives a continuous machinery bruit and thrill at the groin.
B. Acute thrombosis of the femoral artery
Femoral thrombosis causes a cold, pulseless leg rather than hypotension and flank pain.
C. Retroperitoneal haemorrhage from a puncture above the inguinal ligament (correct)
Correct. A high puncture bleeds into the retroperitoneal space, which hides the haematoma from the groin.
D. Femoral pseudoaneurysm
Pseudoaneurysm gives a painful pulsatile groin mass with a bruit.

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.

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is C, Retroperitoneal haemorrhage from a puncture above the inguinal ligament. A puncture above the inguinal ligament lets bleeding track into the retroperitoneum, where it can be concealed and produce shock, flank or back pain and a falling haemoglobin without a groin swelling.

Why is "Arteriovenous fistula at the puncture site" not the answer?

An arteriovenous fistula gives a continuous machinery bruit and thrill at the groin.

Why is "Acute thrombosis of the femoral artery" not the answer?

Femoral thrombosis causes a cold, pulseless leg rather than hypotension and flank pain.

Why is "Femoral pseudoaneurysm" not the answer?

Pseudoaneurysm gives a painful pulsatile groin mass with a bruit.

What concept does this question test?

It tests Vascular surgery: retroperitoneal haemorrhage after femoral puncture in General Surgery. CT confirms it, and management is resuscitation, with endovascular or open repair if bleeding continues.

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: retroperitoneal haemorrhage after femoral puncture?

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.