Vascular surgery: non-viable acute limb ischaemia: 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: non-viable acute limb ischaemia

Sample item

An elderly man presents 24 hours after sudden onset of leg pain. The foot is cold with fixed mottling that does not blanch. There is anaesthesia of the foot, paralysis of the toes and a rigid, woody calf. What is the best management?

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

The answer and the reasoning

A. Primary amputation

Fixed mottling, anaesthesia, paralysis and muscle rigidity indicate irreversible ischaemia (Rutherford class III). Revascularisation would release potassium, myoglobin and lactate and may be fatal, so primary amputation is correct once the limb is non-salvageable.

Option by option

  • A. Primary amputation (correct)

    Correct. The limb is non-viable and revascularisation risks a fatal reperfusion syndrome.

  • B. Emergency embolectomy with a Fogarty catheter

    Embolectomy is meant for viable or marginally threatened limbs.

  • C. Heparin infusion and observation for demarcation

    Heparin alone prevents propagation but cannot rescue dead tissue, and delay risks sepsis and renal failure.

  • D. Catheter-directed thrombolysis

    Thrombolysis is too slow and dangerous in a limb with established muscle necrosis.

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 A, Primary amputation. Fixed mottling, anaesthesia, paralysis and muscle rigidity indicate irreversible ischaemia (Rutherford class III).

Why is "Emergency embolectomy with a Fogarty catheter" not the answer?

Embolectomy is meant for viable or marginally threatened limbs.

Why is "Heparin infusion and observation for demarcation" not the answer?

Heparin alone prevents propagation but cannot rescue dead tissue, and delay risks sepsis and renal failure.

Why is "Catheter-directed thrombolysis" not the answer?

Thrombolysis is too slow and dangerous in a limb with established muscle necrosis.

What concept does this question test?

It tests Vascular surgery: non-viable acute limb ischaemia in General Surgery. Revascularisation would release potassium, myoglobin and lactate and may be fatal, so primary amputation is correct once the limb is non-salvageable.

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: non-viable acute limb ischaemia?

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.