Vascular surgery: effort thrombosis of the subclavian vein: 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: effort thrombosis of the subclavian vein

Sample item

A 24-year-old competitive swimmer has sudden swelling, heaviness and bluish discolouration of the right arm with prominent chest wall veins. Duplex confirms axillosubclavian vein thrombosis. What is the best definitive management plan?

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

The answer and the reasoning

B. Anticoagulation with early thrombolysis then first rib resection

Effort thrombosis (Paget-Schroetter syndrome) results from repeated compression of the subclavian vein at the costoclavicular space in a thoracic outlet. Early catheter-directed thrombolysis restores patency, and decompression by first rib resection prevents recurrence. Anticoagulation alone leaves the compressive anatomy and risks chronic disability.

Option by option

  • A. Immediate amputation of the cervical rib only

    Removing a cervical rib alone neither clears the thrombus nor addresses the usual site of compression.

  • B. Anticoagulation with early thrombolysis then first rib resection (correct)

    Correct. Clearing the clot and then decompressing the thoracic outlet addresses both cause and consequence.

  • C. Observation with arm elevation

    Observation risks propagation and post-thrombotic disability in a young athlete.

  • D. Anticoagulation alone for life

    Anticoagulation without decompression leaves the underlying compression and a high risk of residual symptoms.

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 B, Anticoagulation with early thrombolysis then first rib resection. Effort thrombosis (Paget-Schroetter syndrome) results from repeated compression of the subclavian vein at the costoclavicular space in a thoracic outlet.

Why is "Immediate amputation of the cervical rib only" not the answer?

Removing a cervical rib alone neither clears the thrombus nor addresses the usual site of compression.

Why is "Observation with arm elevation" not the answer?

Observation risks propagation and post-thrombotic disability in a young athlete.

Why is "Anticoagulation alone for life" not the answer?

Anticoagulation without decompression leaves the underlying compression and a high risk of residual symptoms.

What concept does this question test?

It tests Vascular surgery: effort thrombosis of the subclavian vein in General Surgery. Early catheter-directed thrombolysis restores patency, and decompression by first rib resection prevents recurrence. Anticoagulation alone leaves the compressive anatomy and risks chronic disability.

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: effort thrombosis of the subclavian vein?

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.