DHA Vascular Surgery exam questions

6 worked Vascular Surgery practice questions

Original exam-style questions from the bank, spread across the blueprint domains. They are not real or recalled exam questions. Try each one, then open the answer for the rationale and reference. None of them appear in the free mock exam, so reading them will not spoil it.

1. Question 1 · Aortic disease

   Twelve months after EVAR, CT shows contrast in the sac from a lumbar artery. The sac diameter is unchanged from the post-operative scan. What is the most appropriate management?

   1. AImmediate conversion to open repair
   2. BContinue surveillance imaging
   3. CUrgent proximal extension cuff
   4. DRelining of the whole stent graft
   Show answer and explanation

   Correct answer: B. Continue surveillance imaging

   A type II endoleak from branch vessels with a stable sac is usually managed with surveillance, as many resolve. Intervention is considered for significant sac growth; cuffs and relining treat type I and III endoleaks.

   Reference: ESVS Clinical Practice Guidelines on Abdominal Aorto-Iliac Artery Aneurysms 2024

2. Question 2 · Peripheral arterial disease and limb ischaemia

   A 66-year-old smoker has calf pain on walking 200 m. Ankle systolic pressure is 70 mmHg and brachial systolic pressure is 140 mmHg. What does the ankle-brachial index indicate?

   1. A2.0, consistent with calcified vessels
   2. B0.5, which is within the normal range
   3. C1.0, consistent with normal arterial flow
   4. D0.5, consistent with significant arterial disease
   Show answer and explanation

   Correct answer: D. 0.5, consistent with significant arterial disease

   ABI is ankle pressure divided by brachial pressure: 70/140 = 0.5. An ABI of 0.9 or less indicates peripheral arterial disease, and values around 0.5 suggest moderate to severe disease.

   Reference: ESC/ESVS Guidelines on Peripheral Arterial Diseases 2017

3. Question 3 · Peripheral arterial disease and limb ischaemia

   A 60-year-old with stable intermittent claudication at 150 m has an ABI of 0.7. He is on aspirin and a statin. What is the first-line treatment to improve walking distance?

   1. AAngioplasty of the superficial femoral artery
   2. BFemoropopliteal bypass
   3. CLong-term oral warfarin
   4. DSupervised exercise therapy
   Show answer and explanation

   Correct answer: D. Supervised exercise therapy

   Supervised exercise therapy is recommended first-line for intermittent claudication, alongside best medical therapy. Revascularisation is considered if symptoms remain lifestyle-limiting after exercise therapy.

   Reference: ESC/ESVS Guidelines on Peripheral Arterial Diseases 2017

4. Question 4 · Endovascular techniques, imaging and radiation safety

   On arterial duplex, the peak systolic velocity is 80 cm/s proximal to and 240 cm/s within a superficial femoral artery lesion. What does this suggest?

   1. AStenosis of at least 50%
   2. BNormal artery with no stenosis
   3. CComplete occlusion of the artery
   4. DStenosis of less than 20%
   Show answer and explanation

   Correct answer: A. Stenosis of at least 50%

   The peak systolic velocity ratio is 240/80 = 3.0, and a ratio above about 2.0 indicates a stenosis of 50% or more. An occlusion shows no flow within the segment.

   Reference: Zierler's Strandness's Duplex Scanning in Vascular Disorders, 5th ed.

5. Question 5 · Peripheral arterial disease and limb ischaemia

   A patient presents 30 hours after onset of acute leg ischaemia with a fixed mottled calf, complete paralysis, anaesthesia and no arterial or venous Doppler signals. What is the most appropriate management?

   1. ASurgical embolectomy and fasciotomy
   2. BPrimary major amputation
   3. CCatheter-directed thrombolysis
   4. DHeparin alone and reassessment
   Show answer and explanation

   Correct answer: B. Primary major amputation

   These features indicate Rutherford category III irreversible ischaemia, where revascularisation risks severe reperfusion injury and death without limb salvage. Primary amputation (or palliation) is indicated.

   Reference: ESVS Clinical Practice Guidelines on Acute Limb Ischaemia 2020

6. Question 6 · Peripheral arterial disease and limb ischaemia

   A 72-year-old man has an asymptomatic popliteal artery aneurysm found during AAA surveillance. At what diameter is elective repair generally recommended?

   1. A10 mm or more
   2. B40 mm or more
   3. COnly once symptomatic
   4. D20 mm or more
   Show answer and explanation

   Correct answer: D. 20 mm or more

   Elective repair of asymptomatic popliteal aneurysms is generally recommended at a diameter of 20 mm or more, as thromboembolism can cause limb loss. Waiting for symptoms risks acute ischaemia with poor outcome.

   Reference: ESVS Clinical Practice Guidelines on Acute Limb Ischaemia 2020