Free DHA Vascular Surgery mock test

Vascular Surgery sample questions with answers

4 more original exam-style Vascular Surgery questions, worked in full. They are not real or recalled exam questions, and none of them is in the diagnostic above, so sit that first if you have not.

1. Question 1 · Aortic disease

   A 78-year-old man with a known AAA presents with back pain, systolic pressure 80 mmHg and is conscious. CT confirms rupture with anatomy suitable for EVAR. What is the best approach?

   1. AFluid resuscitation to systolic 120 mmHg before surgery
   2. BOpen repair, as EVAR is contraindicated in rupture
   3. CTransfer to ICU for stabilisation overnight
   4. DPermissive hypotension and emergency EVAR
   Show answer and explanation

   Correct answer: D. Permissive hypotension and emergency EVAR

   Permissive (hypotensive) resuscitation, keeping the patient conscious with systolic around 70 to 90 mmHg, limits further bleeding, and EVAR is preferred where anatomy is suitable. Aggressive fluid to normal pressure can worsen haemorrhage.

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

2. Question 2 · Cerebrovascular and carotid disease

   On angiography, the narrowest internal carotid lumen measures 1.5 mm and the normal distal internal carotid artery measures 5 mm. What is the NASCET degree of stenosis?

   1. A30%
   2. B50%
   3. C70%
   4. D85%
   Show answer and explanation

   Correct answer: C. 70%

   NASCET stenosis = (1 - narrowest lumen / normal distal ICA diameter) x 100 = (1 - 1.5/5) x 100 = 70%. The ECST method uses the estimated original bulb diameter and gives higher values.

   Reference: NASCET Collaborators, NEJM 1991

3. Question 3 · Cerebrovascular and carotid disease

   Four days after endarterectomy for a tight stenosis, a patient develops severe ipsilateral headache, hypertension 200/110 mmHg and a focal seizure. CT shows no infarct or bleed. What is the key management?

   1. AImmediate re-exploration of the carotid
   2. BStart full-dose anticoagulation
   3. CStrict blood pressure control
   4. DUrgent carotid stenting of the other side
   Show answer and explanation

   Correct answer: C. Strict blood pressure control

   Hyperperfusion syndrome follows restoration of flow to a chronically hypoperfused hemisphere with impaired autoregulation, and strict blood pressure control prevents progression to haemorrhage. Anticoagulation increases bleeding risk.

   Reference: ESVS Clinical Practice Guidelines on Atherosclerotic Carotid and Vertebral Artery Disease 2023

4. Question 4 · Diabetic foot, amputation, ethics and patient safety

   A patient with diabetes has a hot, swollen foot with fluctuance, crepitus and gas in soft tissues on X-ray. He is febrile. What is the most important immediate management?

   1. AOral antibiotics with outpatient review in 48 hours
   2. BUrgent surgical drainage, debridement and antibiotics
   3. CMRI of the foot before deciding on any intervention
   4. DOffloading boot with daily wound dressings only
   Show answer and explanation

   Correct answer: B. Urgent surgical drainage, debridement and antibiotics

   Deep abscess and gas-forming infection are limb- and life-threatening and need urgent surgical drainage and debridement along with intravenous antibiotics. Vascular assessment follows promptly, and delay for imaging is not appropriate.

   Reference: IWGDF/IDSA Guidelines on Diabetes-Related Foot Infections 2023