Vascular Surgery Prometric exam questions with answers

1. Question 1Aortic diseasemedium

   A 74-year-old woman has an asymptomatic infrarenal AAA under surveillance. Compared with men, what repair threshold is commonly considered?

   1. A6.0 cm, because operative risk is higher in women
   2. B5.0 cm, because rupture risk is higher in women
   3. C5.5 cm, the same as in men
   4. D4.0 cm, because women have smaller aortas
   Show answer and explanation▾

   Answer: B. 5.0 cm, because rupture risk is higher in women

   Women have a higher rupture risk at smaller diameters, so a lower threshold of about 5.0 cm is commonly considered. Repair at 4.0 cm is not supported by evidence.

2. Question 2Aortic diseasehard

   On day 2 after open repair of a ruptured AAA, the patient passes bloody diarrhoea and lactate is rising. What is the most appropriate investigation?

   1. ABarium enema
   2. BFlexible sigmoidoscopy
   3. CStool culture and observation
   4. DCapsule endoscopy
   Show answer and explanation▾

   Answer: B. Flexible sigmoidoscopy

   Bloody diarrhoea after aortic repair suggests ischaemic colitis, usually of the sigmoid after loss of inferior mesenteric flow; prompt sigmoidoscopy assesses severity and guides laparotomy. Barium enema is contraindicated in suspected ischaemia.

3. Question 3Cerebrovascular and carotid diseasemedium

   Two hours after carotid endarterectomy, a patient develops an expanding neck haematoma with stridor and falling oxygen saturation. What is the immediate action?

   1. AGive nebulised adrenaline and observe
   2. BArrange urgent CT of the neck
   3. COpen the wound at the bedside to decompress
   4. DAttempt awake fibreoptic intubation first
   Show answer and explanation▾

   Answer: C. Open the wound at the bedside to decompress

   An expanding haematoma causing airway compromise needs immediate wound opening to relieve pressure, then return to theatre. Imaging or delayed airway attempts can be fatal as laryngeal oedema progresses.

4. Question 4Diabetic foot, amputation, ethics and patient safetymedium

   A 70-year-old with gangrene of the forefoot has full decision-making capacity and declines the recommended below-knee amputation after a thorough discussion. What is the appropriate action?

   1. AProceed with surgery under emergency powers
   2. BAsk his family to sign consent on his behalf
   3. CRespect the decision, document it and offer alternatives
   4. DDischarge him without arranging further follow-up
   Show answer and explanation▾

   Answer: C. Respect the decision, document it and offer alternatives

   A competent adult may refuse surgery even if it may lead to death; the surgeon should document the discussion, explore concerns, offer symptom control and alternatives, and revisit the decision. Family members cannot consent for a capacitous adult.

5. Question 5Vascular trauma and emergencieseasy

   A man with a stab wound to the thigh has pulsatile bleeding and an expanding haematoma. What is the most appropriate management?

   1. ACT angiography before deciding
   2. BDirect operative exploration and repair
   3. CDuplex ultrasound and observation
   4. DPressure dressing and discharge
   Show answer and explanation▾

   Answer: B. Direct operative exploration and repair

   Hard signs such as pulsatile bleeding, expanding haematoma, bruit or thrill, or absent pulses indicate arterial injury and warrant direct operative exploration. Imaging is reserved for soft signs.

6. Question 6Endovascular techniques, imaging and radiation safetymedium

   During fluoroscopy, a nurse moves from 1 metre to 2 metres from the scatter source. How does her radiation dose rate change?

   1. AIt falls to one quarter
   2. BIt falls to one half
   3. CIt stays the same
   4. DIt falls to one eighth
   Show answer and explanation▾

   Answer: A. It falls to one quarter

   Radiation intensity follows the inverse square law, so doubling the distance reduces dose to one quarter. Distance, time and shielding are the core radiation protection principles.

7. Question 7Vascular medicine and perioperative carehard

   A beta-blocker-naive patient is scheduled for elective open aortic surgery tomorrow. A trainee suggests starting high-dose metoprolol on the morning of surgery. What is the correct advice?

   1. AStart it, as it lowers overall mortality
   2. BDo not start high-dose beta-blocker on the day of surgery
   3. CStart it only if heart rate is below 50
   4. DStart it and stop it immediately after surgery
   Show answer and explanation▾

   Answer: B. Do not start high-dose beta-blocker on the day of surgery

   Starting high-dose beta-blockers immediately before surgery reduced myocardial infarction but increased stroke and mortality in the POISE trial. Patients already on beta-blockers should continue them.

8. Question 8Venous disease and thromboembolismeasy

   A patient has varicose veins with lipodermatosclerosis of the gaiter area but no ulcer. What is the CEAP clinical class?

   1. AC4
   2. BC2
   3. CC5
   4. DC6
   Show answer and explanation▾

   Answer: A. C4

   Skin changes such as pigmentation, eczema or lipodermatosclerosis are C4. C5 is a healed ulcer and C6 an active ulcer.

9. Question 9Peripheral arterial disease and limb ischaemiamedium

   A 70-year-old with long-standing diabetes has a non-healing toe ulcer and absent foot pulses, but the ABI is 1.5. What is the most appropriate next test?

   1. ARepeat ABI after exercise
   2. BAccept the ABI as excluding ischaemia
   3. CAnkle pressure with a larger cuff
   4. DToe-brachial index or toe pressures
   Show answer and explanation▾

   Answer: D. Toe-brachial index or toe pressures

   An ABI above 1.4 indicates incompressible, calcified arteries common in diabetes and renal disease, so ankle pressures are unreliable. Toe pressures or toe-brachial index are recommended because digital arteries are usually spared from calcification.

10. Question 10Peripheral arterial disease and limb ischaemiamedium

    A patient with claudication asks about medication to increase walking distance. Which condition contraindicates cilostazol?

    1. AType 2 diabetes mellitus
    2. BTreated hypertension
    3. CCongestive heart failure
    4. DPrevious cholecystectomy
    Show answer and explanation▾

    Answer: C. Congestive heart failure

    Cilostazol is a phosphodiesterase III inhibitor and is contraindicated in heart failure of any severity because related drugs increased mortality in heart failure. Diabetes and hypertension are not contraindications.

11. Question 11Vascular medicine and perioperative caremedium

    In a patient with stable symptomatic PAD at low bleeding risk, which antithrombotic regimen reduced major adverse cardiovascular and limb events compared with aspirin alone?

    1. ARivaroxaban 20 mg daily plus clopidogrel
    2. BWarfarin with INR 2 to 3 plus aspirin
    3. CDipyridamole plus aspirin
    4. DRivaroxaban 2.5 mg twice daily plus aspirin
    Show answer and explanation▾

    Answer: D. Rivaroxaban 2.5 mg twice daily plus aspirin

    In the COMPASS trial, rivaroxaban 2.5 mg twice daily plus aspirin reduced cardiovascular and major limb events in stable PAD, at the cost of more bleeding. Full-dose warfarin with antiplatelet therapy increased bleeding without benefit.

12. Question 12Vascular trauma and emergenciesmedium

    After reduction of a posterior knee dislocation, foot pulses are palpable but the ankle-brachial index on the injured side is 0.8. What is the next step?

    1. ACT angiography of the limb
    2. BDischarge with knee immobilisation
    3. CRepeat ABI in one week
    4. DImmediate above-knee amputation
    Show answer and explanation▾

    Answer: A. CT angiography of the limb

    Popliteal artery injury is common after knee dislocation and pulses may be present despite an intimal injury. An ABI below 0.9 warrants arterial imaging such as CT angiography.

13. Question 13Vascular trauma and emergenciesmedium

    Eight hours after embolectomy for acute leg ischaemia, the patient has severe calf pain on passive toe dorsiflexion and a tense calf, with palpable pedal pulses. What is the correct treatment?

    1. AFour-compartment fasciotomy
    2. BElevation and repeat review in 6 hours
    3. CIncrease opioid analgesia only
    4. DRepeat embolectomy
    Show answer and explanation▾

    Answer: A. Four-compartment fasciotomy

    Pain on passive stretch with a tense compartment after reperfusion indicates compartment syndrome, which needs urgent fasciotomy of all four leg compartments. Pulses are often preserved, so their presence does not exclude it.

14. Question 14Venous disease and thromboembolismmedium

    A patient has a venous leg ulcer above the medial malleolus. Before applying multilayer compression of about 40 mmHg, what must be confirmed?

    1. ANegative wound swab culture
    2. BAdequate arterial supply, such as ABI of 0.8 or more
    3. CNormal D-dimer level
    4. DAbsence of deep venous reflux on duplex
    Show answer and explanation▾

    Answer: B. Adequate arterial supply, such as ABI of 0.8 or more

    Strong compression can cause necrosis if arterial supply is poor, so arterial disease should be excluded (commonly ABI 0.8 or more) before full compression. Wound colonisation is expected and does not prevent compression.

15. Question 15Venous disease and thromboembolismmedium

    A patient with extensive iliofemoral DVT develops a massively swollen, blue, painful leg with blistering and weakening foot pulses. What is the most appropriate treatment?

    1. AClass 2 compression stockings and elevation
    2. BOral rivaroxaban and outpatient review in a week
    3. CInferior vena cava filter insertion alone
    4. DAnticoagulation with urgent thrombus removal
    Show answer and explanation▾

    Answer: D. Anticoagulation with urgent thrombus removal

    Phlegmasia cerulea dolens threatens the limb through venous gangrene, so anticoagulation plus urgent thrombus removal is indicated. Compression is contraindicated, and a filter does not relieve venous outflow obstruction.

Last reviewed September 2026. Questions are original and written to the published exam blueprint; they are not taken from any real paper.