Download VQ 2020 Vascular Surgery Qualifyingination Practice Exam and more Exams Technology in PDF only on Docsity!
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Question 1. Which artery supplies the majority of blood to the lateral aspect of the cerebral hemispheres? A) Anterior cerebral artery B) Middle cerebral artery C) Posterior cerebral artery D) Basilar artery Answer: B Explanation: The middle cerebral artery supplies most of the lateral surfaces of the cerebral hemispheres, including important motor and sensory areas. Question 2. The great saphenous vein drains into which of the following veins? A) Femoral vein B) Popliteal vein C) External iliac vein D) Inferior vena cava Answer: A Explanation: The great saphenous vein terminates by draining into the femoral vein at the saphenofemoral junction. Question 3. Coarctation of the aorta most commonly occurs at which anatomical location? A) Proximal to the left subclavian artery B) At the origin of the renal arteries C) Distal to the ductus arteriosus D) At the aortic bifurcation Answer: C
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Explanation: Coarctation typically occurs just distal to the ligamentum arteriosum, a remnant of the ductus arteriosus. Question 4. Which vessel is most commonly involved in an arteriovenous malformation (AVM) of the brain? A) Anterior cerebral artery B) Middle cerebral artery C) Posterior inferior cerebellar artery D) Superficial cortical veins Answer: B Explanation: AVMs are most frequently supplied by branches of the middle cerebral artery. Question 5. Which of the following best describes the structure of a capillary? A) Single layer of endothelial cells B) Two layers: intima and media C) Thick wall with smooth muscle D) Endothelium and adventitia only Answer: A Explanation: Capillaries consist of a single layer of endothelial cells to facilitate exchange of gases and nutrients. Question 6. Lymphatic drainage from the lower extremities ultimately returns to the central venous system via the: A) Right lymphatic duct B) Thoracic duct C) Inferior vena cava
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D) Cardiac output Answer: C Explanation: Resistance is inversely proportional to the fourth power of the vessel radius. Question 10. The Doppler shift used in vascular ultrasound is primarily a result of: A) Change in blood pressure B) Change in blood velocity C) Change in blood viscosity D) Change in blood temperature Answer: B Explanation: The Doppler effect measures changes in frequency due to moving red blood cells, reflecting velocity. Question 11. Which of the following is initiated by exposure of blood to tissue factor? A) Intrinsic coagulation pathway B) Extrinsic coagulation pathway C) Fibrinolytic pathway D) Platelet aggregation Answer: B Explanation: The extrinsic pathway is activated by exposure to tissue factor (factor III). Question 12. What is the primary enzyme responsible for fibrinolysis? A) Plasmin B) Thrombin
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C) Factor XIII D) Antithrombin III Answer: A Explanation: Plasmin breaks down fibrin clots in the fibrinolytic system. Question 13. Which hypercoagulable state is due to a point mutation leading to resistance to activated protein C? A) Antithrombin III deficiency B) Factor V Leiden C) Protein S deficiency D) Prothrombin G20210A mutation Answer: B Explanation: Factor V Leiden is a mutation making Factor V resistant to inactivation by protein C. Question 14. The first visible lesion in the development of atherosclerosis is: A) Fibrous cap B) Fatty streak C) Calcified plaque D) Cholesterol crystal Answer: B Explanation: Fatty streaks, composed of lipid-laden foam cells, are the earliest lesions. Question 15. Which inflammatory cell predominates in the early atheroma? A) Neutrophil
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B) Rate of growth C) Diameter of the aneurysm D) Degree of calcification Answer: C Explanation: Larger diameter is the strongest predictor of rupture risk (Laplace’s Law). Question 19. Which type of vasculitis primarily affects the aortic arch and its major branches in young women? A) Polyarteritis nodosa B) Giant cell arteritis C) Takayasu's arteritis D) Kawasaki disease Answer: C Explanation: Takayasu's arteritis affects large vessels, especially in young women. Question 20. The most common presenting symptom of giant cell arteritis is: A) Claudication B) Temporal headache C) Hematuria D) Abdominal pain Answer: B Explanation: Temporal headache is classic, often with scalp tenderness in giant cell arteritis. Question 21. The ankle-brachial index (ABI) is calculated as:
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A) Ankle systolic pressure divided by arm systolic pressure B) Arm diastolic pressure divided by ankle diastolic pressure C) Ankle mean pressure divided by arm mean pressure D) Arm systolic pressure divided by ankle systolic pressure Answer: A Explanation: ABI = Ankle systolic / Brachial systolic; values <0.9 suggest PAD. Question 22. Which Doppler ultrasound finding suggests >70% carotid artery stenosis? A) Peak systolic velocity <125 cm/s B) Absence of diastolic flow C) Peak systolic velocity >230 cm/s D) Monophasic waveforms Answer: C Explanation: Peak systolic velocity >230 cm/s strongly suggests severe carotid stenosis. Question 23. Pulse volume recording (PVR) is most useful for: A) Detecting venous thrombosis B) Quantifying arterial occlusive disease C) Measuring pulmonary artery pressures D) Assessing cardiac output Answer: B Explanation: PVR detects changes in limb volume with each pulse, indicating arterial inflow. Question 24. TcPO2 (transcutaneous oxygen pressure) values >40 mmHg at a wound site indicate:
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Question 27. The primary purpose of preoperative pulmonary function tests (PFTs) before vascular surgery is to: A) Diagnose heart failure B) Assess risk for postoperative respiratory complications C) Detect anemia D) Evaluate renal function Answer: B Explanation: PFTs help predict the risk of postoperative pulmonary complications. Question 28. According to USPSTF guidelines, screening for abdominal aortic aneurysm (AAA) is recommended in: A) Men aged 65-75 who have ever smoked B) All women over 60 C) Non-smoking men over 80 D) All adults with hypertension Answer: A Explanation: Men 65-75 who have ever smoked are the target group for AAA screening. Question 29. Indication for repair of an asymptomatic abdominal aortic aneurysm (AAA) is: A) Diameter >5.5 cm in men B) Diameter >4.0 cm in women C) Any evidence of calcification D) Stable size on serial imaging Answer: A Explanation: Repair is indicated when AAA diameter exceeds 5.5 cm in men.
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Question 30. Which postoperative complication is unique to endovascular aneurysm repair (EVAR) compared to open repair? A) Myocardial infarction B) Endoleak C) Renal failure D) Spinal cord ischemia Answer: B Explanation: Endoleak, or persistent blood flow outside the graft but within the aneurysm sac, is specific to EVAR. Question 31. Spinal cord protection during thoracoabdominal aortic aneurysm (TAAA) repair is best achieved by: A) Increasing mean arterial pressure only B) Cerebrospinal fluid (CSF) drainage C) Aggressive cooling D) Renal artery stenting Answer: B Explanation: CSF drainage reduces spinal cord pressure and enhances perfusion. Question 32. For chronic mesenteric ischemia, which symptom is most characteristic? A) Sudden onset severe abdominal pain B) Postprandial abdominal pain and weight loss C) Flank pain D) Intermittent rectal bleeding
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D) Patients with complete occlusion Answer: B Explanation: Symptomatic patients with severe stenosis benefit most from CEA. Question 36. Which is NOT a recognized complication of carotid artery stenting (CAS)? A) Embolic stroke B) Hyperperfusion syndrome C) Myocardial infarction D) Endoleak Answer: D Explanation: Endoleaks are a complication of EVAR, not CAS. Question 37. What is the most common cause of stroke after carotid endarterectomy? A) Myocardial infarction B) Embolism from the operative site C) Hypotension D) Hyperkalemia Answer: B Explanation: Embolism from the operative site is the leading cause of perioperative stroke. Question 38. Claudication is defined as: A) Rest pain in the foot B) Ulceration of the toes C) Pain in the muscles of the lower extremity with exertion, relieved by rest
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D) Swelling of the calf Answer: C Explanation: Claudication is exertional limb pain relieved by rest, due to arterial insufficiency. Question 39. Critical limb ischemia (CLI) is best defined by: A) Rest pain, tissue loss, or non-healing ulcers B) Intermittent claudication C) Limb swelling D) Venous stasis changes Answer: A Explanation: CLI is characterized by rest pain, ulcers, or gangrene due to severe arterial insufficiency. Question 40. The preferred conduit for femoropopliteal bypass is: A) Polytetrafluoroethylene (PTFE) graft B) Dacron graft C) Autogenous saphenous vein D) Synthetic mesh Answer: C Explanation: Autogenous saphenous vein is associated with the best long-term patency. Question 41. Which is a common complication after infrapopliteal/tibial artery interventions? A) Aortic dissection B) Compartment syndrome C) Restenosis
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C) Frequent soaking in hot water D) Proper footwear Answer: C Explanation: Soaking increases the risk of burns and skin breakdown; avoid in diabetic foot care. Question 45. The most common site of deep vein thrombosis (DVT) in the lower limb is: A) Femoral vein B) Popliteal vein C) Posterior tibial vein D) Calf (muscular) veins Answer: D Explanation: Calf veins are the initial site in most DVTs, with risk of proximal extension. Question 46. Which is the first-line anticoagulant for most acute DVT cases? A) Aspirin B) Warfarin C) Low molecular weight heparin (LMWH) D) Clopidogrel Answer: C Explanation: LMWH is widely used for initial DVT management due to efficacy and safety. Question 47. Catheter-directed thrombolysis (CDT) for DVT is best indicated in: A) Isolated distal DVT B) Extensive iliofemoral DVT with limb threat
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C) Chronic post-thrombotic syndrome D) All calf DVTs Answer: B Explanation: CDT is reserved for extensive, limb-threatening DVTs to prevent post-thrombotic syndrome. Question 48. The most common complication of IVC filter placement is: A) Renal failure B) Filter migration C) Filter thrombosis D) Arterial embolism Answer: C Explanation: IVC filter thrombosis is the most frequent complication over time. Question 49. Venous reflux in chronic venous insufficiency is best assessed with: A) Venography B) Duplex ultrasound C) Ankle-brachial index D) D-dimer Answer: B Explanation: Duplex ultrasound allows visualization of reflux and valve incompetence. Question 50. The CEAP classification for chronic venous disease includes all except: A) Clinical
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B) Large saphenous trunk reflux C) Spider veins D) Reticular veins Answer: B Explanation: Sclerotherapy is not effective for large axial veins with significant reflux. Question 54. The main presenting feature of venous thoracic outlet syndrome (Paget-Schroetter syndrome) is: A) Digital gangrene B) Acute upper extremity swelling C) Lower limb edema D) Raynaud’s phenomenon Answer: B Explanation: Paget-Schroetter syndrome presents as acute swelling due to subclavian vein thrombosis. Question 55. First rib resection is indicated in thoracic outlet syndrome when: A) Conservative therapy fails B) There is evidence of arterial compromise C) There is disabling neurogenic TOS D) All of the above Answer: D Explanation: Surgical decompression is reserved for failed conservative therapy or vascular/neurologic compromise. Question 56. The preferred initial vascular access for hemodialysis is:
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A) Tunneled central venous catheter B) Radiocephalic arteriovenous fistula C) Arteriovenous graft D) Femoral vein catheter Answer: B Explanation: Radiocephalic AVF is preferred due to longevity and low complication rate. Question 57. The main advantage of an autogenous AVF over prosthetic AVG for dialysis access is: A) Lower infection rate B) Easier cannulation C) Immediate use D) Higher thrombosis risk Answer: A Explanation: Autogenous AVFs have much lower infection and thrombosis rates. Question 58. Steal syndrome after AVF creation presents as: A) Swelling of the hand B) Ischemic pain and pallor of the hand C) High output heart failure D) Infection at the access site Answer: B Explanation: Steal syndrome results from diversion of arterial blood, causing hand ischemia. Question 59. The best test for diagnosing AVF stenosis is:
