1) A 28 year old female has suffered from diffuse abdominal pain for the past 2 weeks since she

was started on
the contraceptive pill. The pain has increased significantly over the post 10 hours and has been associated with
vomiting. A pregnancy test is negative. What is the most likely diagnosis?

a) Mesenteric venous thrombosis

b) Acute mesenteric embolus
c) Chronic mesenteric ischaemia
d) Ruptured ectopic pregnancy
e) Inflammatory bowel disease

2) A 72 year old man collapses with sudden onset abdominal pain. He has been suffering from back pain
recently and has been taking ibuprofen. What is the most likely cause?

a) Acute mesenteric artery embolus

b) Peritonitis due to peptic ulcer disease
c) Ruptured abdominal aortic aneurysm
d) Bleeding Dieulafoy lesion
e) Pancreatitis

3) A 40 year old lady presents to the surgical clinic with symptoms related to varicose veins. She has noticed
that these first developed when she was pregnant. On examination, she has a truncal varicosity of the medial
leg, there are no ulcers or skin changes. A hand held Doppler examination demonstrates sapheno popliteal
junction reflux. What is the most appropriate course of action?

a) Offer the patient sapheno-popliteal junction ligation

b) Offer the patient foam sclerotherapy of the sapheno-popliteal junction
c) Offer the patient laser ablation of the sapheno-popliteal junction
d) Arrange contrast venography
e) Arrange a duplex scan

4) A 79 year old lady develops sudden onset of abdominal pain and collapses, she has passed a large amount of
diarrhoea. In casualty her pH is 7.35 and WCC is 18. What is the most likely cause?

a) Mesenteric venous thrombosis

b) Acute mesenteric embolus
c) Acute on chronic mesenteric ischaemia
d) Vasculitis
e) Myocardial infarct

5) The medical team refer a 72 year old lady with a bilateral swollen legs. Deep vein thrombosis has been
excluded and there is no response to diuretics. On further questioning, the patient reveals that she was born with
the swelling in both of her legs. What is the most likely diagnosis?

a) Lymphoedema tarda
b) Meige's disease
c) Filariasis
d) Lymphoma
e) Milroy's disease
6) A 65 year old diabetic female presents with a painless ulcer at the medial malleolus, it has been present for
the past 16 years. On examination, she has evidence of truncal varicosities and a brownish discolouration of the
skin overlying the affected area. What is the most likely cause?

a) Chronic obliterative arterial disease

b) Superficial venous insufficiency
c) Deep venous insufficiency
d) Mixed ulcer
e) Neuropathic ulcer

7) A 52 year old obese lady reports a painless grape sized mass in her groin area. She has no medical conditions
apart from some varicose veins. There is a cough impulse and the mass disappears on lying down. What is the
most likely cause?

a) Femoral hernia
b) Inguinal hernia
c) Saphena varix
d) False aneurysm of the femoral artery
e) Arteriovenous malformation

8) A 79 year old retired teacher has had an ulcer for 15 years. It is at the medial malleolus and has associated
lipodermatosclerosis of the lower limb. The ulcer base is heaped up and irregular. What is the most likely
diagnosis?

a) Basal cell carcinoma

b) Superficial venous insufficiency
c) Squamous cell carcinoma
d) Mixed ulcer
e) Chronic obliterative arterial disease

9) A 22 year old professional tennis player attends the emergency department with a swollen painful right arm.
On examination, his fingers are dusky. What is the most appropriate investigation?

a) Chest X-ray
b) Arterial duplex scan
c) CT angiogram
d) Venous duplex scan
e) Venous Doppler test

10) In which of the following operations are Skew flaps created?

a) Hindquarter amputation
b) Above knee amputation
c) Gritti- Stokes amputation
d) Below knee amputation
e) Symes amputation
11) Which of the ABPI measurements shown below is most likely to be found in an 83 year old man with rest
pain?

a) 0.6-0.8
b) <0.4
c) >1.2
d) 1.0
e) 0.5

12) A 72 year old man present in the vascular clinic with calf pain present on walking 100 yards. He is an ex-
smoker and lives alone. On examination, he has reasonable leg pulses. His right dorsalis pedis pulse gives a
monophasic doppler signal with an ankle brachial pressure index measurement of 0.7. All other pressures are
acceptable. There is no evidence of ulceration or gangrene. What is the best course of action?

a) Conservative management with medical therapy and exercise

b) Angioplasty
c) Arterial bypass surgery with PTFE graft
d) Arterial bypass surgery with vein graft
e) Watch and wait

13) A wheelchair bound 78 year old woman with ischaemic heart disease secondary to long smoking history and
longstanding type II diabetes presents with rest pain and a non healing ulcer on the dorsum of her foot.
Angiogram shows reasonable superficial femoral artery and iliacs. At the level of the popliteal artery there is an
occlusion. Below this there is a short area of patent posterior tibial artery and this reconstitutes lower down the
leg to flow to the foot. What is the best treatment option?

a) Long sub intimal angioplasty

b) Femoro-distal bypass graft with PTFE
c) Above knee amputation
d) Below knee amputation
e) Axillo-femoral bypass

14) A 24 year old lady presents with a history of severe epigastric pain that is worse post prandially. On
examination, the abdomen is soft and non tender with no palpable masses, there is a bruit in the epigastrium.
Imaging with USS shows no gallstones and an OGD is normal. What is the most likely diagnosis?

a) Sphincter of oddi dysfunction

b) Irritable bowel syndrome
c) Median arcuate ligament syndrome
d) Mesenteric vein thrombosis
e) GORD

15) A 72 year old man has a CT scan for abdominal discomfort and the surgeon suspects abdominal aortic
disease. It reveals a 6.6cm aneurysm with a 3.5cm neck and it continues to involve the right common iliac. The
left iliac is occluded. He is hypertensive and has Type 2 DM which is well controlled. What is the best course of
action?

a) Abdominal aortic aneurysm repair in next 48 hours

b) Abdominal aortic aneurysm repair in 6 weeks time
c) Review in outpatients in 3 months
d) Endovascular aortic aneurysm repair in 48 hours
e) Discharge the patient
16) A 34 year old teacher attends A&E with a swollen leg. She has been in England for 2 weeks having
previously lived in the Democratic Republic of the Congo. She lives in an area prevalent with mosquitoes and
where there is poor sanitation. What is the most likely diagnosis?

a) Meige's disease
b) Lymphoma
c) Milroy's disease
d) Filariasis
e) Malaria

17) A 23 year old male suffering from hepatitis C presents with right groin pain and swelling. On examination,
there is a large abscess in the groin. Adjacent to this is a pulsatile swelling. There is no cough impulse. What is
the most likely diagnosis?

a) Saphena varix
b) False aneurysm of the femoral artery
c) True aneurysm of the femoral artery
d) Incarcerated hernia
e) Reactive lymphadenopathy

18) A 71 year old man presents with a painful lower calf ulcer, mild pitting oedema and an ABPI of 0.3. What is
the most likely cause?

a) Mixed ulcer
b) Deep venous insufficiency
c) Chronic obliterative arterial disease
d) Squamous cell carcinoma
e) Neuropathic ulcer

19) A 63 year old man is admitted with rest pain and foot ulceration. An angiogram shows a 3 cm area of
occlusion of the distal superficial femoral artery with 3 vessel run off. His ankle - brachial pressure index is 0.4.
What is the most appropriate course of action?

a) Conservative management with medical therapy and exercise

b) Arterial bypass surgery using PTFE
c) Arterial bypass surgery using vein
d) Primary amputation
e) Angioplasty

20) A 60 year old Tibetan immigrant is referred to the surgical clinic with a painless neck swelling. On
examination, it is located on the left side in the anterior triangle. There are no other abnormalities to find. What
is the most likely diagnosis?

a) Carotid body tumour

b) Submandibular gland calculus
c) Carotid artery aneurysm
d) Fibromatosis colli
e) Laryngeal cancer
21) A 48 year old woman is admitted with sepsis secondary to an infected diabetic foot ulcer. She has a necrotic
and infected forefoot with necrosis of the heel. There is a boggy indurated swelling anterior to the ankle joint.
Pulses are normal. What is the best course of action?

a) Above knee amputation

b) Amputation of the foot
c) Below knee amputation
d) Incision and drainage of pus
e) Application of 4 layer bandages

22) An 89 year old man presents with hypotension and collapse and is found by the staff in the toilet of his care
home. He is moribund and unable to give a clear history. He had suffered a cardiac arrest in the ambulance but
has since been resuscitated and now has a Bp of 95 systolic. He has an obviously palpable AAA. What is the
best course of action?

a) Immediate CT scanning of the abdominal aorta

b) Immediate laparotomy
c) Immediate endovascular aortic aneurysm repair
d) Palliation
e) USS of aorta

23) A 35 year old Singaporean female attends a varicose vein pre operative clinic. On auscultation, a mid
diastolic murmur is noted at the apex. The murmur is enhanced when the patient lies in the left lateral position.
What is the most likely underlying lesion?

a) Pulmonary valve stenosis

b) Aortic valve stenosis
c) Aortic sclerosis
d) Mitral valve stenosis
e) Tricuspid regurgitation

24) A 77 year old morbidly obese man with type 2 diabetes presents with leg pain at rest. His symptoms are
worst at night and sometimes improve during the day. He has no areas of ulceration. Which of the ABPI
measurements shown below is most likely to be found?

a) 1.0
b) >1.2
c) 0.3
d) 0.7
e) 0.5

25) A 76 year old man presents acutely with a painful right arm (he is right handed). On examination, he has a
cool right forearm and absent radial and brachial pulses. A duplex scan shows thrombus occluding the brachial
artery. What is the most appropriate course of action?

a) Administration of therapeutic low molecular weight heparin

b) Brachial embolectomy without fasciotomy
c) Intra arterial thrombolysis
d) Systemic thrombolysis
e) Brachial embolectomy with fasciotomy
26) A 66 year old female has long standing mixed arteriovenous ulcers of the lower leg. Over the past 6 months
one of the ulcers has become much worse and despite a number of different topical therapies is increasing in
size. What is the most likely diagnosis?

a) Neuropathic ulcer
b) Mixed ulcer
c) Deep venous insufficiency
d) Marjolins ulcer
e) Chronic obliterative arterial disease

27) A 73 year old male presents with a collapse and is brought to the emergency department. On examination,
he has a cold, painful left hand and forearm. What is the most likely cause?

a) Occlusion of the brachial artery due to atheroma

b) Occlusion of the axillary artery due to atheroma
c) Axillary vein thrombosis
d) Cervical rib
e) Brachial artery embolus

28) A 41 year old man is admitted with peritonitis secondary to a perforated appendix. He is treated with a
laparoscopic appendicectomy but has a stormy post operative course. He is now developing increasing
abdominal pain and has been vomiting. A laparotomy is performed and at operation a large amount of small
bowel shows evidence of patchy areas of infarction. What is the most likely cause?

a) Mesenteric venous thrombosis

b) Superior mesenteric artery embolus
c) Acute on chronic mesenteric ischaemia
d) Vasculitis
e) Median arcuate ligament syndrome

29) A thin 72 year old lady has a 3 week history of postprandial abdominal pain that is centrally located. She has
episodic diarrhoea and occasionally has passed blood PR. She has a history of ischaemic heart disease and
marked renal impairment from ACE inhibitor usage. What is the most appropriate investigation?

a) Colonoscopy
b) Duplex ultrasound scan of abdomen
c) CT angiogram
d) CT scan without contrast
e) Measurement of faecal calprotectin

30) A 54 year old lady presents with recurrent right sided varicose veins. She underwent endovenous laser
ablation 5 years previously. On examination, she has skin changes affected the medial lower leg. Imaging
demonstrates re-canalization of the long saphenous vein and saphenofemoral junction incompetence. What is
the most appropriate option?

a) Offer redo endovenous laser therapy

b) Offer foam sclerotherapy
c) Offer saphenofemoral disconnection, long saphenous stripping to above knee and avulsions as required
d) Offer saphenofemoral disconnection, long saphenous stripping to below knee and avulsions as required
e) Offer saphenofemoral junction ligation alone
31) An 83 year old lady is admitted from a nursing home with infected lower leg ulcers. She underwent an
attempted long superficial femoral artery sub initimal angioplasty 2 weeks previously. This demonstrated poor
runoff below the knee. What is the best course of action?

a) Below knee amputation with Burgess flap

b) Below knee amputation with skew flaps
c) Transfemoral amputation
d) Gritti Stokes amputation
e) Wound debridement

32) A 32 year old male is noted to have a tender mass in the right groin area. There are also red streaks on the
thigh, extending from a small abrasion. What is the most likely explanation?

a) Lymphadenitis
b) Saphena varix
c) Femoral artery aneurysm
d) Abscess
e) Incarcerated hernia

33) Which of the ABPI measurements shown below is most likely to be found in a 45 year old man who
develops calf pain after walking 600 yards. It resolves during periods of rest.

a) >1.2
b) 1.0
c) 0.7
d) 0.5
e) 0.3

34) A 78 year old man develops sudden onset abdominal pain and almost immediately afterwards passes a large
amount of diarrhoea. What is the most appropriate investigation?

a) Abdominal x-ray
b) CT angiogram
c) Abdominal MRI scan
d) Abdominal USS
e) Rigid sigmoidoscopy

35) A 66 year old man is referred via the aneurysm screening programme with an abdominal aortic aneurysm
measuring 4.4 cm. Apart from well controlled type 2 DM he has no other co-morbidities. What is the best
course of action?

a) AAA repair during next 48 hours

b) USS in 6 months
c) CT aortic angiogram
d) MRI aortic angiogram
e) Discharge from the programme
36) A 78 year old man presents with left sided rest pain in his leg and a non healing arterial leg ulcer on the
same leg. Imaging shows normal right leg vessels, on the left side there is a long occlusion of the external iliac
artery that is unsuitable for stenting. He has a significant cardiac history. What is the most appropriate treatment
option?

a) Aorto-bifemoral bypass
b) Axillo-bifemoral bypass
c) Femoro-femoro cross over graft
d) Femoro-distal bypass
e) Amputation

37) A 52 year old lady develops lower leg swelling following redo varicose vein surgery. There is evidence of
swelling of the left leg up to the knee. The overlying skin appears healthy. What is the best management option?

a) Homans operation
b) Multilayer compression bandages
c) High dose frusemide
d) High dose bumetanide
e) Lymphovenous anastomosis

38) A 67 year old patient is due to undergo a femoro-popliteal bypass graft. Which heparin regime should the
surgeon ask for prior to cross clamping the femoral artery?

a) Single therapeutic dose of low molecular weight heparin on the ward prior to coming to theatre
b) Single therapeutic dose of low molecular weight heparin the night before surgery
c) Dose of 10,000 units of unfractionated heparin prior to induction of anaesthesia
d) Dose of 3,000 units of unfractionated heparin, 3 minutes prior to cross clamping
e) Dose of 30,000 units of unfractionated heparin, 3 minutes prior to cross clamping

39) An 18 year old lady presents with extensive varicose veins of her left leg. There is associated port wine
staining. What is the most likely diagnosis?

a) Type 1 diabetes
b) Osler syndrome
c) Gardner's syndrome
d) Proteus syndrome
e) Klippel-Trenaunay-Weber syndrome

40) Which operation below is an amputation of the lower limb in which the femoral condyles are removed and
the patella retained?

a) Transfemoral amputation
b) Gritti Stokes amputation
c) Symes amputation
d) Below knee amputation with Burgess flap
e) Below knee amputation with Skew flap
41) A 66 year old man has been suffering from weight loss and develops severe abdominal pain. He is admitted
to hospital and undergoes a laparotomy. At operation, the entire small bowel is infarcted and only the left colon
is viable. What is the most likely explanation?

a) Mesenteric venous thrombosis

b) Acute on chronic mesenteric ischaemia
c) Acute embolus to the inferior mesenteric artery
d) Acute embolus affecting the coeliac axis
e) Arcuate ligament compression syndrome

42) Which of the interventions listed below would not be conventional treatment for a venous ulcer?

a) Compression bandages
b) Limb elevation to control oedema
c) Optimisation of glycaemic control of diabetic
d) Use of skin grafts in selected cases
e) Excision and closure in selected cases

43) A 23 year old man presents with intermittent symptoms of altered sensation in his arm and discomfort when
he uses his hands. He works as an electrician and his symptoms are worst when he is fitting light fixtures. What
is the most likely cause?

a) Cervical rib
b) Axillary artery embolus
c) Axillary vein thrombosis
d) Raynaud's
e) Atheroma of the subclavian artery

44) During short saphenous vein surgery for varicose veins which of the following nerves is particularly at risk?

a) Sural nerve
b) Popliteal nerve
c) Tibial nerve
d) Femoral nerve
e) Saphenous nerve

45) A 22 year old intravenous drug user is found to have a femoral abscess. The nursing staff contact the on call
doctor as the patient has a temperature of 39oC. He is found to have a pan systolic murmur loudest at the left
sternal edge at the 4th intercostal space. What is the most likely underlying lesion?

a) Aortic regurgitation
b) Mitral regurgitation
c) Aortic stenosis
d) Tricuspid stenosis
e) Tricuspid regurgitation
46) A 21 year old badminton player attends A&E with a painful, swollen right arm. He is right handed.
Clinically he has dusky fingers and his upper limb pulses are present. An axillary vein thrombosis is confirmed.
What is the best acute treatment to achieve vein patency?

a) Intravenous heparin
b) Warfarin
c) Catheter directed tPA
d) Low molecular weight heparin
e) Aspirin

47) A 23 year old man presents with a brachial artery embolus. A cervical rib is suspected as being the
underlying cause. From which of the following vertebral levels do they most often arise?

a) C7
b) C5
c) C4
d) C3
e) C2

48) A 57 year old lady has suffered from lymphoedema for many years. The left leg is swollen to the mid thigh.
Severe limb deformity has developed as a result of process and in spite of compression hosiery.
Lymphoscintography shows no patent lymphatics in the proximal leg. The overlying skin is healthy. Which of
the following options would give the best long term outcome?

a) Multilayer compression bandages

b) Charles operation
c) Homans operation
d) Long term loop diuretic therapy
e) Amputation

49) A 73 year old man with rest pain and ulceration of the foot undergoes a femoro-distal bypass graft with a
PTFE graft. At the end of the procedure there are good distal foot pulses and a warm pink foot. Over the
ensuing 60 days the foot becomes progressively cooler and the pulses diminish. What is the most likely
underlying explanation for this process?

a) Embolus
b) Neo-intimal flap
c) Neo-intimal hyperplasia
d) Polyarteritis
e) Steal syndrome

50) Which of the following is not a typical feature of a chronic venous leg ulcer?

a) Heaped raised borders if the ulcer has been present more than 5 years
b) Evidence of surrounding lipodermatosclerosis
c) Irregular shape to the ulcer
d) 20% of cases will have a previous history of deep vein thrombosis
e) Haemosiderin deposits in surrounding skin
51) A 74 year old man presents with a painful right leg. The pain developed suddenly the preceeding evening.
However, he wondered if it might resolve overnight, instead, it has got worse. On examination, his right leg is
cold and white with diminished distal sensation. A CT angiogram shows a thrombus occluding the external iliac
artery with no atheromatous disease. What is the most appropriate course of action?

a) Femoral embolectomy and below knee fasciotomy

b) Femoral embolectomy alone
c) Femoral popliteal bypass graft without fasciotomy
d) Femoral embolectomy with above and below knee fasciotomy
e) Femoro-femoro cross over graft with above and below knee fasciotomy

52) Which of the following is not a typical feature of an arterial leg ulcer?

a) Well demarcated edges

b) A grey - white base to the ulcer
c) Men are affected more than women
d) Painful
e) Ankle swelling

53) A 65 year old man presents with expressive dysphasia and right sided weakness over 4 hours. His symptoms
have now completely resolved. A CT scan of his head is normal. What is the most useful investigation?

a) Arch aortogram
b) Arterial duplex scan
c) 24 hour cardiac tape
d) Implantation of a reveal device
e) MRI brain

54) Which of the ABPI measurements shown below is most likely to be found in a 43 year old lady with long
standing diabetes who complains of foot pain. It is worse at night and during minor exercise.

a) >1.0
b) 0.9
c) 0.3
d) 0.5
e) 0.7

55) A 66 year old man is admitted with severe angina. There is a lesion of the proximal left anterior descending
coronary artery. Which of the following would be the most suitable conduit for bypass?

a) Long saphenous vein

b) Short saphenous vein
c) Cephalic vein
d) Internal mammary artery
e) Thoraco-acromial artery
56) An 84 year old lady is admitted with an infected diabetic foot. An x-ray shows osteomyelitis of her
calcaneum. She has a fixed flexion deformity of her knee, but normal pulses. What is the best course of action?

a) Above knee amputation

b) Below knee amputation
c) Application of 4 layer bandages
d) Hyperbaric oxygen therapy
e) Debridement of foot bones and application of VAC

57) Which of the following types of lymphedema is congenital?

a) Meiges' disease
b) Milroy's disease
c) Lymphoedema tarda
d) Lymphoedema following surgery
e) Lymphoedema due to venous insufficiency

58) Concerning proximal aortic dissection (Debakey types 1 and 2/ Stanford type A) which statement is false?

a) The intimal tear is typically >50% of the aortic circumference

b) It is usually treated using an endovascular approach
c) They have a 50% mortality in the first 2 days
d) Arch reconstructions may require deep hypothermic circulatory arrest
e) Target systolic pressure of around 110mmHg should be maintained

59) A 63 year old man who previously smoked 20 cigarettes a day and has newly diagnosed type II diabetes. He
presents with rest pain. A diagnostic angiogram demonstrates occlusion of the distal superficial femoral artery
continuing below the knee. He has reasonable posterior tibial artery below this level which branches to give
good runoff to the foot. He has varicose veins. Which of the strategies presented below is most appropriate?

a) Femoro-distal bypass graft using long saphenous vein

b) Femoro-above knee popliteal bypass graft using PTFE
c) Femoro-distal bypass graft using PTFE
d) Femoro-distal bypass graft using PTFE and Miller cuff
e) Above knee amputation

60) A 67 year old male is diagnosed as having a 7cm infra renal abdominal aortic aneurysm. What is the likely
risk of rupture over the next 5 years?

a) <10%
b) 20%
c) 25%
d) 75%
e) 35%
61) A 54 year old man presents to the vascular clinic with severe rest pain and an ulcer on his right foot that is
not healing. On examination he has bilateral absent femoral pulses. Imaging demonstrates a bilateral occlusion
of the common iliac arteries that is not suitable for stenting. What is the most appropriate intervention?

a) Aorto-bifemoral bypass
b) Axillo-bifemoral bypass
c) Bilateral transfermoral amputation
d) Femoro-femoro cross over graft
e) Femoro-popliteal bypass

62) A 24-year-old female is referred to the acute surgical team as she is noted to have an absent left radial pulse.
Apart from some dizziness and lethargy, the patient does not have any features suggestive of an acute ischaemic
limb. Blood tests are as follows:

Na+ 136 mmol/l

K+ 4.1 mmol/l
Urea 2.3 mmol/l
Creatinine 77 µmol/l
ESR 66 mm/hr

What is the most likely diagnosis?

a) Turner's syndrome
b) Takayasu's arteritis
c) Kawasaki disease
d) Coarctation of the aorta
e) Breast carcinoma with local spread

63) A 62 year old diabetic man presents with long standing plantar ulcer he has clinical evidence of a charcot
foot. What is the most likely diagnosis?

a) Mixed ulcer
b) Chronic obliterative arterial disease
c) Neuropathic ulcer
d) Squamous cell carcinoma
e) Deep venous insufficiency

64) A 65 year old man presents, for the first time, with pain at the back of his calves when he mobilises 10
metres. He is known to have hypertension. What is the most appropriate investigation?

a) Arterial duplex scan

b) MRI angiogram
c) DSA angiogram
d) Aortic USS
e) Knee x-ray
65) A 32 year old woman attends clinic for assessment of varicose veins. She has suffered for varicose veins for
many years and can trace their development back to when she suffered a complex tibial fracture. On
examination she has marked truncal varicosities with a long tortuous long saphenous vein. What is the most
appropriate next step?

a) Arrange a venogram
b) Arrange a venous duplex scan
c) List her for a trendelenberg procedure
d) List her for injection foam sclerotherapy
e) List her for multiple avulsion phlebectomies

66) A 21 year old post man notices leg pain after 5 minutes walking during his round. It improves 3 minutes
after stopping. Clinically he is noted to have reduced hair of the lower limbs and his calf muscles appear
atrophied. There is a weak popliteal pulse, but it is still present when the knee is fully extended. What is the
most likely diagnosis?

a) Occlusive arterial disease caused by atherosclerosis

b) Popliteal fossa entrapment
c) Cerebral vascular accident
d) Diabetes mellitus
e) Adductor canal compression syndrome

67) Which of the following is not a feature of a Charcot foot?

a) Bounding foot pulses in the early phases

b) Often occurs in the complete absence of trauma
c) Erythema of the foot in the early phase
d) Autonomic neuropathy
e) Peripheral neuropathy

68) A 34 year old man presents with varicose veins and it is suspected that these are part of the Klippel-
Trenaunay syndrome. Which of the following is not a characteristic of this condition?

a) Presence of varicose veins

b) Gigantism of a limb
c) Long saphenous vein involvement
d) Port wine stains with clear borders
e) Arteriovenous fistulae

69)Which of the following statements related to coronary artery bypass surgery is true?

a) Late graft stenosis is mainly associated with saphenous vein grafts

b) Is indicated if there is stenosis > 70% of the right coronary artery
c) The left atrium is cannulated during the procedure
d) The CHADS score is used to assess peri operative risk
e) Cardioplegia is always undertaken at a 37 degrees
70) A 73 year old man develops sudden onset abdominal pain and collapses. On examination he has a tender
pulsatile mass in his upper abdomen. He has a blood pressure of 90/60mmHg and pulse rate of 105 beats per
minute. Which of the following intravenous fluid regimens is most appropriate, whilst waiting for operative
repair?

a) 1 Litre of pentastarch over 15 minutes

b) 1 litre of Hartmans solution over 4 hours
c) 1 litre of gelofusin over 30 minutes
d) 1 litre of Hartmans solution over 30 minutes
e) 1 litre of blood over 15 minutes

71) An 83 year old woman is admitted with a left intertrochanteric neck of femur fracture. On examination, the
patient is found to have an ejection systolic murmur loudest in the aortic region. There is no radiation of the
murmur to the carotid arteries. Her ECG is normal. What is the most likely lesion?

a) Mitral valve stenosis

b) Aortic valve sclerosis
c) Aortic valve stenosis
d) Tricuspid valve stenosis
e) Mitral valve regurgitation

72) A 73 year old woman collapses with sudden onset of abdominal pain and she passes a large amount of
diarrhoea. On admission, she is vomiting repeatedly. She has recently been discharged from hospital following a
myocardial infarct but recovered well. What is the most likely cause?

a) Acute superior mesenteric artery embolus

b) Acute inferior mesenteric artery embolus
c) Pancreatitis
d) Infection with clostridium difficile
e) Myocarditis

73) A 52 year old male attends the stroke unit with dizziness and vertigo while playing tennis. He is known to
have hypertension and a previous myocardial infarct. He now complains of right arm pain. What is the most
likely diagnosis?

a) Posterior circulation infarct

b) Vertebrobasilar aneurysm
c) Dissection of thoracic aorta
d) Subclavian steal syndrome
e) Left middle cerebral artery infarct

74) A 73 year old lifelong heavy smoker presents to the vascular clinic with symptoms of foot ulceration and
rest pain. On examination, her foot has areas of gangrene and pulses are impalpable. Which of the ABPI
measurements shown below is most compatible with this process?

a) >1.2
b) 1.0
c) 0.3
d) 0.8
e) 0.5
75) A 38 year old lady is troubled by lymphoedema that occurred following a block dissection of the groin for
malignant melanoma many years previously. Despite therapy with compression bandages she has persistent
lower leg swelling impairing her activities of daily living. She has no evidence of recurrent malignancy.
Lymphoscintography demonstrates occlusion of the groin lymphatics. However, the distal lymphatic system
appears healthy. Which of the following options could be considered?

a) Lymphovenous anastomosis
b) Homans procedure
c) Charles procedure
d) Loop diurectic therapy long term
e) Amputation

76) An 83 year old lady with a significant cardiac history is admitted with rest pain and bilateral leg ulcers.
Imaging demonstrates bilateral occlusion of both common iliac arteries that are unsuitable for stenting. What is
the most appropriate intervention?

a) Femoro-femoral cross over graft

b) Axillo-bifemoral bypass graft
c) Bilateral trans femoral amputations
d) Aorto-bifemoral bypass graft
e) Femoro-distal bypass

77) A 19 year old lady presents with recurrent episodes of pain in her hands. She notices that her symptoms are
worst in cold weather. When she gets the pain she notices that her hands are very pale, they then become dark
blue in colour. What is the most likely diagnosis?

a) Axillary artery embolus

b) Brachial artery embolus
c) Raynauds disease
d) Cervical rib
e) Rheumatoid

78) An 80 year old lady is brought to the emergency department by her carers. She has been unwell for the past
few days. On examination, she has a cold, pulseless leg with fixed mottling, below the knee. A duplex scan
shows a stenosis of the profunda femoris and popliteal artery with no flow distal to this. What is the most
appropriate course of action.

a) Femoro-femoro cross over graft

b) Axillo- femoral bypass graft
c) Trans femoral amputation
d) Gritti Stokes amputation
e) Administration of intravenous unfractionated heparin

79) A 74 year old lady has a long standing venous leg ulcer overlying her medial malleolus. Which of the
following statements relating to the management of this condition is false?

a) Pentoxifylline may speed ulcer healing

b) Treatment with daily low dose flucloxacillin may speed ulcer healing
c) Multilayer bandages may provide compression equivalent to 40mmHg
d) Large ulcers may be considered for skin grafting
e) They should not be treated with compression stockings if the ankle / brachial pressure index is 0.4