I85PREP
⌘ K
UKOM Sp.DVE study materials
UKOM Sp.DVE study resources

UKOM Sp.DVE practice questions

One question at a time. Build your UKOM Sp.DVE understanding.

First 50 of 200 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

Continue in the practice tool above to load more questions, 50 at a time.

Question 1Vascular and endovascular anatomy, physiology, and pathophysiology

Which artery most commonly gives origin to the artery of Adamkiewicz, the major radiculomedullary feeder to the lower thoracic cord?

  1. A left lower intercostal or lumbar artery Correct answer.
  2. The celiac trunk directly
  3. The right internal thoracic artery
  4. The median sacral artery

Explanation

The great anterior radiculomedullary artery most often arises from a left-sided intercostal or upper lumbar artery in the lower thoracic region, which is why extent and level of aortic coverage matter in thoracic endovascular repair. Injury here risks anterior spinal cord ischaemia.

Question 2Vascular and endovascular anatomy, physiology, and pathophysiology

In a patient with an infrarenal abdominal aortic aneurysm, which measurement defines the proximal landing zone length required for a standard endovascular stent graft?

  1. The length of non-aneurysmal aorta between the lowest renal artery and the start of the aneurysm Correct answer.
  2. The length of the common iliac arteries
  3. The maximum transverse aneurysm diameter
  4. The distance from the superior mesenteric artery to the aortic bifurcation

Explanation

The proximal neck is the segment of normal-calibre aorta between the lowest renal artery and the aneurysmal segment, and its length determines whether a standard infrarenal device can seal. Diameter, angulation and calcification also influence suitability, but length is the defining measurement for the landing zone.

Question 3Vascular and endovascular anatomy, physiology, and pathophysiology

Which finding on duplex ultrasound most strongly suggests a haemodynamically significant stenosis at the origin of the internal carotid artery?

  1. Focal peak systolic velocity elevation with post-stenotic turbulence Correct answer.
  2. A low-resistance waveform in the external carotid artery
  3. Uniform velocity throughout the common carotid artery
  4. Absent diastolic flow in the common carotid artery

Explanation

A focal rise in peak systolic velocity at the stenosis with downstream spectral broadening and turbulence indicates a pressure-reducing lesion. Velocity criteria are interpreted together with grayscale plaque and contralateral findings rather than in isolation.

Question 4Vascular and endovascular anatomy, physiology, and pathophysiology

A patient has an ankle-brachial pressure index of 1.3 in a limb with rest pain. What is the most appropriate interpretation?

  1. The value suggests venous insufficiency rather than arterial disease
  2. The value excludes significant peripheral arterial disease
  3. The value indicates normal perfusion and no further action
  4. The value is falsely elevated by arterial calcification and further assessment such as toe pressures or duplex is needed Correct answer.

Explanation

An index above about 1.3 usually reflects medially calcified, incompressible tibial arteries, common in diabetes and renal failure, so the measurement overestimates perfusion. Toe-brachial index or duplex imaging is needed because the calf vessels cannot be reliably occluded by the cuff.

Question 5Vascular and endovascular anatomy, physiology, and pathophysiology

Which mechanism best explains why the popliteal artery is vulnerable to injury in a supracondylar femoral fracture?

  1. The artery lies superficial to the patella
  2. The artery has no collateral supply at the knee
  3. The artery is tethered between the adductor hiatus and the soleus arch close to the distal femur Correct answer.
  4. The artery passes through the interosseous membrane

Explanation

The popliteal artery is relatively fixed proximally at the adductor hiatus and distally at the soleus arch, so displaced fracture fragments can stretch or lacerate it. The rich genicular collateral network may mask ischaemia initially, making pulse examination alone unreliable.

Question 6Vascular and endovascular anatomy, physiology, and pathophysiology

Which statement correctly describes the normal direction of flow in the vertebral artery in a patient with a patent circle of Willis?

  1. Flow is bidirectional at rest and unidirectional during exercise
  2. Flow ascends from the subclavian origin to the basilar artery Correct answer.
  3. Flow descends from the basilar artery to the subclavian artery
  4. Flow alternates with the cardiac cycle

Explanation

Normally the vertebral artery carries blood cranially from its subclavian origin, joining the contralateral vessel to form the basilar artery. Reversed flow occurs in subclavian steal when a proximal subclavian stenosis causes the ipsilateral arm to draw blood retrogradely.

Question 7Vascular and endovascular anatomy, physiology, and pathophysiology

In the context of endovascular aneurysm repair, what does a type II endoleak represent?

  1. Retrograde flow into the aneurysm sac from a branch vessel such as a lumbar or inferior mesenteric artery Correct answer.
  2. Leakage at the proximal graft attachment site
  3. Leakage at the distal iliac attachment site
  4. Leakage through a defect in the graft fabric

Explanation

A type II endoleak is sac perfusion from a patent branch artery filling retrogradely, most often lumbar or inferior mesenteric. It differs from attachment-site leaks (types I) and fabric defects (type III), which are managed more aggressively because of higher sac pressurisation.

Question 8Vascular and endovascular anatomy, physiology, and pathophysiology

Which physiological change occurs immediately after successful revascularisation of a chronically ischaemic limb?

  1. Loss of capillary recruitment in the reperfused muscle
  2. Immediate persistent vasoconstriction of the distal arterioles
  3. A rise in systemic vascular resistance caused by limb cooling
  4. Reactive hyperaemia with a fall in peripheral resistance in the reperfused bed Correct answer.

Explanation

Restoring flow to a chronically hypoperfused limb produces vasodilatation and reactive hyperaemia as accumulated metabolites wash out and resistance falls. This underlies the need to monitor for compartment swelling and reperfusion injury after revascularisation.

Question 9Vascular and endovascular anatomy, physiology, and pathophysiology

Which feature of a vein conduit most influences its long-term patency when used for infrainguinal bypass?

  1. Origin from the upper limb rather than the leg
  2. Length greater than 60 cm
  3. Internal diameter of at least 3 mm with a good-quality, compliant wall Correct answer.
  4. Presence of multiple competent valves

Explanation

Adequate calibre and good wall quality reduce the risk of early thrombosis and later intimal hyperplasia, and the great saphenous vein is preferred when suitable. Length matters for reaching the target but not as a determinant of patency, and valves are routinely rendered incompetent.

Question 10Vascular and endovascular anatomy, physiology, and pathophysiology

Which artery is the principal supply to the gluteal region that must be considered during a posterior approach for gluteal artery embolisation?

  1. External iliac artery via the inferior epigastric branch
  2. Internal iliac artery via the superior and inferior gluteal branches Correct answer.
  3. Femoral artery via the profunda femoris only
  4. Obturator artery via the pubic branch

Explanation

The gluteal muscles are supplied mainly by the superior and inferior gluteal arteries arising from the internal iliac artery, which is why pelvic embolisation for gluteal trauma targets these branches. Collateral supply through the profunda femoris and obturator arteries can reconstitute flow after proximal occlusion.

Question 11Vascular and endovascular anatomy, physiology, and pathophysiology

What is the primary haemodynamic consequence of a large arteriovenous fistula in a limb?

  1. Increased peripheral resistance with reduced venous return
  2. Reduced peripheral resistance with increased venous return and a compensatory rise in cardiac output Correct answer.
  3. Isolated fall in cardiac output without change in resistance
  4. Rise in peripheral resistance with bradycardia

Explanation

A fistula bypasses the arteriolar bed, lowering total peripheral resistance and increasing venous return, which raises cardiac output. If the fistula is large and chronic, this volume load can precipitate high-output cardiac failure.

Question 12Vascular and endovascular anatomy, physiology, and pathophysiology

Which statement about the normal great saphenous vein anatomy is correct?

  1. It drains directly into the external iliac vein
  2. It ascends anterior to the medial malleolus and drains into the femoral vein at the saphenofemoral junction Correct answer.
  3. It lies deep to the deep fascia throughout its course
  4. It ascends posterior to the lateral malleolus and drains into the popliteal vein

Explanation

The great saphenous vein passes anterior to the medial malleolus, runs in the superficial compartment and joins the femoral vein at the saphenofemoral junction in the groin. This course is central to planning ablation or stripping and identifying junctional reflux.

Question 13Vascular and endovascular anatomy, physiology, and pathophysiology

Which factor most increases the risk of contrast-induced nephropathy after endovascular aortic imaging in a patient with chronic kidney disease?

  1. Use of carbon dioxide as the sole contrast agent
  2. Elective rather than emergency procedure status
  3. Pre-existing reduced estimated glomerular filtration rate and high contrast volume Correct answer.
  4. A normal haematocrit

Explanation

Baseline renal impairment combined with a large iodinated contrast load is the strongest modifiable predictor of contrast-induced nephropathy. Strategies include volume optimisation, minimising contrast dose and using carbon dioxide angiography or duplex where feasible.

Question 14Vascular and endovascular anatomy, physiology, and pathophysiology

A patient develops acute limb ischaemia with a cold, pulseless leg and paraesthesia but preserved motor function. How is this classified?

  1. Rutherford class IIb, immediately threatened with urgent surgery required
  2. Rutherford class I, viable with no immediate threat
  3. Rutherford class IIa, marginally threatened and suitable for urgent revascularisation Correct answer.
  4. Rutherford class III, irreversible with primary amputation indicated

Explanation

Sensory loss with preserved motor power indicates a marginally threatened limb, corresponding to Rutherford IIa. These limbs need prompt revascularisation, usually within hours, and should be reassessed frequently because progression to IIb changes urgency.

Question 15Vascular and endovascular anatomy, physiology, and pathophysiology

Which change in the arterial wall characterises the early development of an atherosclerotic plaque?

  1. Subendothelial accumulation of lipid-laden macrophages with foam cell formation Correct answer.
  2. Replacement of the intima by smooth muscle without lipid deposition
  3. Uniform medial hypertrophy without intimal change
  4. Acute transmural necrosis of all three arterial layers

Explanation

Atherogenesis begins with endothelial dysfunction and subendothelial retention of lipoproteins, followed by monocyte recruitment and foam cell formation. This fatty streak later evolves into a fibrous cap and necrotic core that determine plaque stability.

Question 16Vascular and endovascular anatomy, physiology, and pathophysiology

What is the main purpose of sizing an endograft with 10 to 20 percent oversizing relative to the aortic landing zone diameter?

  1. To achieve an adequate radial seal and reduce migration risk Correct answer.
  2. To permit continued aneurysm sac expansion
  3. To allow the graft to expand freely within the sac
  4. To reduce the metal content of the stent

Explanation

Moderate oversizing generates radial force that seals the graft against the aortic wall and resists distal migration. Excessive oversizing risks infolding or graft collapse, while undersizing predisposes to type I endoleak.

Question 17Vascular and endovascular anatomy, physiology, and pathophysiology

Which finding on CT angiography indicates a contained rupture of an abdominal aortic aneurysm?

  1. Calcification of the aneurysm wall
  2. Aortic diameter stable over two years
  3. Uniform mural thrombus within the sac
  4. Retroperitoneal haematoma with contrast outside the aortic lumen but confined by surrounding tissue Correct answer.

Explanation

Contrast extending beyond the lumen into a retroperitoneal collection that is still contained by surrounding structures indicates a contained rupture. Free intraperitoneal contrast or active extravasation into the peritoneal cavity indicates uncontained rupture with greater instability.

Question 18Vascular and endovascular anatomy, physiology, and pathophysiology

In a patient with median arcuate ligament syndrome, which physiological mechanism explains the postprandial abdominal pain?

  1. Compression of the renal artery causes renin-mediated hypertension
  2. Compression of the superior mesenteric artery causes chronic bowel ischaemia
  3. Compression of the celiac trunk causes demand ischaemia that collateral flow cannot meet during digestion Correct answer.
  4. Compression of the portal vein causes portal hypertension

Explanation

External compression of the celiac trunk by the median arcuate ligament limits flow, and although collaterals usually maintain resting perfusion, increased postprandial demand can exceed supply and cause pain. The classic angiographic appearance is a hook-shaped focal stenosis that varies with respiration.

Question 19Vascular and endovascular anatomy, physiology, and pathophysiology

Which statement best describes the role of the endothelium in regulating vascular tone?

  1. It releases nitric oxide and prostacyclin to promote vasodilatation and inhibit platelet adhesion Correct answer.
  2. It releases thromboxane as its principal vasodilator
  3. It has no influence on underlying smooth muscle tone
  4. It secretes only vasoconstrictor mediators such as endothelin

Explanation

Healthy endothelium produces nitric oxide and prostacyclin, which relax smooth muscle and inhibit platelet aggregation. Endothelial dysfunction shifts this balance toward vasoconstriction and thrombosis, contributing to atherosclerosis and graft failure.

Question 20Vascular and endovascular anatomy, physiology, and pathophysiology

Which feature makes a popliteal artery aneurysm particularly prone to thromboembolic complications compared with aortic aneurysms?

  1. Its thick muscular wall resists dilatation entirely
  2. A narrow neck and small sac volume promote stasis and layered thrombus that can embolise distally Correct answer.
  3. The absence of branches below the knee removes any embolic target
  4. Its high-flow, low-resistance position prevents thrombus formation

Explanation

Popliteal aneurysms often contain laminated thrombus within a relatively small sac, and the low flow through a tortuous, dilated segment favours embolisation or thrombosis of the tibial runoff. This is why even asymptomatic aneurysms above about 2 cm are usually treated to protect the limb.

Question 21Clinical assessment and non-invasive vascular diagnostics

During a lower-limb arterial duplex, which finding best supports a haemodynamically significant stenosis within the superficial femoral artery?

  1. A wall thickness of 1 mm in the popliteal artery
  2. A diffuse reduction of peak systolic velocity across the whole vessel
  3. A focal doubling of peak systolic velocity compared with the adjacent proximal segment Correct answer.
  4. A monophasic waveform in the common femoral artery only

Explanation

A focal velocity increase of roughly twofold or more relative to the immediately proximal segment is the primary duplex criterion for a significant stenosis, and it is commonly accompanied by post-stenotic spectral broadening and turbulence. Diffuse slowing or isolated waveform changes elsewhere do not localise a stenosis.

Question 22Clinical assessment and non-invasive vascular diagnostics

An ankle-brachial pressure index is measured as 1.35 in a patient with diabetes and long-standing renal failure. What is the most appropriate interpretation?

  1. Falsely elevated index due to arterial calcification, requiring toe pressure assessment Correct answer.
  2. Normal peripheral arterial circulation
  3. Exercise-induced arterial insufficiency
  4. Venous hypertension artefact

Explanation

An index above roughly 1.3 signals non-compressible, calcified tibial arteries, common in diabetes and chronic kidney disease, so the ankle pressure is unreliable. Toe pressures or toe-brachial index are preferred because digital arteries are less often calcified.

Question 23Clinical assessment and non-invasive vascular diagnostics

Which waveform characteristic on continuous-wave or spectral Doppler most reliably indicates a normal, low-resistance artery supplying an organ?

  1. Tardus-parvus upstroke with prolonged acceleration time
  2. Biphasic pattern with brief early diastolic reversal
  3. Sharp systolic upstroke with absent diastolic flow
  4. Broad systolic peak with continuous forward diastolic flow Correct answer.

Explanation

Low-resistance vascular beds such as the renal, hepatic and internal carotid circulations show continuous forward flow throughout diastole. High-resistance limb arteries instead show triphasic flow with early diastolic reversal.

Question 24Clinical assessment and non-invasive vascular diagnostics

When performing a compression ultrasound for suspected deep vein thrombosis, which vein segment is most often incompletely assessed and should be specifically documented?

  1. The common femoral vein at the groin
  2. The paired calf veins within the muscular sinuses Correct answer.
  3. The popliteal vein in the popliteal fossa
  4. The external iliac vein above the inguinal ligament

Explanation

Isolated calf vein thrombosis, including the soleal and gastrocnemius sinuses, is easily missed because these deep muscular veins are not always included in a limited two-point study. Documenting whether calf veins were examined avoids false reassurance.

Question 25Clinical assessment and non-invasive vascular diagnostics

What is the primary purpose of performing a Valsalva manoeuvre during a venous duplex of the lower limb?

  1. To provoke arterial spasm and reveal occult stenosis
  2. To assess venous valvular competence by demonstrating reflux Correct answer.
  3. To increase arterial peak systolic velocity for measurement
  4. To reduce bowel gas artefact over the iliac veins

Explanation

Augmentation and Valsalva manoeuvres test valvular competence; reflux is demonstrated as reversed flow exceeding a defined duration after provocation. This distinguishes primary valvular incompetence from obstructive disease.

Question 26Clinical assessment and non-invasive vascular diagnostics

A patient reports calf pain after walking 200 metres that resolves within two minutes of standing still. Which feature most strongly favours a vascular rather than neurogenic claudication?

  1. Pain that is worse on walking downhill
  2. Pain that radiates down the posterior thigh
  3. Pain relieved by sitting or lumbar flexion
  4. Pain relieved promptly by simply standing in place Correct answer.

Explanation

Vascular claudication is relieved by stopping exercise, and standing still without postural change typically suffices because metabolic demand falls. Neurogenic claudication characteristically requires sitting, crouching or lumbar flexion to relieve symptoms.

Question 27Clinical assessment and non-invasive vascular diagnostics

During carotid duplex, a peak systolic velocity of 260 cm/s with marked spectral broadening and a high end-diastolic velocity is recorded at the origin of the internal carotid artery. What is the most appropriate interpretation?

  1. A severe stenosis that should be graded with additional criteria Correct answer.
  2. A normal velocity for the internal carotid artery
  3. An artefact requiring repeat imaging without further grading
  4. A mild stenosis unlikely to be haemodynamically significant

Explanation

Velocities in this range, combined with spectral broadening and elevated end-diastolic velocity, indicate a high-grade stenosis, but severity should be confirmed using multiple criteria including the internal-to-common carotid velocity ratio and plaque morphology. Single velocity thresholds alone are insufficient for grading.

Question 28Clinical assessment and non-invasive vascular diagnostics

Which measurement best corrects the ankle-brachial index for the effect of a high brachial pressure in a patient with bilateral upper-limb arterial disease?

  1. Using the higher of the two brachial pressures as the denominator Correct answer.
  2. Using the lower of the two brachial pressures as the denominator
  3. Using the systolic pressure from the arm with the strongest pulse only
  4. Averaging the two brachial pressures as the denominator

Explanation

Standard practice uses the higher of the two brachial systolic pressures as the denominator, because the higher value is less likely to be falsely reduced by subclavian or brachial disease. Using the lower value would artificially raise the index.

Question 29Clinical assessment and non-invasive vascular diagnostics

A photoplethysmography trace of a toe shows a rounded, slow-rising waveform with a prolonged crest time. What does this most likely indicate?

  1. Normal digital arterial perfusion
  2. Venous valvular incompetence
  3. Increased sympathetic vasoconstriction alone
  4. Proximal arterial obstruction reducing inflow Correct answer.

Explanation

A damped, slow-rising plethysmographic waveform with prolonged crest time reflects reduced pulsatile inflow, typically from proximal arterial obstruction. Normal traces show a brisk upstroke and a sharp systolic peak.

Question 30Clinical assessment and non-invasive vascular diagnostics

When assessing a dialysis arteriovenous fistula, which combination of findings most suggests a failing access?

  1. Continuous low-velocity flow throughout the cardiac cycle in the feeding artery
  2. A palpable thrill at the anastomosis
  3. Reduced access flow with elevated venous pressures and a damped downstream waveform Correct answer.
  4. High brachial artery flow with a low resistance waveform

Explanation

Falling access flow, rising venous pressures and damping of the outflow waveform together indicate a developing stenosis, usually at the anastomosis or cephalic arch. These findings warrant angiography and possible intervention before thrombosis occurs.

Question 31Clinical assessment and non-invasive vascular diagnostics

What is the main reason for using a continuous-wave Doppler probe rather than pulsed-wave Doppler when screening for deep vein thrombosis in the calf?

  1. Continuous-wave Doppler measures vessel diameter directly
  2. Continuous-wave Doppler detects flow along the entire beam path without aliasing at high velocities Correct answer.
  3. Continuous-wave Doppler provides depth-specific sampling
  4. Pulsed-wave Doppler cannot detect venous flow at all

Explanation

Continuous-wave Doppler has no range gate, so it detects flow anywhere along the beam and does not alias at high velocities, which suits rapid screening of superficial and deep veins. Pulsed-wave Doppler offers depth selection but is more prone to aliasing.

Question 32Clinical assessment and non-invasive vascular diagnostics

A patient has an ankle-brachial index of 0.55 at rest and reports claudication. What does this index value most strongly suggest?

  1. Isolated venous insufficiency
  2. Incompressible arteries from calcification
  3. Normal arterial circulation
  4. Moderate-to-severe peripheral arterial disease Correct answer.

Explanation

An index between roughly 0.5 and 0.9 indicates moderate disease, and values below 0.5 suggest severe disease. A value of 0.55 is consistent with symptomatic peripheral arterial disease and warrants further assessment.

Question 33Clinical assessment and non-invasive vascular diagnostics

During a duplex assessment of the abdominal aorta, which finding is most consistent with a significant stenosis at the origin of the superior mesenteric artery?

  1. Absent flow in the aorta itself
  2. A monophasic waveform in the common iliac artery
  3. Peak systolic velocity of 90 cm/s at the ostium
  4. Peak systolic velocity above 275 cm/s at the ostium with post-stenotic turbulence Correct answer.

Explanation

A focal peak systolic velocity exceeding roughly 275 cm/s at the superior mesenteric artery origin, with turbulence, is a recognised criterion for significant stenosis. Lower velocities at the ostium suggest no haemodynamically important narrowing.

Question 34Clinical assessment and non-invasive vascular diagnostics

Which manoeuvre is most appropriate to improve visualisation of the distal external iliac vein when overlying bowel gas obscures the view?

  1. Increasing the colour Doppler velocity scale
  2. Having the patient perform repeated Valsalva manoeuvres
  3. Imaging in the left lateral decubitus position with slight hip flexion Correct answer.
  4. Applying sustained firm compression with the transducer

Explanation

Repositioning the patient, for example into a left lateral decubitus position with hip flexion, displaces bowel gas and improves access to the iliac veins. Adjusting Doppler settings does not change the anatomical obstruction from gas.

Question 35Clinical assessment and non-invasive vascular diagnostics

A patient with a swollen, painful leg has a normal compression ultrasound of the femoral and popliteal veins but a markedly elevated D-dimer. What is the most appropriate next step in vascular assessment?

  1. Proceed directly to arteriography
  2. Discharge without further imaging
  3. Extend the examination to include the calf veins and iliac segments Correct answer.
  4. Repeat limited compression ultrasound after one week

Explanation

A normal limited study does not exclude isolated calf or iliac thrombosis, particularly with a strongly positive D-dimer. Extending the examination to the calf and iliac veins improves diagnostic yield before considering interval repeat scanning.

Question 36Clinical assessment and non-invasive vascular diagnostics

Which statement correctly describes the relationship between probe frequency and penetration depth in peripheral vascular ultrasound?

  1. Frequency has no effect on resolution or penetration depth
  2. Higher frequency improves both resolution and penetration depth
  3. Higher frequency improves resolution but reduces penetration depth Correct answer.
  4. Lower frequency improves resolution but reduces penetration depth

Explanation

Higher-frequency transducers give better spatial resolution but attenuate more rapidly in tissue, limiting depth. Lower frequencies penetrate further but at the cost of resolution, so probe choice balances the two.

Question 37Clinical assessment and non-invasive vascular diagnostics

A patient with rest pain has an ankle-brachial index of 0.28 and a flat, monophasic Doppler waveform at the dorsalis pedis. What does this combination most strongly indicate?

  1. Critical limb-threatening ischaemia requiring urgent vascular referral Correct answer.
  2. Normal variant flow in a young patient
  3. Venous claudication from deep vein obstruction
  4. Mild claudication manageable with exercise alone

Explanation

An index below 0.4 with rest pain and a monophasic, damped distal waveform indicates severe limb-threatening ischaemia. Urgent specialist referral is required because of the risk of tissue loss.

Question 38Clinical assessment and non-invasive vascular diagnostics

In a duplex study of the internal carotid artery, a peak systolic velocity of 110 cm/s with an internal-to-common carotid ratio of 1.4 is recorded in a vessel with echolucent plaque. How should this be interpreted?

  1. Subclavian steal syndrome
  2. Haemodynamically insignificant stenosis despite the plaque Correct answer.
  3. Occlusion of the internal carotid artery
  4. Severe stenosis requiring urgent endarterectomy

Explanation

Velocities within the normal range and a ratio below the significant threshold indicate no haemodynamically important stenosis, even though plaque is present. Plaque composition informs risk but does not by itself define stenosis severity.

Question 39Clinical assessment and non-invasive vascular diagnostics

A patient with a history of iliofemoral deep vein thrombosis has persistent leg swelling. Duplex shows continuous flow in the common femoral vein that does not vary with respiration and fails to augment on distal compression. What does this pattern most likely represent?

  1. Chronic venous obstruction with collateral drainage Correct answer.
  2. Normal phasic venous flow
  3. Arteriovenous fistula formation
  4. Acute deep vein thrombosis at the common femoral vein

Explanation

Loss of respiratory phasicity and absent augmentation indicate outflow obstruction, and continuous non-pulsatile flow suggests chronic obstruction with collateral pathways. This pattern supports a post-thrombotic aetiology rather than acute thrombosis.

Question 40Clinical assessment and non-invasive vascular diagnostics

During a segmental pressure study, a pressure gradient of 35 mmHg is found between the high thigh and above-knee cuffs in a patient with claudication. What is the most appropriate interpretation?

  1. Significant stenosis in the iliac artery
  2. Significant stenosis in the superficial femoral artery segment Correct answer.
  3. Normal pressure variation between cuffs
  4. Venous insufficiency causing the gradient

Explanation

A segmental gradient of 20 to 30 mmHg or more between adjacent cuffs indicates a significant stenosis in the intervening arterial segment, here the superficial femoral artery. Larger gradients localise more severe disease.

Question 41Arterial occlusive disease (peripheral arterial disease, aortoiliac and infrainguinal disease)

A patient with lifestyle-limiting intermittent claudication has an ankle-brachial index of 0.62 at rest. Which statement best describes the physiological basis of this finding?

  1. The index measures venous reflux in the superficial femoral vein
  2. A low ankle-brachial index reflects increased cardiac output with peripheral vasodilatation
  3. A reduced ankle pressure relative to brachial pressure indicates a haemodynamically significant stenosis or occlusion between the aorta and the ankle Correct answer.
  4. An ankle-brachial index of 0.62 is within normal limits and requires no further assessment

Explanation

The ankle-brachial index compares systolic pressure at the ankle with brachial systolic pressure; a ratio below 0.90 indicates arterial obstruction proximal to the measurement cuff. Values around 0.6 typically correspond to claudication, while values below 0.4 suggest critical limb-threatening ischaemia.

Question 42Arterial occlusive disease (peripheral arterial disease, aortoiliac and infrainguinal disease)

Which classic symptom pattern most strongly suggests intermittent claudication of infrainguinal origin rather than aortoiliac disease?

  1. Cramping calf pain relieved within minutes of standing still Correct answer.
  2. Buttock and thigh pain provoked by walking
  3. Rest pain confined to the toes at night
  4. Pain in the foot relieved by dependency

Explanation

Calf claudication localises the flow-limiting lesion to the femoropopliteal segment, because the exercising calf muscle becomes ischaemic. Relief occurs rapidly with cessation of walking, usually within a few minutes, and the distance is reproducible.

Question 43Arterial occlusive disease (peripheral arterial disease, aortoiliac and infrainguinal disease)

In a patient with suspected peripheral arterial disease, which finding on physical examination most increases the likelihood of haemodynamically significant disease?

  1. Varicose veins along the great saphenous territory
  2. Absent posterior tibial and dorsalis pedis pulses with a femoral bruit Correct answer.
  3. Bilateral pitting oedema to the knees
  4. Palpable popliteal pulse with warm feet

Explanation

Absent distal pulses plus a femoral bruit suggest a flow-limiting iliac or common femoral stenosis, which is a classic sign of aortoiliac occlusive disease. Pulse palpation is operator-dependent, so it is combined with ankle-brachial index measurement to confirm haemodynamic significance.

Question 44Arterial occlusive disease (peripheral arterial disease, aortoiliac and infrainguinal disease)

Which risk factor modification has the strongest evidence for slowing progression of peripheral arterial disease and reducing cardiovascular events?

  1. Long-term bed rest
  2. Vitamin E supplementation
  3. Stopping smoking Correct answer.
  4. Routine antibiotic prophylaxis

Explanation

Smoking cessation is the single most important intervention; it reduces progression to critical limb-threatening ischaemia and lowers overall cardiovascular mortality. Supervised exercise and statin therapy are additional cornerstone measures.

Question 45Arterial occlusive disease (peripheral arterial disease, aortoiliac and infrainguinal disease)

Which imaging modality is generally first-line for planning endovascular or open revascularisation in a patient with infrainguinal peripheral arterial disease and preserved renal function?

  1. Computed tomography angiography Correct answer.
  2. Duplex ultrasound of the whole limb
  3. Magnetic resonance angiography
  4. Digital subtraction angiography

Explanation

Computed tomography angiography provides high-resolution anatomical mapping of stenoses and occlusions and is widely used for procedural planning. Duplex ultrasound is excellent for screening and surveillance but is less reliable for full-length mapping, while catheter angiography is now largely reserved for concurrent intervention.

Question 46Arterial occlusive disease (peripheral arterial disease, aortoiliac and infrainguinal disease)

A patient with claudication has an ankle-brachial index of 1.15 but continued symptoms. Which condition should be considered as an explanation for the discrepancy?

  1. Acute limb ischaemia
  2. Compartment syndrome
  3. Deep vein thrombosis
  4. Medial arterial calcification with non-compressible vessels Correct answer.

Explanation

A falsely elevated index can occur when tibial arteries are calcified and resist compression, as in diabetes or chronic kidney disease. Toe-brachial index or pulse volume recordings should be used to assess the true haemodynamic status.

Question 47Arterial occlusive disease (peripheral arterial disease, aortoiliac and infrainguinal disease)

A 68-year-old smoker presents with buttock and thigh claudication, absent femoral pulses bilaterally, and erectile dysfunction. Which pattern of disease best explains these findings?

  1. Superficial femoral artery stenosis
  2. Popliteal entrapment syndrome
  3. Isolated tibial disease
  4. Aortoiliac occlusive disease Correct answer.

Explanation

The combination of buttock and thigh claudication, absent femoral pulses and erectile dysfunction is the classic triad of aortoiliac occlusive disease, sometimes termed Leriche syndrome when the distal aorta is occluded. The level of claudication corresponds to the muscles supplied distal to the occlusion.

Question 48Arterial occlusive disease (peripheral arterial disease, aortoiliac and infrainguinal disease)

Which feature best distinguishes critical limb-threatening ischaemia from stable claudication?

  1. Claudication distance of less than 200 metres
  2. Rest pain, tissue loss, or gangrene with an ankle pressure typically below 50 mmHg Correct answer.
  3. A femoral bruit on auscultation
  4. Absence of the dorsalis pedis pulse

Explanation

Critical limb-threatening ischaemia is defined by ischaemic rest pain or tissue loss with objective haemodynamic compromise, commonly an ankle systolic pressure below 50 to 70 mmHg or a toe pressure below 30 to 50 mmHg. Claudication alone, however short the distance, does not meet the definition.

Question 49Arterial occlusive disease (peripheral arterial disease, aortoiliac and infrainguinal disease)

For a patient with disabling claudication who has not responded to supervised exercise and risk factor modification, which endovascular option is most appropriate for a short focal iliac stenosis?

  1. Primary amputation
  2. Lumbar sympathectomy
  3. Femoro-femoral crossover bypass
  4. Percutaneous transluminal angioplasty with bailout stenting Correct answer.

Explanation

Short focal iliac stenoses respond well to endovascular treatment, with angioplasty and selective stenting offering good patency and low morbidity. Open bypass is reserved for more extensive disease or failed endovascular therapy.

Question 50Arterial occlusive disease (peripheral arterial disease, aortoiliac and infrainguinal disease)

Which anatomical feature makes the superficial femoral artery particularly prone to restenosis after endovascular treatment?

  1. Its lack of any collateral supply
  2. Its origin directly from the aortic arch
  3. Its long length, muscular surroundings and exposure to flexion and torsion forces Correct answer.
  4. Its short length and entirely intrathoracic course

Explanation

The femoropopliteal segment is long, crosses two joints and is subject to bending, torsion and compression, which contributes to higher restenosis and stent fracture rates. This is why nitinol stents and drug-coated technologies are often preferred for this segment.