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Vascular Surgery & PAD:: MSRA MCQs


Q1. A 75-year-old man presents with a venous ulcer over the medial malleolus. His ABPI is 0.7. What is the most appropriate next step?

 B. Prescribe Class 2 compression stockingsChoose the correct answer

  • A. Start 4-layer compression bandaging

  • B. Prescribe Class 2 compression stockings

  • C. Refer to vascular surgery

  • D. Apply hydrocolloid dressing and review in 2 weeks


✅ Answer: C. Refer to vascular surgery

 👉 Compression is contraindicated when ABPI < 0.8.



Q2. A 60-year-old smoker complains of calf pain after walking 100 metres that is relieved by rest. On exam, pulses are reduced after exercise but normal at rest. What is the next best investigation?

Choose the correct answer

  • A. ABPI

  • B. CT angiogram

  • C. D-dimer

  • D. Venous duplex


✅ Answer: A. ABPI

 👉 Classic intermittent claudication – first-line investigation is ABPI.



Q3. A 70-year-old man with atrial fibrillation presents with sudden onset of cold, painful right leg. The leg is pale, pulseless and he cannot move his foot. What is the most appropriate initial step?

Choose the correct answer

  • A. Oral anticoagulation

  • B. Urgent CT angiogram

  • C. Immediate thrombo-embolectomy referral

  • D. IV antibiotics


✅ Answer: C. Immediate thrombo-embolectomy referral

 👉 6 P’s of acute limb ischaemia → vascular emergency.


Q4. A 68-year-old man collapses at home. He has hypotension and severe abdominal pain. In the ED, a pulsatile mass is palpable. What is the most appropriate next step?

Choose the correct answer

  • A. CT abdomen with contrast

  • B. ABPI

  • C. Transfer to theatre immediately

  • D. IV morphine and observe


✅ Answer: C. Transfer to theatre immediately

 👉 Ruptured AAA = classic triad → resuscitate and operate without delay.



Q5. Which of the following is an advantage of endovascular aneurysm repair (EVAR) over open AAA repair?

Choose the correct answer

  • A. Lower long-term surveillance requirements

  • B. No risk of graft-related complications

  • C. Suitable for all aneurysm anatomies

  • D. Lower perioperative mortality


✅ Answer: D. Lower perioperative mortality 

👉 EVAR is less invasive, but requires lifelong surveillance.


Q6. A 68-year-old man has a TIA. Duplex shows 75% ICA stenosis using NASCET method. He is otherwise stable. What is the most appropriate next step?

Choose the correct answer

  • A. Start aspirin only

  • B. Repeat scan in 6 months

  • C. Refer for carotid endarterectomy

  • D. Begin dual antiplatelets indefinitely


✅ Answer: C. Refer for carotid endarterectomy 

👉 CEA is indicated within 2 weeks if symptomatic + ≥70% (NASCET).


Q7. A 34-year-old woman with aching legs and visible tortuous veins wants treatment. What is the first-line investigation?

Choose the correct answer

  • A. CT venogram

  • B. MR angiogram

  • C. ABPI

  • D. Duplex ultrasound


✅ Answer: D. Duplex ultrasound

 👉 Duplex ultrasound is the first-line test for suspected varicose veins because it:

  • Confirms valvular reflux

  • Maps out vein anatomy

  • Helps guide treatment decisions (e.g., surgery, ablation)



Q8. Which of the following best distinguishes an arterial ulcer from a venous ulcer?

Choose the correct answer

  • A. Medial location

  • B. Granulating base

  • C. Pain worse at night, improved by hanging leg down

  • D. Associated with varicose veins 


✅ Answer: C. Pain worse at night, improved by hanging leg down

 👉 Arterial ulcers have severe rest pain.


Q9. A patient presents with uncomplicated varicose veins and no signs of ulceration or skin changes. What is the next best step?

Choose the correct answer

  • A. ABPI 

  • B. Duplex ultrasound

  • C. Compression bandaging

  • D. Start antibiotics 


✅ Answer: B. Duplex ultrasound

 👉 ABPI is not indicated unless ulcer or compression therapy is planned.


Q10. A patient presents with a chronic ulcer above the medial malleolus, surrounded by pigmentation and eczema. Pedal pulses are present. What is the first step in management?

Choose the correct answer

  • A. Compression bandaging

  • B. Prescribe oral antibiotics 

  • C. Refer for skin grafting

  • D. Carotid ultrasound

 

✅ Answer: A. Compression bandaging

 👉 If ABPI > 0.8, compression is the mainstay treatment.


Q11. A 62-year-old male smoker presents with fatigue when walking, erectile dysfunction, and absent femoral pulses bilaterally. What is the most likely diagnosis?

Choose the correct answer

  • A. Aortoiliac occlusive disease (Leriche’s syndrome)

  • B. Femoral artery aneurysm

  • C. Peripheral neuropathy

  • D. Abdominal aortic aneurysm


✅ Answer: A. Aortoiliac occlusive disease (Leriche’s syndrome) 

👉 Classic triad = buttock claudication + impotence + absent femoral pulses


Q12. A 40-year-old man who smokes heavily presents with fingertip ulcers, rest pain in toes, and superficial thrombophlebitis. Pulses are weak distally. What is the most likely diagnosis?

Choose the correct answer

  • A. Diabetic vasculopathy

  • B. Buerger’s disease

  • C. Atherosclerotic PAD

  • D. Raynaud’s disease


✅ Answer: B. Buerger’s disease 

👉 Young smoker, distal ischaemia + Raynaud’s + superficial phlebitis = classic.


Q13. Which of the following patients benefits most from carotid endarterectomy?

Choose the correct answer

  • A. 68-year-old male with 75% asymptomatic ICA stenosis

  • B. 66-year-old woman with 80% ICA stenosis and TIA 3 weeks

  • C. 72-year-old man with 60% stenosis and recent stroke

  • D. 70-year-old man with 80% ICA stenosis and TIA 5 days ago


✅ Answer: D. 70-year-old man with 80% ICA stenosis and TIA 5 days ago

 👉 CEA most effective if symptomatic + ≥70% (NASCET) stenosis, done within 2 weeks



Q14. A patient has an ABPI of 1.4, but presents with intermittent claudication. What is the most appropriate next step?

Choose the correct answer

  • A. Start compression therapy

  • B. Repeat ABPI in 1 week

  • C. Prescribe statin and discharge

  • D. Arrange toe pressure or duplex imaging


✅ Answer: D. Arrange toe pressure or duplex imaging

 👉 ABPI >1.3 suggests calcified, incompressible arteries (e.g. diabetics)


Q15. A 75-year-old man presents with a pulsatile mass in the groin below and lateral to the pubic tubercle. What is the most likely diagnosis?

Choose the correct answer

  • A. Inguinal hernia

  • B. Saphena varix

  • C. Lymphadenopathy

  • D. Femoral artery aneurysm 


✅ Answer: D. Femoral artery aneurysm

 👉 Pulsatile, below & lateral to pubic tubercle = classic clue


Q16. Which compression class is typically used for venous eczema or healed venous ulcers?

Choose the correct answer

  • A. Class 1

  • B. Class 2

  • C. Class 3

  • D. Class 4 


✅ Answer: B. Class 2

 👉 Class 2 (18–24 mmHg) = venous eczema, lipodermatosclerosis, healed ulcers


Q17. Which patient is the best candidate for naftidrofuryl oxalate?

Choose the correct answer

  • A. Patient with a large, non-healing arterial ulcer

  • B. Patient with acute limb ischaemia

  • C. Patient with PAD who declined surgery and failed exercise

  • D. Patient with ruptured AAA E. Patient with Buerger’s dis


✅ Answer: C. Patient with PAD who declined surgery and failed exercise programme

 👉 Indicated for intermittent claudication when exercise fails & surgery not suitable.


Q18. A 65-year-old male with metastatic renal cancer presents with bilateral leg swelling, prominent superficial veins, and mild tachycardia. What is the most likely cause?

Choose the correct answer

  • A. DVT 

  • B. Nephrotic syndrome

  • C. IVC obstruction 

  • D. Liver failure


✅ Answer: C. IVC obstruction 

👉 Think of bilateral oedema + cancer history = red flag for IVC obstruction

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