1. A 76-year-old man with aortoiliac occlusive disease undergoes percutaneous
transluminal angioplasty of his left common iliac artery. What is the patency rate for
patients who undergo angioplasty for iliac occlusive disease?
a.
b.
c.
d.
20% at 5 years
30% at 5 years
60% at 5 years
80% at 5 years
2. A 68-year-old man presents with pain in his left leg. Examination and workup confirms
diagnosis of a popliteal aneurysm. What is the most common complication that would
result in the patient’s leg pain?
a.
b.
c.
d.
Popliteal aneurysm rupture
Nerve impingement by the popliteal aneurysm
Venous obstruction by the popliteal aneurysm
Thromboembolic events associated with the popliteal aneurysm
3. A 68-year-old man with atrial fibrillation presents to the emergency department with a
cool, pulseless right foot. Sensation is intact. Duplex ultrasonography of the right leg
reveals multiple femoral stenoses and tibioperoneal thrombosis with poor tibial flow. What
is the most appropriate management?
a.
b.
c.
d.
Amputation
Systemic anticoagulation only
Percutaneous embolectomy under local anesthesia
Intra-arterial site-directed thrombolysis
4. A 73-year-old man has developed a pulseless left lower leg 8 days after experiencing a
myocardial infarction (MI) requiring cardiopulmonary resuscitation. On examination, he
has diminished sensation in his left foot. What is the most appropriate definitive
treatment?
a.
b.
c.
d.
Amputation
Anticoagulation using IV heparin
Percutaneous embolectomy under local anesthesia
Intra-arterial site-directed thrombolysis
5. Eighteen months after undergoing an aortobifemoral artery bypass, a 74-year-old man
presents with a painful swelling in his left side groin. Ultrasonography demonstrates a
pseudoaneurysm at the site of the distal anastomosis with surrounding fluid. What is the
likely underlying cause of this condition?
a.
b.
c.
d.
e.
Graft failure
Atheroembolism
Graft infection
Graft thrombosis
Suture failure
6. Eighteen months after undergoing an aortobifemoral artery bypass, a 69-year-old woman
presents with a draining, cellulitic wound in her right-side groin, with exposed
polytetrafluoroethylene graft. What is the most likely pathogen infecting this graft?
a.
b.
c.
d.
S. epidermidis
Klebsiella pneumoniae
S. aureus
P. aeruginosa
7. An 82-year-old man presents to your clinic for follow up 6 weeks after discharge from the
hospital following abdominal aortic aneurysm (AAA) repair. His recovery was complicated
by loss of the left femoral pulse, requiring thrombectomy. You would like to evaluate his
vascular graft for blood flow and to rule out stenosis and false aneurysm. Which of the
following imaging modalities is the best test for this?
a.
b.
c.
d.
e.
B-mode ultrasonography
Color-flow duplex ultrasonography
Digital subtraction arteriography
CT
Magnetic resonance angiography (MRA)
8. A 72-year-old man is seen in clinic preoperatively to prepare for his upcoming femoraltibial bypass for vascular insufficiency. The duplex scan demonstrates poor candidates
for venous conduits, so the use of synthetic graft is anticipated. The long-term outcome
for this patient could be improved by:
a.
b.
c.
d.
e.
daily use of 81 mg aspirin indefinitely
clopidogrel use for the first 3 months after surgery
coumarin use with a goal international normalized ration (INR) of 1.5
the use of support stockings
low-molecular-weight heparin injection for the first 6 weeks after surgery
9. A 28-year-old professional violinist woman presents with headaches, neck pain, and
hand clumsiness in her right hand. She also reports occasional numbness in the hand
and right-side chest pain. Which of the following is the likely cause of her symptoms?
a.
b.
c.
d.
Carpal tunnel syndrome
Coronary artery disease
Thoracic outlet syndrome
Paget-Schroetter syndrome
10. An 82-year-old man with a history of severe chronic obstructive pulmonary disease
presents with claudication and is found to have occlusive disease localized to the left
common iliac artery. Which of the following procedures is the most appropriate for
management of this patient’s disease?
a.
b.
c.
d.
e.
Femoral to femoral artery bypass with venous autograft
Anticoagulation using IV heparin
Conservative treatment
Aortobifemoral artery bypass with synthetic graft
Percutaneous transluminal angioplasty under local anesthesia
11. A 30-year-old man presents with facial swelling, engorged neck veins, and complaints of
dizziness for the prior 3 months. He had been diagnosed with unresectable malignant
thymoma 2 years earlier, but he completed only two rounds of radiotherapy. How should
you proceed with treatment?
a.
b.
c.
d.
e.
Internal jugular to right atrial bypass
Inpatient heparinization until therapeutic on coumarin
Balloon angioplasty and endovascular stenting of the superior vena cava
Extra-anatomic bypass from the internal jugular to the femoral vein
Exploratory thoracotomy
12. A 78-year-old man who originally presented with stable angina due to extensive coronary
artery disease is undergoing pre-operative evaluation for a two-vessel CABG. Clinical
examination reveals a faint, questionable carotid bruit from the left carotid artery. He is
scheduled for carotid angiogram, which reveals 20% and 45% stenoses of his right and
left carotid arteries respectively. How should this patient be managed?
a.
b.
c.
d.
Proceed to CABG without further treatment of his carotid disease
Combined coronary artery bypass-carotid endarterectomy (CEA) operation
Staged CEA followed by coronary artery bypass under separate anesthetic
Staged coronary artery bypass followed by CEA under separate anesthetic
13. A 78-year-old woman with a history of TIAs and coronary disease presents to the ED with
pain in her distal right lower extremity. She describes the pain as a dull aching sensation
in her toes that is worse at night when she lies flat in bed, and she, therefore, often
sleeps in a chair. A careful inspection of the extremity does not reveal any signs of
necrosis or gangrene. The forefoot is purple red when the foot is down while seated and
very white when the foot is elevated. To assess the severity of this patient’s disease, an
ankle-brachial (systolic pressure) index (ABI) is performed at the bedside. What is the
most likely ABI value range to be found in this patient?
a.
b.
c.
d.
e.
ABI between 0.7 and 0.9
ABI between 0.6 and 0.7
ABI between 0.5 and 0.6
ABI between 0.3 and 0.4
ABI between 0.1 and 0.2
14. A 45-year-old man is admitted to the ICU with presumed sepsis. After the patient is
stabilized, the decision is made to place a central venous catheter. The patient’s
platelets, INR, and partial thromboplastin time ratio are within normal limits. He is
breathing at a rate of 20 breaths per minute on room air with an oxygen saturation of
99%. He has no other significant past medical history. The preferred location for central
venous access is:
a.
b.
c.
d.
e.
right femoral vein
left internal jugular vein
left subclavian vein
right internal jugular vein
left femoral vein
15. A 54-year-old man presents to his gastroenterologist after 3 weeks of right upper
quadrant pain, jaundice, and intermittent hemobilia. An ultrasonography and duplex scan
are performed, showing a 2.5-cm intrahepatic artery aneurysm in the left lobe of the liver.
The best option for treatment is:
a.
b.
c.
d.
e.
serial radiological studies to evaluate for expansion over time
coil embolization of the aneurysm with radiological guidance
open surgical ligation
left hepatectomy
resection of the aneurysm and reconstruction of the hepatic arterial tree
16. A 72-year-old man with a history of coronary artery disease and hypertension is found to
have a 6.8-cm infrarenal AAA and bilateral common iliac occlusive disease. He is taken
to the operating room for elective repair by aortobifemoral grafting. What is the most
common indication for internal iliac artery revascularization during aortic aneurysm
repair?
a.
b.
c.
d.
Absence of retrograde flow in the internal iliac artery
Absence of anterograde flow in the internal iliac artery
Unilateral aneurysmla dilation of the internal iliac artery origin
Postoperative rest pain due to buttock ischemia
17. A 67-year-old, otherwise healthy woman referred to you after arteriographic workup for
multiple left hemispheric ischemic attacks reveals a “string of beads” appearance in the
distal left internal carotid artery, proximal to the carotid canal at the base of the skull.
There is no further evidence of narrowing at the bifurcation on the left side or of any
disease of the right internal carotid artery. What is the most appropriate management of
this patient?
a.
b.
c.
d.
e.
High, internal CEA
Carotid artery interposition graft
Percutaneous transluminal balloon dilation
Chronic anticoagulation with regular observation
Open transluminal balloon dilation with stent placement
18. A 72-year-old man with a history of hypertension, hyperlipidemia, diabetes mellitus, and
an irregular heart rhythm presents in the ED with the acute onset of unremitting right leg
pain below the knee. He denies trauma and states that he regularly walks a block to the
grocery store without difficulty. On physical examination, the leg appears white and cool
to touch and is noticeably painful to palpation. In addition, no dorsalis pedis or posterior
tibialis pulse can be palpated nor can a signal be identified with use of the Doppler probe.
The most likely etiology for this patient’s peripheral ischemia is:
a.
b.
c.
d.
e.
acute thrombosis
embolic disease
chronic atherosclerotic disease
drug-induced ischemia
vasculitis