100+ Free FRCS Vascular Surgery Practice Questions

Explanation: An aneurysm of 4.2 cm falls into the medium category (4.5–5.4 cm is yearly in some schemes, but the UK NAAASP uses 3.0–4.4 cm = annual and 4.5–5.4 cm = 3-monthly surveillance). A 4.2 cm AAA is therefore surveyed annually until it reaches the 5.5 cm threshold or grows rapidly. Elective repair is generally offered at ≥5.5 cm, symptomatic, or rapidly expanding (>1 cm/year).

Explanation: In ruptured AAA, permissive (hypotensive) resuscitation aims to keep the systolic BP low enough to limit further bleeding and clot disruption while maintaining cerebral and cardiac perfusion (a conscious patient indicates adequate perfusion). Over-resuscitation raises blood pressure, dislodges clot and worsens haemorrhage. Definitive control requires aortic clamping (open) or balloon occlusion/stent (EVAR).

Explanation: A type III endoleak results from a defect in the graft fabric or, classically, from separation/inadequate overlap between modular stent-graft components (a junctional leak). Like a type I leak it pressurises the sac and usually requires prompt re-intervention, typically with a bridging stent or relining of the junction.

Explanation: This is a type II endoleak from the IMA and lumbar arteries. Type II leaks associated with sac enlargement (typically >5 mm) warrant intervention, most commonly trans-arterial or trans-lumbar embolisation of the feeding vessels and/or sac. Open conversion is reserved for failed embolisation or when sac growth threatens rupture.

Explanation: The proximal infrarenal neck (an adequate length of healthy aorta below the lowest renal artery, with acceptable diameter and limited angulation) provides the seal zone for the stent graft. Inadequate neck length, excessive diameter, conicity or severe angulation are the commonest reasons a standard infrarenal device is unsuitable and a fenestrated/branched device or open repair is required.

Explanation: Connective-tissue disorders such as Marfan syndrome carry a markedly higher risk of dissection at smaller diameters, so the ascending aortic/root threshold for elective repair is lowered to around 4.5–5.0 cm (and even lower with adverse features such as rapid growth or family history of dissection), compared with ~5.5 cm for degenerative ascending aneurysms.

Explanation: A dissection sparing the ascending aorta and beginning distal to the left subclavian is Stanford type B. Uncomplicated type B dissection (no rupture, no malperfusion, controllable pain/hypertension) is managed medically with anti-impulse therapy — intravenous beta-blockade to lower heart rate and systolic blood pressure (target ~100–120 mmHg). TEVAR is reserved for complicated type B disease.

Explanation: Suprarenal aortic clamping abruptly increases left ventricular afterload, raising blood pressure proximally and myocardial oxygen demand, while organs distal to the clamp (kidneys, gut, spinal cord) become ischaemic. Anaesthetic management anticipates this with afterload reduction and careful clamp/declamp coordination; reperfusion on unclamping causes washout of lactate and a metabolic acidosis with hypotension.

Explanation: NAAASP invites men for a single abdominal ultrasound during the year they turn 65 (men over 65 who have not been screened can self-refer). Men have a far higher AAA prevalence than women, which is why population screening targets 65-year-old men rather than women or younger adults.

Explanation: Colonic ischaemia after AAA repair classically affects the sigmoid/left colon, where collateral supply via the marginal artery and the watershed at the splenic flexure is most tenuous, especially after IMA ligation and a hypotensive ruptured presentation. Bloody diarrhoea early postoperatively should prompt urgent flexible sigmoidoscopy; transmural ischaemia mandates laparotomy and resection.