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Sample FRCS Vascular Surgery Practice Questions

Try these sample questions to review concepts for the FRCS Vascular Surgery exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 74-year-old man is found on abdominal ultrasound during AAA screening to have an asymptomatic infrarenal abdominal aortic aneurysm measuring 4.2 cm in maximum anteroposterior diameter. According to the UK NAAASP / NICE pathway, what is the appropriate management?
A.Refer urgently for elective open or endovascular repair
B.Surveillance ultrasound every 3 months
C.Surveillance ultrasound at 12-month intervals
D.Discharge with no further follow-up
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).
2A 78-year-old man presents collapsed with sudden severe back pain, hypotension (BP 80/50) and a known 6 cm AAA. CT angiography confirms a contained retroperitoneal rupture. Which of the following is the most appropriate immediate haemodynamic target while arranging emergency repair?
A.Aggressive crystalloid resuscitation to a systolic BP > 120 mmHg
B.Withhold all fluids until the aorta is clamped
C.Immediate vasopressor infusion to a mean arterial pressure of 100 mmHg
D.Permissive hypotension, maintaining a systolic BP around 70–90 mmHg if the patient is conscious
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).
3During endovascular aneurysm repair (EVAR) for an infrarenal AAA, completion angiography demonstrates contrast filling the sac arising from flow between the two overlapping stent-graft components at the iliac limb junction. Which type of endoleak does this describe?
A.Type I endoleak
B.Type II endoleak
C.Type III endoleak
D.Type IV endoleak
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.
4A 68-year-old woman undergoes surveillance CT after EVAR. The sac has enlarged by 8 mm over 12 months. Imaging shows contrast within the aneurysm sac fed retrogradely by a patent inferior mesenteric artery and lumbar vessels, with no graft junctional defect. What is the most appropriate next step for this persistent sac-enlarging endoleak?
A.Immediate open conversion and graft explantation
B.Proximal cuff extension at the aortic neck
C.Reassurance and routine annual surveillance only
D.Embolisation of the feeding vessels / sac (e.g. coil or glue embolisation)
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.
5Which anatomical feature is the single most important determinant of suitability for standard infrarenal EVAR using a commercially available bifurcated stent graft?
A.Maximum aneurysm sac diameter
B.Degree of mural thrombus within the sac
C.Patency of the inferior mesenteric artery
D.Proximal aortic neck length, diameter and angulation
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.
6A 60-year-old man with Marfan syndrome has a thoracic aortic aneurysm. At what maximum aortic root/ascending aortic diameter is elective surgical repair generally recommended in Marfan syndrome, given the increased dissection risk compared with degenerative aneurysms?
A.4.0 cm
B.7.0 cm
C.6.0 cm
D.4.5–5.0 cm
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.
7A 55-year-old hypertensive man presents with sudden severe tearing interscapular chest pain radiating to the back. CT angiography shows a dissection flap confined to the descending thoracic aorta beginning distal to the left subclavian artery, with no malperfusion and no rupture. How is this dissection classified and what is the standard initial management?
A.Stanford type A — emergency open surgical repair
B.Stanford type A — medical therapy alone
C.Stanford type B, complicated — immediate TEVAR regardless of features
D.Stanford type B, uncomplicated — medical (anti-impulse) therapy with blood pressure and heart-rate control
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.
8A patient is undergoing open repair of a juxtarenal abdominal aortic aneurysm requiring a suprarenal aortic cross-clamp. Which of the following physiological consequences should the surgeon most anticipate on clamp application?
A.A fall in cardiac afterload and systemic vascular resistance
B.Reflex bradycardia and reduced left ventricular wall stress
C.Immediate metabolic alkalosis from reduced lactate production
D.A rise in afterload with increased myocardial oxygen demand and risk of renal and visceral ischaemia
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.
9The UK NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP) offers a single screening ultrasound to which population?
A.All men and women aged 60
B.All adults aged 50 and over with hypertension
C.Women aged 70 with a family history of AAA only
D.Men in the year they turn 65
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.
10A 70-year-old man develops bloody diarrhoea and left-sided abdominal pain on the second day after open repair of a ruptured infrarenal AAA in which the inferior mesenteric artery was ligated. Flexible sigmoidoscopy shows patchy mucosal ischaemia of the sigmoid colon. What is the most likely diagnosis?
A.Clostridioides difficile colitis
B.Small-bowel obstruction from adhesions
C.Aorto-enteric fistula
D.Ischaemic (colonic) ischaemia, typically affecting the sigmoid/left colon
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.

About the FRCS Vascular Surgery Exam

The FRCS (Vascular Surgery) is the UK and Ireland Intercollegiate Specialty Fellowship Examination taken near completion of vascular surgery training. Section 1 tests applied knowledge with single best answer written papers delivered via Pearson VUE, and Section 2 assesses clinical reasoning and communication through structured clinical scenarios and orals.

Exam sponsor: Joint Committee on Intercollegiate Examinations (JCIE). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

Two-part exam: Section 1 written SBA papers delivered by computer-based testing, followed by Section 2 clinical examination and structured orals.

Time Limit

Two Section 1 written papers of approximately 2 hours 15 minutes each, plus a separate Section 2 clinical and oral day.

Passing Score

Criterion-referenced; the pass mark is set per diet by the Intercollegiate Specialty Board using a modified Angoff standard-setting method, so there is no fixed percentage threshold.

Exam / Certification Fees

Section 1 GBP 580 and Section 2 GBP 1,420 (total GBP 2,000) for exams taken up to 31 December 2026; from 1 January 2027 the fees rise to GBP 600 (Section 1) and GBP 1,470 (Section 2).

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

15%

Aortic Aneurysm Disease

Elective and ruptured AAA, thoracic/thoracoabdominal aorta, dissection, EVAR/TEVAR, endoleaks and AAA screening and surveillance.

12%

Peripheral Arterial Disease

Claudication, chronic limb-threatening ischaemia, best medical therapy, bypass and endovascular revascularisation and graft surveillance.

9%

Carotid and Cerebrovascular Disease

Carotid stenosis management, endarterectomy versus stenting, duplex criteria, dissection and procedural complications.

9%

Venous Disease

Varicose veins and ablation, DVT and PE, post-thrombotic syndrome and venous compression syndromes.

9%

Vascular Access

Arteriovenous fistula/graft planning and creation, steal syndrome, central venous stenosis and access salvage for dialysis.

8%

Vascular Trauma

Penetrating and blunt vascular injury, damage-control surgery, temporary shunts, iatrogenic injury and pseudoaneurysm.

7%

Acute Limb Ischaemia

Rutherford classification, embolus versus thrombosis, anticoagulation, revascularisation, compartment syndrome and reperfusion injury.

6%

Endovascular Techniques and Pharmacology

Access and sheaths, intraprocedural heparin, contrast and radiation safety and spinal cord protection.

5%

Diabetic Foot

Neuro-ischaemic ulceration, infection, Charcot neuroarthropathy, angiosome-directed revascularisation and MDT limb salvage.

5%

Mesenteric and Renovascular Disease

Acute and chronic mesenteric ischaemia, NOMI, fibromuscular dysplasia and renal artery stenosis evidence.

4%

Upper Limb Vascular Disease

Thoracic outlet syndrome, Raynaud phenomenon, subclavian steal and large-vessel vasculitis.

4%

Amputation, Lymphoedema and Tissue Loss

Amputation level selection and healing, rehabilitation, phantom limb pain and lymphoedema.

4%

Vascular Imaging

Duplex ultrasound, CT/MR and catheter angiography, CO2 angiography and Doppler interpretation.

3%

Basic Science and Perioperative Care

Atherosclerosis biology, vascular physiology, risk-factor modification, perioperative optimisation and statistics.

Preparing for the FRCS Vascular Surgery Exam

What You Need to Know

  • Passing score: Criterion-referenced; the pass mark is set per diet by the Intercollegiate Specialty Board using a modified Angoff standard-setting method, so there is no fixed percentage threshold.
  • Assessment: Two-part exam: Section 1 written SBA papers delivered by computer-based testing, followed by Section 2 clinical examination and structured orals.
  • Time limit: Two Section 1 written papers of approximately 2 hours 15 minutes each, plus a separate Section 2 clinical and oral day.
  • Exam / certification fees: Section 1 GBP 580 and Section 2 GBP 1,420 (total GBP 2,000) for exams taken up to 31 December 2026; from 1 January 2027 the fees rise to GBP 600 (Section 1) and GBP 1,470 (Section 2). Official sources

Using Our Practice Resources

  • Work through all 100 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

FRCS Vascular Surgery: Suggested Study Strategy

1Map your revision directly to the 2023 JCIE vascular surgery syllabus blueprint and practise SBAs that demand a single best answer, not just recall of facts.
2Drill applied decision-making from current UK evidence and guidelines (NICE PAD and varicose vein guidance, BASIL-2, IMPROVE, EVAR-1, NASCET/CREST) so you can justify management choices under time pressure.
3Use the official JCIE vascular sample questions to learn the question style and reasoning, then rehearse clinical scenarios out loud to prepare for the Section 2 orals.

Frequently Asked Questions

How is the FRCS Vascular Surgery exam structured?

It has two sections. Section 1 is a written examination of single best answer papers delivered by computer-based testing at Pearson VUE centres. Section 2 is a clinical and oral examination using structured clinical scenarios and orals. Both are run by the JCIE.

What does the FRCS Vascular Surgery exam cost?

For exams taken up to 31 December 2026 the JCIE fee is GBP 580 for Section 1 and GBP 1,420 for Section 2 (GBP 2,000 total). From 1 January 2027 the fees rise to GBP 600 and GBP 1,470 (GBP 2,070 total).

What is the pass mark for the FRCS Vascular Surgery exam?

There is no fixed percentage pass mark. The standard is criterion-referenced and set for each diet by the Intercollegiate Specialty Board using a modified Angoff method, so the threshold varies between sittings.

What topics does Section 1 cover?

Section 1 is blueprinted to the JCIE vascular surgery syllabus, spanning aortic and peripheral arterial disease, carotid/cerebrovascular disease, venous disease, vascular access, endovascular procedures, vascular trauma, diabetic foot, mesenteric/renovascular disease, amputation and basic science.