Cigarette smoking increases the odds ratio of peripheral vascular disease by which of the following?

1. Sevenfold
   
2. Threefold
   
3. Ninefold
   
4. Twofold
   
5. None of the above

The underlying mechanism(s) of peripheral vascular disease is/are which of the following?

1. Atherosclerosis
   
2. Hypoperfusion
   
3. Artery spasm
   
4. A and C

The highest incidence worldwide of peripheral vascular disease is seen in which of the following populations?

1. Asian Indians
   
2. Native American Indians
   
3. Indo-Caribbeans
   
4. Eskimo Indians

Which of the following is/are correct about peripheral vascular disease (PVD)?

1. Framingham risk score >10% has a higher incidence of PVD
   
2. Aspirin does not appear to help those with mild disease
   
3. Leg pain that is worsened by standing in one place but better with walking
   
4. Age over 70 years is associated with higher prevalence of PVD
   
5. All of the above

A 30-year-old male 6 ft 8 in tall, myopic, presents with left-sided transient ischemic attack. This patient is at high risk for what other conditions or what features?

1. High incidence of venous thromboembolism in postoperative state.
   
2. Abnormal lower extremity pulse examination
   
3. Bony abnormalities
   
4. Shortened life span
   
5. Autosomal recessive inheritance
   
6. Autosomal dominant inheritance
   
7. A, B, C, D, and E
   
8. A, B, C, D, and F

Which of the following statements regarding smoking cannabis is/are correct?

1. Causes arteritis picture like Burger’s disease
   
2. δ-8- and δ-9-tetrahydrocanabinols cause severe vasospasm
   
3. May cause strokes
   
4. Venous thrombosis may occur
   
5. All of the above

Which of the following statement(s) is/are true regarding ankle brachial index (ABI)?

1. An ABI of 1.5 is associated with high cardiovascular mortality
   
2. Is the first-line study upon suspicion peripheral arterial disease (PAD)
   
3. A decrease in ABI of 15–20% after exercise would be diagnostic of PAD
   
4. An ABI of 0.4 is associated with high cardiovascular mortality
   
5. All of the above

A 60-year-old male has a history of smoking and hypertension and complains of intermittent claudication. His ABI is 0.7. What is the best next step?

1. Computed tomography (CT) of lower extremities
   
2. Magnetic resonance angiography (MRA) of lower extremities
   
3. Doppler ultrasound of lower extremities
   
4. Angiography
   
5. Cardiac risk factor modification and a supervised exercise regimen

Which of the following is used for PAD classification?

1. Trans-Atlantic Inter-Society Consensus (TASC) II
   
2. Wound, ischemia, and foot infection (WIfI)
   
3. Fontaine stages
   
4. Robert B. Rutherford
   
5. All of the above

Which of the following is/are correct?

1. Individuals with PAD have an exceptionally elevated risk for cardiovascular events
   
2. The majority will eventually die of a cardiac or cerebrovascular etiology
   
3. Prognosis is correlated with the severity of the PAD as measured by the ABPI
   
4. Large-vessel PAD increases mortality from cardiovascular disease significantly
   
5. PAD carries a greater than 20% risk of a coronary event in 10 years
   
6. All of the above.

Which of the following is the commonest clinical presentation of PAD in patients ≥50 years of age?

1. Asymptomatic
   
2. Atypical leg pain
   
3. Classic claudication
   
4. Threatened limb

A 57-year-old male with 30-year smoking history and diabetes mellitus presents with buttock pain on walking and erectile dysfunction. He also reports that his legs look thinner than in the past. On examination there is an extremely weak femoral pulse bilaterally. What is the most likely diagnosis?

1. Coarctation of the aorta
   
2. Leriche syndrome
   
3. Lumbar spinal stenosis
   
4. All of the above

A 56-year-old male with history of smoking and diabetes mellitus presents with calf pain on walking that resolves with resting. Bedside ABI is 0.91. What is the best next step?

1. Doppler ultrasound
   
2. CT
   
3. MRA
   
4. Exercise testing

A 56-year-old male with history of smoking and diabetes presents with a right cold foot. Ultrasound shows a thrombosed popliteal artery aneurysm. What is the treatment of choice?

1. Tissue plasminogen activator infusion followed by stent implantation
   
2. Direct covered stent implantation
   
3. Tissue plasminogen activator infusion of the aneurysm followed by surgical bypass
   
4. None of the above

What is/are the indication for popliteal artery aneurysm repair?

1. All popliteal aneurysms should be repaired
   
2. All symptomatic aneurysms that present with acute limb ischemia regardless of size
   
3. Patients with patent popliteal aneurysms ≥2.0 cm in diameter
   
4. B and C

A 25-year-old female with no significant medical history presents with calf pain upon competitive bicycling. Bedside ABI is 0.91. The popliteal pulse is diminished upon plantar flexion of the foot against the floor. What is the most likely diagnosis?

1. Popliteal aneurysm
   
2. Popliteal arteritis
   
3. Popliteal entrapment syndrome
   
4. None of the above

A 40-year-old obese male with no medical problem presents complaining of chronic intermittent claudication. ABI is 1.0, and Doppler ultrasound normal. Angiogram shows obstruction of right popliteal artery. What is the most likely diagnosis?

1. Atherosclerosis of the popliteal artery
   
2. Popliteal artery spasm
   
3. Adventitial cystic disease
   
4. Buerger’s disease

A 45-year-old male heavy smoker presents with black skin discoloration and pain in both hands and feet. What is the strongest risk factor?

1. Diabetes mellitus
   
2. Cigarette smoking
   
3. Hypertension
   
4. Hyperlipidemia

Which of the following is/are an indication for intervention to the infrageniculate arteries?

1. Rest pain
   
2. Nonhealing ulcerations
   
3. Severe pain on walking
   
4. A and B

Which of the following is/are true about an arterial ulcer?

1. It occurs at tips of toes, heel, and lateral ankle
   
2. Painful
   
3. Edema
   
4. A and B

Which of the following is/are a feature of a venous ulcer?

1. Minimal pain
   
2. Large punched-out ulcer
   
3. Capillary refill >3.0 s
   
4. None of the above

A 69-year-old male with history of smoking, diabetes mellitus, hypertension, and paroxysmal atrial fibrillation on aspirin presents with acute severe right foot pain. Examination reveals delayed capillary refill, weakness, decreased sensation, and inaudible arterial Doppler. What is the best next step?

1. Angiography
   
2. Thrombolysis
   
3. Emergency embolectomy
   
4. Intravenous heparin

A 56-year-old female presents complaining of leg pain and heaviness. Examination shows varicose veins, with pigmentation and edema. No ulcer. What is the clinical, etiological, anatomical, and pathophysiological (CEAP) class in this patient?

1. C1
   
2. C2
   
3. C3
   
4. C4a

Which of the following is/are a risk factor for chronic venous disease?

1. Increased body mass index
   
2. Smoking
   
3. Presence of arteriovenous shunt
   
4. Flat feet
   
5. All of the above

A 25-year-old obese female with no significant medical history presents with recurrent left lower extremity deep vein thrombosis. Antithrombin III, protein C, protein S, factor V Leiden, and prothrombin G20210A are all normal. What is the most accurate confirmatory diagnostic test?

1. Intravascular ultrasound
   
2. Venography
   
3. Venous/interstitial pressure measurement
   
4. Plethysmography

Which of the following is/are a contraindication to lower extremity venous ablation?

1. Acute deep vein thrombosis
   
2. Joint disease that interferes with mobility
   
3. Klippel–Trenaunay syndrome
   
4. All of the above

Which of the following is/are a complication of varicose veins?

1. Stasis dermatitis
   
2. Pulmonary embolism
   
3. Carcinoma
   
4. A, B, and C

A 78-year-old diabetic male with history of a quadruple coronary artery bypass graft 8 years ago is referred to you by his primary care doctor for difficult-to-control blood pressure (BP). He was admitted to the hospital 3 months ago with acute pulmonary edema. He is currently on benazepril 40 mg/day, amlodipine 10 mg/day, metoprolol 50 mg BID. His BP is 180/110 mmHg. You add clonidine 0.1 mg TID. The creatinine is 1.9 mg/gL. What is the next most appropriate step?

1. Renal vein renin sampling
   
2. CT angiography
   
3. Abdominal angiography using carbon dioxide
   
4. MRA

What is the gold standard for diagnosing renal artery stenosis (RAS)?

1. CT angiography
   
2. MRA
   
3. Renal arteriography
   
4. Duplex Doppler ultrasonography

Which of the following describes superior mesenteric artery syndrome?

1. A clinical entity characterized by a decreased acuity of the angle between the aorta and superior mesenteric artery due to the loss of mesenteric fat between the superior mesenteric artery and aorta resulting in compression of the third portion of the duodenum.
   
2. Present with symptoms consistent with a proximal small bowel obstruction.
   
3. An aortomesenteric artery angle of ≤40° is the most sensitive measure of diagnosis.
   
4. A and B
   
5. A, B, and C

An 80-year-old female presents with chronic postprandial abdominal pain and weight loss of 30 lb over the last 6 months. She can only eat small portions due to severe abdominal pain. She has prior percutaneous coronary intervention to the left anterior descending and right coronary arteries. She also had a right superficial femoral artery stent 8 months ago. There is a history of a transient ischemic attack in the past, and she has a left carotid bruit. Abdominal examination detects an abdominal bruit. Abdominal ultrasound is normal. What is the most likely clinical diagnosis?

1. RAS
   
2. Chronic pancreatitis
   
3. Celiac artery compression syndrome
   
4. None of the above

Which of the following is/are types of varicosities?

1. Reticular veins
   
2. Telangiectasia
   
3. Varicose veins
   
4. Venulectasia
   
5. All of the above

ACC/AHA guidelines recommend which of the following in critical limb ischemia (CLI)?

1. Patients with CLI in whom open surgical repair is anticipated should undergo assessment of cardiovascular risk.
   
2. Patients with CLI and features to suggest athero-embolization should not be evaluated for aneurysmal disease.
   
3. Systemic antibiotics should be initiated promptly in patients with CLI, skin ulcerations, and evidence of limb infection.
   
4. A and C

In PAD diagnosis, which of the following is/are correct?

1. Exercise treadmill tests are recommended to provide the most objective evidence of the magnitude of the functional limitation of claudication and to measure the response to therapy.
   
2. Duplex ultrasound of the extremities is useful to diagnose anatomic location and degree of stenosis of PAD.
   
3. Duplex ultrasound of the extremities can be useful to select patients as candidates for endovascular intervention.
   
4. Duplex ultrasound can be useful to select patients as candidates for surgical bypass and to select the sites of surgical anastomosis.
   
5. All of the above

In treatment of PAD, which of the following is correct?

1. Beta-adrenergic blocking drugs are effective antihypertensive agents and are not contraindicated in patients with PAD.
   
2. Antiplatelet therapy is indicated to reduce the risk of myocardial infarction (MI), stroke, or vascular death in individuals with atherosclerotic lower extremity PAD.
   
3. A therapeutic trial of cilostazol should be considered in all patients with lifestyle-limiting claudication (in the absence of heart failure).
   
4. All of the above.

Which of the following is/are indications for percutaneous revascularization of RAS?

1. Patients with hemodynamically significant RAS
   
2. Recurrent, unexplained congestive heart failure
   
3. Sudden, unexplained pulmonary edema
   
4. A and B
   
5. A, B, and C

Which of the following statements regarding chronic intestinal ischemia is/are true?

1. Should be suspected in patients with abdominal pain and weight loss without other explanation, especially those with cardiovascular disease.
   
2. Only duplex ultrasound, but not CT angiography, and gadolinium-enhanced MRA are useful initial tests for supporting the clinical diagnosis of chronic intestinal ischemia.
   
3. Surgical revascularization is indicated for patients with asymptomatic intestinal arterial obstructions.
   
4. Percutaneous endovascular treatment of intestinal arterial stenosis is not indicated in patients with chronic intestinal ischemia.

An 80-year-old male undergoes endovascular aneurysm repair uneventfully. The next day he develops severe abdominal pain and a “trash” foot. The next best step is which of the following?

1. Duplex sonography of the abdomen is an appropriate diagnostic tool for suspected acute intestinal ischemia.
   
2. Surgical consultation
   
3. Angiography
   
4. CT angiography

A 23-year-old female presents with symptoms of hypertension, intermittent claudication, and renal failure. What is the most likely diagnosis?

1. RAS
   
2. Pheochromocytoma
   
3. Midaortic syndrome
   
4. Renal vein thrombosis