Vascular Final Exam Review with
questions and verified answers with
rationale updated 2026
1. Which of the following is the outermost layer of an artery?
A. Tunica intima
B. Tunica media
C. Tunica externa
D. Endothelium
Answer: C. Tunica externa
Rationale: The tunica externa (also called tunica adventitia) is the outermost layer, composed of
connective tissue that provides structural support and anchoring for the vessel.
2. The primary component of the tunica media is:
A. Collagen
B. Elastin
C. Smooth muscle
D. Endothelial cells
Answer: C. Smooth muscle
Rationale: The tunica media is primarily composed of smooth muscle cells and elastic fibers, which
regulate vessel diameter and therefore blood pressure and flow.
3. What is the primary function of capillaries?
A. To withstand high pressure
B. To exchange nutrients and waste products
C. To regulate blood pressure
D. To store blood
Answer: B. To exchange nutrients and waste products
Rationale: Capillaries are the smallest blood vessels, consisting of a single endothelial layer, which
allows for the efficient exchange of gases, nutrients, and waste between blood and tissues.
4. Which type of blood vessel has the highest compliance?
A. Artery
B. Arteriole
C. Capillary
D. Vein
Answer: D. Vein
Rationale: Veins are highly compliant (distensible) and act as a reservoir for a large portion of the
body's blood volume (about 70%).
5. The term "anastomosis" refers to:
A. The narrowing of a blood vessel
B. The surgical removal of a blood vessel
C. The connection between two blood vessels
D. The inflammation of a blood vessel
Answer: C. The connection between two blood vessels
,Rationale: An anastomosis is a connection or opening between two things, particularly between
blood vessels, providing alternative pathways for blood flow.
6. The most common site for an arterial aneurysm is:
A. Popliteal artery
B. Femoral artery
C. Abdominal aorta
D. Thoracic aorta
Answer: C. Abdominal aorta
Rationale: The infrarenal abdominal aorta is the most common location for an arterial aneurysm,
often referred to as an AAA (abdominal aortic aneurysm).
7. A major risk factor for an abdominal aortic aneurysm (AAA) is:
A. Diabetes mellitus
B. Hypertension
C. Smoking
D. Hyperlipidemia
Answer: C. Smoking
Rationale: Smoking is the strongest modifiable risk factor for the development and rupture of an
abdominal aortic aneurysm.
8. What is the classic triad of symptoms for a ruptured AAA?
A. Nausea, vomiting, and diarrhea
B. Hypertension, bradycardia, and headache
C. Hypotension, abdominal pain, and a pulsatile mass
D. Fever, chills, and flank pain
Answer: C. Hypotension, abdominal pain, and a pulsatile mass
Rationale: The classic triad for a ruptured AAA is hypotension (from bleeding), severe abdominal or
back pain, and a palpable, pulsatile abdominal mass.
9. A patient presents with a "blue toe" and a normal pedal pulse. This is most suggestive of:
A. Acute arterial occlusion
B. Atheroembolism (Blue Toe Syndrome)
C. Deep vein thrombosis
D. Raynaud's phenomenon
Answer: B. Atheroembolism (Blue Toe Syndrome)
Rationale: Blue Toe Syndrome is caused by microemboli (often cholesterol crystals) breaking off
from a proximal atheromatous plaque, occluding small digital arteries while larger pedal pulses
remain intact.
10. The most common cause of acute arterial occlusion is:
A. Trauma
B. Embolism
C. Thrombosis in situ
D. Vasospasm
Answer: B. Embolism
Rationale: An embolus, most commonly originating from the heart (e.g., in atrial fibrillation), is the
most frequent cause of acute arterial occlusion.
, 11. Which of the following is NOT a classic sign of acute arterial occlusion (the "5 Ps")?
A. Pain
B. Pallor
C. Paresthesia
D. Petechiae
Answer: D. Petechiae
Rationale: The classic "5 Ps" of acute arterial occlusion are Pain, Pallor, Pulselessness, Paresthesia,
and Paralysis (or Poikilothermia). Petechiae are small red spots, not a classic sign.
12. The gold standard for diagnosing an acute arterial occlusion is:
A. Ankle-Brachial Index (ABI)
B. Duplex Ultrasound
C. Computed Tomography Angiography (CTA)
D. Arteriography (DSA)
Answer: D. Arteriography (DSA)
Rationale: While CTA is often used first, catheter-based arteriography (Digital Subtraction
Angiography) is the gold standard as it can precisely define the location and extent of the occlusion
and potentially allow for immediate intervention.
13. The primary treatment for an acute arterial occlusion is:
A. Elevation and warm compresses
B. Anticoagulation with heparin
C. Emergent revascularization
D. Amputation
Answer: C. Emergent revascularization
Rationale: Acute arterial occlusion is a surgical emergency. The goal is to restore blood flow as
quickly as possible, typically through embolectomy or thrombolysis, to prevent irreversible tissue
damage.
14. What is the most common symptom of chronic lower extremity arterial disease (PAD)?
A. Rest pain
B. Intermittent claudication
C. Tissue loss/gangrene
D. Swelling
Answer: B. Intermittent claudication
Rationale: Intermittent claudication is a reproducible muscle pain (aching, cramping) that occurs
with exercise and is relieved by rest, caused by inadequate blood flow to meet the metabolic
demands of the muscle.
15. An Ankle-Brachial Index (ABI) of 0.6 indicates:
A. Normal arterial flow
B. Mild arterial disease
C. Moderate arterial disease
D. Severe arterial disease
Answer: C. Moderate arterial disease
Rationale: ABI values are interpreted as follows: >1.3 (non-compressible), 1.0-1.3 (normal), 0.91-
0.99 (borderline), 0.41-0.90 (mild to moderate PAD), <0.40 (severe PAD). An ABI of 0.6 falls into the
moderate category.
questions and verified answers with
rationale updated 2026
1. Which of the following is the outermost layer of an artery?
A. Tunica intima
B. Tunica media
C. Tunica externa
D. Endothelium
Answer: C. Tunica externa
Rationale: The tunica externa (also called tunica adventitia) is the outermost layer, composed of
connective tissue that provides structural support and anchoring for the vessel.
2. The primary component of the tunica media is:
A. Collagen
B. Elastin
C. Smooth muscle
D. Endothelial cells
Answer: C. Smooth muscle
Rationale: The tunica media is primarily composed of smooth muscle cells and elastic fibers, which
regulate vessel diameter and therefore blood pressure and flow.
3. What is the primary function of capillaries?
A. To withstand high pressure
B. To exchange nutrients and waste products
C. To regulate blood pressure
D. To store blood
Answer: B. To exchange nutrients and waste products
Rationale: Capillaries are the smallest blood vessels, consisting of a single endothelial layer, which
allows for the efficient exchange of gases, nutrients, and waste between blood and tissues.
4. Which type of blood vessel has the highest compliance?
A. Artery
B. Arteriole
C. Capillary
D. Vein
Answer: D. Vein
Rationale: Veins are highly compliant (distensible) and act as a reservoir for a large portion of the
body's blood volume (about 70%).
5. The term "anastomosis" refers to:
A. The narrowing of a blood vessel
B. The surgical removal of a blood vessel
C. The connection between two blood vessels
D. The inflammation of a blood vessel
Answer: C. The connection between two blood vessels
,Rationale: An anastomosis is a connection or opening between two things, particularly between
blood vessels, providing alternative pathways for blood flow.
6. The most common site for an arterial aneurysm is:
A. Popliteal artery
B. Femoral artery
C. Abdominal aorta
D. Thoracic aorta
Answer: C. Abdominal aorta
Rationale: The infrarenal abdominal aorta is the most common location for an arterial aneurysm,
often referred to as an AAA (abdominal aortic aneurysm).
7. A major risk factor for an abdominal aortic aneurysm (AAA) is:
A. Diabetes mellitus
B. Hypertension
C. Smoking
D. Hyperlipidemia
Answer: C. Smoking
Rationale: Smoking is the strongest modifiable risk factor for the development and rupture of an
abdominal aortic aneurysm.
8. What is the classic triad of symptoms for a ruptured AAA?
A. Nausea, vomiting, and diarrhea
B. Hypertension, bradycardia, and headache
C. Hypotension, abdominal pain, and a pulsatile mass
D. Fever, chills, and flank pain
Answer: C. Hypotension, abdominal pain, and a pulsatile mass
Rationale: The classic triad for a ruptured AAA is hypotension (from bleeding), severe abdominal or
back pain, and a palpable, pulsatile abdominal mass.
9. A patient presents with a "blue toe" and a normal pedal pulse. This is most suggestive of:
A. Acute arterial occlusion
B. Atheroembolism (Blue Toe Syndrome)
C. Deep vein thrombosis
D. Raynaud's phenomenon
Answer: B. Atheroembolism (Blue Toe Syndrome)
Rationale: Blue Toe Syndrome is caused by microemboli (often cholesterol crystals) breaking off
from a proximal atheromatous plaque, occluding small digital arteries while larger pedal pulses
remain intact.
10. The most common cause of acute arterial occlusion is:
A. Trauma
B. Embolism
C. Thrombosis in situ
D. Vasospasm
Answer: B. Embolism
Rationale: An embolus, most commonly originating from the heart (e.g., in atrial fibrillation), is the
most frequent cause of acute arterial occlusion.
, 11. Which of the following is NOT a classic sign of acute arterial occlusion (the "5 Ps")?
A. Pain
B. Pallor
C. Paresthesia
D. Petechiae
Answer: D. Petechiae
Rationale: The classic "5 Ps" of acute arterial occlusion are Pain, Pallor, Pulselessness, Paresthesia,
and Paralysis (or Poikilothermia). Petechiae are small red spots, not a classic sign.
12. The gold standard for diagnosing an acute arterial occlusion is:
A. Ankle-Brachial Index (ABI)
B. Duplex Ultrasound
C. Computed Tomography Angiography (CTA)
D. Arteriography (DSA)
Answer: D. Arteriography (DSA)
Rationale: While CTA is often used first, catheter-based arteriography (Digital Subtraction
Angiography) is the gold standard as it can precisely define the location and extent of the occlusion
and potentially allow for immediate intervention.
13. The primary treatment for an acute arterial occlusion is:
A. Elevation and warm compresses
B. Anticoagulation with heparin
C. Emergent revascularization
D. Amputation
Answer: C. Emergent revascularization
Rationale: Acute arterial occlusion is a surgical emergency. The goal is to restore blood flow as
quickly as possible, typically through embolectomy or thrombolysis, to prevent irreversible tissue
damage.
14. What is the most common symptom of chronic lower extremity arterial disease (PAD)?
A. Rest pain
B. Intermittent claudication
C. Tissue loss/gangrene
D. Swelling
Answer: B. Intermittent claudication
Rationale: Intermittent claudication is a reproducible muscle pain (aching, cramping) that occurs
with exercise and is relieved by rest, caused by inadequate blood flow to meet the metabolic
demands of the muscle.
15. An Ankle-Brachial Index (ABI) of 0.6 indicates:
A. Normal arterial flow
B. Mild arterial disease
C. Moderate arterial disease
D. Severe arterial disease
Answer: C. Moderate arterial disease
Rationale: ABI values are interpreted as follows: >1.3 (non-compressible), 1.0-1.3 (normal), 0.91-
0.99 (borderline), 0.41-0.90 (mild to moderate PAD), <0.40 (severe PAD). An ABI of 0.6 falls into the
moderate category.
