Deck 9: The Blood Vessels of the Lower Extremity

Question 1

A 47-year-old woman complaining of a dull, aching pain in the lower part of both legs visited her physician. She stated that the pain was particularly severe at the end of a long day of standing at her work. On examination, the patient was found to have widespread

-The following symptoms and signs supported the diagnosis except which?

A) The patient stated that the skin down the medial side of the leg was irritated especially in dry weather.
B) If the patient coughed in the standing position, a fluid thrill was transmitted from the abdomen to the hand palpating the veins.
C) The skin showed marked discoloration over the medial malleoli and was dry and scaly.
D) The patient had a large family of six children and the varicose veins showed improvement during each pregnancy.
E) The great and small saphenous veins in both legs were enlarged and elongated.

Answer 1

The patient had a large family of six children and the varicose veins showed improvement during each pregnancy.

Question 2

A 65-year-old man told his physician that he could walk only about $50 \mathrm{yd}(46 \mathrm{~m})$ before a cramp-like pain in his left leg forced him to rest. After a thorough physical examination, a diagnosis of severe intermittent claudication of the left leg was made.

-The following findings in this patient supported the diagnosis except which?

A) His femoral pulses were normal in both legs.
B) The popliteal, posterior tibial, and dorsalis pedis pulses were present in the right leg and completely absent in the left leg.
C) Arteriography revealed a blockage of the left femoral artery at the level of the adductor tubercle.
D) The lower part of the left leg was receiving its blood supply through the muscular and genicular branches of the femoral artery and the muscular and genicular branches of the popliteal artery.
E) The collateral circulation in the left leg was adequate to prevent gangrene but was insufficient to supply oxygen to the active leg muscles.
F) The perforating branches of the profunda femoris artery did not participate in the collateral circulation around the blocked femoral artery.

Answer 2

The perforating branches of the profunda femoris artery did not participate in the collateral circulation around the blocked femoral artery.

Question 3

A 58-year-old businessman flew to Korea from New York by plane. Except for infrequent visits to the toilet, he remained in his seat sleeping or reading. Toward the end of the long flight, he experienced mild cramplike pain in his right calf. On feeling his leg, he found it to be tender but thought nothing more about it. On reaching his destination, he was walking down the ramp from the plane when he suddenly collapsed with severe pain in his left chest and was experiencing extreme respiratory distress. The airport physician made the diagnosis of pulmonary embolism, secondary to deep vein thrombosis of the right calf.

-The blood clot (embolus) reached the left lung via the following blood vessels except which?

A) The right popliteal vein
B) The right common iliac vein
C) The inferior vena cava
D) The pulmonary trunk
E) The left pulmonary vein

Answer 3

The left pulmonary vein

Question 4

A 65-year-old man was seen in the emergency department complaining of the onset of a sudden pain in his right foot. He said that for the past 6 months he had experienced some aching pain in the lower part of the right leg, but the foot pain had occurred quite suddenly and was different. On examination, a tender pulsatile swelling could be palpated in the right popliteal space. In anatomic terms explain the chronic aching pain in the right lower leg. What is your explanation for the sudden onset of pain in the right foot?

Question 5

Explain the significance of the valved perforating veins of the lower limbs. What is the surface marking of the small saphenous vein at the ankle?

Question 6

What is the surface marking of the femoral artery? Name the structures that are pierced by the insertion of a catheter into the femoral artery. What is the relationship of the femoral artery to the femoral vein and the hip joint?

Question 7

Compare in anatomic and practical terms the advantages and disadvantages of cutting down on the great saphenous vein at the groin and ankle. What is the surface marking of the great saphenous vein in the groin and at the ankle? What is the relationship of the saphenous nerve to the great saphenous vein at the ankle?

Question 8

What are the common complications of femoral vein catheterization? What is the surface marking of the femoral vein?