Anatomy of Venous Ulceration

Question 1

At the inguinal ligament, what does the left external iliac artery become?

Answer 1

left femoral artery, then the left popliteal artery, which then bifurcates into the left anterior tibial artery and the left posterior tibial artery

Question 2

What is the dorsalis pedis artery a continuation of?

Answer 2

ant. tibial artery

Question 3

What do the medial and lateral plantar arteries bifurcate from?

Answer 3

posterior tibial artery

Question 4

What is the name for a dorsal arch?

Answer 4

arcuate artery

Question 5

What does untreated occlusion of an end artery result in?

Answer 5

infarction of the occluded area

Question 6

What should you not use when performing surgery in the vicinity of end arteries?

Answer 6

local anaesthetic solution containing adrenaline

Question 7

How can experienced doctors limit blood loss at the scene?

Answer 7

pressing on a pulse point (or applying a tourniquet) proximal to the injury

Question 8

Where can a pulse in the neck be felt?

Answer 8

bifurcation of the common carotid artery

anterior to sternocleidomastoid muscle at level of upper border of thyroid cartilage

Question 9

Where is the brachial artery pulse palpated?

Answer 9

medial to biceps tendon in the cubital fossa

Question 10

Where is the radial artery pulse palpated?

Answer 10

lateral to tendon of flexor carpi radialis

Question 11

Where is the femoral pulse palpated?

Answer 11

inferior to midpoint of inguinal ligament

Question 12

Where is the popliteal pulse palpated?

Answer 12

in popliteal fossa (immediately posterior to knee joint)

Question 13

Where is the posterior tibial pulse palpated?

Answer 13

between the posterior border of the medial malleolus & the achilles tendon

Question 14

Where is the dorsalis pedis pulse palpated?

Answer 14

medial to tendon of extensor hallucis longus distal to the ankle joint

Question 15

What two main categories of problems can ischaemia cause in blood vessels?

Answer 15

reduced arterial perfusion pressure

increased venous drainage pressure

Question 16

What does reduced arterial perfusion pressure cause?

Answer 16

left ventricular failure
arterial bleed (injury)
arterial rupture (aneurysm)
occlusion of lumen (atherosclerosis: PVD)
arterial spasm
external compression of arterial supply (e.g. tumour/compartment syndrome/crossing legs!!/inflammation/ tamponade)

Question 17

What does increased venous drainage pressure cause?

Answer 17

right (or congestive) cardiac failure
DVT
external compression (e.g. tumour…)

Question 18

Where is the cubital fossa?

Answer 18

anterior aspect of elbow region

Question 19

What does the basilic vein drain into?

Answer 19

brachial vein at level of mid-arm

Question 20

What does the cephalic vein drain into?

Answer 20

the axillary vein which becomes the subclavian vein at the lateral border of rib 1

Question 21

8% of patients have no connecting veins in the what?

Answer 21

cubital fossa

Question 22

What does the great saphenous vein drain into?

Answer 22

femoral vein

Question 23

What does the small saphenous vein drain into?

Answer 23

popliteal vein

Question 24

What type of veins does the calf muscle pump involve?

Answer 24

deep veins

Question 25

In what direction does venous blood normally flow?

Answer 25

normally flows from the superficial veins into the deep veins AND from distal to proximal

Question 26

What happens when valves are incompetent?

Answer 26

Reverse flow into superficial veins which can then dilate (varicose veins)

Question 27

Varicose veins are a predisposing factor for which 2 things?

Answer 27

development of DVT and venous ulceration

Question 28

What actually causes skin ulceration to happen?

Answer 28

chronic venous insufficiency causing superficial microcirculatory deficiencies

Question 29

What type of infarction is caused if the small peripheral artery is occluded?

Answer 29

small wedge infarction

Question 30

What type of infarction is caused if the segmental artery is occluded?

Answer 30

infarction of bronchopulmonary segment

Question 31

What type of infarction is caused if the lobar artery is occluded?

Answer 31

middle lobe infarction

Question 32

What type of infarction is caused if the pulmonary artery is occluded?

Answer 32

infarction of one entire lung

Question 33

complete occlusion of the what arrests the circulation?

Answer 33

pulmonary trunk by a saddle embolus

Question 34

Give 3 complications of skin biopsy.

Answer 34

bleeding (damage to superficial veins) motor or sensory nerve damage loss of function

Question 35

Location of the sentinel node is determined using what?

Answer 35

preoperative lymphoscintigraphy

Question 36

How should you close a wound of an elliptical excision?

Answer 36

simple interrupted sutures

Question 37

Describe the distance from the great saphenous vein to the patella?

Answer 37

one hands breadth MEDIAL to medial border of patella

Question 38

Where is the great saphenous vein in relation to the malleolus?

Answer 38

immediately ANTERIOR to the MEDIAL malleolus

Question 39

What type of fascia is relatively tough and has a sheet-like, white, sometimes glistening, appearance?

Answer 39

deep fascia

Question 40

What does this describe: fibrous bands connecting deep fascia to skin – sometimes numerous?

Answer 40

skin ligaments

Question 41

Where should you look for aggregates of adipocytes?

Answer 41

limb superficial veins in superficial fascia