Applied Anatomy

Question 1

What are the three layers of the vessels ?

Answer 1

Tunica intima – thin innermost endothelial lining
Tunica media – middle smooth muscle and elastin layer
Tunica adventitia – outer connective tissue coat with collagen

Question 2

What are the 5 types of blood vessels?

Answer 2

Arteries –> Arterioles –> Capillaries –> Venules –> Veins

Question 3

Which is high pressure out of the artery and vein?

Answer 3

The artery

Question 4

What feature does an artery have and why?

Answer 4

The artery is more muscular

Maintain the high pressure system

Helps to maintain blood pressure

Question 5

What are the three types of arteries ?

Answer 5

3 types of arteries
Large elastic (conducting)
Medium muscular (distributing)
Small arteries and arterioles (resistance)

Question 6

What vessel is a large elastic artery ?

What is the normal size

Answer 6

Aorta
Pulmonary trunk

2cm

Question 7

What is the regular size for a large elastic artery ?

Why is this important ?

Answer 7

2cm

For diagnosing a AAA

Question 8

What are the features of the medial muscular artery?

Answer 8

smooth muscle

Question 9

What is the function of the medium muscular artery ?

Answer 9

Distributing blood to areas that require it

Question 10

What artery does antihypertensives target ?

Answer 10

Arterioles

Question 11

Which artery does the peripheral resistance/ blood pressure come from ?

Answer 11

arterioles

Question 12

Explain hydrostatic pressure

Question 13

Explain osmotic pressure

Question 14

Explain structure of capilaries

Answer 14

Exchange vessels

Form interweaving networks of capillary beds

Local control through pre-capillary sphincters

Question 15

When do the sphincters of the capillaries open/ close?

Question 16

What type of veins is there ?

Answer 16

Venules and veins

Question 17

What is a venous plexus ?

Answer 17

multiple veins coming together

Question 18

How big is the inferior vena cava

Answer 18

3cm

Question 19

Why do we have a volume reservoir in the veins?

Answer 19

• The body will compensate when needed by using the blood in veins whilst making new blood cells.
• Increase ventricular filling and thus cardiac output needed during exercise
  accommodate for volume differences in relation to changes in blood pressure
  maintain cardiac output by compensatory mechanisms during times of blood loss (small amount of bleeding/ donating blood…)

Question 20

Which veins do not have valves ?

Answer 20

Those within thoracic cavity

Question 21

What is anastomoses?

Answer 21

Communication between branches of an artery

Question 22

What is an AV shunt ?

Answer 22

Connections between small arteries and veins allowing blood flow without going into the capillary beds

Question 23

What is collateral circulation

Answer 23

where alternate channels increase in size to provide a blood supply beyond a blockage

Question 24

When do you check for collateral circulaiton ?

Answer 24

When taking an ABG

Question 25

What is a portal system ? Where are they ?

Answer 25

2 capillary beds in series e.g. liver, pituitary

Question 26

What is an Arcade ?

Answer 26

– A series of anastomosing arterial arches between the arterial branches

Question 27

What problems can you get with blood pressure ?

Answer 27

hypertension/ hypotension/ shock

Question 28

What problems can you get with an artery wall ?

Answer 28

- Aneurysm - Dissection - Coarctation - Venous insufficiency

Question 29

What inflammatory problems can you get with the vessels?

Answer 29

vasculitis, arteritis, phlebitis, thrombophlebitis

Question 30

What obstructions can you get with the vessels ?

Answer 30

- Atherosclerosis - Arterial occlusion - VTE/DVT - Embolism - Thrombosis, vasospasm, (SOL)

Question 31

What is the main cause of thrombophlebitis?

Answer 31

Inserting a cannula

Question 32

What is AV malfromations the main cause of ?

Answer 32

Subarachnoid haemorrhage

Question 33

What level does the aorta become the abdominal aorta ?

Answer 33

T12

Question 34

Wher does the right brachial artery supply ?

Answer 34

right head neck and upper limb

Question 35

What location is the Inferior mesenteric artery?

Answer 35

L3

Question 37

What location is the Renal ?

Answer 37

L1 + L2

Question 38

What location is the Gonodal artery ?

Answer 38

L3

Question 39

Where does the aorta bifurcate into the common illiac artery?

Answer 39

l4

Question 40

If you had an AAA between 3-5.5 would you intervene ?

Answer 40

No surgical intervention required? Keep a close eye and regular scans

Question 41

When does an AAA need repared

Answer 41

5.5 and above

Question 42

What are the risk factors of AAA?

Answer 42

HTN Smoking Age Connective tissue disorder > 70 with abdominal pain required a scan to check no AAA!

Question 43

Where is the most common place for an AAA

Answer 43

Abdominal

Question 44

Who is commonly gets a aortic disection

Answer 44

men age 50-70 with HTN

Question 45

Explain the difference between type A and B for a aortic dissection using stanford DeBakey.

Answer 45

Type A - More dangerous. This can result in a prolapse of the aortic valve which leads to leaking of blood into the pericardium and can result in a tamponade. Includes the aortic arch Type B - Only includes descending aorta.

Question 46

What can happen to blood pressure of there is a problem with the aorta eg AAA or aortic disection?

Answer 46

Big difference between two arms !

Question 47

Whats first line treatment for aortic disections ?

Answer 47

CT scan Type A - Surgical intervention Type B - medical intervention

Question 48

Why is it important that the internal jugular vein is directly connected to the right atrium?

Answer 48

If there is a build-up of pressure in the right atrium you will see it in the right jugular vein.

Question 49

What is the definition of a pulse?

Answer 49

A palpable systolic blood pressure ?

Question 50

What are the major pulses in the head and neck ?

Answer 50

- Carotid - C6 - Temporal - Facial

Question 51

What condition can you get in the temporal pulse ?

Answer 51

Temporal artertitis ? The patient can go blind if not found

Question 52

What are the pulses in the lower limb arteries ?

Answer 52

- Femoral - Popliteal - Dorsalis Pedis Pulse - Posterior Tibial Pulse

Question 53

Why would you feel for the arteries in the legs?

Answer 53

- Check there is no peripheral arteriole disease - Reduced blood supply to legs - This leads to limb ischemia

Question 54

What are the arteries within the lower limbs?

Answer 54

Iliac arteries Femoral artery Popliteal artery Anterior tibial artery Posterior tibial artery Dorsalis pedis artery

Question 55

What are the common sites of trauma for the lower limb arteries?

Answer 55

Superficial (eg ones you can palpate) Close to bone/ joints

Question 56

When a patient gets a fracture or dislocation what do you need to check?

Answer 56

Check they are nuerovascularly intact.

Question 57

What is an arteriogram ?

Answer 57

An arteriogram is an imaging test that uses x-rays and a special dye to see inside the arteries. It can be used to view arteries in the heart, brain, kidney, and other parts of the body.

Question 58

What is claudication ?

Answer 58

Intermiditted blood loss - eg when walking

Question 59

Symptoms of a limb schema? (6 P)

Answer 59

Pain Pulseless Palour Perishingly cold Paralyses Paraesthesia (Loss of sensation

Question 60

Treatment of limb sichema

Answer 60

Potentially surgery

Question 61

What is this ?

Answer 61

Tissue necrosis

Question 62

Arterieal ulcers !!

Question 63

Venous ulcers!!

Question 64

Common site of compression in lower limb arteries ? What is this called ? What is the treatment ?

Answer 64

Popliteal artery By the tarsal tunnel of the foot Compartment syndrome Surgery

Question 65

What can make you likely to get compartment syndrome?

Answer 65

Fracture Cast Deep burns Ischaemic reperfusion injury

Question 66

What is this vein ?

Answer 66

Dorsal venous arch

Question 67

What are the veins in the lower limb ?

Answer 67

Deep veins Superficial veins Dorsal venous arch Short saphenous vein Long saphenous vein (direct superficial to deep perforators)

Question 68

Where is a DVT found ?

Answer 68

Within the deep veins Usually legs

Question 69

How much bigger is one leg than the other in a DVT?

Answer 69

3cm bigger than the other

Question 70

What is this ?

Answer 70

Varicose vein

Question 71

What are the stages of Virchow's triad ?

Answer 71

Question 72

What are the three stages of virchows triad ?

Answer 72

- hypercoagulation state - Vascular wall injury - circulatory statis

Question 73

What does virchows triad assess ?

Answer 73

Risk of DVT

Question 74

What are the stages of venous insufficiency?

Answer 74

Question 75

What are the pulces in the upper limb arteries ?

Answer 75

-Axillary - Radial - Barchial - Ulna

Question 76

What are the arteries in the upper limbs ?

Answer 76

Subclavian artery Axillary artery Brachial artery Radial artery Ulnar artery Palmar arches

Question 77

What can cause problems in arteries ?

Answer 77

Trauma Athersclerosis Arterial thombosis vs embolus

Question 78

What are true end arteries ?

Answer 78

Where there is no anastamosis

Question 79

What are the veins in the upper limb ?

Answer 79

Deep veins - brachial and riadial Superficial veins Basilic vein Cephalic vein Cubital vein

Question 80

CASE STUDY Primary care: 72 year old male 5/12 intermittent claudication Sudden onset sever pain in lower limb PMH & SH: Hypertension, hypercholesterolaemia, Smokes 35 cigarettes/ day On examination: BMI = 32 Feet on floor while sat in chair = top picture Feet elevated = bottom picture When he puts his feet up the colour drains from the right foot.

Answer 80

Peripheral arterial disease secondry to atherosclerosis.

Question 81

CASE STUDY Primary care: 25 year old female 2/7 hot and swollen left leg PMH & SH: OCP Smokes 20 cigarettes/ day On examination: Left leg pitting oedema to mid thigh Left leg 5 cm > then right below tibial tuberosity Localised tenderness along deep veins HR 74 bpm & BP 115/72 mmHg Temp 36.8oC What investigations are we gonna do

Answer 81

Deep vein thrombosis - Most likely Differential compartment syndrome Vasculitis Superficial thrombolites Cellulitis Ruptured bakers cyst Investigations well score D dimer - if raised ultrasound known as a Doppler

Question 82

Case Study Primary care: 32 year old male RTC – thrown from motorbike & landed on left arm 10/10 pain PMH & SH: Nil On examination: Deformity of left arm Open wound No other apparent injury HR 115 bpm & BP 95/52 mmHg

Answer 82

Humeral shaft fracture Humeral Head fracture Dislocation Comprise brachial artery and vein Radial and Brachial pulse will be compromised Treatment - Fluid brings BP up - Pain brings HR down - Assess neuromuscular structure - Refer on to the orthapedic team