Vascular

Question 1

You are asked by your colleague to see an elderly patient in clinic who has a
positive Buerger’s test. From the list of options below, select the most likely reason
for a positive Buerger’s test.
A. Venous insufficiency of the upper limbs
B. Arterial insufficiency of the lower limbs
C. Venous insufficiency of the lower limbs
D. Arterial insufficiency of the upper limbs
E. None of the above

Answer 1

B. Arterial insufficiency of the lower limbs

Buerger’s test involves lifting the legs of the supine patient to 45degrees above the horizontal, the legs are kept here to observe for developing pallor (around 2 minutes). If pallor appears rapidly this is a por sign of diminished arterial supply.

After 2 minutes the legs are dropped off the side of the bed and blood returns via venous filling, the rate of which is observed.

If there is arterial insufficicy on one side this side will develop a reactive hyperaemia (this is a dusky crimson colour). This is arterial vasodilation due to anaerobic metaolites. A positive finding in both legs will only be apparent if the legs are carefully inspected at the start of the test.

Not to be confused with Buuerger’s disease (thromboangitis obliterans)

Question 2

You are asked to see a 67-year-old woman admitted with severe limb ischaemia. Your senior colleague asks you to examine the patient and report your findings. What are the two most likely clinical features that suggest the patient has severe limb ischaemia?

A. Pulselessness and pain
B. Paraesthesia and paralysis
C. Perishingly cold limb and pallor
D. Pallor and pain
E. Paraesthesia and pallor

Answer 2

B. Paraesthesia and paralysis

The six P’s of acute limb ischaemia are;

• Pallor
• Perishingly cold
• Pain
• Pulseless
• Paraestesia
• Paralysis

Neurological deficit (parastesia and paralysis) are late signs as the ischaemia is severe enough to start killing nerves, urgent surgical intervention is indicated here.

Acute limb ischaemia is caused mainly by a Thrombus (40%) or an Embolus (38%). Other causes include a graft/angioplasty occlusion (~15%) or trauma

Question 3

As part of the peripheral vascular examination, you are asked to record the
ankle–brachial pressure index of the patient. Which one of the following values
reflects a normal ankle–brachial pressure index?

A. Between 0.9 and 0.6
B. Greater than 1.3
C. Between 0.6 and 0.3
D. Greater or equal to 1.0
E. Less or equal to 0.3

Answer 3

D. Greater or equal to 1.0

The ABPI (ankle brachial pressure index) is a ratio of the arterial pressure at the ankle divided by the pressure at the upper arm. The Brachial pressure is measured using a manual sphygmomanometer at the upper arm and a doppler probe at the brachial artery.The anle pressure is measured with the cuff over the calf and the probe over the dorsalis pedis and then posterior tibial arteries (the higer reading is used).

By deviding the ankle blood pressure over the bracial we devise the ABPI, due to the greater vascular resistance in the leg (greater distance from the heart) the blod pressure should be slightly higher to maintain the same perfusion. As such the ABPI should be equal to or greater than 1.

a ratio of 0.9-0.6 [A] suggests peripheral vascular occlusive disease. eg intermittant claudication

a ratio of 0.6-0.3 [C] is moe suggestive of critical limb ischaemia

a ratio of less than 0.3 [E] implies impendng gangrene

a ratio greater than 1.3 [B] implies that the femral arteries are somewhat incompressible, likely due to calcification.

Question 4

A 55-year-old man, with a positive smoking history, presents to you in outpatient clinic with pain in the lower leg which is brought on by walking. The pain is cramping in nature, well localized to the left calf only, and is relieved by rest. The patient has noticed that his walking distance has progressively decreased because of the cramps in the left calf. There are no abnormal findings on physical examination. What is the most appropriate way to investigate the patient’s symptoms?

A. Measure the ankle–brachial pressure index
B. Angiography
C. Radiograph of the lower limbs
D. Ultrasound
E. None of the above

Answer 4

A. Measure the ankle–brachial pressure index

Peripheral vascular disease commonly affects the abdominal aorta and lower limb arteries. This becomes critical in 50% of the vessel diameter or 75% of the cross sectional area is occluded. At this point the metabolic demands of the limbs cannot be met and ischaemia occurs, in intermittent claudication this occurs during exercise and resolves when resting.

This cramp like pain is experienced in the buttock, thigh or calf depending on the level of the occlusion.

ABPI is the first line diagnostic investigation for chronic limb ischaemia.

Ultrasound (D) may detect stenosed areas but provides no measure of phsiological impairment.

A radiograph (C) may not show anything abnormal

Angiography (B) is used to aid surgical or interventional planning, it is not first line.

Question 5

A 60-year-old woman has been diagnosed as having claudication of the lower
limbs. The patient is a smoker and has hyperlipidaemia for which she is taking a ‘statin’. You are asked to discuss with the patient the treatment options available to her. From the list below, choose the recommended treatment option for this patient.

A. Angioplasty
B. Amputation
C. Thrombectomy
D. Increasing exercise and quitting smoking
E. Continue with the cholesterol-lowering medication and follow up in
outpatients in 3 months

Answer 5

D. Increasing exercise and quitting smoking

As with all medicine, there are stages of treatment; Expectant, lifestyle (conservative), best medical, interventional, and best surgical.

in the case of this patientshe has obvious lifestyle risk factors that can be addressed so this should be the aproach rather than expectant (E)

Smoking is a huge risk for vascular disease and increasing exercise will promote formation of a collateral supply, making (D) the best first step in management.

If that fails or the disease progresses then a more risky interventional treatment such as angioplasty (A) and Thrombectomy (C) can be considered.

The sugical option of amputation (B) is the last available option

Question 6

You are told by your colleague that a 44-year-old woman, who underwent elective right hip replacement, is suspected of having deep vein thrombosis of the left calf. You are asked to carry out a pretest clinical probability score (Wells score) and a D-dimer test. Which is the most likely scenario where deep vein thrombosis can be excluded from your list of differential diagnoses?

A. Wells score of 4 and a positive D-dimer result
B. Wells score of 2 and a negative D-dimer result
C. Wells score of 0 and a negative D-dimer result
D. Wells score of 3 and a positive D-dimer result
E. None of the above

Answer 6

B. Wells score of 2 and a negative D-dimer result

Venous thrombosis forms due to one of the factors described by Virchow in his triad; Venous stasis, vessel wall damage, and a hypercoaguble state.

In clinical parctice these equate to the following risk factors; Age over 40, pregnancy, obesity, OCP use, clotting abnormalities, malignancy, recent pelvic or orthopaedic surgery, trauma, immobility, long-haul flights, and failure to provide DVT prophylaxis.

This question requires a bit of logic, given the low specificity of the D-dimer you would (should) only order it for patients with an intermediate risk of DVT (a wells score of 1-2), a negative D-dimer would rule ot a DVT in that case (B)

a high wells score (3+) is treated as suspected DVT and a duplex or compression ultrasound performed, no D-dimer is requested (A) or (D).

A Wells score of 0 or less is a low probability and so no D-dimer would be performed, making (C) an improbable scenario

Question 7

A 65-year-old man presents for the first time to your clinic with a painless wound in his right leg, which has been present for over 2 months. On examination you notice a 3 cm x 4 cm leg ulcer in the gaiter area of the right leg, covering the medial malleolus. The shallow bed of the ulcer is covered with granulation tissue, which is surrounded by sloping edges. There is no history of trauma. From the list below, choose the most likely diagnosis.
A. Arterial leg ulcer
B. Neuropathic ulcer
C. Venous ulcer
D. Traumatic ulcer
E. Neoplastic ulcer

Answer 7

C. Venous ulcer

Venous ulcers tend to be painless, with sloped edges, in the gaiter area, larger, shallow and there tends to be skin changes such as haemosiderin deposition.

(A) an arterial ulcer would be very painful and would be small and ‘punched out’, it would also likly be on a pressere site (heel or toes). The base tends to be non granulated, and necrotic. There is often a loss of hair, pale brittle skin and erythema.

(B) There is an overlap with peripheral arterial disease and diabetes. They usually appear punched out of the surrounding callous of high pressure sites. They are often painless and the patient may not have noticed them.

(D) There is no history of trauma in this case.

(E) malignant ulcers may be primary or secondary, there is no indication of a malignant process here.

Question 8

Your colleague consults you with regard to a 56-year-old patient who has suffered an episode of amaurosis fugax. From the list below, choose the most likely site of pathology which may give rise to amaurosis fugax.

A. Vertebrobasilar artery territory
B. Carotid artery territory
C. Posterior communicating artery territory
D. Spinal artery territory
E. Anterior communicating artery territory

Answer 8

B. Carotid artery territory

Amaurosis fugax means fleeting blindness and is often described as a dark curtain falling on the vision, it is unilateral. It occurs when an athrogenic emboli breaks off in the carotid and obstructs the lumen of the retinal artery circulation leading to ischaemia.

Other causes of amaurosis fugax incude cardiac emboli, temporary vasospasm of the retinal artery, atherosclerosis of the retinal artery or giant cell arteritis (leading to chronic granulomatous inflamation).

Question 9

You have decided to investigate the symptom experienced by the patient in
Question 8 (Amaurosis fugax). From the list below, select the most appropriate investigation that you would order first to investigate the site of pathology.

A. Magnetic resonance angiography
B. Digital subtraction angiography
C. Computed tomography scan of the head and neck
D. Duplex ultrasound scanning
E. None of the above

Answer 9

D. Duplex ultrasound scanning

Amaurosis fugax is strongly associated with carotid artery disease, such as atherosclerosis. The best modality for investigating this would be a duplex of the carotids.

DSA (B) is more invasive and expensive so is not preferred as an initial investigation, although it is gold standard for assesment of the grade and severity of stenosis.

MRA (A) is sometimes used after duplex

CT (C) doesn’t adequately visualise the pathology

Question 10

You are told that a 45-year-old woman, who presented to the vascular surgery
clinic, has a positive tourniquet test in the left leg. On the basis of the information conveyed to you, from the list below, choose the most likely diagnosis that is associated with a positive tourniquet test.

A. Varicose veins
B. Chronic leg ischaemia
C. Deep vein thrombosis
D. Arterial ulcer
E. Acute leg ischaemia

Answer 10

A. Varicose veins

The tourniquet test is a modified Trendelenburg test. In this test the Sapho-femoral junction is occluded by a tourniquet.

First the patient lies on the couch and the affect leg is elevated and the varicosities are emptied by ‘milking’. with the leg still elevated the tourniquet is applied high on the thigh. The patient then stands and the rate at which the varicosities fill is assessed, if they fill rapidly the defect must be below the tourniquet, and vice versa.

Question 11

You are in the vascular surgery outpatient clinic explaining the indications for
undergoing carotid endarterectomy to a patient. From the list below, select the
most likely scenario where carotid endarterectomy is likely to be indicated.

A. Symptomatic carotid artery stenosis of between 50 per cent and 60 percent
B. Asymptomatic carotid artery stenosis of between 70 per cent and 80 percent
C. Asymptomatic carotid artery stenosis of between 50 per cent and 60 percent
D. Symptomatic carotid artery stenosis of between 70 per cent and 80 percent
E. None of the above

Answer 11

D. Symptomatic carotid artery stenosis of between 70 per cent and 80 percent

Patients with symptomatic (TIA, Amaurosis fugax) stenosis of 70-80% have been identified in studies as good cadidates for carotid endarterectomy, providing they are otherwise fit and well.

Given the morbidity/mortality rate for this procedure (5%), it is not advised to offer this procedure to a patient with a 70-80% stenosis in the abscence of symptoms (B) and certainly not in a less significant stenosis (C)

A symptomatic patient with a 50-60% stenosis (A) is usually put on best medical therapy as a first line.

Question 12

You see a 65-year-old man in your clinic, who is being monitored for an abdominal aortic aneurysm. The patient smokes 20 cigarettes a day and has a 25-year history of poorly controlled hypertension. From the list below, select the most appropriate investigation that can be used to monitor the progression of this patient’s condition.

A. Computed tomography scan of the abdomen
B. Angiography
C. Abdominal plain film radiography
D. Magnetic resonance imaging
E. Ultrasound

Answer 12

E. Ultrasound

An aneurysm is defined as the dilitation of an artery to >150% of its origional size. With a true aneurysm involving all layers of the vessel wall and being defined as fusiform (essentially uniform enlargement) or saccular (a berry aneurysm).

A psudoaneurysm doesn’t involve all the layers, it is where blood leaks between the layers and forms a haematoma leading to a dilatation of the vessel but not the lumen.

For the purposes of screening and monitoring a sub-threshold AAA (less than 5.5cm) ultrasound is the tool of choice. Should surgical intervention become necessary then a CT scan will be invaluable fo planning any procedure and creating a 3d model of the anatomy.

An abdominal plain film lacks sensitivity

angiography is invasive and carries risk

MRI is more expensive and less accessable than ultrasound which makes it less useful as a screening and assessemnt tool.

Question 13

During a ward round you are asked about the conditions that must be met in order to qualify a patient for elective abdominal aortic aneurysm repair. From the list below, select the most likely abdominal aortic aneurysm size that warrants elective repair providing the patient is fit for surgery.

A. Greater than 5.0 cm
B. Greater than 5.5 cm
C. Less than 5.0 cm
D. Greater than 4.5 cm
E. Less than 5.5 cm

Answer 13

B. Greater than 5.5 cm

The qualifying criteria for repair of a AAA is that it has to be greater than 5.5cm (and the patient is fit for surgery).

Aneurysms less than 5.5cm are usually monitored with yearly ultrasound scans. those aneurysms greater than 5cm expand by 4-6mm per year on average, which is faster than smaller aneurysms.

Other indications for surgical repair other than pure size include; expansion rate greater than 1cm per year, symptomatic (back pain, distal embolisation), or tenderness.

Any sudden onset back pain and signs of hypoolamia indicates the need for emergency repair, this procedure has a 50-75% mortality, which is better than the certainty of death with no intervention.

Question 14

A 41-year-old woman, diagnosed with varicose veins in the left leg, presents to
your clinic with a 2-month history of severe pain in the left leg on prolonged
standing. The patient is obese and the pain has affected her working and social lifestyle and she asks you about the most effective treatment option. From the list below, choose the most effective treatment option that you would discuss with this patient.

A. Use of compression stockings
B. Injection sclerotherapy
C. Surgery
D. Weight loss
E. None of the above

Answer 14

C. Surgery

Although in this case the patient’s symptoms would be improved by lifestyle measures, the question asks for the most effective treatment given the detrimental affect on function. Given that, the answer is surgery as this is the most effective treatment.

Weight loss will aid in the prevention of reccurrence and will help symptoms.

injection sclerotherapy can prove effective but surgery is the most effective treatment.

Question 15

A 55-year-old woman, who is obese and has a positive smoking history, is to have varicose vein surgery in the next 12 hours. Your senior colleague asks you to ensure that deep vein thrombosis prophylaxis is commenced. From the list below, choose the most appropriate form of deep vein thrombosis prophylaxis that you would use.

A. Low-molecular-weight heparin
B. Warfarin
C. Aspirin
D. Clopidogrel
E. None of the above

Answer 15

A. Low-molecular-weight heparin

LMWH is an effective DVT prophylaxis in those patients about to undergo surgery.

Warfarin has a prothrombotic effect within the first 48hrs and takes up to 72hrs to be effective.

Aspirin and clopidogrel are anti-platelet drugs and so are more effective in arterial thrombos prophylaxis.

Question 16

You see a 50-year-old woman with a history of atrial fibrillation, who presents to the emergency department with a sudden onset of pain in the left forearm. The pain started 3 hours ago, and has been increasing in intensity since. On
examination, the left forearm is cold and pale. The left axillary pulse is present but distal pulses are absent. Movement and sensation are intact in the left hand. There is no history of trauma. What is the most appropriate next step in this patient’s management?

A. Commence a heparin infusion and send the patient to theatre for
vascular intervention
B. Give analgesia and manage the patient in the emergency department
C. Administer oral aspirin and send the patient to theatre for vascular
intervention
D. Request an angiogram
E. Request anteroposterior and lateral plain radiographs of the left forearm

Answer 16

A. Commence a heparin infusion and send the patient to theatre for
vascular intervention

This patient has acute limb ischaemia, a surgical emergency. It can present with 6 classic symptoms (the 6 P’s); Pain, Pallor, Pulseless, Perishingly cold, Paraestesia and paralysis.

With this presentation and the history of atrial fibrilation it points towards a thrombos from the left atrium.

With the preservation of movement and sensation this limb is likely salvagable and the occlusion (likely at the brachial artery) needs to be surgically removed. A heparin infusion is needed to protect against further emboli, whereas aspirin (C) is less effective.

As a surgical emergency management in the ED (B) is inappropriate, as is delaying treatment for imaging (D) or (E), Radiographs would only be of use if you believed the occlusion was due to a fracture which there is no indication of here.

Question 17

You see a 60-year-old man with a history of coronary heart disease and
hyperlipidaemia in your clinic. The patient has found it increasingly hard to walk
due to the gradual increase in intensity of the cramping pain he experiences in his right leg on walking and which is relieved by resting a few minutes. In addition, he tells you that cramps have started to occur at night when he is sleeping. On examination of the right leg, you notice that there is a ‘punched out’ ulcer at the right heel. The right posterior tibial and dorsalis pedis pulses are weak. You suspect that this patient has critical limb ischaemia. What is the most appropriate next line investigation that would support your diagnosis?

A. Computed tomography angiography
B. Ankle–brachial pressure index
C. Radiograph the lower limbs
D. Magnetic resonance angiography
E. None of the above

Answer 17

B. Ankle–brachial pressure index

This patient is presenting with clinical signs of critical limb ischaemia, which is when claudication progresses to rest pain, ulceration (eventually gangrene), nocturnal limb pain.

If an ABPI (B) was performed and showed a figure of 0.6-0.3 it would be highly suggestive of critical limb ischaemia when taken in the context of this clinical presentation.

Doppler ultrasound would also be an appropriate option, it has the advatage of being able to identify the location and extent of the stenosis. It wasn’t available in this question though.

A plain film (C) would be pretty pointless

CTA and MRI would aid diagnosis but are not the next step in the diagnosis.

Question 18

The most common postoperative complication associated with carotid
endarterectomy is:

A. Surgical site infection
B. Cranial nerve injury
C. Stroke
D. Hypertension
E. Patch rupture

Answer 18

D. Hypertension

Approximately 66% of patients experience hypertension following a carotid endarterectomy, the mechanism of which is unclear.

of the other sequale, the risks are much lower;

Stroke - 5-8% (2/3 due to postoperative carotid stenosis, the remainder are intercranial haemorrhage)

Cranial nerve injury - 5% of patients

Wound infection and patch rupture both have a rate of around 1%

Question 19

You are asked to see a 56-year-old homeless man who presented to the emergency department with a severe pain in his right leg, which started over 6 hours ago. On examination, the right leg is pale in colour in comparison with the left leg, from below the knee to the toes. The right leg is cold and the popliteal, posterior tibial and dorsalis pedis pulses are absent. There is no sensation in the right leg and the patient is unable to flex the knee or move the toes due to fixed flexion deformities. In addition, the patient is apyrexial and heart rate is 85 beats per minute and regular. What is the most likely diagnosis?

A. Critical limb ischaemia
B. Acute limb ischaemia
C. Intermittent claudication
D. Necrotizing fasciitis
E. Spinal claudication

Answer 19

B. Acute limb ischaemia

It is important to remember the difference in the terms critical and acute in this context, critical limb ischaemia is when there is a progressive disease process that has now crossed a threshold, conrasted with an acute ischaemia where there is a sudden loss of perfusion.

Acute limb ischaemia is charecterised by the ‘6 P’s’ (pain, pallor, pulselessness, paraesthesia, paralysis and perishingly cold). It is usually a result of an embolic event. In this case the prescence of all 6 ‘P’ symptoms indicate an unsalvagable limb.

Necrotizing fasciitis is an infection of the deep layers of skin and subcutaneous tissue that then spreads along the tissue planes, Group A strep is the most common causative organism and usually arises following some form of trauma. The lack of fever and tachycardia go against this, as patients are usually very unwell. cultures and pus aspiration followed by surgical debridement is indicated.

Spinal claudication/stenosis occurs as a result of nerve root compression (usually there is a history of trauma). The pain is rapid onset and made worse by movement.

Question 20

From the list below, select the most appropriate treatment option for the patient in Question 19 (acute limb ischaemia, with all 6 ‘P’ symptoms of greater than 6hr duration + fixed flexion).

A. Percutaneous transluminal angioplasty
B. Revascularization through endarterectomy
C. Revascularization through bypass grafting
D. Endoluminal stent grafting
E. Amputation

Answer 20

E. Amputation

The prescence of all 6 ‘P’ symptoms indicates that the limb is gangrenous, the prescence of fixed flexion deformities adds creedence to this diagnosis. Amputation is thus indicated in this case.

Indications for amputation are:
• useless limb (i.e. fixed flexion deformities, vestigial fingers)
• dead limb (i.e. extensive tissue loss due to trauma or widespread
necrosis or peripheral vascular disease that cannot be treated with
reconstructive surgery)
• lethal limb (i.e. malignancy or ischaemia).

Types of amputations include:
• hind quarter (the entire lower limb is removed from the sacroiliac
joint – not commonly performed)
• above knee amputation
• through knee amputation
• below knee amputation (knee joint left intact)
• foot amputation
• forefoot amputation (transmetatarsal amputation)
• metatarsal amputation – a ray amputation may be used if necrosis
is present in the digits and muscles of the foot. The incision is
made from either side of the affected digit(s) to the base of the
metatarsal. This creates a ‘V shape’ and narrows the foot
Answers 183
• toe amputation – removal of the head of the metatarsal but requires
revascularization in order to be successful

Question 21

From the list below, select the most appropriate investigation for the prompt
diagnosis of an aortic dissection?

A. Electrocardiogram
B. Echo cardiogram
C. Computed tomography scan
D. Chest radiograph
E. Magnetic resonance imaging

Answer 21

C. Computed tomography scan

Although MRI is considered gold standard in may centeres, it is much slower and this question calls for an investigation for prompt diagnosis, which would be a CT (C)

ECG (A) wouldn’t be helpful, an Echo (B) isn’t the best modality for the aortic arch and descending aorta as these structures are behind the sternum and heart respectively. A chest radiograph (D) is not sensitive enough.

Aortic dissection is a surgical emergency, it is charecterised as a split in the internal lining and the tunica media leading to the passage of blood into the media, creating a double lumen. This process can occlude branches of the aorta leading to ischaemia, there can be rupture (tamponade or fatal haemorrhage) or aortic valve disruption.

aortic dissections are classed as Type A (affecting the ascending aorta, 70% of cases) or Type B (affecting the descending aorta, 30% of cases).

It can be associated with congenital conditions such as Marfan’s and Ehlers-Danlos. Or acquired risk factors such as hypertension and atherosclerosis.

Patients with dissections usually present with sudden onset tearing back pain associated with shortnes of breath, dizzyness, hemiplegia if there is carotid involvement, haematuri in renal involvement, and they will have signs of shock. There may also be difference in the blood pressure in each arm, and abnormalities in the pulses.

Managemen involves, resuscitation with a permissive hypotension (less than 100mmHg), cross-matching 10 units, blood tests, and getting some senior help. The high risk of tamponade in type A dissections warrents surgical intervention, whereas typ B dissections can be managed conservatively.

Question 22

Raynaud’s syndrome can be caused by which one of the following
antihypertensives?

A. a-blockers
B. Angiotensin-converting enzyme inhibitors
C. b-blockers
D. Calcium channel blockers
E. Angiotensin receptor blockers

Answer 22

C. b-blockers

Raynaud’s disease is primary and idiopathic, the aetiology is unknown. It is casued by a reflex vasospasm of the distal arterioles, clinically this results in pallor, followed by cyanosis (relaxation of arterioles but not venules), then reactive hyperaemia (complete reversal). It predominately affects women.

Raynauds Syndrome is a secondary phenomena with the same clinical presentation. It can be a result of SLE, polyarteritis nodosa, Rheumatoid arthritis, cervical rib, cryoglobulinaemia, polycythemia and drugs (beta blockers and ergot alkaloids)

Raynauds Syndrome can be unilateral, whereas Raynauds disease is systemic and is always bilateral.

Question 23

In association with a diagnosed popliteal aneurysm, a patient is more likely to
have:

A. A berry aneurysm
B. A femoral aneurysm
C. An aortic aneurysm
D. A carotid artery aneurysm
E. None of the above

Answer 23

C. An aortic aneurysm

Popliteal aneurysms account for around 80% of all peripheral aneurysms, of those patients with popliteal aneurysms around 40% have an associated abdominal aortic aneurysm.

Of interest, around 50% of popliteal aneurysms are bilateral.

Question 24

You are assisting a bypass grafting procedure in theatre. Your senior colleague asks you to show him where the common femoral artery arises. From the list below choose the statement that best describes the anatomical landmark and course of the common femoral artery.

A. As the external iliac artery passes over the inguinal ligament, it
becomes the common femoral artery and gives off the superficial
femoral artery before continuing down to the thigh, medial to the
femur, as the profunda femoris artery
B. As the internal iliac artery passes under the inguinal ligament, it
becomes the common femoral artery and gives off the profunda femoris
artery before continuing down to the thigh, medial to the femur, as the
superficial femoral artery
C. As the external iliac artery passes under the inguinal ligament, it
becomes the common femoral artery and gives off the profunda femoris
artery before continuing down to the thigh, medial to the femur, as the
superficial femoral artery
D. As the internal iliac artery passes over the inguinal ligament, it becomes
the common femoral artery and gives off the profunda femoris artery
before continuing down to the thigh, medial to the femur, as the
superficial femoral artery
E. As the external iliac artery passes under the inguinal ligament, it
becomes the common femoral artery and gives off the superficial
femoral artery before continuing down to the thigh, medial to the
femur, as the profunda femoris artery

Answer 24

C. As the external iliac artery passes under the inguinal ligament, it
becomes the common femoral artery and gives off the profunda femoris
artery before continuing down to the thigh, medial to the femur, as the
superficial femoral artery

The inguinal ligament is superficial to the neurovascular structures of the femoral triangle. Crossing the inguinal ligament marks the orgin of the common femoral artery. The profunda femoris is highly branched and supplies the posterior leg. The superficial femoral artery becomes the popliteal artery at the knee.

Question 25

As the external carotid artery courses inferosuperiorly from the common carotid bifurcation, it gives off the first of seven of its arterial branches just below the greater cornu of the hyoid bone. From the list below, select the name of the first branch of the external carotid artery.

A. Ascending pharyngeal artery
B. Facial artery
C. Lingual artery
D. Maxillary artery
E. Superior thyroid artery

Answer 25

E. Superior thyroid artery

There are seven principal branches of the external carotid artery, from first to last:

• superior thyroid artery
• ascending pharyngeal artery
• lingual artery
• facial artery
• occipital artery
• posterior auricular artery
• maxillary artery
• superficial temporal artery

See the acronym, Some Anatomists Like Freaking Out Poor Medical Students