APE 5: Peripheral Vasculature and the Autonomic Nervous System

Question 1

Where is the subclavian artery found?

Answer 1

Between the clavicle and the first rib

Question 2

What is the origin of the right and left subclavian artery?

Answer 2

Right= from the brachiocephalic trunk
Left= from the arch of aorta

Question 3

How is the subclavian artery divided, based on its position relative to the anterior scalene?

Answer 3

First part= origin of subclavian artery to medial border of anterior scalene
Second part= posterior to anterior scalene
Third part= lateral border of anterior scalene to lateral border of first rib

Question 4

Where does the subclavian artery become the axillary artery?

Answer 4

At the lateral border of the first rib

Question 5

Where does the axillary artery become the brachial artery?

Answer 5

At the distal border of the teres major

Question 6

How is the axillary artery divided, based on its position relative to the pectoralis minor muscle?

Answer 6

First part= proximal to pec minor
Second part= posterior to pec minor
Third part= distal to pec minor

Question 7

What does the brachial artery bifurcate into?

Answer 7

The radial and ulnar arteries

Question 8

Where does the brachial artery normally bifurcate into the radial and ulnar arteries?

Answer 8

About 1cm distal to the bend of the elbow, roughly at the level of the neck of the radius

Question 9

Which three structures lie in the cubital fossa?

Answer 9

Biceps tendon, brachial artery and median nerve

Question 10

Why would a clinician become very familiar with the brachial artery?

Answer 10

To measure blood pressure

Question 11

What are the borders of the cubital fossa?

Answer 11

Lateral border= medial border of the brachioradialis muscle
Medial border= lateral border of pronator teres muscle
Superior border= hypothetical lines between epicondyles of humerus

Question 12

What is the route of the ulnar artery in the forearm?

Answer 12

Descends to the anterior compartment and enters the palm anterior to the flexor retinaculum

Question 13

What is the route of the radial artery?

Answer 13

Crosses the lateral aspect of the wrist beneath tendons that pass to the thumb, and passes into the posterior aspect of the hand

Question 14

What is the anatomical snuffbox?

Answer 14

Triangular area bounded by tendons

Question 15

Give 2 reasons why a clinician will be familiar with the radial artery?

Answer 15

• taking a pulse

- arterial blood gas

Question 16

Which 2 palmar arteries are there?

Answer 16

Superficial and deep

Question 17

What are venae comitantes?

Answer 17

A pair (or more) of veins

Question 18

Which vein drains the blood from the upper half of the body?

Answer 18

The superior vena cava

Question 19

What does the superior vena cava bifurcate into?

Answer 19

The left and right brachiocephalic veins

Question 20

What are the two superficial veins of the upper limb?

Answer 20

Cephalic and basilic

Question 21

What is the positioning of the cephalic and basilic veins?

Answer 21

Cephalic= lateral, radial side
Basilic= medial, ulnar side

Question 22

Where does the cephalic vein drain into the deep venous system?

Answer 22

In the delto-pectoral groove

Question 23

Where does the basilic vein drain into the deep venous system?

Answer 23

Cubital fossa

Question 24

What is the antecubital fossa and where does it lie?

Answer 24

A shallow depression anterior to the elbow, where the median cubital vein is found

Question 25

Why would a clinician be familiar with the ante-cubital fossa?

Answer 25

Venupuncture

Question 26

What does the abdominal aorta divide into?

Answer 26

The two common iliac arteries

Question 27

At which vertebral level does the abdominal aorta bifurcate?

Answer 27

L4

Question 28

What are the two divisions of the common iliac artery?

Answer 28

Internal and external

Question 29

What does the internal iliac artery supply?

Answer 29

The pelvis

Question 30

Where does the external iliac artery pass into?

Answer 30

The inguinal ligament

Question 31

What is the position of the femoral artery?

Answer 31

Medial to the femmoral nerve | Lateral to the femoral vein

Question 32

Where can the pulse of the femoral artery be felt?

Answer 32

At the mid-inguinal point

Question 33

What is the importance of the femoral artery at the mid-inguinal point?

Answer 33

It is where blood samples are taken for blood gas determination and taking pulse

Question 34

Where is the inguinal ligament found?

Answer 34

Between the pubic symphysis and the ASIS

Question 35

Which profession is commonly associated with penetrating wounds involving the femoral artery?

Answer 35

Butchers

Question 36

Where does the profunda femoris artery arise from?

Answer 36

The lateral and posterior part of femoral artery, 2-5cm below the inguinal ligament

Question 37

What does the profunda femoris artery supply?

Answer 37

The head and neck of the femur

Question 38

What would a fracture to the head and neck of the femur cause?

Answer 38

Death from avascular necrosis

Question 39

What are the borders of the femoral triangle?

Answer 39

Superior border= inguinal ligament Lateral border= medial border of sartorius muscle Medial border= medial border of adductor longus muscle

Question 40

What is the arrangement of the neurovascular structures in the femoral triangle?

Answer 40

``` N- femoral nerve A- femoral artery V- femoral vein E- empty space L- lymph canal (outside to inside) ```

Question 41

What is the importance of the empty space in the femoral triangle?

Answer 41

Allows veins and lymph vessels to distend, so they can cope with diff levels of flow

Question 42

Where does the femoral artery cross?

Answer 42

The posterior aspect of the thigh

Question 43

Where is the femoral artery accessed?

Answer 43

The base of the femoral triangle

Question 44

Which medical procedures use the femoral artery?

Answer 44

Coronary angiography

Question 45

When does the femoral artery become the popliteal artery?

Answer 45

When it enters the popliteal fossa

Question 46

What are the two branches of the popliteal artery?

Answer 46

Anterior and posterior tibial arteries

Question 47

What does the anterior tibial artery branch into?

Answer 47

Dorsalis pedis artery

Question 48

What does the posterior tibial artery branch into?

Answer 48

Fibular artery

Question 49

Where does the fibular artery run?

Answer 49

It descends along the medial side of the fibula

Question 50

What is a popliteal aneurysm and how can it be detected?

Answer 50

- dilation of popliteal artery - compresses tibial nerve - detected by palpable pulsation in popliteal fossa (swelling behind the knee)

Question 51

What are the 2 superficial veins of the lower limb?

Answer 51

Great and small saphenous veins

Question 52

Where does the great saphenous vein run?

Answer 52

Posterior to the knee and anterior to the medial malleolous

Question 53

What is the great saphenous vein used for?

Answer 53

Emergency fluid resuscitation

Question 54

Where does the small saphenous vein run?

Answer 54

Starts at the continuation of the veins in the lateral side of the dorsum of the foot, then runs proximally, posterior to the lateral malleolus

Question 55

Where does the small saphenous vein drain into?

Answer 55

The popliteal fossa

Question 56

What happens when veins have incompetent connections to the deep system?

Answer 56

They become varicosed

Question 57

What does the pooling of blood in the deep veins of the lower limb result in and what can it be caused by?

Answer 57

Deep Vein Thrombosis | Can be caused by sitting on a long flight for example

Question 58

What is the saphenous vein often used for?

Answer 58

Graft to bypass a narrowing of the coronary arteries

Question 59

What is found in the neurovascular bundle of the neck?

Answer 59

Common carotid artery, internal jugular vein and vagus nerve

Question 60

What are the borders of the carotid triangle/anterior triangle of the neck?

Answer 60

``` Superiorly= inferior border of mandible Laterally= anterior border of sternocleidomastoid Medially= sagittal line down the midline of the neck ```

Question 61

What are the 2 common carotid arteries and what do they supply?

Answer 61

``` External= supplies the face Internal= enters the skull and supplies the brain ```

Question 62

What are the two different origins of the subclavian artery on the right and left?

Answer 62

``` Right= brachiocephalic trunk Left= aorta ```

Question 63

What is the first, and largest, branch of the subclavian artery?

Answer 63

Vertebral artery

Question 64

Where does the vertebral artery run?

Answer 64

Posteriorly towards transverse foramen of 6th cervical vertebra and then cranially through the foramina of the transverse processes

Question 65

Where do the vertebral arteries give rise to the posterior cerebral arteries?

Answer 65

After they enter the foramen magnum

Question 66

What do the posterior cerebral arteries contribute to?

Answer 66

The Circle of Willis

Question 67

Where does the external jugular vein run?

Answer 67

From the base of the skull, on a level with the angle of the mandible, to where it drains into the deep venous system

Question 68

Why is the external jugular vein important in clinical examination?

Answer 68

Used for venous access during cardiac arrest

Question 69

Where does the internal jugular vein begin?

Answer 69

In the posterior compartment of the jugular foramen at the base of the skull

Question 70

Why is the internal jugular vein commonly used for clinical intervention?

Answer 70

Observed for pulsations to give an estimation of right atrial pressure

Question 71

What landmarks are used to identify the position of the internal jugular vein?

Answer 71

On either side of thyroid gland, above clavicle, found in the carotid triangle

Question 72

What are the 2 components of the autonomic nervous system and what is their outflow?

Answer 72

Sympathetic- thoraco-lumbar outflow | Parasympathetic- cranio-sacral outflow

Question 73

How does the sympathetic chain communicate with the spinal nerves?

Answer 73

Via white and grey rami communicantes

Question 74

Which of the sacral nerves carry parasympathetic outflow?

Answer 74

S2-4