Circulation Of The Limb

Question 1

What branches does the femoral artery give off?

Answer 1

Deep artery of the thigh

Medial and lateral circumflex femoral arteries

Question 2

What branches off of the internal iliac artery?

Answer 2

The obturator artery

Question 3

How does the femoral artery enter the posterior leg?

Answer 3

Through the abductor hiatus into the popliteal fossa

Question 4

What arteries supply the hip joint?

Answer 4

Retinacular arteries
Artery to head of the femur
Medial circumflex artery
Lateral circumflex artery

Question 5

What is the blood supply to the knee joint?

Answer 5

Popliteal artery
Superior and inferior medial genicular arteries
Superior and inferior lateral genicular arteries

Question 6

What supplies blood to the lateral compartment of the leg?

Answer 6

Perforating branches of the posterior tibial artery and fibular artery

Question 7

What is the blood supply to the posterior compartment of the leg?

Answer 7

Posterior tibial artery and fibular artery

Question 8

What are the branches of the popliteal artery?

Answer 8

Branches into the posterior and anterior tibial arteries

Fibular artery branches of the posterior tibial artery

Question 9

What supplies the anterior leg and how does it travel from the posterior?

Answer 9

The anterior tibial artery pierces through the interosseous membrane below the popliteal fossa.

Question 10

Where does the posterior tibial artery enter the foot and what does it branch into?

Answer 10

Enters the foot posterior to the medial malleolus, under the flexor retinaculum and bifurcates into the lateral and medial plantar arteries

Question 11

Where does the anterior tibial artery enter the foot and what does it become?

Answer 11

Continues down dorsum of foot as the dorsalis pedis artery

Question 12

Where would you palpate the dorsalis pedis?

Answer 12

Lateral to the extensor hallicus tendon 1/3 of the way down the dorsum of the foot

Question 13

Where would you palpate the posterior tibial artery?

Answer 13

Behind the medial malleolus

Question 14

What is intermittent claudication and what is it caused by?

Answer 14

Pain in the limb when walking, relieved by rest.

Caused by build up of atherosclerotic plaque which limits blood flow to the muscles causing ischaemia

Question 15

What are the common sites of atheromas?

Answer 15

Abdominal aorta and iliac arteries
Proximal coronary arteries
Thoracic aorta
Femoral and popliteal arteries
Internal carotid arteries
Vertebral, basilar and middle cerebral arteries

Question 16

Where does the external iliac artery become the femoral artery?

Answer 16

Once it has gone under the inguinal ligament

Question 17

What are the signs of peripheral arterial disease? (Poor perfusion)

Answer 17

Lack of hair
Skin problems
Cold to touch
Ulcers
Infections
Skin Necrosis 
Loss of pulses

Question 18

How would you treat peripheral arterial disease?

Answer 18

Antiplatelet therapy eg aspirin

Risk factor modification eg lipid lowering therapy, smoking cessation, BP control, diabetes control, increased exercise

Question 19

How can acute ischaemia occur in the lower limbs?

Answer 19

Can develop where atherosclerosis is present, plaque rupture occurs and allows a thrombus to form.

Can develop because of an arterial bleed, puts pressure on the arteries causing compression and ischaemia.

Can develop as a result of trauma or infection, which cause swelling

Question 20

What is a popliteal aneurysm? How would it present?

Answer 20

Abnormal dilation of the popliteal artery in the popliteal fossa.

Present with odema and pain in the popliteal fossa, appears as a mass with palpable pulsations, may also hear a bruit on auscultation.

Question 21

Describe the passage of the great saphenous vein

Answer 21

Arises from the dorsal venous arch of the foot, passes anterior to the medial malleolus, passes the medial aspect of the knee (hands breath from the patella), passes through the fascia lata at the saphenous opening to drain into the femoral vein

Question 22

Describe the passage of the small saphenous vein

Answer 22

Arises from the lateral marginal vein of the foot, passes posterior to the lateral malleolus and up the posterior aspect of the calf, drains into the popliteal vein at the popliteal fossa.

Question 23

What is saphenous cutdown and when is it used? What are the risks?

Answer 23

Used in emergency situations when it is difficult to find a vein for venopuncture or cannula insertion.
Great saphenous vein is located anterior to the medial malleolus by making a skin incision at this location.
Causes pain along the medial border of the foot and risk of saphenous nerve injury.

Question 24

Where can the deep veins of the leg be found?

Answer 24

Accompanying all major arteries, as paired venae comitantes.

Question 25

How does venous drainage of the lower limbs occur?

Answer 25

Blood drains from the superficial veins to the deep veins via perforating veins. Valves prevent back flow.

Assisted by contraction of the calf muscles: compresses the deep veins and propels blood to the heart (any blood pushed downwards causes the lower valve to close, preventing flow away from heart).

Question 26

What are varicose veins?

Answer 26

Dilated tortuous superficial veins where the valve flaps fail to meet or become damaged & incompetent. Causes back flow and stasis of blood.

Question 27

What are the risk factors for DVT?

Answer 27

Virchows triad: stasis, hypercoaguability, vascular damage

Question 28

What are the signs of DVT and where is it likely to occur?

Answer 28

Signs: tender & swollen calf, warmth and erythema of limb

Sites: calf veins (most common but can propagate), also occurs in femoral, popliteal & iliac veins

Question 29

What are possible consequences of a DVT?

Answer 29

Risk of pulmonary embolism: chest pains, breathlessness, cardiac shock.

Risk of postphlebitic syndrome: chronic deep venous insufficiency, damage to venous valves, lymphoedema

Question 30

When does the subclavian artery become the axillary and brachial arteries?

Answer 30

Subclavian becomes axillary as it passes the first rib.

Axillary becomes brachial as it passes the inferior border of Teres Major

Question 31

Where does the brachial artery bifurcate? What are the branches?

Answer 31

Bifurcates just distal to the cubital fossa, into the ulna and radial artery.

Question 32

Describe the superficial venous drainage of the upper limb

Answer 32

The cephalic vein runs up the lateral side of the limb in the groove between the deltoid and pec major, drains into the axillary vein.

The basilic vein runs up the medial side, passes deep to pec major, drains into the brachial vein.

These are connected by the median cubital vein, superficial to the cubital fossa.

Question 33

Describe the deep venous drainage of the upper limb

Answer 33

Arises from the deep palmar arch, accompany the major arteries as venae comitantes.