Clinical Anatomy of venous ulceration

Question 1

What makes up the upper limb?

Answer 1

Axilla
Arm (brachium) 
Elbow/cubital fossa
Forearm (ante-brachium)
Wrist
Hand

Question 2

What makes up the lower limb?

Answer 2

Inguinal region 
Thigh
Knee/popliteal fossa
Leg
Ankle
Foot

Question 3

Where does the subclavian pass through?

Answer 3

Passes above the 1st rib

Question 4

What is the arterial supply to the limbs?

Answer 4

Subclavian artery
Axillary artery
Brachial artery
Deep brachial artery
Radial artery
Ulnar artery
Metacarpal and digital arteries

Question 5

How many digital arteries are there per digit?

Answer 5

4

Question 6

What is the arterial supply to the lower limbs?

Answer 6

External iliac artery
Deep femoral artery
Femoral artery - perforating arteries 
Popliteal artery
Anterior tibial artery
Posterior tibial artery 
Dosalis pedis artery
Medial and lateral plantar artery
Arcuate artery
Metatarsa and digital arteries

Question 7

What does the brachial artery give off?

Answer 7

Radial and ulnar arteries

Question 8

What does the popliteal artery give off?

Answer 8

Anterior tibial artery

Posterior tibial artery

Question 9

What does the anterior tibial artery give off?

Answer 9

Dorsalis pedis artery

Question 10

What does the posterior tibial artery give off?

Answer 10

Medial and lateral plantar arteries

Question 11

What artery between the radial and ulnar is medial?

Answer 11

Ulnar is medial

Radial is lateral

Question 12

Where does the brachial artery lie?

Answer 12

Medial biceps tendon in the cubital fossa

Question 13

Where does the radial artery lie?

Answer 13

Lateral to the tendon of flexor carpi radialis

Question 14

Where does the femoral artery lie?

Answer 14

Inferior to the midpoint of inguinal ligament

Question 15

Where does the popliteal artery lie?

Answer 15

In popliteal fossa

Question 16

Where does the posterior tibial artery lie?

Answer 16

Between the posterior border of the medial malleolus and the achilles tendon

Question 17

Where does the dorsalis pedis artery lie?

Answer 17

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

Question 18

What are the characteristics of superficial veins?

Answer 18

Small and thin
Run in superficial fascia
Highly variable
Drain into deep vein

Question 19

What are the characteristics of deep veins?

Answer 19

Large and thick
Run deep to deep fascia
More predictable
Occur in neurovascular bundles

Question 20

What makes up the superficial fascia?

Answer 20

Loose connective tissue and fat
Varies in depth
Superficial blood vessels, cutaneous nerves, lymphatics and sweat glands

Question 21

What makes up the deep fascia?

Answer 21

Tough and sheet like 
Dense connective tissue
Usually white, glistening in appearance
Covers most of body deep to skin and superficial fascia 
Divides limbs into compartments

Question 22

What is the function of the IT (Iliotibial Tract) band?

Answer 22

Keeps the lateral aspect of hip connected to the lateral aspect of the crurus

Question 23

What is the origin of the cephalic vein?

Answer 23

Arises from the posterolateral aspect of the dorsal venous network

Question 24

What is the origin of the basilic vein?

Answer 24

Arises from the anterolateral aspect of the dorsal venous network

Question 25

Where does the cephalic vein drain?

Answer 25

Into the axillary vein which drains into the subclavian vein at the lateral border of rib 1

Question 26

Where does the basilic vein drain into?

Answer 26

The brachial vein

Question 27

What joins the cephalic vein to the basilic vein?

Answer 27

Medial cubital vein

Question 28

What is the origin of the great saphenous vein?

Answer 28

Arises from the anteriomedial aspect of the dorsal venous arch

Question 29

What is the origin of the small saphenous vein?

Answer 29

Arises from the posterolateral aspect of the dorsal venous arch

Question 30

Where does the great saphenous vein drain?

Answer 30

Into the femoral vein in the femoral triangle

Question 31

Where does the small saphenous vein drain?

Answer 31

Into the popliteal vein in the popliteal fossa

Question 32

What is the venous drainage of the upper limb?

Answer 32

``` Deep palmar venous arch Radial and Ulnar veins Brachial vein Axillary vein Subclavian vein Internal jugular vein and brachiocephalic vein ```

Question 33

What is the venous drainage of the lower limb?

Answer 33

``` Planter arch Posterior and anterior tibial vein Fibular vein Popliteal vein Deep and non-deep femoral vein External iliac Common iliac IVC SVC ```

Question 34

What is a vena comitantes?

Answer 34

When 3 veins surround an artery wrapped in a vascular sheath helping venous drainage

Question 35

What is the purpose of venous valves?

Answer 35

To ensure unidirectional blood flow

Question 36

What happens when there is an incompetent venous valve?

Answer 36

Results in revese flow into superficial veins leading to varicose veins

Question 37

What do varicose veins predispose to?

Answer 37

DVT and venous ulceration

Question 38

What does deep vein stasis lead to?

Answer 38

Thrombosis/ embolism

Question 39

What does superficial microcirculatory deficiencies lead to?

Answer 39

Skin ulceration

Question 40

What is the commenest site of venous ulceration?

Answer 40

Gaiter area - medial aspect of distal leg drained by the great saphenous vein

Question 41

What is a saddle embolus?

Answer 41

Blockage of the pulmonary trunk

Question 42

What is the pathway of superficial lymphatics in the upper limb?

Answer 42

Arise from plexuses in fingers and hand | Follow cephalic and baisilic veins

Question 43

Where do basilic lymphatics drain to?

Answer 43

Cubital lymph nodes which drain to lateral pectoral lymph nodes

Question 44

Where do cephalic lymphatics drain to?

Answer 44

Apical pectoral nodes

Question 45

Where do the deep lymphatics of the upper limb drain to?

Answer 45

Deep veins of upper limb and then drain to the lateral pectoral lymph nodes

Question 46

Where do pectoral lymph nodes drain to?

Answer 46

Subclavian lymph nodes

Question 47

Where do the superficial lymph nodes of the lower limb drain to?

Answer 47

Follow saphenous veins Great saphenous drains to superficial inguinal nodes which drain to external iliac nodes Small saphenous drains to popliteal nodes which drain to deep inguinal nodes which drain to external iliac nodes

Question 48

Where do the deep lymphatics of the lower limb drain to?

Answer 48

The popliteal lymph nodes which drain to the deep inguinal which drain to the external iliac

Question 49

Where do the external iliac nodes drain to?

Answer 49

Common iliac nodes which drain into the lumbar lymphatics

Question 50

What palmar arch does the radial artery form?

Answer 50

Deep palmar arch

Question 51

What palmar arch does the ulnar artery form?

Answer 51

Superficial palmar arch | Ulnar sUperficial

Question 52

What are the borders of the popliteal fossa?

Answer 52

Superomedially: semitendinosus/ semimembranosus Superolaterally: biceps femoris Inferiorly: gastrocnemius

Question 53

What are the contents of the popliteal fossa?

Answer 53

Tibial nerve Popliteal vein Popliteal artery Popliteal lymph nodes

Question 54

What are the ligaments of the joint capsule of the hip?

Answer 54

Iliofemoral Pubofemoral Ischiofemoral

Question 55

What joint in the foot allows for inversion and eversion?

Answer 55

Midtarsal joints

Question 56

What are the borders of the femoral triangle?

Answer 56

Superior: inguinal ligament Laterally: sartorius Medially: adductor longus Floor: iliopsoas laterally and pectineus medially

Question 57

What action does the radiocapitellar joint do?

Answer 57

Supination and pronation

Question 58

What action does the humeroulnar joint do?

Answer 58

Flexion and extension