Download 1. In the process of escaping from T. rex in Jurassic Park the heroine

1. In the process of escaping from T. rex in Jurassic Park the heroine
punctures the skin on the medial side of her wrist on a spiny bush.
A few days later, due to the toxin, an infection is seen spreading
up the medial side of her arm along the large cutaneous vein
extending from the dorsum of her hand to the medial side of her
arm. The vein involved is the:
basilic
brachial
cephalic
median cubital
ulnar
2. The lateral antebrachial cutaneous nerve comes from the:
Axillary nerve
Medial cord nerve
Musculocutaneous nerve
Radial nerve
Ulnar nerve
3. In withdrawing a blood sample from the median cubital vein the
needle passes slightly deep and medial; which nerve might
possibly be injured?
Dorsal ulnar cutaneous
Lateral antebrachial cutaneous
Medial antebrachial cutaneous
Posterior antebrachial cutaneous
Superficial radial
4. The vein of choice for withdrawing blood is the:
Basilic
Cephalic
Median antebrachial
Median cubital
A man is in an auto accident and sustains several injuries, among
them are:
1. Skin lacerations:
on the back of his head in the occipital area,
on his chest just above the nipple,
on the lateral side of his arm,
lateral forearm at midlength,
dorsal hand between his thumb and index finger.
2. Abrasions and contusions (bruises) about his right shoulder
3. A fractured right radius near its distal end
5. After X-ray examination, you are called upon to suture his
lacerations in the emergency room. Which laceration (from your
observations in the gross anatomy lab) would you expect to be the
most difficult to suture because of thick skin?
back of his head in the occipital area
chest, just above the nipple
lateral side of arm
lateral forearm
dorsal side of hand
6. While you are stitching up his hand, he notes that you did not have
to give him an anesthetic since the area between his thumb and
index finger on the dorsal side was already numb. Which nerve
must have been injured (most likely by the fracture of his wrist) for
this area to be numb?
lateral antebrachial cutaneous
medial antebrachial cutaneous
median
superficial radial
superficial ulnar
7. The injured nerve (from the skin of his hand) contains afferent
nerve fibers that travel through which of the following parts of a
spinal nerve?
dorsal primary ramus
dorsal root
gray ramus communicans
posterior cutaneous branch
ventral root
8. A sixteen-year-old boy receives a superficial cut on the thumb side
of his forearm. The superficial vein most likely affected is the:
Basilic
Cephalic
Median antebrachial
Median cubital
Radial
9. A sixteen-year-old boy received a superficial cut on the ulnar side
of his forearm. The superficial vein most likely affected is the:
Basilic
Cephalic
Median antebrachial
Median cubital
Radial
10.
During insertion of an IV cannula in the median cubital vein,
the patient suddenly lost feeling on the radial side of the forearm.
What nerve was injured?
Lateral antebrachial cutaneous
Medial antebrachial cutaneous
Musculocutaneous
Posterior antebrachial cutaneous
Superficial radial nerve
11.
After trying to throw a curve ball, a pitcher lost sensation
from the tip of the little finger. This indicates injury to which nerve?
Radial
Median
Ulnar
Musculocutaneous
Medial antebrachial cutaneous
12.
While having an IV needle inserted into the cephalic vein of
the forearm, the patient suddenly screamed in pain and felt tingling
in part of the skin of the forearm supplied by the nerve
accompanying the vein. What nerve was injured?
Posterior antebrachial cutaneous
Lateral antebrachial cutaneous
Medial antebrachial cutaneous
Musculocutaneous
Superficial radial
13.
Because of scarring of a patient's median cubital vein, the
technician chooses to insert an infusion needle into her basilic vein
at the level of the medial epicondyle. Despite the certainty that the
needle does not pass through the deep (investing) fascia, there is
still a chance that it might nick or impale which of the following?
Brachial artery
Lateral antebrachial cutaneous nerve
Medial antebrachial cutaneous nerve
Median nerve
Radial nerve
14.
Following a car accident in which the patient received a deep
laceration on the medial side of his right knee, the patient notices
numbness along the medial side of his right leg and foot. He has
no motor deficit. The nerve which appears to have been injured is
the:
femoral nerve
saphenous nerve
sural nerve
superficial fibular nerve
deep fibular nerve
15.
A 'saphenous vein cut-down' is a procedure used to locate
the great saphenous vein at the ankle. To find this vein, the skin
would be incised:
anterior to the lateral epicondyle
posterior to the medial epicondyle
anterior to the medial malleolus
posterior to the lateral malleolus
over the base of the fifth metatarsal
16.
While doing a physical examination on a young boy, you
noticed an enlarged superficial inguinal lymph node. The patient
indicated that he has recently sustained an infected skin wound in
the:
anterior abdominal wall above the umbilicus.
anterior chest wall.
skin of the lower limb.
upper back.
17.
A patient with a diabetic ulcer in the anterior midline of the
ankle region experienced loss of cutaneous sensation on the
dorsal surface of the foot. Which nerve was most likely damaged?
Femoral
Lateral sural cutaneous
Saphenous
Superficial fibular
Sural
18.
A construction worker, who wears a heavy work belt all day
on the job, notices a tingling sensation on the anterolateral surface
of his thigh. This is most likely a condition called:
compartment syndrome
cryptorchidism
hydrocoele
meralgia parasthetica
thrombophlebitis
19.
A saphenous cutdown is a surgical procedure that involves
cutting through the skin to locate the greater saphenous vein in
order to insert a catheter or cannula. You can find the vein as it
passes ___________________ with the saphenous nerve.
Anterior to the medial epicondyle
Anterior to the medial malleolus
Through the saphenous opening
Tributaries to the posterior tibial vein
Subcutaneous branches of the posterior tibial artery
20.
A cashier develops painful and tortuous varicose veins in her
lower limb. Her doctor explains that prolonged standing at her job
led to failure of the valves in the:
deep femoral vein
great saphenous vein
lesser saphenous vein
perforating veins
popliteal vein
21.
Your patient complains of pain on her calf. Upon inspection,
you find tortuous, dilated vessels lying subcutaneously on the
posterior aspect of her leg. These vessels are most likely:
Tributaries to the greater saphenous vein
Tributaries to the lesser saphenous vein
Perforating veins
Through the iliotibial tract
Through the popliteal fascia
22.
A 50-year-old female patient has large varicose veins located
primarily on the posterior aspect of her calf. These veins are most
likely direct tributaries to the:
great saphenous vein
sural vein
small saphenous vein
femoral vein
dorsal venous arch
23.
You are in the clinic when a patient presents with varicose
saphenous veins in her lower limb. The attending physician asks
where the venous valves are located that are defective and cause
this condition. Having just studied a clinical case in that regard,
you respond. "The valves in the:
deep veins."
perforating veins."
superficial veins."
venae commitantes."
24.
Subcutaneous venous varicosities were observed in the
anteromedial thigh. The vein involved is likely to be the:
Femoral
Greater saphenous
Lesser saphenous
Popliteal
Superficial external pudendal
25.
The distal part of the lesser saphenous vein was mobilized
for grafting. Following the operation, the patient complained of
numbness (loss of cutaneous sensation) on the distal lateral side
of the leg and the lateral side of the foot. What nerve was
damaged during the operation?
Deep fibular (peroneal)
Posterior femoral cutaneous
Saphenous
Superficial fibular (peroneal)
Sural
26.
Varicosities in the subcutaneous veins of the medial thigh
were observed at physical examination. The vein involved was
most likely the:
Femoral.
Greater saphenous.
Lesser saphenous.
Popliteal.
Pudendal.
27.
The lesser saphenous vein was mobilized for grafting.
Following the surgery, the patient complained of a loss of
cutaneous sensation at the distal posterolateral side of the leg,
lateral side of the foot and small toe. What nerve was damaged
during the operation?
common fibular (peroneal)
saphenous
superficial fibular (peroneal)
sural
tibial
28.
Competency of venous valves in a patient with severe crural
varicose veins was tested as follows: The superficial veins were
emptied by elevating the limb and then they were compressed with
a band just below the saphenous opening in the proximal thigh.
When the patient quickly stood up, filling of the superficial veins
took more than 30 seconds. The delayed filling of the superficial
veins demonstrates that the valves of the:
deep (central) veins are competent
deep (central) veins are incompetent
perforating veins are competent
perforating veins are incompetent
superificial veins are competent
29.
A needle biopsy of the sural nerve resulted in the formation
of a hematoma. Which of the following veins closely adjacent to
the nerve was accidently injured?
accessory saphenous
femoral
greater saphenous
lesser saphenous
superficial external pudendal
1. The correct answer is:
basilic
There are two large cutaneous veins running up the forearm. Both veins
take origin from the dorsal venous arch of the hand and run up the
lateral and medial sides of the forearm. On the medial side (near the 5th
digit) there is the basilic vein. On the lateral side, there is the cephalic
vein. Since the infection is on the medial side, the correct answer is the
basilic vein. (Remember that the hands are supinated in the anatomical
position--this comes in handy when you are thinking about the medial
and lateral sides of the forearm.)
The brachial vein runs with the brachial artery-- it is a deep vein that
ends at the level of the elbow. The ulnar vein runs with the ulnar artery,
draining the ulnar side of the forearm. Neither of these veins are located
in superficial tissue. The median cubital vein is a cutaneous vein, but it is
short and only found in the median cubital fossa. It provides a
connection between the cephalic vein and basilic vein.
2. The correct answer is:
Musculocutaneous nerve
The musculocutaneous nerve provides cutaneous innervation to the skin
of the anterolateral side of the forearm through the lateral antebrachial
cutaneous nerve. The axillary nerve supplies the skin of the upper lateral
arm with the superior lateral brachial cutaneous nerve. The radial nerve
supplies cutaneous innervation to the skin of the posterior arm, forearm,
and hand through many different cutaneous nerves. The ulnar nerve
supplies sensory innervation to the skin of the medial side of the wrist
and hand and skin of the medial 1 1/2 digits on the palmar side, and 2
1/2 digits on the dorsum of the hand.
If you are having problems conceptualizing these areas of cutaneous
innervation, check out on-line color pictures in the dissector answers, or
plate 481 in Netter's!
3.
The correct answer is:
Medial antebrachial cutaneous
The medial antebrachial cutaneous nerve is a direct branch from the
medial cord of the brachial plexus. Since it provides cutaneous
sensation to the medial side of the anterior forearm, it is slightly medial
to the medial cubital vein and could be injured by a needle. If the needle
had gone laterally, it might have injured the lateral antebrachial
cutaneous nerve, which is running down the lateral side of the anterior
forearm. This nerve is a branch of the musculocutaneous nerve. The
posterior antebrachial cutaneous nerve runs on the posterior surface of
the arm--it comes from the radial nerve. The dorsal ulnar cutaneous
nerve is the nerve which runs on the dorsal side of the hand, providing
cutaneous innervation to the ulnar side of the wrist, hand, and the medial
1.5 fingers. Finally, the superficial radial nerve innervates the dorsum of
the radial side of the hand.
4.
The correct answer is:
median cubital
The median cubital vein connects the cephalic and basilic veins in the
cubital fossa. This vein shunts blood from the cephalic vein to the basilic
vein. Venipunctures are usually done in the median cubital vein, so this
is the best answer to pick. Another reason that median cubital vein is a
favorite is the fact that it is anchored in place by a perforating vein
connecting to the brachial veins - so that it doesn't move out of the way
of the venipuncture needle. However, don't forget that venipunctures can
be done in other veins, including the basilic and cephalic veins. Both of
these veins arise from the dorsal venous arch of the hand--the basilic
vein travels up the medial side of the arm and the cephalic vein travels
up the lateral side of the arm. The median antebrachial vein travels in
the center of the forearm and drains into the median cubital vein.
5.
The correct answer is:
back of the head, just above the occipital area
Remember back to the very early labs-- the back of the head is the one
place in the body where the skin is the thickest. The skin should be
thinner in all of the other locations.
6. The correct answer is:
superficial radial nerve
The superficial radial nerve provides cutaneous innervation to the radial
side of the dorsum of the hand for the first 2 1/2 digits. An injury to this
nerve would correlate to the loss of sensation between the thumb and
index finger on the dorsum of the hand. The lateral antebrachial
cutaneous innervates the lateral anterior side of the forearm--it is a
branch of the musculocutaneous nerve. The medial antebrachial
cutaneous nerve comes off the medial cord of the brachial plexus--it
innervates the medial anterior side of the forearm. The median nerve
provides cutaneous branches that innervate the radial side of the palmar
or volar surface of the hand for the first 3 1/2 digits. Finally, the
superficial ulnar nerve innervates the ulnar side of the hand on both the
palm and the dorsum, covering the final 1 1/2 fingers on the volar
surface and 2 1/2 fingers on the dorsum.
7. The correct answer is:
dorsal root
The dorsal root of a spinal nerve contains afferent sensory fibers, while
the ventral root of a spinal nerve contains efferent motor fibers. The
dorsal primary ramus, which is the first dorsal nerve branching from the
spinal nerve, contributes motor innervation to the muscles of the back
and gives off posterior cutaneous nerves which innervate the skin of the
back. Although these cutaneous sensory nerves contain afferent fibers,
there are no posterior cutaneous nerves on the skin of the hand, so this
is not the correct answer. Finally, a gray ramus communicans is a
structure that postganglionic sympathetic fibers use to leave the
sympathetic chain ganglion to reach a ventral primary ramus.
8. The correct answer is:
cephalic
There are two large cutaneous veins running up the arm. Both veins
take origin from the dorsal venous arch of the hand and run up the
lateral and medial sides of the arm. On the medial side (near the 5th
digit) there is the basilic vein. On the lateral side (by the thumb), there is
the cephalic vein. Since the infection is on the thumb side of the forearm,
the correct answer is the cephalic vein.
The median antebrachial vein runs down the center of the anterior
forearm. The median cubital vein connects the cephalic vein to the
basilic vein in the cubital fossa. Finally, the radial vein is a deep vein that
runs with the radial artery.
9.
The correct answer is:
Basilic
The basilic vein is on the ulnar side of the forearm--near the 5th finger.
The basilic vein takes rise from the medial side of the dorsal venous
arch of the hand, and drains blood from the medial (ulnar) side of the
arm. The cephalic vein takes origin from the lateral side of the dorsal
venous arch of the hand, and then runs up the lateral (radial) forearm.
The median antebrachial vein runs down the center of the anterior
forearm, draining into the median cubital vein. The median cubital vein
connects the cephalic vein to the basilic vein in the cubital fossa. Finally,
the radial vein is a deep vein that runs with the radial artery.
10. The correct answer is:
lateral antebrachial cutaneous nerve
There are 3 nerves that might be damaged due to a venipuncture in the
median cubital fossa. If the needle goes a bit lateral, the lateral
antebrachial cutaneous nerve might be injured. This nerve is a branch of
the musculocutaneous nerve which supplies the skin of the lateral side
of the forearm. The patient's symptoms (loss of feeling on the radial side
of the forearm) match with an injury to the lateral antebrachial cutaneous
nerve. If the needle goes a bit medial, it could injure the medial
antebrachial cutaneous nerve. This nerve is a direct branch of the
medial cord of the brachial plexus--it innervates skin on the medial side
of the forearm. If the needle goes too deep, the median nerve might be
injured. This would cause the patient to lose sensation on the palmar
side of the lateral 3.5 digits.
The posterior antebrachial cutaneous nerve is a branch of the radial
nerve which supplies the posterior forearm. The superficial radial nerve
is a terminal branch of the radial nerve which supplies the dorsum of the
hand and the dorsal side of the lateral 2.5 digits. Neither of these nerves
would be affected by a venipuncture in the median cubital fossa!
11. The correct answer is:
Ulnar nerve
The ulnar nerve innervates the medial 1.5 digits on the palmar surface of
the hand, and 2.5 digits on the dorsal side. So, this is the nerve
responsible for innervating the tip of the little finger. The radial nerve
innervates the dorsal side of the lateral 2.5 digits, but does not innervate
the tips of these fingers. The median nerve, which innervates the palmar
side of the lateral 3.5 digits, also innervates the fingertips of these 3.5
fingers. The musculocutaneous nerve does not provide cutaneous
innervation to the skin, but its branch, the lateral antebrachial cutaneous
nerve, innervates the lateral skin of the forearm. The medial antebrachial
cutaneous nerve innervates the medial skin of the forearm - this nerve is
a direct branch of the medial cord of the brachial plexus.
12.
The correct answer is:
Lateral antebrachial cutaneous nerve
The lateral and medial antebrachial cutaneous nerves supply the skin of
the lateral and medial side of the anterior forearm, respectively. The
lateral antebrachial cutaneous nerve is a branch of the
musculocutaneous nerve, which runs on the lateral forearm near the
cephalic vein. So, this is the nerve that must have been injured. The
medial antebrachial cutaneous nerve is a direct branch of the medial
cord of the brachial plexus--it runs near the basilic vein. This nerve could
be injured during a venipuncture to the basilic vein. The posterior
antebrachial cutaneous is a branch of the radial nerve that supplies the
skin on the posterior forearm--it is not located near any sites for
venipuncture. Finally, the superficial radial nerve supplies cutaneous
innervation to the dorsal side of the hand, including the dorsal side of the
radial 2 1/2 digits.
13. The correct answer is:
medial antebrachial cutaneous nerve
The basilic vein is on the medial side of the arm, so a venipuncture into
the basilic vein might damage the medial antebrachial cutaneous nerve
which also runs on the medial side of the arm. The brachial artery,
median nerve, and radial nerve are deeper structures that would not be
damaged during a venipuncture. The lateral antebrachial cutaneous
nerve is near the cephalic vein, not the basilic vein.
14.
The correct answer is:
saphenous
The saphenous nerve travels with the great saphenous vein, running
along the medial side of the leg and thigh. It provides cutaneous
innervation to the medial leg and foot and does not provide motor
innervation to any muscles. So, both the case history and the symptoms
point to a saphenous nerve injury. Branches of the femoral nerve
provide cutaneous innervation to the skin of the anterior thigh--these
nerves would not have been involved with this accident. The sural nerve
runs with the lesser saphenous vein, posterior to the lateral malleolus
and up the back of the leg. It provides cutaneous innervation to the skin
of the posterior surface of the lower leg and the skin of the lateral side of
the foot. The superficial fibular nerve provides sensory innervation to the
distal third of the leg and the dorsal surface of the foot. Finally the deep
fibular nerve is not a major nerve for cutaneous innervation--it innervates
the muscles of the anterior compartment of the leg as well as the web of
skin between the 1st and 2nd toe. If this nerve was injured, a patient
would not have a distinct loss of cutaneous sensation (except in that
small web of skin). Instead, the prominent symptom would be "foot
drop."
15. The correct answer is:
anterior to the medial malleolus
At the ankle, the great saphenous vein travels anterior to the medial
malleolus. At the knee, it travels posterior to the medial condyle of the
femur. However, saphenous cut-downs are done at the ankle, not the
knee, so anterior to the medial malleolus is the correct answer. The
other important relationship to remember is that the lesser saphenous
vein travels posterior to the lateral malleolus.
16. The correct answer is:
skin of the lower limb
The skin of the lower limb is drained by superficial lymph vessels that
send lymph to the superficial inguinal lymph nodes. These important
nodes also receive lymph from the anal canal below the level of the
pectinate line, the external genitalia, and the lower abdominal wall. The
anterior abdominal wall is drained by superficial lymphatic vessels
accompanying the subcutaneous veins. If these vessels are superior to
the umbilicus, they direct lymph to the axillary lymph nodes, and if they
are inferior to the umbilicus, they send lymph to the superficial inguinal
lymph nodes. So, a skin infection above the umbilicus would cause an
enlargement of the axillary nodes. The anterior chest wall and skin of the
upper back also drain to subdivisions of the axillary nodes.
17.
The correct answer is:
superficial fibular
The superficial fibular nerve provides cutaneous innervation to the lower
anterior third of the leg and the dorsum of the foot. It reaches the dorsum
of the foot by crossing over the anterior midline of the ankle region. Both
the area of injury and the subsequent symptoms should point to damage
of the superficial fibular nerve. The femoral nerve is mostly important as
a motor nerve--it innervates the quads, sartorius, and pectineus. Its
anterior femoral cutaneous branches provide sensory innervation to the
medial and anterior thigh. Another branch of the femoral nerve, the
saphenous nerve, provides sensory innervation to the medial side of the
leg and the foot. The lateral sural cutaneous nerve is a branch of the
common fibular nerve--it provides sensory innervation to the skin of the
lateral side of the leg. Finally, the sural nerve, which runs down the
posterior leg with the lesser saphenous vein, provides sensory
innervation to the posterior surface of the lower leg and the lateral side
of the foot.
18. The correct answer is:
Meralgia paresthetica
Meralgia paresthetica is a sense of tingling and itching on the lateral side
of the thigh, in the area of distribution of the lateral femoral cutaneous
nerve. It is a palsy of the lateral cutaneous nerve of the thigh, and it is
often caused by wearing something that presses against this nerve, like
tight jeans or a work belt. Compartment syndrome relates to a group of
symptoms which indicate a nerve, blood vessel or tendon is being
constricted due to swelling within a closed anatomic space. Anterior
comparment syndrome is commonly seen in the leg, and carpal tunnel
syndrome is a compartment syndrome in the wrist. Symptoms of
compartment syndrome include numbness, tingling, pain or loss of
movement in an extremity. Cryptorchidism is the term for undescended
testes. Hydrocoele is the term for the presence of excess fluid in a
persistent processus vaginalis. This congenital anomaly may be
associated with an indirect inguinal hernia. Thrombophlebitis is the name
for inflammation that may develop around a vein once there is a
thrombus in that vein.
19.
The correct answer is:
Anterior to the medial malleolus
At the ankle, the great saphenous vein travels anterior to the medial
malleolus, with the saphenous nerve. So, you want to make an incision
anterior to the medial malleolus, because this is where you will insert the
catheter or cannula. At the knee, the great saphenous vein travels
posterior to the medial epicondyle of the femur, and it will eventually
travel up the thigh and drain into the femoral vein at the saphenous
opening. However, saphenous cutdowns are done anterior to the medial
malleolus, not at the saphenous opening or behind the medial
epicondyle!
20. The correct answer is:
Perforating veins
Perforating veins are anastamosing channels that shunt blood from the
superficial veins to deep veins. These perforating veins have valves to
ensure that blood only flows in the superficial to deep direction. If these
valves fail, blood will back up in the superficial veins, causing valves to
fail in the superficial veins, too. Then, the superficial veins become
varicose. So, the primary cause of the varicose veins is the failure of the
valves in the perforating veins.
The greater and lesser saphenous veins are superficial veins which may
become varicose once the perforating veins fail, but these are not the
veins at the root of the problem. Deep veins, like the deep femoral vein
or the popliteal vein, do not become varicose or cause other veins to
become varicose--these veins receive blood from the superficial veins.
21. The correct answer is:
Tributaries to the lesser saphenous vein
When the valves of the perforating veins fail, subcutaneous varicose
veins develop. Perforating veins direct venous blood from superficial
veins to deeper veins; they have valves that are designed to prevent
blood from flowing backwards into the superficial veins. If these valves
fail, all of the blood from the superficial veins and some blood from the
deep veins is forced into the superficial veins. Because these superficial
veins become distended, their valves fail too, and they become the
varicose veins. Even though the perforating veins are the primary
culprits here, this question is not asking about them--it is asking you to
identify the superficial veins on the posterior aspect of the calf that have
become varicose.
The lesser saphenous vein is a superficial vein that runs down the
middle of the back of the leg. It, and its tributaries, would be the cause of
varicose veins on the posterior lower leg, so this is the answer. The
greater saphenous vein is a superficial vein on the anteromedial side of
the leg and thigh--it can also develop varicosities, but it's not in the right
area for this question.
The posterior tibial vein and its tributaries are deep veins--these veins
don't become varicose. Finally, remember that these varicosities develop
in superficial veins, never in superficial arteries!
22. The correct answer is:
small saphenous vein
When the valves of the perforating veins fail, subcutaneous varicose
veins develop. Perforating veins direct venous blood from superficial
veins to deeper veins; they have valves that are designed to prevent
blood from flowing backwards into the superficial veins. If these valves
fail, all of the blood from the superficial veins and some blood from the
deep veins is forced into the superficial veins. Because these superficial
veins become distended, their valves fail too, and they become varicose.
So, this question is asking you to identify the superficial veins on the
posterior aspect of the calf.
The lesser or small saphenous vein is a superficial vein that begins as
the dorsal venous arch and runs behind the lateral malleolus, up the
middle of the back of the leg, and terminates as the popliteal vein in the
popliteal fossa. It would be the cause of varicose veins on the posterior
lower leg, so it's the answer. The greater saphenous vein is on the
medial side of the leg. It also begins as the dorsal venous arch of the
foot, and then heads up the leg, anterior to the medial malleolus. At the
knee, it goes behind the medial condyle of the femur, and then turns
slightly anterior and lateral as it moves up the thigh. It travels through the
saphenous opening and drains into the femoral vein.
The femoral vein is a deep vein that drains much of the thigh. It is not a
vein that would become varicose. Finally, the dorsal venous arch is
located on the dorsum of the foot, and it is where the lesser and greater
saphenous veins begin. This is not a common site for varicose veins.
23. The correct answer is:
perforating veins
Perforating veins are anastamosing channels that shunt blood from the
superficial veins to deep veins. These perforating veins have valves to
ensure that blood only flows in the superficial to deep direction. If these
valves fail, blood will back up in the superficial veins, causing valves to
fail in the superficial veins, too. Then, the veins become varicose. Venae
commitantes are special veins, usually paired, that accompany deep
arteries in the limbs. They surround arteries in an irregular branching
network that creates a vascular sheet around the arteries.
The veins in the lower limb that are most likely to become varicose are
the greater and lesser saphenous veins and their tributaries.
24. The correct answer is:
greater saphenous
Remember: Subcutaneous venous varicocities happen when valves of
the perforating veins fail, causing blood to pool in the superficial veins.
Because these superficial veins become distended, their valves fail too,
and they become varicose. So, this question is asking you to identify the
superficial veins on the anteromedial thigh.
The greater saphenous vein is on the medial side of the leg. It begins as
the dorsal venous arch of the foot, and then heads up the leg, anterior to
the medial malleolus. At the knee, it goes behind the medial condyle of
the femur, and then turns slightly anterior and lateral as it moves up the
thigh. It travels throught the saphenous opening and drains into the
femoral vein. Since this is a superficial vein on the anteromedial side of
the leg, that's the answer!
The femoral vein is a deep vein that drains much of the thigh. It is not a
vein that would become varicose. The lesser saphenous vein is a
superficial vein that runs up the middle of the back of the leg. It could be
the cause of varicose veins on the posterior lower leg. The popliteal vein
is a deep vein behind the knee that receives the lesser saphenous vein
and eventually becomes the femoral vein. Finally, the superficial external
pudendal vein is a superficial branch of the femoral vein that drains the
external genitalia.
25. The correct answer is:
sural
The sural nerve runs with the lesser saphenous vein, posterior to the
lateral malleolus and up the back of the leg. It provides cutaneous
innervation to the skin of the posterior surface of the lower leg and the
skin of the lateral side of the foot. So, both the case history and the
symptoms point to a sural nerve injury. The deep fibular nerve is not a
major nerve for cutaneous innervation--it innervates the muscles of the
anterior compartment of the leg as well as the web of skin between the
1st and 2nd toe. If this nerve was injured, a patient would not have a
distinct loss of cutaneous sensation (except in that small web of skin).
Instead, the prominent symptom would be "foot drop." The posterior
femoral cutaneous nerve provides sensory innervation to the skin of the
lower buttock and posterior thigh. The saphenous nerve travels with the
great saphenous vein and provides cutaneous innervation to the medial
leg and foot. Finally, the superficial fibular nerve provides sensory
innervation to the anterior surface of the distal third of the leg and the
dorsal surface of the foot.
26. The correct answer is:
greater saphenous
Remember: subcutaneous venous varicocities occur in the superficial
veins due to valve failure in the perforating veins! Varicose veins can be
caused by activities that allow blood to pool in the legs, like excessive
standing. Since the greater saphenous vein is a superficial vein on the
anteromedial side of the leg and thigh, it's our winner! The femoral vein
is a deep vein that drains much of the thigh. It is not a vein that would
become varicose. The lesser saphenous vein is a superficial vein that
runs up the middle of the posterior leg. It could be the cause of varicose
veins on the posterior lower leg. The popliteal vein is a deep vein behind
the knee which receives the lesser saphenous vein and eventually
becomes the femoral vein. It is deep in the leg, so it's not the type of vein
that would become varicose. Finally, the pudendal veins drain the
external genitalia--they are not really relevant here.
27.
The correct answer is:
sural
The sural nerve runs with the lesser saphenous vein, posterior to the
lateral malleolus and up the back of the leg. It provides cutaneous
innervation to the skin of the posterior surface of the lower leg and the
skin of the lateral side of the foot. So, both the case history and the
symptoms point to a sural nerve injury. The common fibular nerve gives
rise to the lateral sural cutaneous nerve, superficial fibular nerve, and
deep fibular nerve. If this nerve was injured, the patient would have a
sensory defect on the distal third of the leg and the dorsum of the foot,
stemming from the loss of the superficial fibular nerve. Damage to the
common fibular nerve would also result in significant motor loss--no
innervation to the anterior or lateral compartments of the leg would
cause foot drop. The saphenous nerve travels with the great saphenous
vein and provides cutaneous innervation to the medial leg and foot.
Finally, the tibial nerve is most important as a motor nerve--it innervates
the posterior compartments of the leg and the plantar foot. It also
provides the sensory innervation to the plantar surface of the foot.
28. The correct answer is:
perforating veins are competent
The job of the perforating veins is to shunt blood from the superficial
veins to the deeper veins. If these valves are incompetent, there will be
no way to stop blood from flowing into the cutaneous veins, and they will
immediately fill with blood. If the valves are competent, you should see a
delayed filling time, indicating that blood can't just simply flow backwards
through defective perforating veins. Since the patient has a delayed
filling time, that is an indication that her valves are competent.
Although the obvious abnormality with varicose veins involves the
superficial veins, the underlying problem tends to involve the valves of
the perforating veins.
29. The correct answer is:
lesser saphenous
The sural nerve runs directly next to the lesser saphenous vein, so that
is the source of the hematoma. The accessory saphenous vein is a
small branch of the greater saphenous vein that lies on the medial side
of the thigh. The femoral vein is a large, deep vein that drains the upper
thigh. The greater saphenous vein is a superficial vein that lies on the
medial side of the leg. It travels anterior to the medial malleolus and
posterior to the medial condyle of the femur to lay on the anteromedial
side of the thigh. The superficial external pudendal vein drains the
external genitalia.