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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.