VENOUS BLOOD RETURN FROM THE LOWER LIMB 1. The great saphenous vein is the largest superficial vein of the lower limb at the ankle, it is located anteriorly to the medial malleolus has numerous valves which permit the venous blood to flow only in headward direction all are correct A and B are correct Very good. No, D is correct. The great saphenous vein is the largest of the superficial veins of the lower limb. At the ankle, it is located anteriorly to the medial malleolus and at this site, a section of this vein is made for infusion of intravenous fluids. Valves within the great saphenous vein permit blood to flow only in the headward direction. 2. The upper part of the great saphenous vein receives the superficial epigastric vein the superficial circumflex iliac vein the inferior epigastric vein A and B are correct Right. Wrong, the answer is D. Other tributaries of the upper part of the great saphenous vein include the external pudendal veins out of which one is joined by the superficial dorsal vein of the penis and the deep external pudendal veins which join the great saphenous vein at its termination in the saphenous opening. The inferior epigastric vein drains into the external iliac vein. 3. After opening of the lumen of the great saphenous vein at the ankle, in which direction would you place the intravenous cannula? into the distal end of this vein with the proximal end tied into the proximal end with the distal end tied Yes. No, B is correct. The venous valves which are within the great saphenous vein will permit the infused fluid to flow only in the headward direction. 4. The great saphenous vein drains into the femoral vein at the groin, 2.5 to 3.5 cm below the inguinal ligament the medial side of the thigh and within the adductor canal Hooray! No, A is right. The great saphenous vein joins the femoral vein deep to the cribriform fascia and within the femoral sheath. 5. The great saphenous vein all along its course is accompanied by the cutaneous branches of the femoral nerve on the thigh and the saphenous nerve on the leg and the foot by the saphenous nerve only Yes. No, A is correct. Cutaneous branches on the thigh are from the medial cutaneous nerve. 6. The small saphenous vein begins as a continuation of the lateral marginal vein of the foot. At the ankle, it is related to the medial malleolus - it is behind it the lateral malleolus - it is behind it the lateral malleolus - it is in front of it Yes. No, B is correct. 7. The small saphenous vein drains into the femoral vein the posterior tibial deep veins the popliteal vein Correct. Wrong, C is the answer. The small saphenous vein drains into the popliteal vein within the popliteal fossa. It perforates the fascia crura and passes between both heads of the gastrocnemius muscle. 8. The superficial veins of the lower limb are the great and the small saphenous veins. The deep veins of the lower limb consist of the deep veins which accompany the arteries the intramuscular veins both Certainly. No, C is the answer. 9. The deep veins of the leg are paired while the deep veins of the thigh are single. The venous blood within these veins flows from the deep veins to the superficial veins from the superficial veins to the deep veins and in a headward direction Of course. No, B is correct. The venous blood flows from the superficial to the deep veins and in a headward direction. This is due to the valves within these veins. When the valves are defective or insufficient, venous blood flows in opposite direction i.e., varicose veins. 10. The term "calf pump" is applied to the muscles of the calf all the muscles of the lower limb Great! No, A is correct. These muscles are within the thigh sleeve of deep fascia. In an upright position, the venous return from the lower limb depends almost entirely on muscular activity. 11. Perforating veins connect the superficial and the deep veins. Valves within them guarantee the flow of the venous blood from the superficial to the deep veins. The most important perforating veins are located around the medial malleolus and the lower third of the medial side of the calf all of them pierce the fascia crura just posterior to the medial margin of the tibia at the posterior aspect of the calf only A and B are correct Very good. No, D is the answer. 12. The intramuscular veins of the muscles of the calf drain into the deep posterior and anterior tibial vein as well as into the deep peroneal veins into the superficial veins and then from them via the perforating veins into the above mentioned veins Bravo! No, the correct answer is A. It was stated before that the intramuscular veins are part of the deep venous system of the lower limb as well as that the venous blood flows from the superficial into the deep veins. 13. Using your knowledge of the venous blood return from the lower limb, how would you treat surgically, varicose veins of the lower limb? ligature of the perforating veins removing the superficial veins combine technique A and B all of the above are correct Correct. No, D is correct. During the surgical treatment, you must close all insufficient perforating veins and at the same time it may be required to remove extended superficial veins with destroyed valves. 14. What examinations will allow you with most accuracy to examine the state of the valvular apparatus of the veins of the lower limb? physical examinations venography of the veins of the lower limb Yes. No, B is the answer. Venography will show you the status of the superficial and the deep veins regardless of the state of the advancement of the pathologic process within them. Most of the lymph from the lower limb traverses a terminal group of lymph nodes in the groin. These are the superficial and the deep inguinal lymph nodes. Before reaching these lymph nodes the lymph may pass through outlying intermedary nodes which are present only in small numbers in the lower limb. 15. The superficial inguinal lymph nodes are arranged in upper and lower groups. The upper inquinal superficial lymph nodes receive afferent vessels from the gluteal region and from the adjoining part of the anterior abdominal wall below the umbilicus the external genitalia (including in the female the vagina below the hymen), the lower part of the anal canal and the perineal region the uterus, the fundus all of the above Excellent! No, the correct answer is D. 16. The lower superficial inguinal lymph nodes receive afferent vessels from the superficial structures of the whole lower limb the superficial structure of the lower limb except those on the back and the lateral side of the calf and the foot Certainly! No, B is the answer. The popliteal lymph nodes receive lymph from this region of the lower limb. 17. All the superficial lymph nodes drain into the external iliac lymph nodes the internal iliac lymph nodes Hooray! No, A is the answer. 18. The deep inguinal lymph nodes are situated deep to the fascia lata. They are on the medial side of the femoral vein. They total 2-3 in number. Their afferent vessels come from the deep lymph vessel accompanying the femoral artery the lymph vessels from the glans penis (or glans clitoris) both of the above Yes. No, the correct answer is C. 19. The deep inguinal lymph nodes drain into the external iliac lymph nodes the internal iliac lymph nodes Good. No, A is the answer. The efferent vessels from the deep inguinal lymph nodes pass through the femoral canal. 20. The popliteal lymph nodes total 6-7 in number. They are embedded in the fat of the popliteal fossa. Their efferent vessels drain into the superficial inguinal lymph nodes the deep inguinal lymph nodes the external iliac lymph nodes A and B Of course. Too bad, D is the answer. Those draining into the superficial inguinal lymph nodes accompany the great saphenous vein.