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Anatomy
Lower Limb
You are performing a vascular examination on a patient with suspected claudication. The posterior tibial artery pulse is best palpated at which of the following sites:
Answer:
The posterior tibial pulse may be palpated posterior and inferior to the medial malleolus, midway between the medial malleolus and the heel.Tibial Arteries
Anatomy / Lower Limb / Anterior Leg / Posterior Leg
Last Updated: 11th April 2019
After exiting the popliteal fossa between the gastrocnemius and popliteus muscle, the popliteal artery bifurcates into the anterior and posterior tibial arteries at the lower border of the popliteus.
Anterior Tibial Artery
The anterior tibial artery penetrates the interosseous membrane to enter and supply the anterior compartment of the leg, continuing inferiorly into the foot where it becomes the dorsalis pedis artery.
Posterior Tibial Artery
The posterior tibial artery descends through the deep region of the posterior compartment of the leg, giving rise to its two major branches, the circumflex fibular artery and the fibular artery and supplying the posterior and lateral compartments of the leg before passing posterior to the medial malleolus, and entering the sole of the foot via the tarsal tunnel.
The posterior tibial pulse may be palpated posterior and inferior to the medial malleolus, midway between the medial malleolus and the heel.
![Modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons](https://mrcemsuccess.com/wp-content/uploads/2017/01/Posterior-Tibial-Artery.png)
Tibial Arteries. (Image modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons)
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
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