Study Guide
Clinical Notes on Lower Limb Anatomy
-
University:
Kentucky State University -
Course:
BIO 301 | Human Anatomy Academic year:
2021
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Views:
330
Pages:
65
Author:
FrextWhestembki
Clinical Notes on Lower Limb
Anatomy THE FEMORAL ARTERY begins midinguinal point and ends at the opening in the
adductor magnus where it becomes THE POPLITEAL ARTERY
The popliteal artery ends at the lower border of the popliteus muscle
by dividing into ANTERIOR AND POSTERIOR TIBIAL ARTERIES
The anterior tibial artery supplies the anterior compartment of the leg and terminates in
front of the ankle joint by becoming THE DORSALIS PEDIS ARTERY
The posterior tibial artery supplies the posterior and the lateral compartments of the leg
ends deep to the flexor retinaculum by dividing into MEDIAL AND LATERAL
PLANTER ARTERIES which supply the sole
Clinically, the pulsation of a peripheral blood vessel is an
indication of the blood flow through that vessel. Arterial
patency is evaluated by palpation of the vessel Every health professional should know the
precise position of the main arteries within
the lower limb, for he or she may be called
on to arrest a severe hemorrhage or palpate
different parts of the arterial tree in
patients with arterial occlusion.
The five P signs of acute
arterial occlusion are:
pain, pallor, paresthesia,
paralysis, and pulselessness Femoral artery
In the femoral triangle, its pulse is
easily felt just inferior to the
inguinal ligament midway between
the pubic symphysis and the
anterior superior iliac spine
Popliteal artery
Its pulse is difficult to find but
usually can be detected on deep
palpation just medial to the midline
of the popliteal fossa Posterior tibial artery
is palpable just posteroinferior to the medial
malleolus between the heel and medial
malleolus
Dorsalis pedis artery
on the dorsal aspect of the foot and over the
tarsal bones, between the tendon of extensor
hallucis longus and the tendon of the extensor
digitorum longus to the second toe Popliteal artery
Dorsalis pedis artery
may be absent in around 15
% of people
Anterior tibial
artery
Posterior tibial artery
Fibular artery
Some have congenitally
nonpalpable dorsalis pedis
pulses, the variation is usually
bilateral. In these cases, the
dorsal artery of the foot is
replaced by an enlarged
perforating fibular artery Fibular artery
Anterior tibial artery
Dorsalis Pedis Artery
(the Dorsal Artery of the Foot)
Dorsal view An angiogram detects blockages taken during
the injection of a contrast agent (iodine dye)
MR angiogram showing right
femoral artery
atherosclerosis, occlusion and
narrowing, especially marked
at the adductor hiatus Ischemic changes of the foot due to peripheral vascular disease
blocking distal arteries
Gangrene in a patient with type 2 diabetes and severe peripheral
arterial disease Deep Vein Thrombosis and
Long-Distance Air Travel
Passengers who sit immobile for
hours on long-distance flights are
very prone to deep vein
thrombosis in the legs.
Thrombosis of the veins of the
soleus muscle gives rise to mild
pain or tightness in the calf and
calf muscle tenderness.
Deep vein thrombosis can also
occur with no signs or symptoms.
Thrombus is a blood clot
Preventative measures include stretching of the
legs every hour to improve the venous
circulation Swelling
Pain
Red or discolored skin
Warmth
Deep vein thrombosis can be very
serious (often fatal) because blood clots
in the veins can break loose, travel
through the bloodstream and lodge in
the lungs, blocking blood flow
(pulmonary embolism). Varicose Veins
A varicosed vein is one that has a
larger diameter than normal and
is elongated and tortuous. This
condition commonly occurs in the
superficial veins of the lower
limb
Varicosed veins have many
causes:
1- Hereditary weakness of the
vein walls and incompetent
valves
2- Elevated intra-abdominal
pressure as a result of multiple
pregnancies or abdominal tumors
3- Thrombophlebitis of the deep
veins
Varicose veins Spider veins appear as thin, red lines or as
weblike networks of blood vessels on the
surface of the skin. Spider veins, a mild
form of varicose veins It is easy to understand how varicose
vein can be produced by
incompetence of a valve in a
perforating vein.
Every time the patient exercises,
higher pressure venous blood
escapes from the deep veins into the
superficial veins and produces a
varicosity, which might be localized
to begin with but becomes more
extensive later
Perforating
vein
Deep vein
Superficial
vein Surface anatomy Surface anatomy Compartment syndrome
Occurs when there is swelling within a
fascial enclosed compartment in the
limbs.
Typical causes:
Limb trauma
Intracompartment hemorrhage
Limb compression
As pressure within the compartment
elevates, capillary blood flow is
compromised
(prevents nourishment and oxygen from
reaching nerve and muscle cells)
Can lead to neuromuscular damage if not
treated Femoral Nerve Injury
The femoral nerve can be injured in stab or gunshot wounds, but a complete division
of the nerve is rare.
The following clinical features are present when the nerve is completely divided:
Motor: The quadriceps femoris muscle is paralyzed, and the knee cannot be extended
Sensory: Skin sensation is lost over the anterior and medial sides of the thigh, over
the medial side of the leg, and along the medial border of the foot (as far as the ball of
the big toe )
Obturator Nerve Injury
It is rarely injured in:
Penetrating wounds
Anterior dislocations of the hip joint
It may be pressed on by the fetal head during parturition
The following clinical features occur:
Motor: All the adductor muscles are paralyzed except the hamstring part of the
adductor magnus (sciatic nerve).
Sensory: The cutaneous sensory loss is minimal on the medial aspect of the thigh Sciatic Nerve Injury
The nerve is sometimes injured by:
Penetrating wounds
Fractures of the pelvis
Dislocations of the hip joint
Badly placed intramuscular injections in the gluteal region
Most nerve lesions are incomplete, and in 90% of injuries, the common fibular part of the
nerve is the most affected . The common fibular nerve fibers lie most superficial in the sciatic
nerve.
The following clinical features are present:
Motor:
The hamstring muscles are paralyzed, but weak flexion of the knee is possible because of
the action of the sartorius (femoral nerve) and gracilis (obturator nerve).
All the muscles below the knee are paralyzed, and the weight of the foot causes it to
assume the plantar-flexed position, or footdrop
Sensory:
Sensation is lost below the knee, except for a narrow area down the medial side of the leg
and along the medial border of the foot (Saphenous nerve (femoral nerve)).
Development of trophic ulcers Sciatica
is a medical condition characterized
by pain going down the leg from the
lower back
Sciatica can be caused by prolapse of
an intervertebral disc, with pressure
on one or more roots of the lower
lumbar and sacral spinal nerves,
pressure on the sacral plexus or sciatic
nerve by an intrapelvic tumor, or
piriformis syndrome
MRI scan of the lower back showing a
prolapsed disc Common Fibular Nerve Injury
The common fibular nerve is in an exposed position as it leaves the popliteal fossa and winds
around the neck of the fibula
Can be injured in fractures of the neck of the fibula and by pressure from casts or splints
The following clinical features are present:
Motor: The muscles of the anterior and lateral compartments of the leg are paralyzed (the tibialis
anterior, the extensor digitorum longus and brevis, the fibularis tertius, the extensor hallucis
longus (supplied by the deep fibular nerve), and the fibularis longus and brevis (supplied by the
superficial fibular nerve)
As a result, the opposing muscles, the plantar flexors of the ankle joint and the invertors of the
subtalar and transverse tarsal joints, cause the foot to be plantar flexed (foot drop) and inverted
Sensory: Loss of sensation occurs down the anterior and lateral sides of the leg and dorsum of
the foot and toes, including the medial side of the big toe. The lateral border of the foot is
virtually unaffected (sural nerve (tibial nerve)). The medial border of the foot as far as the ball of
the big toe is completely unaffected (saphenous nerve (femoral nerve)) Footdrop. With this condition, the individual catches his or
her toes on the ground when walking Tibial Nerve Injury
The tibial nerve leaves the popliteal
fossa by passing deep to the
gastrocnemius and soleus muscles.
Because of its deep and protected
position, it is rarely injured.
Complete division results in the
following clinical features:
Motor: All the muscles in the back of
the leg and most intrinsic muscles of the
foot are paralyzed. The opposing
muscles dorsiflex the foot at the ankle
joint and evert the foot at the subtalar
and transverse tarsal joints
(calcaneovalgus)
Sensory: Sensation is lost on the sole of
the foot; later, trophic ulcers develop PBL
Problem Based Learning
Study the following case histories and select the
best answers to the question following them. Case number 1
In the middle of a collegiate rugby tournament a
player gets tackled just as he is kicking the ball.
He has all of his weight planted on his left leg
when another player clips him on one side of his
knee. He falls to the ground and clutches his knee
in pain. When the team physician examines the
knee he is able to elicit abnormal side to side
movement of the femur on the tibia and abnormal
forward motion of the tibia on the femur The forward motion is caused by damage to
which of the following ligaments?
A.Oblique popliteal ligament
B.Patellar ligament
C.Anterior cruciate ligament
D.Posterior cruciate ligament When diagnosing damage to the knee joint, it is
important to look at the three structures most
often damaged. These three structures, otherwise
known as the "unhappy triad" include
the_________________
A.Medial meniscus, anterior cruciate ligament,
tibial collateral ligament
B.Lateral meniscus, posterior cruciate ligament,
fibular collateral ligament
C.Lateral meniscus, oblique popliteal ligament,
fibular collateral ligament
D.Oblique popliteal ligament, patellar ligament,
anterior cruciate ligament The tendons that strengthen and stabilize the knee
joint on the lateral side consist of all of the
following except:
A.Biceps femoris
B.Gastrocnemius
C.Iliotibial tract
D.Soleus The tendons supporting the medial side of the knee
joint include the three which form the pes anserinus.
Which one of the following four tendons is not part
of the pes anserinus:
A.Semitendinosus
B.Sartorius
C.Gracilis
D.Semimembranosus Case number 2
A fourth year medical student did an elective working with
the camp pediatrician at a rural camp in northern Maine.
One day when a young boy came down with a high fever
the pediatrican gave the child an intramuscular injection. In
his haste the physician plunged the needle into the medial
aspect of the boy's right gluteus maximus.
A few hours later the medical student observed the boy
walking to his cabin. He noticed the boy was walking in a
strange manner. He seemed to be lifting his right foot
unusually high and letting it hang down while he walked.
After examining the boy the medical student realized that
the boy's unusual gait was a result of his inability to
dorsiflex and evert his right foot. The medical student remembered that the nerve
that innervates the muscles which are directly
responsible for dorsiflexion and eversion of the
foot is the:
A) Tibial nerve
B) Deep fibular (peroneal) nerve
C) Sciatic nerve
D) Common fibular nerve The muscles responsible for dorsiflexion of the foot include
the:
A) Tibialis Posterior
B) Tibialis Anterior
C) Extensor Digitorum Longus
D) Two of the above. Both the Tibialis Anterior and the
Extensor Digitorum Longus dorsiflex the foot Remembering the pediatrician's earlier IM injection
into the boy and considering the symptoms, the third
year student determined that the damage from the
injection must have occurred to which nerve in the
gluteal region:
A) Obturator
B) Superior gluteal
C) Common fibular portion of the sciatic
D) Inferior gluteal
E) Tibial portion of the sciatic The name for this clinical condition is:
A) Obturator syndrome
B) Gluteus medius limp
C) Positive Trendelenberg sign
D) Foot drop Case number 3
On his 50th birthday a sedentary father of three makes a personal
resolution to exercise more and to lead a healthier lifestyle. The next day,
eager to begin his new training regime he gets up early and begins a
three mile jog. Less than one mile into the run, however, his leg muscles
cramp and he is forced to stop. Humbly, he walks home wincing with the
pain of every step.
The next day at his yearly exam the man tells his physician of the pain in
his legs upon exercise. The physician commends him for his initiative
but warns him to start exercising at a slower pace. He examines the
man's legs and notes tenderness along their anterior aspect. He tells the
man that the pain he is experiencing is most likely caused by the swelling
of his muscles upon experiencing unusual exertion. The swelling causes
compression of the blood vessels and subsequent lack of oxygen to the
muscles. The muscles most likely to lose oxygen and cause this
man's symptoms (Anterior Compartment Syndrome)
include all of the following except:
A) Tibialis anterior
B) Extensor digitorum longus
C) Extensor hallicus brevis
D) Extensor hallicus longus The blood supply might be compromised in which of the
following arteries due to Anterior Compartment
Syndrome:
A) Anterior tibial
B) Posterior tibial
C) Dorsal pedis artery
D) Two of the above. Both the Anterior tibial and the
Dorsalis pedis artery might be compromised In order to check and see if the nerve travelling in the
anterior compartment is damaged the physician checks
for sensory loss in:
A) The area between the first and second toes
B) The area along the dorsum of the foot
C) The area along the lateral aspect of the fifth toe
D) The area between the fourth and fifth toes Case number 4
A 62-year-old woman slips and falls on
the bathroom floor. As a result, she has a
posterior dislocation of the hip joint and
a fracture of the neck of the femur. Rupture of the ligamentum teres capitis femoris may lead to
damage to a branch of which of the following arteries?
(A) Medial circumflex femoral
(B) Lateral circumflex femoral
(C) Obturator
(D) Superior gluteal
(E) Inferior gluteal Fracture of the neck of the femur results in avascular
necrosis of the femoral head, probably resulting from lack
of blood supply from which of the following arteries?
(A) Obturator
(B) Superior gluteal
(C) Inferior gluteal
(D) Medial femoral circumflex
(E) Lateral femoral circumflex If the acetabulum is fractured at its posterosuperior margin by
dislocation of the hip joint, which of the following bones
could be involved?
(A) Pubis
(B) Ischium
(C) Ilium
(D) Sacrum
(E) Head of the femur The woman experiences weakness when abducting and
medially rotating the thigh after this accident. Which of the
following muscles is most likely damaged?
(A) Piriformis
(B) Obturator internus
(C) Quadratus femoris
(D) Gluteus maximus
(E) Gluteus minimus Case number 5
A propane tank explodes during a medical school 4th of
July barbeque and sends metal shrapnel into one of the
dinner guests. A large piece of metal embeds itself in the
student's left thigh. The student is conscious but appears to
be in shock and is bleeding profusely from his femoral
artery. The femoral artery travels within the adductor canal
(Hunter's Canal) to reach the popliteal fossa. Which of
the following muscles forms the anterior lateral
boundary of the canal?
A) Vastus lateralis
B) Sartorius
C) Vastus medialis
D) Adductor magnus Which of the following travel within the adductor
canal?
A) Femoral Vein
B) Profunda Femoris Artery
C) Profunda Femoris Vein
D) Two of the above The proximal part of the femoral artery is enclosed within
the femoral sheath, along with the femoral vein. The
femoral canal contains lymph vessels, connective tissue
and fat. In relation to the vein and artery the femoral
canal:
A) Is lateral to the femoral vein and medial to the femoral
artery
B) Is medial to the femoral vein and lateral to the femoral
artery
C) Is lateral to both the femoral vein and the femoral artery
D) Is medial to both the femoral artery and the femoral
vein After a major abdominal operation, a patient was given a course of
antibiotics by intramuscular injection. The nurse was instructed to give
the injections into the right buttock. Later, when the patient left the
hospital, he developed several symptoms and signs that suggested that
the injections into the gluteus maximus muscle had been given over the
course of the sciatic nerve and had caused a lesion of the common fibular
nerve.
The symptoms and signs displayed by this patient included the following except
which?
A) He experienced numbness and tingling sensations down the anterior and lateral sides
of the right leg and the dorsum of the foot.
B) His right foot tended to catch on steps and on the edges of the carpet.
C) On testing, he had impaired skin sensation on the lateral side of the right thigh.
D) The patient tended to hold the foot plantar flexed and slightly inverted.
E) Dorsiflexion of the right ankle joint was weaker than the same movement of the left
ankle.
F) The everter muscles of the right midtarsal joints were weaker than those of the
opposite side. A 45-year-old man complaining of a lump in the groin was seen by his
physician. The lump, which caused him no pain or discomfort, was first
recognized 3 months previously. On examination, a large discrete hard
lump was found about 2 in. (5 cm) below and lateral to the pubic tubercle
on the front of the right thigh.
The following signs indicated that this patient had a melanoma of the right big toe
with secondaries in the inguinal lymph nodes except which?
A) Two smaller hard swellings were found immediately below the large swelling.
B) On flexing the right knee joint, three small hard swellings could be palpated in the
popliteal fossa.
C) The external genitalia were found to be normal.
D) Examination of the anal canal revealed nothing abnormal.
E) A small pigmented mole was discovered beneath the nail of the right big toe. A 54-year-old woman complaining of abdominal pain and repeated
vomiting was seen in the emergency department. On questioning, the
patient stated that the pain was severe and colicky in nature and most
intense in the region of the umbilicus. On examination, the abdomen was
distended, and excessively loud bowel peristaltic sounds could be heard
with the stethoscope. A diagnosis of acute intestinal obstruction was
made secondary to a left femoral hernia.
The following statements concerning this case are correct except which?
(a) A small, tender, tense swelling was found in the front of the left thigh.
(b) When the patient was asked to cough, there was no expansion of the swelling in the
left thigh.
(c) The swelling in the left thigh was located below and medial to the left pubic
tubercle.
(d) The hernia had strangulated because of the unyielding nature of the femoral ring.
(e) A loop of small intestine was forced into the femoral sac and the pain from the small
bowel was referred to the umbilicus.
(f) Venous congestion followed by arterial occlusion of the intestinal loop was
responsible for the intestinal obstruction. A medical student, while playing football, collided with another player
and fell to the ground. As he fell, the right knee, which was taking the
weight of his body, was partially flexed; the femur was rotated medially;
and the leg was abducted on the thigh. A sudden pain was felt in the right
knee joint, and he was unable to extend it. The student was diagnosed as
having a torn medial meniscus of the knee joint.
The following statements concerning this case confirmed the diagnosis except
which?
(a) The right knee joint quickly became swollen.
(b) Severe local tenderness was felt along the medial side of the joint line.
(c) The medial meniscus split along part of its length, and the detached portion became
jammed between the articular surfaces, limiting further extension.
(d) The trauma stimulated the production of synovial fluid, which filled the joint cavity.
(e) The distention of the suprapatellar bursa was responsible for the large amount of
swelling above the injured knee.
(f) The pain sensation from the injured knee was confined to the femoral nerve as it
ascended to the central nervous system. 27-year-old woman was found to have an unstable right knee joint
following a severe automobile accident. On examination, it was possible
to pull the tibia excessively forward on the femur. A diagnosis of
ruptured anterior cruciate ligament was made.
The following statements concerning this patient are correct except which?
A) The anterior cruciate ligament is attached to the tibia in the anterior part of the
intercondylar area.
B) The anterior cruciate ligament passes upward, backward, and laterally from its tibial
attachment.
C) The anterior cruciate ligament is attached above to the posterior part of the medial
surface of the lateral femoral condyle.
D) The anterior cruciate ligament is more commonly torn than is the posterior cruciate
ligament.
E) Because the cruciate ligaments are located outside the synovial membrane, bleeding
from a torn ligament does not enter the joint cavity. An 18-year-old woman was running across some rough ground when she
fell and overinverted her left foot. On examination in the emergency
department of the local hospital, the lateral side of the left ankle was
tender and swollen. A small area of great tenderness was found below
and in front of the lateral malleolus. X-ray examination of the ankle joint
was negative. A diagnosis of sprain of the left ankle was made.
The following statements concerning this patient are correct except which?
A) The movement of inversion of the foot takes place at the ankle joint.
B) Overinversion places a strain on the lateral ligaments of the ankle joint.
C) The localized tenderness felt below and in front of the lateral malleolus would
indicate that some of the fibers of the anterior talofibular ligament had been torn.
D) The resulting hemorrhage from the torn ligament was responsible for the swelling in
the area.
E) By immobilizing the ankle joint with adequate splinting, the torn fibers of the
anterior talofibular ligament are repaired with new fibrous tissue A 54-year-old man was told by his physician to reduce his weight. He
was prescribed a diet and was advised to exercise more. One morning
while jogging, he heard a sharp snap and felt a sudden pain in his right
lower calf. On examination in the emergency department, the physician
noted that the upper part of the right calf was swollen and a gap was
apparent between the swelling and the heel. A diagnosis of rupture of the
right Achilles tendon was made.
The following statements concerning this patient are correct except which?
A) With the patient supine, gentle squeezing of the upper part of the right calf did not
produce plantar flexion of the ankle joint.
B) The Achilles tendon is the tendon of insertion of the gastrocnemius and soleus
muscles.
C) The Achilles tendon is inserted into the posterior surface of the talus.
D) Rupture of the Achilles tendon results in the bellies of the gastrocnemius and soleus
muscles retracting upward, leaving a gap between the divided ends of the tendon.
E) Normally, the gastrocnemius and soleus muscles are the main muscles responsible
for plantar flexion of the ankle joint. A 17-year-old girl was dealing drugs on a street corner when she became
involved in a fight. During the fight she received a deep knife wound to
the front of her right thigh. After a thorough examination in the
emergency department of the local hospital, it was determined that the
knife point had severed the trunk of the right femoral nerve just below
the inguinal ligament.
This patient had the following signs and symptoms except which?
A) The right quadriceps femoris muscle failed to contract when the
patient was asked to extend her right knee joint.
B) Skin sensation was lost over the anterior and medial sides of the
thigh.
C) Skin sensation was lost along the medial border of the big toe.
D) Skin sensation was lost on the lower part of the leg and the medial
border of the foot as far as the ball of the big toe. A 5-year-old girl is brought to the emergency department because of
fever and severe abdominal pain. Acute appendicitis is diagnosed. In the
examination room, she keeps her right hip flexed and resists active
extension of the hip.
The inflamed structure associated with these symptoms is most
likely in contact with which of the following structures?
A.
B.
C.
D.
Obturator internus muscle
Psoas major muscle
Quadratus lumborum muscle
Transversus abdominis muscle A 30-year-old man comes to the emergency department 1 hour after
injuring his left knee in a volleyball game. He says he twisted his left leg
when he fell to the floor after he and a teammate accidentally collided.
He cannot bear weight on his left leg. Physical examination shows
tenderness and swelling of the left knee. When the patient sits on the
edge of the examination table, the left knee can be displaced anteriorly at
an abnormal degree.
Which of the following is most likely injured in this patient?
A. Anterior cruciate ligament
B. Fibular collateral ligament
C. Meniscofemoral ligament
D. Oblique popliteal ligament
E. Transverse ligament of the knee 12-year-old boy is brought to the physician
by his mother because of a 1-month history
of pain below the left knee. His mother says,
"He can usually walk around, but he hasn't
been able to play in any of his soccer games
since this all began."
Examination of the left knee shows warmth,
swelling, and tenderness. An x-ray of the
knee is shown.
Which of the following structures is
attached to the abnormal anterior tibial
area?
(A) Anterior cruciate ligament
(B) Gastrocnemius muscle
(C) Patellar ligament
(D) Popliteus muscle
(E) Posterior cruciate ligament
(F) Soleus muscle Which muscle is able to produce flexion at the knee
joint more efficiently if the hip joint is in flexion at the
same time?
A. Semimembranosus
B. Rectus femoris
C. Hamstring part of adductor magnus
D. Sartorius
E. Short head of biceps femoris A 20-year-old patient cannot flex and medially rotate
the thigh while running and climbing. Which of the
following muscles is most likely damaged?
A.
B.
C.
D.
E.
Semimembranosus
Sartorius
Rectus femoris
Vastus intermedius
Tensor fasciae latae A 14-year-old boy is brought to the emergency department
after being hit with a baseball bat on the lateral side of his
leg immediately below the knee. He is unable to dorsiflex
his foot. Which of the following nerves is most likely
injured?
(A) Common fibular (peroneal)
(B) Femoral
(C) Obturator
(D) Sural
(E) Tibial
USMLE Approximately 70-85% of ankle sprains are inversion injuries.
The anterior talofibular ligament is one of the most commonly involved ligaments in
this type of sprain
The ligament usually injured in a hyper-inversion of the foot
(sprained ankle) is the:
A. Anterior tibiotalar
B. Posterior tibiotalar
C. Medial collateral (deltoid)
D. Lateral collateral A 21-year-old man was involved in a motorcycle
accident, resulting in destruction of the groove in the
lower surface of the cuboid bone. Which of the
following muscle tendons is most likely damaged?
(A) Flexor hallucis longus
(B) Fibularis brevis
(C) Fibularis longus
(D) Tibialis anterior
(E) Tibialis posterior A 55-year-old man comes to the physician because of a 2week history of recurrent, widespread blister formation.
Physical examination shows lesions that are most numerous in
the flexural areas including the axillae and groin. The blisters
do not break easily, and there are no oral lesions. These
blisters are most likely the result of adhesion failure involving
which of the following?
(A) Basement membrane
(B) Dermal papillae
(C) Langerhans cells
(D) Melanocytes
(E) Merkel cells
USMLE A 24-year-old man comes to the office
because of a 2-day history of a red,
itchy rash on his buttocks and legs.
Four days ago, he returned from a
cruise to the Caribbean, during which
he swam in the ship’s pool and used the
hot tub. He appears well. His vital
signs are within normal limits. Physical
examination shows the findings in the
photograph. The infectious agent
causing these findings most likely
began to proliferate in which of the
following locations?
(A) Apocrine gland
(B) Dermis
(C) Eccrine gland
(D) Hair follicle
(E) Sebaceous gland
USMLE
Clinical Notes on Lower Limb Anatomy
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