FMGE 2019 — Surgery

Q: A 45-year-old policeman presents with pain in the right leg after duty. On examination, the pulse in the right popliteal fossa is absent, and there is pain in the right buttock. The left side is normal. At which level is the blockage?

Iliac. ***Iliac*** - Pain in the **right buttock** suggests a blockage in the **internal iliac artery** or its branches, which supply the gluteal muscles. - The absence of a pulse in the right **popliteal fossa** indicates significant arterial obstruction proximal to this level, consistent with an iliac artery lesion. *Popliteal* - A popliteal blockage would primarily cause symptoms below the knee, and would not explain **buttock pain**. - A popliteal pulse would be absent, but pulses proximal to the popliteal artery (like femoral) would generally be present. *Aortoiliac* - A blockage at the **aortoiliac** level might affect both legs or cause more widespread symptoms, but the description specifies the right leg. - While buttock pain can occur in aortoiliac occlusion, it often presents with bilateral claudication or erectile dysfunction (Leriche syndrome), which are not mentioned here. *Femoral* - A femoral blockage would cause symptoms in the thigh and calf, and would not explain **buttock pain** due to the collateral circulation. - The **femoral pulse** would be absent, but the pain distribution doesn't directly point to an isolated femoral lesion as the primary cause of buttock pain.

21 Questions — Page 3 of 3

Q21

A 45-year-old policeman presents with pain in the right leg after duty. On examination, the pulse in the right popliteal fossa is absent, and there is pain in the right buttock. The left side is normal. At which level is the blockage?