Thorax: pericardiocentesis: practice question

A Anatomy question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anatomy · Thorax: pericardiocentesis

Sample item

A 30-year-old man with a stab wound to the chest has hypotension, raised jugular venous pressure and muffled heart sounds. Emergency pericardiocentesis is performed by the subxiphoid route. Which direction is the needle aimed?

AHorizontally backwards into the fourth left intercostal spaceBUpward and to the left, towards the left shoulderCDownwards through the central tendon of the diaphragmDUpward and to the right towards the right shoulder

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Upward and to the left, towards the left shoulder

In tamponade the pericardial sac is tapped at the left xiphocostal angle with the needle directed at about 45 degrees towards the left shoulder, which aims at the inferior pericardium where fluid collects while keeping clear of the pleura and the liver. Needle contact with the myocardium is detected by ST elevation on a monitored lead.

Option by option

A. Horizontally backwards into the fourth left intercostal space
Entry through the left fourth intercostal space risks the lung and the left internal thoracic and lateral vessels.
B. Upward and to the left, towards the left shoulder (correct)
Correct. The left shoulder direction reaches the pericardial cavity from below and avoids the lung and liver.
C. Downwards through the central tendon of the diaphragm
The central tendon lies below the pericardium; passing through it risks peritoneal and hepatic injury.
D. Upward and to the right towards the right shoulder
A rightward direction risks entering the right atrium or liver rather than the dependent pericardial fluid.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Anatomy question

What is the answer to this Anatomy question?

The best answer is B, Upward and to the left, towards the left shoulder. In tamponade the pericardial sac is tapped at the left xiphocostal angle with the needle directed at about 45 degrees towards the left shoulder, which aims at the inferior pericardium where fluid collects while keeping clear of the pleura and the liver.

Why is "Horizontally backwards into the fourth left intercostal space" not the answer?

Entry through the left fourth intercostal space risks the lung and the left internal thoracic and lateral vessels.

Why is "Downwards through the central tendon of the diaphragm" not the answer?

The central tendon lies below the pericardium; passing through it risks peritoneal and hepatic injury.

Why is "Upward and to the right towards the right shoulder" not the answer?

A rightward direction risks entering the right atrium or liver rather than the dependent pericardial fluid.

What concept does this question test?

It tests Thorax: pericardiocentesis in Anatomy. Needle contact with the myocardium is detected by ST elevation on a monitored lead.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Thorax: pericardiocentesis?

Learn every nerve by its route, its muscles and what a lesion looks like at the bedside. That one habit answers a large share of questions. Then use the flashcards and the other Anatomy questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.