Pericardium: pericardiocentesis approach: 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 · Pericardium: pericardiocentesis approach

Sample item

A 40-year-old man with a stab wound to the chest has hypotension, distended neck veins and muffled heart sounds, and is taken for emergency pericardiocentesis. Why is the subxiphoid approach, with the needle aimed towards the left shoulder, commonly preferred?

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

The answer and the reasoning

C. It reaches the pericardial sac through the left xiphocostal angle while avoiding the pleura and the internal thoracic vessels

The pericardial sac lies behind the left xiphocostal angle, where the pericardium is in contact with the diaphragm and is not covered by pleura. A needle passed upward and to the left, at a shallow angle, avoids the lungs and the internal thoracic artery that runs lateral to the sternum. Echocardiographic guidance is used when available.

Option by option

  • A. It passes through the right atrium, which lies directly beneath the xiphoid process

    The right atrium forms the right border of the heart and is not the target, since entering it would cause haemorrhage.

  • B. It enters the oblique sinus directly behind the left atrium

    The oblique sinus is a blind pocket behind the left atrium and cannot be reached from the front.

  • C. It reaches the pericardial sac through the left xiphocostal angle while avoiding the pleura and the internal thoracic vessels (correct)

    Correct. The angle provides access to the sac beneath the xiphoid without crossing pleura or the internal thoracic vessels.

  • D. It crosses the costodiaphragmatic recess, which lies in front of the pericardium

    The costodiaphragmatic recess is a pleural space at the lower chest wall, not part of the pericardial approach.

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.

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Questions about this Anatomy question

What is the answer to this Anatomy question?

The best answer is C, It reaches the pericardial sac through the left xiphocostal angle while avoiding the pleura and the internal thoracic vessels. The pericardial sac lies behind the left xiphocostal angle, where the pericardium is in contact with the diaphragm and is not covered by pleura.

Why is "It passes through the right atrium, which lies directly beneath the x…" not the answer?

The right atrium forms the right border of the heart and is not the target, since entering it would cause haemorrhage.

Why is "It enters the oblique sinus directly behind the left atrium" not the answer?

The oblique sinus is a blind pocket behind the left atrium and cannot be reached from the front.

Why is "It crosses the costodiaphragmatic recess, which lies in front of the…" not the answer?

The costodiaphragmatic recess is a pleural space at the lower chest wall, not part of the pericardial approach.

What concept does this question test?

It tests Pericardium: pericardiocentesis approach in Anatomy. A needle passed upward and to the left, at a shallow angle, avoids the lungs and the internal thoracic artery that runs lateral to the sternum. Echocardiographic guidance is used when available.

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 Pericardium: pericardiocentesis approach?

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.