Upper limb and brachial plexus: supraclavicular block: 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 · Upper limb and brachial plexus: supraclavicular block

Sample item

During a brachial plexus block with the needle directed behind the subclavian artery and above the first rib, the patient coughs and becomes breathless. Which structure was most likely punctured?

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

The answer and the reasoning

B. Cervical pleura and apex of the lung

At the supraclavicular level the trunks lie on the first rib behind the subclavian artery, in close relation to the cupola of the pleura. A needle that passes too deep can cause pneumothorax. This is why ultrasound guidance is used.

Option by option

  • A. Vertebral artery

    The vertebral artery lies deeper and more medial and is not close to the needle path.

  • B. Cervical pleura and apex of the lung (correct)

    Correct. The pleural dome lies just deep to the trunks, so pneumothorax is the risk.

  • C. Phrenic nerve

    Phrenic nerve palsy is a feature of the interscalene approach and does not cause cough with pleuritic breathlessness.

  • D. Recurrent laryngeal nerve

    The recurrent laryngeal nerve lies in the tracheo-oesophageal groove, away from this site.

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 B, Cervical pleura and apex of the lung. At the supraclavicular level the trunks lie on the first rib behind the subclavian artery, in close relation to the cupola of the pleura.

Why is "Vertebral artery" not the answer?

The vertebral artery lies deeper and more medial and is not close to the needle path.

Why is "Phrenic nerve" not the answer?

Phrenic nerve palsy is a feature of the interscalene approach and does not cause cough with pleuritic breathlessness.

Why is "Recurrent laryngeal nerve" not the answer?

The recurrent laryngeal nerve lies in the tracheo-oesophageal groove, away from this site.

What concept does this question test?

It tests Upper limb and brachial plexus: supraclavicular block in Anatomy. A needle that passes too deep can cause pneumothorax. This is why ultrasound guidance is used.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Upper limb and brachial plexus: supraclavicular block?

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.