SBA — Single Best Answer · Review
Question 12
Anatomy → Abdominal wall
Classification
Question
SSBAQuestion Header
A woman with obesity and previous midline laparotomy requires an alternative site for Veress needle entry. Which location corresponds to Palmer's point?
Question Stem
A) Three centimetres below the left subcostal margin in the midclavicular line
B) Midway between the xiphoid process and umbilicus
C) Immediately infraumbilical in the midline
D) Two and a half centimetres medial to the left anterior superior iliac spine
E) Three centimetres below the right subcostal margin in the midclavicular line
B) Midway between the xiphoid process and umbilicus
C) Immediately infraumbilical in the midline
D) Two and a half centimetres medial to the left anterior superior iliac spine
E) Three centimetres below the right subcostal margin in the midclavicular line
Options
A
Three centimetres below the left subcostal margin in the midclavicular line
B
Midway between the xiphoid process and umbilicus
C
Immediately infraumbilical in the midline
D
Two and a half centimetres medial to the left anterior superior iliac spine
E
Three centimetres below the right subcostal margin in the midclavicular line
Explanation
Palmer's point is a left upper quadrant laparoscopic entry site located approximately 3 cm below the left subcostal margin in the midclavicular line. It particularly as an alternative entry site in patients with obesity and in those with previous laparotomy scars. This makes it clinically relevant when standard umbilical access may be less desirable. The Lee-Huang point is in the middle upper abdomen, midway between the xiphoid process and the umbilicus. The Jain point is paraumbilical on the left, defined in relation to a line medial to the anterior superior iliac spine. An infraumbilical site is a common location for primary entry but does not define Palmer's point.
Option Validity
B) This describes the Lee-Huang point rather than Palmer's point.
C) Infraumbilical access is a common primary entry location but is not Palmer's point.
D) This description relates to the Jain point rather than Palmer's point.
E) Palmer's point is specifically in the left, not right, upper quadrant.
Further Reading
Part 1 MRCOG Revision Notes and Sample SBAs. Cambridge University Press, 2020. Section 1: Anatomy, Chapter 1. https://doi.org/10.1017/9781108644396