Tracheal Bifurcation — FRCA Primary MCQ

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EasyAnatomyTracheal BifurcationFRCA Primary

In an adult at end-expiration, the tracheal bifurcation (carina) is classically located at which vertebral level?

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Correct answer: C — T4–T5 intervertebral disc

The correct answer is C. At end-expiration, the trachea classically bifurcates at the carina at the T4–T5 intervertebral disc, corresponding approximately to the transverse thoracic plane through the sternal angle. Its position is not fixed: caudal movement during inspiration can bring the carina down towards T6. This makes T6 a plausible distractor if the respiratory phase is not specified. T5–T6 is also too caudal for the standard end-expiratory landmark, whereas T3–T4 and T2–T3 are too cephalad. Specifying end-expiration is therefore necessary for a uniquely answerable anatomy question.

Reference: Royal College of Anaesthetists. Guide to the FRCA Examination—The Final, Fourth Edition, SOE 1 Answers: anatomy relevant to percutaneous tracheostomy. January 2020. https://www.rcoa.ac.uk/media/49226