Intercostal Neurovascular Bundle — FRCA Primary MCQ
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Correct answer: E — Vein, artery, nerve
Explanation lettering: C = shown as B · B = shown as C · E = shown as D · D = shown as E
The correct answer is D: vein, artery, nerve. The main intercostal neurovascular bundle follows the inferior border of the rib within the costal groove, between the internal and innermost intercostal muscle layers. Its superior-to-inferior arrangement is remembered as VAN. Options A and B incorrectly place the artery superior to the vein, while C and E incorrectly place the intercostal nerve uppermost; the nerve is normally the most inferior component of the main bundle. This relationship is clinically relevant when traversing an intercostal space because the principal bundle is concentrated near the inferior border of the rib above, although smaller collateral branches and anatomical variation may also be present.
Reference: Severn NHS Deanery, Core Training: Clinical Anatomy and Physiology — Thoracic Walls and Lungs, 2012, https://surgery.severndeanery.nhs.uk/assets/Surgery/Events/thorax-spine-objectives.pdf