Root of the Neck Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Root of the Neck. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Root of the Neck Indian Medical PG Question 1: The thyrocervical trunk is a branch of which part of subclavian artery?
- A. 1st part (Correct Answer)
- B. 2nd part
- C. 3rd part
- D. 4th part
Root of the Neck Explanation: ***1st part***
- The **thyrocervical trunk** is one of the three primary branches arising from the **first part** of the subclavian artery.
- The first part lies medial to the **anterior scalene muscle**.
*2nd part*
- The **second part** of the subclavian artery gives rise to the **costocervical trunk**.
- This part lies posterior to the **anterior scalene muscle**.
*3rd part*
- The **third part** of the subclavian artery typically has no branches or may give off the **dorsal scapular artery**.
- This part lies lateral to the **anterior scalene muscle**.
*4th part*
- This option is incorrect as the **subclavian artery has only three parts**, divided by their relationship to the anterior scalene muscle.
- There is no anatomical fourth part of the subclavian artery.
Root of the Neck Indian Medical PG Question 2: Superior sulcus tumor of the lungs characteristically presents with:
- A. Breathlessness
- B. Hemoptysis
- C. Pancoast syndrome (Correct Answer)
- D. Horner's syndrome
Root of the Neck Explanation: ***Pancoast syndrome***
- A **superior sulcus tumor**, specifically a Pancoast tumor, is defined by its characteristic presentation as **Pancoast syndrome**.
- This syndrome includes a constellation of symptoms resulting from the tumor's invasion of surrounding structures, such as the **brachial plexus**, **cervical sympathetic chain**, and **vertebral bodies**.
*Horner's syndrome*
- **Horner's syndrome** is a *component* of Pancoast syndrome, caused by the tumor's invasion of the **cervical sympathetic chain**.
- While it's a key feature, it doesn't encompass the entire clinical presentation of a superior sulcus tumor, which also includes shoulder and arm pain due to brachial plexus involvement.
*Breathlessness*
- **Shortness of breath** is a general symptom of many lung conditions, including central lung tumors [1], but it is **not characteristic** of a superior sulcus tumor's typical presentation.
- Superior sulcus tumors are located peripherally at the lung apex and often present with local invasive symptoms rather than respiratory distress unless very advanced [2].
*Hemoptysis*
- **Hemoptysis** (coughing up blood) is more commonly associated with tumors invading central airways or large vessels [1], but it is **not a characteristic initial presentation** of a superior sulcus tumor.
- The location of a superior sulcus tumor in the lung apex makes bleeding into the airways less likely as a primary symptom.
Root of the Neck Indian Medical PG Question 3: Which of the following structures is NOT innervated by the phrenic nerve?
- A. Diaphragm
- B. Mediastinal pleura
- C. Serratus anterior (Correct Answer)
- D. Pericardium
Root of the Neck Explanation: ***Serratus anterior***
- The **serratus anterior** muscle is innervated by the **long thoracic nerve (roots C5, C6, C7)**, not the phrenic nerve.
- Its primary actions are to protract and rotate the scapula, and it is crucial for overhead arm movements.
*Diaphragm*
- The **diaphragm** is primarily innervated by the **phrenic nerve (C3, C4, C5)**, which is essential for its role in respiration [1].
- Sensory fibers from the phrenic nerve also supply the central part of the diaphragm.
*Mediastinal pleura*
- The **mediastinal pleura**, which lines the mediastinum, receives sensory innervation from the **phrenic nerve**.
- Irritation of this pleura can cause referred pain to the shoulder, due to shared innervation origins.
*Pericardium*
- The **fibrous pericardium** and the **parietal layer of the serous pericardium** are innervated by the **phrenic nerves**.
- This innervation accounts for referred pain to the shoulder in conditions affecting the pericardium.
Root of the Neck Indian Medical PG Question 4: All of the following arteries are branches of ECA that supply nasal septum except:
- A. Facial artery
- B. Superior labial artery
- C. Anterior ethmoidal artery (Correct Answer)
- D. Sphenopalatine artery
Root of the Neck Explanation: ***Anterior ethmoidal artery***
- The **anterior ethmoidal artery** is a branch of the **ophthalmic artery**, which itself is a branch of the **internal carotid artery (ICA)**, not the external carotid artery (ECA).
- It supplies the **upper anterior nasal septum** and lateral wall of the nasal cavity.
*Facial artery*
- The **facial artery** is a direct branch of the **external carotid artery (ECA)**.
- It contributes to the blood supply of the nasal septum through its septal branches.
*Superior labial artery*
- The **superior labial artery** is a branch of the **facial artery**, meaning it indirectly originates from the **external carotid artery (ECA)**.
- It sends a septal branch to supply the **anterior inferior part of the nasal septum**.
*Sphenopalatine artery*
- The **sphenopalatine artery** is a direct terminal branch of the **maxillary artery**, which is one of the terminal branches of the **external carotid artery (ECA)**.
- It is the major blood supply to the **posterior nasal septum** and lateral wall, forming part of Kesselbach's plexus.
Root of the Neck Indian Medical PG Question 5: A patient has carcinoma on the right side of anterior 2/3rd of the tongue with lymph node of size 4cm in level 3 on the left side of the neck. Stage of the disease is
- A. N0
- B. N3
- C. N2 (Correct Answer)
- D. N1
Root of the Neck Explanation: ***N2 (Correct Answer)***
- The patient has a **contralateral lymph node** (left side neck node with right-sided primary tumor) measuring **4 cm**.
- According to TNM 8th edition, this classifies as **N2c**: bilateral or contralateral lymph nodes ≤6 cm without extranodal extension (ENE-).
- N2c is a subcategory of N2, making this the correct answer.
- The 4 cm size is within the N2 range (>3 cm but ≤6 cm) and the contralateral location specifically indicates N2c.
*N0 (Incorrect)*
- **N0** indicates no regional lymph node metastasis.
- This is clearly incorrect as the patient has a clinically evident 4 cm lymph node in level 3.
*N3 (Incorrect)*
- **N3a** requires a lymph node **>6 cm** in size, OR
- **N3b** requires evidence of **extranodal extension (ENE+)**.
- Since this node is 4 cm (not >6 cm) and there is no mention of extranodal extension, N3 is incorrect.
*N1 (Incorrect)*
- **N1** is defined as a single **ipsilateral** lymph node ≤3 cm without ENE.
- This patient fails N1 criteria on two counts: the node is **contralateral** (not ipsilateral) and measures **4 cm** (exceeds 3 cm limit).
Root of the Neck Indian Medical PG Question 6: All are true regarding brachial plexus injury, except:
- A. In Klumpke's palsy, Horner's syndrome may be present on the ipsilateral side
- B. Preganglionic lesions have a better prognosis than postganglionic lesions (Correct Answer)
- C. Erb's palsy causes paralysis of the abductors and external rotators of the shoulder
- D. Histamine test is useful to differentiate between the preganglionic and postganglionic lesions
Root of the Neck Explanation: ***Preganglionic lesions have a better prognosis than postganglionic lesions***
- **Preganglionic lesions** involve the avulsion of nerve roots from the spinal cord, making nerve regeneration and surgical repair more challenging, therefore resulting in a **worse prognosis**.
- In contrast, **postganglionic lesions** involve damage to the nerves distal to the dorsal root ganglion, which often allows for **spontaneous recovery** or more successful surgical intervention, leading to a better prognosis.
*In Klumpke's palsy, Horner's syndrome may be present on the ipsilateral side*
- **Klumpke's palsy** results from injury to the **lower trunk** of the brachial plexus (C8-T1), which can involve the sympathetic fibers that exit at T1.
- Damage to these fibers can lead to **Horner's syndrome** (miosis, ptosis, anhydrosis) on the ipsilateral side.
*Erb's palsy causes paralysis of the abductors and external rotators of the shoulder*
- **Erb's palsy** involves injury to the **upper trunk** of the brachial plexus (C5-C6), affecting muscles innervated by these roots.
- This results in paralysis of muscles such as the deltoid (abductor) and supraspinatus/infraspinatus (external rotators), leading to the characteristic "waiter's tip" posture.
*Histamine test is useful to differentiate between the preganglionic and postganglionic lesions*
- The **histamine test** (or histamine wheal test) is used to assess the integrity of peripheral unmyelinated postganglionic sympathetic fibers.
- If a wheal and flare reaction occurs, it suggests intact postganglionic fibers, indicating a **preganglionic lesion**; absence of a reaction suggests a **postganglionic lesion**.
Root of the Neck Indian Medical PG Question 7: Which of the following is NOT a feature of Horner's syndrome?
- A. Anhidrosis
- B. Enophthalmos
- C. Hyperchromatic iris (Correct Answer)
- D. Miosis
Root of the Neck Explanation: ***Hyperchromatic iris***
- The iris in Horner's syndrome typically presents as **heterochromia iridis**, where the affected eye's iris is **hypochromatic (lighter)** compared to the healthy eye due to reduced melanin synthesis from sympathetic denervation
- This occurs particularly with congenital or early-onset Horner's syndrome (before age 2 years)
- A **hyperchromatic (darker) iris is NOT a feature** of Horner's syndrome, making this the correct answer
*Anhidrosis*
- **Anhidrosis** (decreased sweating) on the affected side of the face and neck is a classic feature of Horner's syndrome
- Results from disruption of postganglionic sympathetic fibers supplying sweat glands in the ipsilateral facial and neck regions
- Pattern of anhidrosis helps localize the lesion (central, preganglionic, or postganglionic)
*Enophthalmos*
- **Mild enophthalmos** (sunken eyeball appearance) occurs in Horner's syndrome
- Due to paralysis of **Müller's muscle** (superior tarsal muscle), which normally helps maintain globe position
- Combined with ptosis, this creates the characteristic sunken appearance of the affected eye
*Miosis*
- **Miosis** (pupillary constriction) is a hallmark feature of Horner's syndrome
- Results from paralysis of the **iris dilator muscle** due to interrupted sympathetic innervation
- Leads to unopposed parasympathetic activity, causing the characteristic small pupil
- Dilation lag can be demonstrated with dim lighting or cocaine test
Root of the Neck Indian Medical PG Question 8: A patient presents with winging of the scapula. Which nerve is most likely involved?
- A. Thoracodorsal nerve
- B. Lateral pectoral nerve
- C. Long thoracic nerve (Correct Answer)
- D. Musculocutaneous nerve
Root of the Neck Explanation: ### Long thoracic nerve
- The long thoracic nerve innervates the **serratus anterior muscle**, which is responsible for scapular protraction and upward rotation.
- Damage to this nerve paralyzes the serratus anterior, leading to **winging of the scapula** as the medial border and inferior angle of the scapula become prominent.
### Thoracodorsal nerve
- This nerve supplies the **latissimus dorsi muscle**, which is involved in adduction, extension, and internal rotation of the humerus [1].
- Injury to the thoracodorsal nerve would weaken movements of the shoulder, but not directly cause **scapular winging**.
### Lateral pectoral nerve
- The lateral pectoral nerve innervates the **pectoralis major muscle** (upper and middle parts) [1].
- Damage to this nerve primarily affects shoulder adduction and internal rotation, but does not result in **scapular winging**.
### Musculocutaneous nerve
- This nerve innervates the **coracobrachialis**, **biceps brachii**, and **brachialis muscles** in the anterior compartment of the arm.
- Injury to the musculocutaneous nerve would impair elbow flexion and forearm supination, and is unrelated to **scapular movement**.
Root of the Neck Indian Medical PG Question 9: The internal thoracic artery is a branch of which vessel?
- A. Arch of aorta
- B. Subclavian artery (Correct Answer)
- C. Superior epigastric artery
- D. Thyrocervical trunk
Root of the Neck Explanation: Subclavian artery
- The internal thoracic artery (also known as the internal mammary artery) is a direct branch of the first part of the subclavian artery.
- It descends into the chest and supplies the anterior chest wall, breasts, and contributes to the supply of the diaphragm.
Arch of aorta
- The arch of the aorta gives off major branches such as the brachiocephalic trunk, left common carotid artery, and left subclavian artery.
- While the subclavian artery originates from the arch (or the brachiocephalic trunk on the right), the internal thoracic artery is a more distal branch off the subclavian itself, not directly off the arch.
Superior epigastric artery
- The superior epigastric artery is actually one of the two terminal branches of the internal thoracic artery, indicating it is a distal continuation, not its origin [1].
- It descends into the rectus sheath to anastomose with the inferior epigastric artery [1].
Thyrocervical trunk
- The thyrocervical trunk is a short, thick artery that arises from the first part of the subclavian artery.
- Its branches (inferior thyroid, superficial cervical, and suprascapular arteries) primarily supply structures in the neck and shoulder, not the internal thoracic artery.
Root of the Neck Indian Medical PG Question 10: Which structure is most likely injured in a 25-year-old man with a bullet wound in the neck, resulting in a tension pneumothorax and collapse of the right lung?
- A. Costal pleura
- B. Cupula (Correct Answer)
- C. Right mainstem bronchus
- D. Right upper lobe bronchus
Root of the Neck Explanation: ***Cupula***
- The **cupula** (or cervical pleura) extends into the root of the neck, superior to the first rib, making it vulnerable to neck injuries [1].
- A penetrating injury to this region can directly damage the pleura, leading to **pneumothorax** and subsequent lung collapse [1].
*Costal pleura*
- The **costal pleura** lines the inner surface of the thoracic wall and would primarily be affected by injuries directly to the chest wall, not the neck [1].
- Injury to this part of the pleura is less likely to result from a **neck wound** causing a pneumothorax unless the wound extended significantly downwards.
*Right mainstem bronchus*
- The **right mainstem bronchus** is located deep within the mediastinum and would typically require a much deeper and more centrally located injury to be affected.
- While mainstem bronchial injuries can cause **pneumothorax**, a bullet wound in the neck is less likely to reach this structure without causing more extensive mediastinal damage.
*Right upper lobe bronchus*
- The **right upper lobe bronchus** is also situated within the mediastinum, deep to the pleura and lung parenchyma.
- An isolated injury to this bronchus from a neck wound is unlikely; simpler, more superficial structures like the **cupula** are more probable targets.
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