Surgical Approaches to the Neck Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Surgical Approaches to the Neck. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Surgical Approaches to the Neck Indian Medical PG Question 1: Which muscle divides the neck into anterior and posterior triangles?
- A. Platysma
- B. Digastric
- C. Trapezius
- D. Sternocleidomastoid (Correct Answer)
Surgical Approaches to the Neck Explanation: ***Sternocleidomastoid***
- The **sternocleidomastoid muscle** runs obliquely across the neck from the mastoid process to the sternum and clavicle.
- It serves as a crucial anatomical landmark, dividing the neck into the **anterior** and **posterior triangles**.
*Platysma*
- The **platysma** is a superficial muscle of facial expression located in the subcutaneous tissue of the neck.
- It does not divide the neck into major anatomical triangles but rather covers the anterior and lateral aspects of the neck.
*Digastric*
- The **digastric muscle** is a suprahyoid muscle located in the anterior neck region.
- It aids in jaw depression and elevation of the hyoid bone, but it is not responsible for dividing the neck into its main triangles.
*Trapezius*
- The **trapezius muscle** is a broad, flat muscle located in the posterior neck and upper back.
- While it forms the posterior boundary of the posterior triangle, it does not divide the neck into anterior and posterior triangles itself.
Surgical Approaches to the Neck Indian Medical PG Question 2: What is the name of this technique for palpation of thyroid where a thumb is placed on the lateral side of trachea and patient is swallowing?
- A. Pizzilo method
- B. Lahey's method
- C. Crile method (Correct Answer)
- D. Kocher's test
Surgical Approaches to the Neck Explanation: Crile method
- The Crile method for thyroid palpation involves placing a thumb on one side of the trachea and gently pushing the thyroid lobe to the opposite side to better assess it during swallowing.
- This technique helps to stabilize the gland and makes it easier to feel for nodules or enlargement.
Pizzilo method
- There is no widely recognized or standardized thyroid palpation technique called the Pizzilo method in medical literature.
- This term is therefore incorrect in the context of thyroid examination.
Lahey's method
- Lahey's method for thyroid examination involves standing behind the patient and palpating the thyroid gland as the patient swallows, using both hands [1].
- It differs from the Crile method by typically using both hands from behind the patient, rather than focusing on a single thumb on the lateral side of the trachea [1].
Kocher's test
- Kocher's test is primarily used to assess for exophthalmos in patients with Graves' disease, by observing the involuntary retraction of the upper eyelid when gazing downwards.
- It is not a technique for the palpation of the thyroid gland itself.
Surgical Approaches to the Neck Indian Medical PG Question 3: Post operative parotitis is caused by -
- A. E.coli
- B. Streptococcus
- C. Pneumococcus
- D. Staph aureus (Correct Answer)
Surgical Approaches to the Neck Explanation: ***Staph aureus***
- **Staphylococcus aureus** is the most common cause of **acute suppurative (post-operative) parotitis**
- Post-surgical conditions including **dehydration**, **poor oral hygiene**, **reduced salivary flow**, and **immunosuppression** facilitate **bacterial ascension** through Stensen's duct from the oral cavity
- The bacterium proliferates in stagnant saliva, causing acute infection of the parotid gland
*E.coli*
- **Escherichia coli** is primarily associated with **gastrointestinal and urinary tract infections**
- Rarely implicated in salivary gland infections and not a typical cause of post-operative parotitis
*Streptococcus*
- While **Streptococcal species** can cause various infections, they are less commonly associated with **acute bacterial parotitis** compared to **Staphylococcus aureus**
- May occasionally cause parotitis but not the predominant organism in post-operative settings
*Pneumococcus*
- **Streptococcus pneumoniae** commonly causes **pneumonia, meningitis, and otitis media**
- Rarely causes **acute suppurative parotitis** and is not typically associated with post-operative parotitis
- When sialadenitis occurs, it usually affects different patient populations
Surgical Approaches to the Neck Indian Medical PG Question 4: One of the most important complication of tracheostomy is:
- A. Hemorrhage
- B. Surgical emphysema
- C. Displacement of tube (Correct Answer)
- D. Recurrent laryngeal nerve palsy
Surgical Approaches to the Neck Explanation: ***Displacement of tube***
- **Accidental decannulation** or displacement of the tracheostomy tube is considered one of the most serious and common complications, particularly in the immediate post-operative period.
- This can lead to **loss of airway**, requiring immediate intervention to prevent severe hypoxia and potential brain injury or death.
*Hemorrhage*
- While hemorrhage can occur during or after tracheostomy, it is often a concern during the procedure or in the immediate postoperative period and is usually managed effectively.
- Significant, life-threatening hemorrhage such as **tracheo-innominate fistula** is a rare but severe complication.
*Surgical emphysema*
- Surgical emphysema (subcutaneous emphysema) is a relatively common but usually benign complication that occurs when air leaks from the trachea into the subcutaneous tissues.
- It typically resolves spontaneously and rarely poses a direct threat to the airway unless severe and rapidly progressive.
*Recurrent laryngeal nerve palsy*
- **Recurrent laryngeal nerve injury** is a rare complication of tracheostomy, as the nerve is usually well clear of the incision site in the neck.
- While it can cause hoarseness or vocal cord paralysis, it typically does not present an immediate life-threatening situation or emergency comparable to airway compromise.
Surgical Approaches to the Neck Indian Medical PG Question 5: Which anatomical structure is most commonly the target of incisions during major gynecological surgical procedures?
- A. Ovary
- B. Cervix
- C. Fallopian tube
- D. Uterus (Correct Answer)
Surgical Approaches to the Neck Explanation: ***Uterus***
- The **uterus** is the primary anatomical target for many major gynecological procedures, such as **hysterectomy** (removal of the uterus) and **myomectomy** (removal of fibroids from the uterus).
- These are among the most commonly performed major gynecological surgeries, making the uterus the most frequent target for incisions in gynecological practice.
- In obstetric procedures, the uterus is also incised during **cesarean sections**, highlighting its central role in both obstetric and gynecologic surgery.
*Ovary*
- While ovaries are involved in gynecological surgery (e.g., **oophorectomy**, cystectomy), they are not as frequently the *primary* target for incisions as the uterus in the context of major procedures.
- Ovarian surgeries are often performed for **cysts**, **tumors**, or in conjunction with hysterectomy, but are less common than uterine procedures.
- Many ovarian procedures can be managed laparoscopically without major incisions.
*Cervix*
- The **cervix** is incised in procedures like **trachelectomy** for cervical cancer or during specific cervical cerclage procedures, but these are less frequent compared to surgeries involving the uterine body itself.
- Many cervical procedures are considered minor (e.g., LEEP, cone biopsy) or are part of a larger uterine surgery.
*Fallopian tube*
- The **fallopian tubes** are primarily targeted for procedures like **salpingectomy** (removal of the tube, often for ectopic pregnancy or sterilization) or salpingostomy.
- While significant, these procedures are generally less common than those involving the uterus and overall less frequently associated with major incisions compared to uterine procedures.
Surgical Approaches to the Neck Indian Medical PG Question 6: Shrugging of shoulder following neck surgery is due to injury to:
- A. Vagus nerve
- B. Spinal accessory nerve (Correct Answer)
- C. Thoracodorsal nerve
- D. Bell's nerve
Surgical Approaches to the Neck Explanation: Spinal accessory nerve
- Injury to the spinal accessory nerve (cranial nerve XI) can lead to weakness or paralysis of the trapezius muscle, which is responsible for shrugging the shoulder.
- Due to its superficial course in the posterior cervical triangle, it is vulnerable to iatrogenic injury during neck surgery, lymph node biopsies, or neck dissections.
Thoracodorsal nerve
- The thoracodorsal nerve innervates the latissimus dorsi muscle, which is involved in adduction, extension, and internal rotation of the arm [1].
- Injury to this nerve would primarily affect these arm movements, not shoulder shrugging.
Bell's nerve
- This term is often used to refer to the long thoracic nerve (nerve to serratus anterior).
- Injury to the long thoracic nerve leads to scapular winging due to serratus anterior paralysis, but not directly to impaired shoulder shrugging.
Vagus nerve
- The vagus nerve (cranial nerve X) has widespread functions including innervation of the pharynx, larynx, and thoracic/abdominal viscera.
- Injury to the vagus nerve typically causes symptoms like dysphagia, hoarseness, or autonomic dysfunction, unrelated to shoulder movement.
Surgical Approaches to the Neck Indian Medical PG Question 7: Surgical neck fracture leads to all EXCEPT
- A. Deltoid muscle palsy
- B. Weakness of abduction
- C. Teres minor palsy
- D. Teres major palsy (Correct Answer)
Surgical Approaches to the Neck Explanation: ***Teres major palsy***
- The **teres major** muscle is innervated by the **lower subscapular nerve** (C5-C7).
- A surgical neck fracture of the humerus typically injures the **axillary nerve**, which does not innervate the teres major.
*Deltoid muscle palsy*
- The **axillary nerve**, which innervates the **deltoid muscle**, is commonly injured in a surgical neck fracture due to its proximity.
- Injury to the axillary nerve would result in **deltoid muscle palsy**, leading to weakness in shoulder abduction and external rotation.
*Weakness of abduction*
- The **deltoid muscle** is the primary abductor of the arm after the initial 15 degrees, and it is innervated by the **axillary nerve**.
- A surgical neck fracture carries a high risk of **axillary nerve injury**, compromising deltoid function and causing significant weakness in abduction.
*Teres minor palsy*
- The **teres minor muscle** is innervated by the **axillary nerve**, which is vulnerable in surgical neck fractures.
- Palsy of the teres minor would impair **external rotation** of the shoulder.
Surgical Approaches to the Neck Indian Medical PG Question 8: Treatment of resectable T4N0M0 stage of head and neck carcinoma is?
- A. Radiotherapy alone
- B. Surgery and Radiotherapy (Correct Answer)
- C. Chemoradiation
- D. Surgery alone
Surgical Approaches to the Neck Explanation: ***Surgery and Radiotherapy***
- For **resectable T4N0M0 head and neck carcinoma**, the standard treatment is **surgical resection** of the primary tumor followed by **adjuvant radiotherapy**.
- This approach achieves optimal **local control** for advanced primary tumors without nodal involvement.
- **Adjuvant radiotherapy** is essential for T4 tumors due to high risk of microscopic residual disease and local recurrence.
- Surgery allows for complete tumor removal with negative margins, while radiotherapy addresses subclinical disease.
*Radiotherapy alone*
- Radiotherapy alone is **insufficient as monotherapy** for T4 tumors due to the large tumor burden and extensive local invasion.
- Single modality radiation cannot reliably achieve adequate tumor control for advanced primary lesions.
- Generally reserved for early-stage disease or patients unfit for surgery.
*Chemoradiation*
- **Definitive chemoradiation** is an alternative for **unresectable T4 tumors** or when organ preservation is desired (e.g., laryngeal cancer).
- For **resectable** T4N0M0 disease, surgery with adjuvant RT is preferred as it provides better local control and allows pathological staging.
- Chemoradiation may be used postoperatively if high-risk features are found (positive margins, perineural invasion, extranodal extension).
- In this **N0 case with resectable tumor**, upfront surgery is the preferred initial approach.
*Surgery alone*
- While surgical resection is crucial for T4 tumors, **surgery alone is inadequate** due to high risk of locoregional recurrence.
- T4 classification indicates extensive local invasion, necessitating **adjuvant radiotherapy** to eradicate microscopic disease.
- Combined modality treatment (surgery + RT) significantly improves local control and survival compared to surgery alone.
Surgical Approaches to the Neck Indian Medical PG Question 9: Supraomohyoid dissection is a type of?
- A. Selective neck dissection (Correct Answer)
- B. Modified radical neck dissection
- C. Radical neck dissection
- D. Posterolateral dissection
Surgical Approaches to the Neck Explanation: ***Selective neck dissection***
- **Supraomohyoid dissection** specifically refers to a type of selective neck dissection, characterized by the removal of lymph node levels **I, II, and III**.
- This procedure is commonly performed for early-stage oral cavity cancers due to their typical lymphatic spread patterns.
*Modified radical neck dissection*
- This dissection preserves one or more **non-lymphatic structures** (e.g., sternocleidomastoid muscle, internal jugular vein, spinal accessory nerve) that are typically removed in a radical neck dissection.
- It involves a broader range of lymph node levels (typically **I-V**) compared to a supraomohyoid dissection.
*Radical neck dissection*
- This is a more extensive procedure involving the removal of all lymph node groups (levels **I-V**), along with the **sternocleidomastoid muscle**, **internal jugular vein**, and **spinal accessory nerve**.
- It is reserved for advanced neck disease due to its significant morbidity.
*Posterolateral dissection*
- **Posterolateral neck dissection** is a term not commonly used within the standard classification of neck dissections (radical, modified radical, selective).
- Lymphatic dissection is typically categorized based on anatomical levels rather than a general directional term like posterolateral.
Surgical Approaches to the Neck Indian Medical PG Question 10: Which of the following statements is true about branchial cysts?
- A. Branchial cysts are more common in males than females.
- B. They mostly arise from the second branchial cleft. (Correct Answer)
- C. Surgical intervention is not always necessary.
- D. They can cause dysphagia and hoarseness if infected.
Surgical Approaches to the Neck Explanation: ***They mostly arise from the second branchial cleft.***
- **Second branchial cleft cysts** are the most common type, accounting for approximately **95%** of all branchial anomalies.
- They typically present as a smooth, fluctuant mass along the **anterior border of the sternocleidomastoid muscle** at the junction of the upper and middle third of the neck.
- These cysts result from **incomplete obliteration** of the second branchial cleft during embryonic development.
*Branchial cysts are more common in males than females.*
- Branchial cysts have **no significant sex predilection**, affecting males and females with roughly equal frequency.
- The overall incidence is relatively rare, with most cases presenting in late childhood or early adulthood.
*Surgical intervention is not always necessary.*
- **Complete surgical excision** is the **definitive treatment** and is strongly recommended for all branchial cysts.
- Indications for surgery include: prevention of **recurrent infections**, risk of **abscess formation**, elimination of cosmetic concerns, and removal due to potential (though rare) **malignant transformation**.
- While very small asymptomatic cysts may occasionally be observed, this carries significant risk of future complications, making surgery the standard of care in clinical practice.
*They can cause dysphagia and hoarseness if infected.*
- While an **infected branchial cyst** causes local inflammatory signs (pain, swelling, warmth, erythema), it **rarely causes dysphagia or hoarseness** unless exceptionally large.
- These symptoms would require the cyst to compress the **pharynx** (dysphagia) or involve the **recurrent laryngeal nerve** (hoarseness), which is uncommon even with infection.
- The primary presentation of infected cysts includes **tender neck mass** with overlying skin changes and possible **abscess formation**.
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