Neck Practice Questions

Q: Which of the following muscle is not innervated by the nerve shown in the image?

Thyrohyoid. ***Thyrohyoid*** - The **thyrohyoid muscle** is unique among the infrahyoid muscles as it is innervated directly by the **hypoglossal nerve (CN XII)** via a branch that contains fibers from the **C1 spinal nerve**. - Unlike the other infrahyoid muscles, which receive innervation from the **ansa cervicalis** (C1-C3), the thyrohyoid receives its motor supply independently via the hypoglossal nerve pathway. *Omohyoid* - The **omohyoid muscle** (both superior and inferior bellies) is innervated by the **ansa cervicalis**. - It belongs to the group of infrahyoid muscles responsible for depressing the hyoid bone during swallowing and speech. *Sternohyoid* - The **sternohyoid muscle** is a superficial infrahyoid muscle innervated by the **ansa cervicalis**. - It works to depress the hyoid bone, helping to stabilize it during activities such as speaking and deglutition. *Sternothyroid* - The **sternothyroid muscle** is an infrahyoid muscle that is also innervated by the **ansa cervicalis**. - It serves to depress the larynx (thyroid cartilage) following elevation during the act of swallowing.

Q: A neonate is noted at birth to have a small jaw, cleft palate, and glossoptosis causing airway obstruction. A clinical geneticist suspects a defect in neural crest cell migration into a specific pharyngeal arch during the fourth week of embryonic development. The cartilaginous element of the affected arch that normally forms two specific middle ear ossicles is which of the following?

A. Meckel's cartilage, giving rise to the malleus and incus. ***A. Meckel's cartilage, giving rise to the malleus and incus*** - The clinical triad of **micrognathia** (small jaw), **glossoptosis**, and **cleft palate** defines **Pierre Robin sequence**, which results from a defect in the **first pharyngeal arch**. - **Meckel's cartilage** is the cartilaginous component of the first arch, and its proximal parts ossify to form the **malleus** and **incus** of the middle ear. *B. Reichert's cartilage, giving rise to the stapes and styloid process* - This cartilage is derived from the **second pharyngeal arch** (hyoid arch) and gives rise to the **stapes**, styloid process, and lesser horn of the hyoid. - Defects in the second arch would not result in the mandibular hypoplasia (micrognathia) or palatal defects seen in this patient. *C. The hyoid cartilage, giving rise to the body and lesser horns of the hyoid* - The **lesser horn** and upper part of the hyoid body come from the **second arch**, while the **greater horn** and lower body come from the **third arch**. - While the hyoid is associated with upper airway support, it is not the primary structure involved in the skeletal defects of **Pierre Robin sequence**. *D. The ala temporalis cartilage, giving rise to the greater wing of the sphenoid* - The **ala temporalis** contributes to the formation of the **greater wing of the sphenoid** via endochondral ossification. - It is a part of the neurocranium/chondrocranium and does not form the middle ear ossicles or the primary elements of the **first pharyngeal arch**.

Q: Level III neck nodes are located in which region?

Around the middle one-third of the internal jugular vein. The cervical lymph nodes are classified into levels (I–VII) based on their anatomical relationship to specific landmarks, primarily the Sternocleidomastoid (SCM) muscle and the Internal Jugular Vein (IJV) [2]. **Level III (Middle Deep Cervical Nodes)** refers to the lymph nodes located around the **middle one-third of the internal jugular vein**. Its boundaries are: * **Superior:** The horizontal plane of the hyoid bone [2]. * **Inferior:** The horizontal plane of the lower border of the cricoid cartilage. * **Anterior:** The lateral border of the sternohyoid muscle. * **Posterior:** The posterior border of the SCM muscle. **Analysis of Incorrect Options:** * **A. Submental triangle:** This corresponds to **Level IA**. Level IB refers to the submandibular triangle. * **B. Posterior triangle:** This corresponds to **Level V**, bounded by the posterior border of the SCM, the anterior border of the trapezius, and the clavicle. * **C. Midline from hyoid to suprasternal notch:** This corresponds to **Level VI** (Anterior compartment nodes), which includes the pre-tracheal, para-tracheal, and precricoid (Delphian) nodes [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Level II:** Upper deep cervical nodes (Hyoid to Skull base). Contains the **Jugulodigastric node**, which is the main node for the palatine tonsil. * **Level III:** Contains the **Jugulo-omohyoid node**, often involved in cancers of the tongue and larynx. * **Level IV:** Lower deep cervical nodes (Cricoid to Clavicle). * **Virchow’s Node:** Located in the left supraclavicular fossa (part of Level V), often the first sign of gastric malignancy (Troisier’s sign). * **Surgical Landmark:** The **Omohyoid muscle** (superior belly) crosses the IJV and serves as a landmark separating Level III from Level IV.

Q: A 10-year-old child suddenly choked while consuming food. After a failed Valsalva's maneuver, a needle cricothyrotomy was performed. Into which of the following regions would this procedure open?

Infraglottic cavity. **Explanation:** The **cricothyroid membrane** (conus elasticus) is located between the lower border of the thyroid cartilage and the upper border of the cricoid cartilage. A needle cricothyrotomy involves piercing this membrane to establish an emergency airway. **1. Why the Infraglottic Cavity is Correct:** The interior of the larynx is divided into three parts by the vestibular and vocal folds. The **infraglottic cavity** (subglottis) is the lowermost part, extending from the vocal folds to the lower border of the cricoid cartilage (where it becomes continuous with the trachea). Since the cricothyroid membrane lies immediately below the vocal folds, any instrument piercing it enters directly into the infraglottic cavity. **2. Analysis of Incorrect Options:** * **Rima Glottidis:** This is the narrow triangular fissure between the two vocal folds. It is the boundary between the upper and lower respiratory tracts, not a cavity itself. * **Laryngeal Vestibule:** This is the upper part of the laryngeal cavity, located between the laryngeal inlet and the vestibular folds (false vocal cords). It is situated well above the cricothyroid membrane. * **Laryngeal Ventricle:** Also known as the sinus of the larynx, this is a small lateral recess between the vestibular fold (above) and the vocal fold (below). It is superior to the site of a cricothyrotomy. **Clinical Pearls for NEET-PG:** * **Emergency Airway:** Cricothyrotomy is preferred over tracheostomy in acute emergencies because the cricothyroid membrane is subcutaneous, easily palpable, and relatively avascular. * **Landmark:** The cricoid cartilage is the only complete cartilaginous ring in the airway and corresponds to the **C6 vertebral level**. * **Safety:** The procedure is performed below the vocal cords, thus avoiding damage to the vocal apparatus if performed correctly.

Question 1

Which of the following muscle is not innervated by the nerve shown in the image?

Accepted Answer

Thyrohyoid

Answer

Omohyoid

Answer

Sternohyoid

Answer

Sternothyroid

Question 2

A neonate is noted at birth to have a small jaw, cleft palate, and glossoptosis causing airway obstruction. A clinical geneticist suspects a defect in neural crest cell migration into a specific pharyngeal arch during the fourth week of embryonic development. The cartilaginous element of the affected arch that normally forms two specific middle ear ossicles is which of the following?

Accepted Answer

A. Meckel's cartilage, giving rise to the malleus and incus

Answer

B. Reichert's cartilage, giving rise to the stapes and styloid process

Answer

C. The hyoid cartilage, giving rise to the body and lesser horns of the hyoid

Answer

D. The ala temporalis cartilage, giving rise to the greater wing of the sphenoid

Question 3

Contents of the suboccipital triangle are formed by all of the following structures, EXCEPT?

Accepted Answer

Lesser occipital nerve

Answer

Vertebral artery

Answer

Suboccipital nerve

Answer

Greater occipital nerve

Question 4

Level III neck nodes are located in which region?

Accepted Answer

Around the middle one-third of the internal jugular vein

Answer

Submental triangle

Answer

Posterior triangle

Answer

Midline from hyoid to suprasternal notch

Question 5

A 10-year-old child suddenly choked while consuming food. After a failed Valsalva's maneuver, a needle cricothyrotomy was performed. Into which of the following regions would this procedure open?

Accepted Answer

Infraglottic cavity

Answer

Rima glottidis

Answer

Laryngeal vestibule

Answer

Laryngeal ventricle

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