Cervical Fascia — MCQs
The fascia around the nerve bundle of the brachial plexus is derived from?
Which of the following is not a branch of the cervical plexus?
Which of the following statements about Sibson's fascia is correct?
What is the primary function of the superior cervical ganglion?
Which of the following layers are cut during fasciotomy ?
Joint involved in movement of head from left to right.
All of the following surgeries are done in SUI except
Which of the following structures is NOT pierced by the parotid duct?
Upward movement of the thyroid gland is prevented due to?
Abnormal regeneration of which nerve is the cause of crocodile tears?
Cervical Fascia Indian Medical PG Practice Questions and MCQs
Question 1: The fascia around the nerve bundle of the brachial plexus is derived from?
- A. Superficial cervical fascia
- B. Pretracheal fascia
- C. Investing layer
- D. Prevertebral fascia (Correct Answer)
Explanation: ***Prevertebral fascia*** - The **brachial plexus** and the subclavian artery emerge between the **anterior and middle scalene muscles**. - As they exit the neck, they become surrounded by a tubular sheath derived from the **prevertebral fascia**, forming the **axillary sheath**. *Pretracheal fascia* - This fascia surrounds the **trachea**, esophagus, thyroid gland, and infrahyoid muscles. - It lies anterior to the vertebral column and has no direct involvement in forming the sheath around the brachial plexus. *Investing layer* - The investing layer of deep cervical fascia encircles the entire neck, enclosing the **sternocleidomastoid** and **trapezius muscles**. - While it's a superficial layer of deep cervical fascia, it does not specifically form the immediate sheath around the brachial plexus. *Superficial cervical fascia* - This layer is synonymous with the **subcutaneous tissue** of the neck and contains the platysma muscle. - It is superficial to the deep cervical fascia layers and does not contribute to the fibrous sheath of the brachial plexus.
Question 2: Which of the following is not a branch of the cervical plexus?
- A. Suprascapular nerve (Correct Answer)
- B. Supraclavicular nerve
- C. Lesser occipital nerve
- D. Greater auricular nerve
Explanation: ***Suprascapular nerve*** - The **suprascapular nerve** originates from the **brachial plexus** (specifically the upper trunk), not the cervical plexus. - It primarily innervates the **supraspinatus** and **infraspinatus muscles**. *Lesser occipital nerve* - The **lesser occipital nerve** is a cutaneous branch of the **cervical plexus** (C2) that supplies the skin behind the ear. - It provides sensory innervation to the **scalp posterior to the auricle**. *Greater auricular nerve* - The **greater auricular nerve** is a branch of the **cervical plexus** (C2, C3) and provides sensory innervation to the skin over the parotid gland, mastoid process, and auricle. - It supplies sensation to the **external ear** and the **angle of the mandible**. *Supraclavicular nerve* - The **supraclavicular nerves** (C3, C4) are cutaneous branches of the **cervical plexus** that provide sensory innervation to the skin over the shoulder and upper chest. - They provide sensory innervation to the skin overlying the **clavicle** and the **pectoral region**.
Question 3: Which of the following statements about Sibson's fascia is correct?
- A. Part of scalenus anterior muscle
- B. Vessel pass above the fascia
- C. Covers apical part of lung (Correct Answer)
- D. Attached to the inner border of 2nd rib
Explanation: ***Covers apical part of lung*** - **Sibson's fascia**, also known as the **suprapleural membrane**, is a dense fascial layer that covers and reinforces the **apex of the lung** and pleura. - It protects the lung apex and helps to support structures in the **root of the neck**. *Part of scalenus anterior muscle* - Sibson's fascia is a **separate fascial structure** extending from the first rib to the C7 transverse process, and is not a part of the scalenus anterior muscle. - The **scalenus anterior muscle** is one of the muscles of the neck, and while anatomically related by proximity to the fascia, it is not structurally part of it. *Vessel pass above the fascia* - Key neurovascular structures like the **subclavian artery** and the **brachial plexus** pass *below* Sibson's fascia, as the fascia protects the lung apex. - The fascia acts as a barrier, separating the lung apex from the more superficial structures of the neck. *Attached to the inner border of 2nd rib* - Sibson's fascia is primarily attached to the **inner border of the first rib** and the transverse process of the seventh cervical vertebra. - Its attachment to the first rib is crucial for its supportive role over the lung apex.
Question 4: What is the primary function of the superior cervical ganglion?
- A. Is the largest cervical ganglion
- B. Supplies sympathetic fibers to the dilator pupillae muscle (Correct Answer)
- C. Deep petrosal nerve of pterygopalatine ganglion is derived from plexus around internal carotid artery
- D. Left superior cervical cardiac branch goes to deep cardiac plexus
Explanation: Supplies sympathetic fibers to the dilator pupillae muscle - The superior cervical ganglion is the primary source of postganglionic sympathetic fibers to the head and neck. - One of its key functions is providing sympathetic innervation to the dilator pupillae muscle [1] via the long ciliary nerves, causing mydriasis (pupil dilation) [2]. - This represents a clear physiological function of the ganglion in autonomic control of the eye. Is the largest cervical ganglion - While the superior cervical ganglion is indeed the largest of the three cervical sympathetic ganglia, this is an anatomical characteristic, not a function. - Size is a structural feature, not a physiological role. Left superior cervical cardiac branch goes to deep cardiac plexus - The superior cervical ganglion does contribute cardiac branches to the cardiac plexus for sympathetic innervation of the heart. - However, this describes an anatomical pathway rather than the primary function itself, and specifying "left" and "deep cardiac plexus" makes it overly specific rather than addressing overall function. Deep petrosal nerve of pterygopalatine ganglion is derived from plexus around internal carotid artery - The superior cervical ganglion does send postganglionic fibers forming a plexus around the internal carotid artery, which contributes to the deep petrosal nerve. - However, this is an anatomical derivation/pathway, not a functional description of what the ganglion does physiologically.
Question 5: Which of the following layers are cut during fasciotomy ?
- A. Skin
- B. Skin+subcutaneous tissue+Superficial fascia
- C. Skin+subcutaneous tissue+Superficial fascia+deep fascia (Correct Answer)
- D. Skin+subcutaneous tissue
Explanation: ***Skin+subcutaneous tissue+Superficial fascia+deep fascia*** - A **fasciotomy** is a surgical procedure to relieve **compartment syndrome** by releasing the **deep fascia** that constricts muscle compartments. - To access and incise the deep fascia, all overlying layers must be cut: **skin**, **subcutaneous tissue** (also called superficial fascia or hypodermis), and finally the **deep fascia** itself. - Note: "Superficial fascia" and "subcutaneous tissue" refer to the same anatomical layer, but both terms are listed here to reflect common clinical terminology. *Skin* - Cutting only the skin does not provide access to the deep fascia and cannot relieve compartment syndrome. - The skin is merely the outermost protective layer. *Skin+subcutaneous tissue* - While both these layers must be incised, stopping here leaves the **deep fascia** intact. - The deep fascia is the primary constricting structure in compartment syndrome and must be released. *Skin+subcutaneous tissue+Superficial fascia* - This option is anatomically redundant since superficial fascia and subcutaneous tissue are the same layer. - More importantly, this still does not include division of the **deep fascia**, which is essential for decompression in a true fasciotomy.
Question 6: Joint involved in movement of head from left to right.
- A. Atlanto axial (Correct Answer)
- B. Atlanto occipital
- C. C2- C3 Joint
- D. C3- C4 Joint
Explanation: ***Atlanto axial*** - The **atlantoaxial joint** is responsible for the **rotation of the head**, allowing for movements such as shaking the head "no." - This joint is a **pivot joint** formed between the atlas (C1 vertebra) and the axis (C2 vertebra), specifically the **dens** of the axis articulating with the anterior arch of the atlas. *Atlanto occipital* - The **atlanto-occipital joint** primarily facilitates **flexion and extension of the head** (nodding "yes" movement). - This joint connects the **atlas (C1)** to the **occipital bone** of the skull. *C2- C3 Joint* - The **C2-C3 joint** is a typical **intervertebral joint** in the cervical spine. - While it contributes to overall cervical spine mobility, it does not primarily mediate the **rotational movement** of the head. *C3- C4 Joint* - The **C3-C4 joint** is another **intervertebral joint** in the cervical spine. - Its main roles include some degree of **flexion, extension, and lateral bending**, but it is not the primary joint for head rotation.
Question 7: All of the following surgeries are done in SUI except
- A. Aldridge sling
- B. Shirodkar sling (Correct Answer)
- C. Kelly's stitch
- D. Marshall Marchetti Krantz
Explanation: ***Shirodkar sling*** - The **Shirodkar sling** procedure is primarily used for the treatment of **cervical incompetence** in pregnancy, not stress urinary incontinence (SUI). - It involves placing a **cerclage** (suture) around the cervix to reinforce it and prevent preterm birth. *Aldridge sling* - The **Aldridge sling** is a type of **pubovaginal sling**, which is a surgical procedure used to treat SUI. - It involves using a **fascial sling** (often autologous) to support the bladder neck and urethra, increasing outlet resistance. *Kelly's stitch* - **Kelly's stitch**, also known as the **Kelly plication**, is a historical procedure for SUI that involves approximating the **periurethral tissues** anterior to the urethra. - While less common today as a standalone procedure, it aimed to reinforce the bladder neck and improve urethral coaptation. *Marshall Marchetti Krantz* - The **Marshall-Marchetti-Krantz (MMK) procedure** is a well-established **retropubic urethropexy** used for SUI. - It involves suturing the **periurethral tissues** to the **pubic bone** to elevate and stabilize the bladder neck and proximal urethra.
Question 8: Which of the following structures is NOT pierced by the parotid duct?
- A. Buccopharyngeal fascia
- B. Buccinator muscle
- C. Buccal fat pad
- D. Investing layer of deep cervical fascia (Correct Answer)
Explanation: ***Investing layer of deep cervical fascia*** - The parotid duct (Stensen's duct) **does not pierce** the investing layer of the deep cervical fascia. - The investing layer **forms the capsule** of the parotid gland itself, and the duct **emerges from within** this fascial investment at the anterior border of the gland. - Since the duct originates from within the parotid gland (which is enclosed by the investing fascia), it does not pierce through this layer. *Buccopharyngeal fascia* - This is **also NOT pierced** by the parotid duct in its typical course. - The buccopharyngeal fascia covers the outer surface of the buccinator muscle and pharyngeal constrictors. - The parotid duct runs **superficial** to this fascial layer before piercing the buccinator muscle itself. - However, for exam purposes, the **investing layer of deep cervical fascia** is the most clearly established structure that is NOT pierced. *Buccinator muscle* - The parotid duct **definitively pierces** the buccinator muscle to reach the oral cavity. - It enters the oral vestibule **opposite the upper second molar tooth**. - This is a consistent anatomical landmark. *Buccal fat pad* - The parotid duct runs **lateral and superficial** to the buccal fat pad (Bichat's fat pad). - The duct does **not typically pierce through** the buccal fat pad; rather, it courses along its superficial surface. - The buccal fat pad lies deep to the buccinator muscle and provides cushioning in the cheek.
Question 9: Upward movement of the thyroid gland is prevented due to?
- A. Berry ligament (Correct Answer)
- B. Sternothyroid muscle
- C. Thyrohyoid membrane
- D. Pretracheal fascia
Explanation: ***Berry ligament*** - The **Berry ligament** (or suspensory ligament of Berry) firmly anchors the thyroid gland to the **trachea** and **cricoid cartilage** [1]. - This strong fibrous connection prevents the thyroid gland from moving upward, thus ensuring its stability [1]. *Sternothyroid muscle* - The **sternothyroid muscle** is an infrahyoid muscle that depresses the hyoid bone and larynx. - While it covers a portion of the thyroid gland, its primary function is **laryngeal movement**, not to prevent upward displacement of the thyroid. *Thyrohyoid membrane* - The **thyrohyoid membrane** connects the thyroid cartilage to the hyoid bone. - Its main role is to provide a broad attachment for muscles involved in **laryngeal elevation and depression**, not to stabilize the thyroid gland itself. *Pretracheal fascia* - The **pretracheal fascia** encloses the thyroid gland and creates a capsule around it, but it is not the primary structure preventing upward movement [2]. - It helps to contain the gland but does not provide the specific strong anatomical anchor that prevents its superior migration.
Question 10: Abnormal regeneration of which nerve is the cause of crocodile tears?
- A. Facial Nerve (Correct Answer)
- B. Glossopharyngeal Nerve
- C. Mandibular Nerve (V3)
- D. Vagus Nerve (CN X)
Explanation: Facial Nerve - **Crocodile tears**, or Bogorad's syndrome, result from aberrant regeneration of the **facial nerve (CN VII)** after injury, often occurring after Bell's palsy or trauma. - During regeneration, parasympathetic secretomotor fibers that should reinnervate salivary glands mistakenly regrow to innervate the **lacrimal gland**, leading to tearing (lacrimation) during salivation or eating. - The mechanism involves misdirected regeneration of fibers from the **greater petrosal nerve** or **chorda tympani** branches of CN VII. *Mandibular Nerve (V3)* - The mandibular nerve is a branch of the **trigeminal nerve (CN V)** and is primarily responsible for motor innervation to the muscles of mastication and sensory innervation to the lower face and mouth. - Its fibers are not involved in **lacrimal gland innervation** nor does its aberrant regeneration lead to crocodile tears. *Vagus Nerve (CN X)* - The vagus nerve is responsible for extensive innervation of the **visceral organs**, including the heart, lungs, and gastrointestinal tract, and plays a role in swallowing and speech. - It does not contain fibers that innervate the **lacrimal gland** or significantly contribute to facial gland secretion. *Glossopharyngeal Nerve* - The glossopharyngeal nerve (CN IX) primarily provides **sensory innervation** to the posterior tongue and pharynx, and motor innervation to the stylopharyngeus muscle. - It also carries parasympathetic fibers to the **parotid salivary gland**, but its aberrant regeneration does not cause lacrimation with salivation.
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