Neck — MCQs

Neck Indian Medical PG Practice Questions and MCQs

Question 131: What is the correct description of the vertebral artery?

A. Arises from the first part of the subclavian artery, posterior to the scalenus anterior.
B. Lies posterior to the inferior thyroid artery.
C. Passes through the C6 foramen transversarium. (Correct Answer)
D. Passes posterior to the lateral mass of the atlas and then enters the foramen magnum.

Explanation: ### Explanation The vertebral artery is a vital branch of the **first part of the subclavian artery**. It is traditionally divided into four segments (V1–V4). **Why Option C is Correct:** The vertebral artery (V1 segment) ascends and enters the **foramen transversarium of the C6 vertebra**. It then continues superiorly through the foramina of C5 to C1. Crucially, it **bypasses the C7 foramen transversarium**, which usually only contains small accessory vertebral veins. **Analysis of Incorrect Options:** * **Option A:** While it arises from the first part of the subclavian artery, it lies **medial** to the scalenus anterior muscle, not posterior to it. * **Option B:** The artery actually lies **anterior** to the inferior thyroid artery as it ascends toward the C6 transverse process. * **Option D:** After exiting the C1 foramen transversarium, the artery winds **posteriorly** around the lateral mass of the atlas (lying in the groove on the posterior arch) and then enters the skull through the **foramen magnum**. While this sounds correct, Option C is the most definitive anatomical landmark tested in NEET-PG regarding its entry point into the cervical spine. **High-Yield Clinical Pearls:** * **Suboccipital Triangle:** The V3 segment of the vertebral artery is found in the floor of the suboccipital triangle. * **Basilar Artery:** The two vertebral arteries unite at the lower border of the **pons** to form the basilar artery. * **Wallenberg Syndrome:** Occlusion of the PICA (a branch of the V4 segment) or the vertebral artery itself leads to Lateral Medullary Syndrome.

Question 132: Which of the following statements is NOT true about the superior laryngeal nerve?

A. Its block anesthetizes the laryngeal mucosa.
B. It supplies the larynx below the vocal cords. (Correct Answer)
C. It passes through the thyrohyoid membrane.
D. It passes between the thyroid cartilage and the hyoid bone.

Explanation: The **Superior Laryngeal Nerve (SLN)** is a branch of the Vagus nerve (CN X) that divides into Internal and External branches [1]. Understanding its sensory and motor distribution is high-yield for NEET-PG. ### **Explanation of the Correct Answer** **Option B is False (Correct Answer):** The SLN (specifically the internal laryngeal branch) provides sensory innervation to the larynx **above the level of the vocal cords**. The area **below the vocal cords** is supplied by the **Recurrent Laryngeal Nerve (RLN)** [1]. This anatomical division is a frequent exam focus. ### **Analysis of Other Options** * **Option A:** The internal laryngeal nerve is purely sensory. Blocking this nerve (often done for awake intubations) successfully anesthetizes the laryngeal mucosa down to the level of the vocal folds. * **Options C & D:** These describe the same anatomical pathway. The **Internal Laryngeal Nerve**, along with the superior laryngeal artery, pierces the **thyrohyoid membrane**. This membrane spans the gap **between the thyroid cartilage and the hyoid bone**. ### **NEET-PG High-Yield Pearls** 1. **Internal Laryngeal Nerve:** Sensory above vocal cords; pierces thyrohyoid membrane; mediates the **afferent** limb of the cough reflex [1]. 2. **External Laryngeal Nerve:** Purely motor; supplies only the **Cricothyroid muscle** (the "tenser" of vocal cords). It is closely related to the Superior Thyroid Artery. 3. **Recurrent Laryngeal Nerve:** Sensory **below** vocal cords; motor to all intrinsic muscles of the larynx **except** the cricothyroid [1]. It is closely related to the Inferior Thyroid Artery. 4. **Clinical Correlation:** Injury to the External Laryngeal Nerve during thyroidectomy leads to a weak, husky voice and loss of high-pitched tones [2].

Question 133: A patient developed recurrent laryngeal nerve palsy during thyroid surgery. Which of the following laryngeal muscles is/are affected?

A. Posterior cricoarytenoid
B. Lateral cricoarytenoid
C. Thyroarytenoid
D. All (Correct Answer)

Explanation: The **Recurrent Laryngeal Nerve (RLN)**, a branch of the Vagus nerve (CN X), provides motor innervation to almost all the intrinsic muscles of the larynx. The only exception is the **Cricothyroid muscle**, which is supplied by the External Laryngeal Nerve. 1. **Why "All" is correct:** The RLN supplies all intrinsic muscles of the larynx except the cricothyroid. This includes: * **Posterior cricoarytenoid:** The only abductor of the vocal cords (the "safety muscle"). * **Lateral cricoarytenoid:** The primary adductor. * **Thyroarytenoid (and Vocalis):** Relaxes the vocal cords. * **Interarytenoid (Transverse and Oblique):** Closes the posterior glottis. [1] Since the RLN supplies all these muscles, a palsy during thyroid surgery will affect all of them. Damage might result in a cord that remains in a midline position or paramedian position. [2] 2. **Analysis of Options:** * **Option A, B, and C:** While each of these muscles is individually affected, they are all supplied by the RLN. Therefore, selecting only one would be incomplete. **High-Yield Clinical Pearls for NEET-PG:** * **The "Safety Muscle":** The Posterior Cricoarytenoid is the only muscle that opens (abducts) the vocal cords. Bilateral RLN injury leads to respiratory distress because the cords cannot abduct. [2] * **Semon’s Law:** In progressive RLN lesions, the abductor fibers (Posterior cricoarytenoid) are more susceptible and paralyzed earlier than the adductor fibers. * **Anatomical Course:** The **Right RLN** hooks around the Right Subclavian Artery, while the **Left RLN** hooks around the Arch of Aorta. [1] * **Thyroid Surgery:** The RLN is most vulnerable near the **Ligament of Berry** and where it crosses the **Inferior Thyroid Artery**. [3]

Question 134: The vertebral artery passes through the foramen of the transverse processes of which vertebrae?

A. All cervical vertebrae
B. 2nd to 5th cervical vertebrae
C. All except the 1st cervical vertebra
D. All except the 7th cervical vertebra (Correct Answer)

Explanation: ### Explanation **1. Understanding the Vertebral Artery Anatomy** The vertebral artery is the first branch of the first part of the subclavian artery. It is anatomically divided into four segments (V1–V4). The **second segment (V2)** is the "foraminal" portion. It typically enters the **foramen transversarium of the 6th cervical vertebra (C6)** and ascends vertically through the foramina of all subsequent vertebrae above it (C5 to C1). **2. Why Option D is Correct** The **7th cervical vertebra (C7)** does possess a foramen transversarium, but it is typically smaller and transmits only the **accessory vertebral vein**. The vertebral artery itself almost always passes **in front of** the C7 transverse process rather than through its foramen. Therefore, the artery passes through the foramina of C1 through C6, making "All except the 7th cervical vertebra" the correct anatomical description. **3. Analysis of Incorrect Options** * **Option A:** Incorrect because the artery skips the C7 foramen. * **Option B:** Incorrect because it ignores the 1st and 6th vertebrae, which are primary conduits for the artery. * **Option C:** Incorrect because the 1st cervical vertebra (Atlas) is a critical landmark where the artery (V3 segment) curves behind the lateral mass in the suboccipital triangle. **4. NEET-PG High-Yield Clinical Pearls** * **Entry Point:** The most common site of entry for the vertebral artery is the **C6** foramen transversarium. * **V3 Segment:** This segment lies in the **suboccipital triangle** and is prone to compression during extreme rotation of the head. * **Termination:** The two vertebral arteries join at the lower border of the **pons** to form the **Basilar artery**. * **C7 Foramen Content:** Remember, the C7 foramen transversarium is not empty; it contains the **accessory vertebral vein**.

Question 135: Where is the stellate ganglion located?

A. Cerebellum
B. Midbrain
C. Medulla oblongata
D. Near the lower cervical spine (Correct Answer)

Explanation: **Explanation:** The **stellate ganglion** (also known as the cervicothoracic ganglion) is a sympathetic ganglion formed by the fusion of the **inferior cervical ganglion** and the **first thoracic (T1) ganglion**. It is located anterior to the transverse process of the **C7 vertebra** and the neck of the first rib, placing it anatomically **near the lower cervical spine**. It lies medial to the vertebral artery and posterior to the carotid sheath. **Analysis of Options:** * **Options A, B, and C (Cerebellum, Midbrain, Medulla oblongata):** These are all components of the Central Nervous System (CNS) located within the cranial cavity. The stellate ganglion is a part of the Peripheral Nervous System (specifically the autonomic sympathetic chain) and is located in the neck/upper thorax, not the brain [1]. **Clinical Pearls for NEET-PG:** * **Horner’s Syndrome:** Injury to the stellate ganglion (e.g., due to a Pancoast tumor at the lung apex) results in ipsilateral miosis, ptosis, and anhidrosis. * **Stellate Ganglion Block:** This procedure is clinically used to treat chronic pain syndromes (like CRPS Type I), Raynaud’s phenomenon, and hyperhidrosis of the upper limb by interrupting sympathetic outflow. * **Relations:** It is situated in the **Scalenovertebral triangle** (Triangle of the Vertebral Artery). * **Sibson’s Fascia:** The ganglion lies just posterior to the cervical pleura (suprapleural membrane) [2].

Question 136: Where is the carotid sinus located?

A. At the termination of the common carotid artery
B. Behind the bifurcation of the common carotid artery
C. At the beginning of the internal carotid artery
D. Both at the termination of the common carotid artery and at the beginning of the internal carotid artery (Correct Answer)

Explanation: ### Explanation The **carotid sinus** is a localized fusiform dilatation acting as a **baroreceptor** (pressure receptor) [1]. It is strategically located at the site where the Common Carotid Artery (CCA) divides into its terminal branches. **Why Option D is Correct:** Anatomically, the dilatation of the carotid sinus involves both the **terminal part of the common carotid artery** and the **commencement (proximal part) of the internal carotid artery** [1]. While many textbooks emphasize its presence in the internal carotid, it physiologically and structurally spans the bifurcation zone. It is innervated primarily by the **nerve of Hering** (a branch of the Glossopharyngeal nerve, CN IX) and the Vagus nerve (CN X) [1]. **Analysis of Incorrect Options:** * **Option A & C:** These are partially correct but incomplete. Selecting only one ignores the continuous nature of the dilatation across the bifurcation. * **Option B:** This describes the **Carotid Body** [2]. The carotid body is a small, reddish-brown structure located *behind* the bifurcation [2]. Unlike the sinus (a baroreceptor), the carotid body is a **chemoreceptor** sensitive to low oxygen ($PaO_2$), high carbon dioxide ($PaCO_2$), and low pH [2]. **High-Yield Clinical Pearls for NEET-PG:** * **Carotid Sinus Hypersensitivity:** Excessive pressure on the sinus (e.g., a tight collar or shaving) can cause extreme bradycardia or syncope due to overstimulation of the baroreceptor reflex [1]. * **Reflex Pathway:** Afferent limb = Glossopharyngeal nerve (CN IX); Efferent limb = Vagus nerve (CN X) [1]. * **Histology:** The tunica adventitia of the carotid sinus is thick, while the tunica media is relatively thin to allow for greater stretch sensitivity [1].

Question 137: Which nerve supplies the sternocleidomastoid muscle?

A. Vagus nerve
B. Spinal accessory nerve (Correct Answer)
C. Marginal mandibular branch of facial nerve
D. None of the above

Explanation: The **Spinal Accessory Nerve (CN XI)** is the motor supply to two major muscles of the neck: the **sternocleidomastoid (SCM)** and the **trapezius**. Specifically, it is the spinal part of the nerve (arising from C1-C5 segments) that enters the skull via the foramen magnum and exits through the jugular foramen to reach these muscles. While the SCM also receives sensory fibers from the cervical plexus (C2, C3) for proprioception, the primary motor drive is provided by CN XI [1]. **Analysis of Incorrect Options:** * **Vagus Nerve (CN X):** Supplies the muscles of the pharynx (except stylopharyngeus), larynx, and soft palate (except tensor veli palatini). It does not provide motor innervation to the SCM. * **Marginal Mandibular Branch of Facial Nerve:** This nerve supplies the muscles of the lower lip and chin (e.g., depressor anguli oris). While it runs superficial to the upper part of the SCM, it does not innervate it. * **None of the above:** Incorrect, as the spinal accessory nerve is the well-established motor supply. **High-Yield Clinical Pearls for NEET-PG:** * **Surface Anatomy:** The spinal accessory nerve is found in the **posterior triangle** of the neck, lying on the levator scapulae muscle. It is highly vulnerable to injury during lymph node biopsies in this region. * **Clinical Testing:** Injury to CN XI results in weakness in turning the head to the **opposite side** (SCM function) and drooping of the shoulder with an inability to shrug (Trapezius function) [1]. * **Torticolis (Wry Neck):** Often involves permanent contraction or fibrosis of the SCM, leading to a tilted head position.

Question 138: Which of the following is NOT an elastic laryngeal cartilage?

A. Epiglottis
B. Corniculate
C. Cuneiform
D. Thyroid (Correct Answer)

Explanation: ### Explanation The laryngeal cartilages are classified into two types based on the histological nature of their matrix: **Hyaline** and **Elastic**. **1. Why Thyroid is the Correct Answer:** The **Thyroid cartilage** is composed of **hyaline cartilage**. Hyaline cartilages have a tendency to undergo **calcification and ossification** as a person ages (usually starting after age 25). Other hyaline cartilages in the larynx include the **Cricoid** and the **base of the Arytenoid** cartilages. **2. Analysis of Incorrect Options (Elastic Cartilages):** The elastic cartilages of the larynx contain abundant elastic fibers, providing flexibility. Crucially, **elastic cartilages do not calcify with age.** * **Epiglottis (Option A):** A leaf-shaped elastic cartilage that prevents food from entering the larynx. * **Corniculate (Option B):** Small, conical elastic nodules situated atop the arytenoid cartilages. * **Cuneiform (Option C):** Rod-shaped elastic cartilages located within the aryepiglottic folds. * *Note:* The **vocal process** and **apex** of the Arytenoid are also elastic. **3. NEET-PG High-Yield Pearls:** * **Mnemonic for Elastic Cartilages:** "**E**very **C**loud **C**ontains **A**ir" (**E**piglottis, **C**orniculate, **C**uneiform, **A**pical/vocal process of Arytenoid). * **Paired vs. Unpaired:** * *Unpaired:* Thyroid, Cricoid, Epiglottis. * *Paired:* Arytenoid, Corniculate, Cuneiform. * **Clinical Significance:** Because the Thyroid and Cricoid cartilages are hyaline, they become visible on X-rays in older adults due to calcification, which can sometimes be mistaken for foreign bodies.

Question 139: A 38-year-old man has had thyroid surgery to remove his papillary carcinoma. The external laryngeal nerve, which accompanies the superior thyroid artery, is damaged during the surgery. This injury could result in a severe impairment of function of which of the following?

A. Relaxing the vocal cords
B. Rotating the arytenoid cartilages
C. Tensing the vocal cords (Correct Answer)
D. Widening the rima glottidis

Explanation: ### Explanation **1. Why the Correct Answer is Right:** The **external laryngeal nerve** (a branch of the superior laryngeal nerve) provides motor innervation to a single muscle: the **cricothyroid**. The cricothyroid muscle acts by tilting the thyroid cartilage forward or the cricoid cartilage backward, thereby increasing the distance between the thyroid and arytenoid cartilages. This action stretches and **tenses the vocal cords**, which is essential for increasing the pitch of the voice. Damage to this nerve typically results in a weak, breathy voice and an inability to hit high-pitched notes. **2. Why the Incorrect Options are Wrong:** * **A. Relaxing the vocal cords:** This is primarily the function of the **thyroarytenoid** (and vocalis) muscles. These are innervated by the **recurrent laryngeal nerve (RLN)** [1]. * **B. Rotating the arytenoid cartilages:** This action is performed by the **lateral cricoarytenoid** (adduction/internal rotation) and **posterior cricoarytenoid** (abduction/external rotation) muscles. Both are innervated by the **RLN** [2]. * **D. Widening the rima glottidis:** This refers to **abduction** of the vocal cords, which is exclusively performed by the **posterior cricoarytenoid** muscle (the "safety muscle of the larynx"), innervated by the **RLN** [1]. **3. NEET-PG High-Yield Pearls:** * **Nerve-Artery Relationship:** The **External Laryngeal Nerve** travels with the **Superior Thyroid Artery** (ligate the artery far from the gland to avoid injury). The **Recurrent Laryngeal Nerve** travels with the **Inferior Thyroid Artery** (ligate the artery close to the gland) [3]. * **The "Rule of One":** The external laryngeal nerve supplies only **one** muscle (cricothyroid); all other intrinsic muscles of the larynx are supplied by the RLN. * **Clinical Presentation:** Injury to the external laryngeal nerve is often subtle but devastating for professional singers or public speakers due to the loss of high-pitch control.

Question 140: The carotid sheath encloses all of the following except:

A. Common carotid artery (CCA) and Internal carotid artery (ICA)
B. External carotid artery (ECA) and Internal carotid artery (ICA) (Correct Answer)
C. Internal jugular vein
D. Vagus nerve

Explanation: The **carotid sheath** is a condensation of deep cervical fascia that extends from the base of the skull to the arch of the aorta. Understanding its contents is a high-yield topic for NEET-PG. ### **Why Option B is the Correct Answer** The **External Carotid Artery (ECA)** is the "odd one out." While the ECA originates from the Common Carotid Artery (CCA) at the level of the upper border of the thyroid cartilage (C4), it almost immediately **leaves the carotid sheath** to supply the structures of the neck and face [1]. Therefore, a sheath containing both the ECA and ICA is anatomically incorrect. ### **Analysis of Incorrect Options (Contents of the Sheath)** * **Option A (CCA and ICA):** These are the primary arterial contents. The CCA is located medially in the lower part of the sheath, and the ICA continues medially in the upper part [1]. * **Option C (Internal Jugular Vein):** The IJV lies **laterally** within the sheath throughout its course. * **Option D (Vagus Nerve):** The Vagus nerve (CN X) is located **posteriorly**, in the groove between the artery and the vein. ### **High-Yield Clinical Pearls for NEET-PG** 1. **Mnemonic (ALV):** **A**rtery (Medial), **L**ymphatics/Vein (Lateral), **V**agus (Posterior). 2. **Ansa Cervicalis:** The superior root of the ansa cervicalis is embedded in the **anterior wall** of the carotid sheath, while the inferior root lies on its lateral aspect. 3. **Sympathetic Chain:** Crucially, the sympathetic trunk is **not** inside the sheath; it lies posterior to it, embedded in the prevertebral fascia. 4. **Deep Cervical Lymph Nodes:** These are located along the internal jugular vein within the sheath.

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