Neck — MCQs

Neck Indian Medical PG Practice Questions and MCQs

Question 141: A person receives a shallow knife wound just behind the sternocleidomastoid muscle and about 1 1/2 inches above the clavicle. There is an immediate numbness of the skin below the wound and over the acromion and clavicle. Which nerve is most likely severed?

A. Greater auricular nerve
B. Lesser occipital nerve
C. Supraclavicular nerve (Correct Answer)
D. Suprascapular nerve

Explanation: ### Explanation **Correct Option: C. Supraclavicular nerve** The clinical presentation describes a wound at the **nerve point of the neck** (Erb’s point). This point is located at the posterior border of the sternocleidomastoid (SCM) muscle, approximately at its midpoint. From here, the cutaneous branches of the cervical plexus emerge. The **supraclavicular nerves (C3, C4)** descend from this point, passing deep to the platysma and crossing the clavicle to provide sensory innervation to the skin over the **clavicle, the acromion (top of the shoulder), and the upper part of the pectoral region**. A wound 1.5 inches above the clavicle behind the SCM directly intercepts these descending fibers, leading to the described numbness. **Analysis of Incorrect Options:** * **A. Greater auricular nerve (C2, C3):** This nerve ascends vertically across the SCM toward the parotid gland. It supplies the skin over the angle of the mandible and the lower part of the auricle. * **B. Lesser occipital nerve (C2):** This nerve ascends along the posterior border of the SCM to supply the scalp behind the auricle. * **D. Suprascapular nerve:** This is a **motor and sensory nerve** arising from the upper trunk of the brachial plexus. It travels deep to the clavicle to supply the supraspinatus and infraspinatus muscles and the shoulder joint; it does not provide cutaneous innervation to the skin over the clavicle. **NEET-PG High-Yield Pearls:** * **Erb’s Point (Neck):** The site where four cutaneous nerves emerge: Lesser occipital, Greater auricular, Transverse cervical, and Supraclavicular nerves. * **Nerve Block:** The posterior border of the SCM is the landmark for a **Cervical Plexus Block**, used for carotid endarterectomies. * **Referred Pain:** Pain from the diaphragm (phrenic nerve, C3-C5) is often referred to the shoulder tip because the **supraclavicular nerves** share the same spinal segments (C3, C4).

Question 142: What action does the thyroarytenoid muscle perform?

A. Adduction of vocal cord
B. Tenses vocal cord
C. Relaxes vocal cord (Correct Answer)
D. Closes inlet of larynx

Explanation: The **thyroarytenoid muscle** is one of the intrinsic muscles of the larynx. To understand its action, one must look at its attachments: it originates from the inner surface of the thyroid cartilage and inserts into the arytenoid cartilage. ### Why the correct answer is right: * **Relaxation of Vocal Cords:** When the thyroarytenoid muscle contracts, it pulls the arytenoid cartilages toward the thyroid cartilage. This action **shortens and thickens** the vocal ligaments, thereby **relaxing** them. * **Vocalis Muscle:** The medial-most fibers of the thyroarytenoid are known as the *Vocalis* muscle. These fibers allow for fine-tuning of tension along the vocal folds, essential for changing the pitch and quality of the voice. ### Why the other options are wrong: * **A. Adduction of vocal cord:** While the thyroarytenoid has a minor adducting component, the **Lateral Cricoarytenoid** is the primary adductor of the vocal cords. * **B. Tenses vocal cord:** This is the function of the **Cricothyroid** muscle. It tilts the thyroid cartilage forward, increasing the distance between the thyroid and arytenoid, thus stretching (tensing) the cords. * **D. Closes inlet of larynx:** This is primarily the function of the **Aryepiglottic** and **Oblique Arytenoid** muscles, which act as a sphincter for the laryngeal inlet during swallowing. ### High-Yield NEET-PG Pearls: 1. **The "Singer’s Muscle":** The **Cricothyroid** is the only intrinsic muscle supplied by the **External Laryngeal Nerve**; all others are supplied by the Recurrent Laryngeal Nerve (RLN). 2. **The "Safety Muscle":** The **Posterior Cricoarytenoid** is the only **abductor** of the vocal cords. Paralysis of this muscle leads to airway obstruction. 3. **The "Relaxor":** Remember **T**hyroarytenoid = **T**erminate tension (Relaxation).

Question 143: All of the following are true about the digastric triangle EXCEPT:

A. It is bordered anteriorly by the anterior belly of the digastric muscle. (Correct Answer)
B. Its floor is formed by the mylohyoid muscle.
C. Its floor is formed by the hyoglossus muscle.
D. It contains the mylohyoid nerve and vessels.

Explanation: The **Digastric Triangle** (Submandibular Triangle) is a key anatomical region of the neck. Understanding its boundaries and contents is high-yield for NEET-PG. ### **Why Option A is the Correct Answer (The False Statement)** The digastric triangle is bordered **anteroinferiorly** by the anterior belly of the digastric and **posteroinferiorly** by the posterior belly of the digastric (along with the stylohyoid). Its **superior boundary** (base) is formed by the lower border of the mandible and a line extending to the mastoid process. Therefore, stating it is bordered "anteriorly" is anatomically imprecise compared to its specific inferior boundaries. ### **Analysis of Other Options** * **Options B & C (Floor):** The floor of the digastric triangle is formed by two muscles: the **mylohyoid** anteriorly and the **hyoglossus** posteriorly. A small part of the middle constrictor of the pharynx also contributes to the posterior floor. * **Option D (Contents):** The triangle contains several vital structures. In the superficial part, you find the submandibular salivary gland and lymph nodes. Deep to the gland, the **mylohyoid nerve and vessels** are located on the surface of the mylohyoid muscle. ### **High-Yield Clinical Pearls for NEET-PG** * **Contents:** Facial artery (deep to gland), Facial vein (superficial to gland), Hypoglossal nerve (CN XII), and the Carotid sheath (posteriorly). * **Roof:** Formed by the skin, superficial fascia (containing platysma and cervical branch of facial nerve), and the investing layer of deep cervical fascia. * **Clinical Significance:** This triangle is the primary site for submandibular gland excision and level Ib lymph node dissection in oral malignancies.

Question 144: A surgeon inadvertently sections the recurrent laryngeal nerve during a procedure. Which of the following muscles would retain its innervation subsequent to this injury?

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

Explanation: ### Explanation The intrinsic muscles of the larynx are supplied by two branches of the **Vagus nerve (CN X)**: the **Recurrent Laryngeal Nerve (RLN)** and the **Superior Laryngeal Nerve (SLN)**. **1. Why Cricothyroid is the Correct Answer:** The **Cricothyroid** muscle is the only intrinsic laryngeal muscle supplied by the **External Laryngeal Nerve** (a branch of the Superior Laryngeal Nerve). Because its nerve supply originates higher up in the neck and follows a different path than the RLN, it remains functional even if the recurrent laryngeal nerve is sectioned. **2. Why the Other Options are Incorrect:** * **Lateral cricoarytenoid, Posterior cricoarytenoid, and Thyroarytenoid:** These are all intrinsic muscles of the larynx. All intrinsic muscles—**except for the cricothyroid**—are innervated by the **Recurrent Laryngeal Nerve** [1]. Therefore, injury to the RLN would result in paralysis of all three of these muscles [2]. **3. Clinical Pearls & High-Yield Facts for NEET-PG:** * **The "Tenser":** The Cricothyroid muscle tenses the vocal cords (increases pitch). Damage to the external laryngeal nerve leads to a **hoarse, low-pitched voice** and inability to hit high notes. * **The "Safety Muscle":** The **Posterior cricoarytenoid** is the only **abductor** of the vocal cords. Bilateral RLN injury can lead to respiratory distress because the cords cannot abduct (open) [2]. * **Anatomical Course:** The right RLN hooks around the **subclavian artery**, while the left RLN hooks around the **arch of the aorta** [1]. * **Surgery Risk:** The RLN is most commonly injured during **thyroidectomy** due to its close proximity to the inferior thyroid artery [3].

Question 145: Which of the following laryngeal muscles is supplied by the external laryngeal nerve?

A. Cricothyroid (Correct Answer)
B. Thyroarytenoid
C. Cricoarytenoid
D. Vocalis

Explanation: The nerve supply of the laryngeal muscles is a high-yield topic for NEET-PG. The key to answering this question lies in understanding the "Rule of Laryngeal Innervation." ### **Explanation** All intrinsic muscles of the larynx are supplied by the **Recurrent Laryngeal Nerve (RLN)**, with the **sole exception of the Cricothyroid muscle**, which is supplied by the **External Laryngeal Nerve** (a branch of the Superior Laryngeal Nerve). 1. **Cricothyroid (Correct):** This muscle acts as a tensor of the vocal cords. It is embryologically derived from the fourth pharyngeal arch, explaining its unique innervation by the external laryngeal nerve. 2. **Thyroarytenoid (Incorrect):** This muscle relaxes the vocal cords and is supplied by the RLN. 3. **Cricoarytenoid (Incorrect):** Both the Lateral (adductor) and Posterior (abductor) cricoarytenoids are supplied by the RLN. 4. **Vocalis (Incorrect):** This muscle, which fine-tunes vocal tension, is also supplied by the RLN. ### **High-Yield Clinical Pearls** * **The "Safety Muscle":** The **Posterior Cricoarytenoid** is the only abductor of the vocal cords. Bilateral RLN injury can lead to respiratory distress because the cords cannot abduct [1]. * **Surgical Landmark:** The external laryngeal nerve is closely related to the **superior thyroid artery**. During thyroidectomy, the artery should be ligated close to the gland to avoid damaging this nerve. * **Clinical Sign:** Damage to the external laryngeal nerve results in a **weak, husky voice** and loss of the ability to produce high-pitched sounds (due to loss of cricothyroid tension). * **Sensory Supply:** Above the vocal cords is the Internal Laryngeal Nerve; below the vocal cords is the Recurrent Laryngeal Nerve.

Question 146: The ascending pharyngeal artery is a branch of which of the following?

A. Middle branch of the external carotid artery.
B. Medial branch of the external carotid artery. (Correct Answer)
C. Terminal branch of the external carotid artery.
D. Anterior branch of the external carotid artery.

Explanation: ### Explanation The **External Carotid Artery (ECA)** is the primary source of blood supply to the neck and face. It typically gives off eight branches, which are categorized based on their anatomical direction of origin. **1. Why the Correct Answer is Right:** The **Ascending Pharyngeal Artery** is the smallest branch of the ECA. It arises from the **medial (inner) aspect** of the artery near its origin. It ascends vertically between the internal carotid artery and the pharynx to supply the pharyngeal walls, soft palate, tonsils, and the middle ear. **2. Analysis of Incorrect Options:** * **Anterior Branches:** There are three anterior branches: the **Superior Thyroid**, **Lingual**, and **Facial** arteries. * **Middle Branch:** This is not a standard anatomical classification for the ECA branches. * **Terminal Branches:** The ECA terminates within the parotid gland by dividing into the **Maxillary** and **Superficial Temporal** arteries. * **Posterior Branches:** These include the **Occipital** and **Posterior Auricular** arteries. **3. High-Yield Clinical Pearls for NEET-PG:** * **Smallest Branch:** The ascending pharyngeal is the smallest branch of the ECA. * **Mnemonic for ECA Branches:** "**S**ome **A**natomists **L**ike **F**reaking **O**ut **P**oor **M**edical **S**tudents" (**S**uperior thyroid, **A**scending pharyngeal, **L**ingual, **F**acial, **O**ccipital, **P**osterior auricular, **M**axillary, **S**uperficial temporal). * **Clinical Significance:** It provides the meningeal branch that enters the cranium via the jugular foramen, hypoglossal canal, and foramen lacerum; it is often involved in the blood supply to glomus jugulare tumors.

Question 147: Which of the following statements regarding the hyoid bone is incorrect?

A. The hyoid bone is typically located at the level of the 3rd cervical vertebra.
B. It develops from the 3rd and 4th branchial arches. (Correct Answer)
C. A fracture of the hyoid bone is strongly suggestive of strangulation.
D. The lesser horns provide attachment to the stylohyoid ligament.

Explanation: ### Explanation The hyoid bone is a unique, "U-shaped" bone that does not articulate with any other bone. To identify the incorrect statement, we must look at its embryological origins. **1. Why Option B is the Correct Answer (The Incorrect Statement):** The hyoid bone develops from the **2nd and 3rd branchial (pharyngeal) arches**, not the 4th. * **2nd Arch (Reichert’s cartilage):** Gives rise to the **lesser horns** (cornua) and the upper part of the body. * **3rd Arch:** Gives rise to the **greater horns** and the lower part of the body. * The 4th arch contributes to the laryngeal cartilages (thyroid cartilage), not the hyoid. **2. Analysis of Other Options:** * **Option A:** In a neutral position, the hyoid bone lies at the level of the **C3 vertebra**, between the mandible and the thyroid cartilage. * **Option C:** Because it is highly protected by the mandible, a **fracture of the hyoid** is rare. It occurs almost exclusively during manual strangulation or hanging, making it a critical finding in forensic medicine. * **Option D:** The **stylohyoid ligament** extends from the styloid process of the temporal bone to the **lesser horn** of the hyoid, suspending the bone. **High-Yield Clinical Pearls for NEET-PG:** * **"Floating Bone":** It is the only bone in the human body that lacks a bony articulation; it is suspended by muscles and ligaments. * **Muscle Attachments:** It serves as an anchor for suprahyoid (elevators) and infrahyoid (depressors) muscles, essential for swallowing and speech. Knowledge of embryology, such as the descent of the thyroid from the tongue base past the hyoid, is essential for understanding thyroglossal duct cysts [1]. * **Digastric Muscle:** The intermediate tendon of the digastric muscle is held to the hyoid by a fibrous pulley.

Question 148: Which nerve supplies the posterior belly of the digastric muscle?

A. Mandibular nerve
B. Hypoglossal nerve
C. Accessory nerve
D. Facial nerve (Correct Answer)

Explanation: **Explanation:** The correct answer is **D. Facial nerve**. The nerve supply of the digastric muscle is a classic high-yield anatomy concept based on **embryological origin**. The digastric muscle consists of two bellies with different developmental backgrounds: * **Posterior Belly:** Derived from the **second pharyngeal arch**. Therefore, it is supplied by the nerve of the second arch—the **Facial nerve (CN VII)** (specifically, the digastric branch). * **Anterior Belly:** Derived from the **first pharyngeal arch**. It is supplied by the nerve of the first arch—the **Mandibular nerve (V3)** (specifically, the nerve to mylohyoid). **Analysis of Incorrect Options:** * **A. Mandibular nerve:** Supplies the *anterior* belly of the digastric and the mylohyoid muscle. * **B. Hypoglossal nerve (CN XII):** Supplies all intrinsic and extrinsic muscles of the tongue (except palatoglossus). While it passes near the digastric, it does not supply it. * **C. Accessory nerve (CN XI):** Supplies the sternocleidomastoid and trapezius muscles. **High-Yield Clinical Pearls for NEET-PG:** 1. **Stylohyoid Connection:** The posterior belly of the digastric and the stylohyoid muscle are both second-arch derivatives and are both supplied by the facial nerve. 2. **Intermediate Tendon:** The two bellies are connected by an intermediate tendon which is held to the hyoid bone by a fibrous pulley. 3. **Digastric Triangle:** The two bellies of the digastric form the superior boundaries of the submandibular (digastric) triangle, which contains the submandibular gland and facial artery.

Question 149: Name the paired cartilages of the larynx?

A. Thyroid cartilage
B. Cricoid cartilage
C. Corniculate cartilage (Correct Answer)
D. Hyoid bone

Explanation: The larynx consists of a skeletal framework of nine cartilages: three are **unpaired** (single) and three are **paired** (six total). Understanding this classification is a high-yield topic for NEET-PG. ### Why Option C is Correct The **Corniculate cartilages** (of Santorini) are small, conical nodules situated at the apices of the arytenoid cartilages. They are part of the **paired cartilages**, which include: 1. **Arytenoid cartilages:** Pyramidal-shaped; crucial for vocal cord movement. 2. **Corniculate cartilages:** Located atop the arytenoids. 3. **Cuneiform cartilages:** Club-shaped; located within the aryepiglottic folds. ### Why Other Options are Incorrect * **A. Thyroid cartilage:** This is the largest **unpaired** cartilage. It forms the "Adam's apple" (laryngeal prominence). * **B. Cricoid cartilage:** This is an **unpaired** cartilage. It is the only complete cartilaginous ring in the respiratory tract, shaped like a signet ring. * **D. Hyoid bone:** While it provides attachment for laryngeal muscles and ligaments, the hyoid is a **bone**, not a laryngeal cartilage. ### NEET-PG High-Yield Pearls * **Unpaired Cartilages:** Thyroid, Cricoid, and Epiglottis. * **Elastic vs. Hyaline:** The Epiglottis, Corniculate, and Cuneiform cartilages are made of **elastic cartilage** (they do not calcify with age). The Thyroid, Cricoid, and most of the Arytenoid are **hyaline cartilage** (prone to ossification). * **Safety Landmark:** The cricoid cartilage is the landmark for the **Sellick maneuver** (cricoid pressure) during intubation to prevent gastric regurgitation. * **Narrowest Part:** In adults, the narrowest part of the airway is the **Rima Glottidis**; in infants, it is the **Cricoid cartilage**.

Question 150: Infrahyoid muscles are contained within which anatomical space?

A. Muscular triangle (Correct Answer)
B. Submental triangle
C. Anterior digastric triangle
D. Carotid triangle

Explanation: ### Explanation **Correct Answer: A. Muscular triangle** The **muscular triangle** (also known as the inferior carotid triangle) is a subdivision of the anterior triangle of the neck. It is bounded superiorly by the hyoid bone, inferolaterally by the anterior border of the sternocleidomastoid, and superolaterally by the superior belly of the omohyoid muscle. Its primary contents are the **infrahyoid muscles** (sternohyoid, sternothyroid, thyrohyoid, and omohyoid) and the viscera of the neck, including the thyroid and parathyroid glands, larynx, and trachea. **Why the other options are incorrect:** * **Submental triangle:** This is an unpaired midline triangle bounded by the two anterior bellies of the digastric muscles and the hyoid bone. Its primary contents are the submental lymph nodes and small veins that form the anterior jugular vein. * **Anterior digastric (Submandibular) triangle:** Bounded by the anterior and posterior bellies of the digastric muscle and the lower border of the mandible. It primarily contains the submandibular gland, facial artery/vein, and the hypoglossal nerve. * **Carotid triangle:** Bounded by the posterior belly of the digastric, superior belly of the omohyoid, and the sternocleidomastoid. It is clinically significant for containing the carotid sheath (common carotid artery, internal jugular vein, and vagus nerve). **High-Yield NEET-PG Pearls:** * **Innervation:** All infrahyoid muscles are supplied by the **Ansa Cervicalis (C1-C3)**, *except* for the **thyrohyoid**, which is supplied by C1 fibers via the hypoglossal nerve. * **Function:** These muscles are often called "strap muscles" and function to depress the hyoid bone and larynx during swallowing and vocalization. * **Surgical Landmark:** The muscular triangle is the site for performing a **tracheostomy** or a **thyroidectomy**.

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Cervical Fascia

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Triangles of the Neck

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Deep Structures of the Neck

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Thyroid and Parathyroid Glands

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Lymphatic Drainage

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Cervical Plexus

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