Neck Practice Questions

Q: A knife wound to the neck damages the posterior cord of the brachial plexus. Which of the following muscles would be most likely to be paralyzed?

Deltoid. The brachial plexus is a high-yield topic for NEET-PG. To solve this question, one must trace the terminal branches of the **Posterior Cord**. **1. Why Deltoid is Correct:** The posterior cord (formed by the posterior divisions of all three trunks, C5-T1) gives rise to five terminal branches, remembered by the mnemonic **ULTRA**: **U**pper subscapular, **L**ower subscapular, **T**horacodorsal, **R**adial, and **A**xillary nerves. The **Axillary nerve (C5, C6)** specifically innervates the **Deltoid** and Teres minor muscles. Therefore, damage to the posterior cord will result in paralysis of the deltoid, leading to loss of shoulder abduction (beyond 15 degrees). **2. Why the Other Options are Incorrect:** * **Flexor carpi ulnaris (B):** This muscle is innervated by the **Ulnar nerve**, which is a terminal branch of the **Medial cord**. * **Flexor digitorum superficialis (C):** This muscle is innervated by the **Median nerve**, which is formed by contributions from both the **Medial and Lateral cords**. * **Flexor pollicis brevis (D):** The superficial head is innervated by the **Median nerve** (Recurrent branch) and the deep head by the **Ulnar nerve**. Neither originates from the posterior cord. **Clinical Pearls for NEET-PG:** * **Posterior Cord mnemonic (ULTRA):** Upper subscapular (Subscapularis), Lower subscapular (Subscapularis/Teres major), Thoracodorsal (Latissimus dorsi), Radial (Extensors of arm/forearm), Axillary (Deltoid). * **Crutch Palsy/Saturday Night Palsy:** These typically involve compression of the posterior cord or the radial nerve. * **Quadrangular Space:** The Axillary nerve passes through this space along with the posterior circumflex humeral artery; a fracture of the surgical neck of the humerus is a common site of injury.

Q: What structures pass between the superior and middle constrictor muscles of the pharynx?

Glossopharyngeal nerve and stylopharyngeus muscle. ### Explanation The pharyngeal wall is composed of three overlapping constrictor muscles. Between these muscles, there are four distinct "gaps" or intervals that serve as conduits for specific neurovascular and muscular structures to enter or exit the pharynx. **1. Why Option C is Correct:** The gap between the **Superior and Middle constrictors** is the second pharyngeal space. It provides passage for: * **Glossopharyngeal nerve (CN IX):** It winds around the stylopharyngeus to reach the base of the tongue. * **Stylopharyngeus muscle:** It originates from the styloid process and enters the pharyngeal wall through this gap to elevate the pharynx. * **Stylohyoid ligament:** Also passes through this interval. **2. Analysis of Incorrect Options:** * **Option A & D:** The **Internal laryngeal nerve** and **Superior laryngeal vessels** pass through the thyrohyoid membrane, which is located in the gap between the **Middle and Inferior constrictors**. * **Option B:** While the stylopharyngeus is correct, the superior laryngeal vessels belong to the gap below (between middle and inferior constrictors). **3. High-Yield Clinical Pearls for NEET-PG:** * **Gap 1 (Above Superior Constrictor):** Auditory (Eustachian) tube, Levator veli palatini, and Ascending palatine artery. * **Gap 3 (Middle & Inferior Constrictors):** Internal laryngeal nerve and Superior laryngeal artery. * **Gap 4 (Below Inferior Constrictor/Recurrent Laryngeal Space):** Recurrent laryngeal nerve and Inferior laryngeal artery. * **Killian’s Dehiscence:** A weak area between the thyropharyngeus and cricopharyngeus parts of the inferior constrictor; it is the site for **Zenker’s diverticulum**.

Q: Which of the following is true about the vertebral artery?

It enters the skull through the foramen magnum.. The **vertebral artery** is a vital vessel supplying the hindbrain and the posterior part of the cerebrum. It is divided into four segments (V1–V4). ### **Explanation of the Correct Option** **Option B is correct:** After ascending through the transverse foramina of the C6 to C1 vertebrae (V2 segment) and winding behind the lateral mass of the atlas (V3 segment), the vertebral artery pierces the posterior atlanto-occipital membrane and the dura mater. It then **enters the cranial cavity through the foramen magnum** to become the V4 segment. ### **Analysis of Incorrect Options** * **Option A:** The vertebral artery is the **first branch of the first part of the subclavian artery**, not the thyrocervical trunk. The thyrocervical trunk typically gives off the inferior thyroid, suprascapular, and transverse cervical arteries. * **Option C:** The two vertebral arteries unite at the lower border of the pons to form the **Basilar artery**. The posterior cerebral artery is a terminal branch of the basilar artery, not a direct continuation of the vertebral arteries. * **Option D:** The vertebral artery is a **large, major vessel**. It is the primary source of blood to the brainstem, cerebellum, and posterior spinal cord. ### **High-Yield Clinical Pearls for NEET-PG** * **Course:** It enters the transverse foramen of the **C6 vertebra** (skipping C7). * **Segments:** The **V3 segment** lies in the suboccipital triangle and is prone to compression during extreme neck rotation. * **Branches:** The largest branch of the vertebral artery is the **PICA (Posterior Inferior Cerebellar Artery)**. Occlusion of this branch leads to **Lateral Medullary Syndrome (Wallenberg Syndrome)**. * **Subclavian Steal Syndrome:** Occurs when there is proximal stenosis of the subclavian artery, causing retrograde flow in the vertebral artery to supply the arm.

Q: Which of the following veins crosses the superficial surface of the sternocleidomastoid muscle directly beneath the platysma muscle?

External jugular. The **External Jugular Vein (EJV)** is the correct answer based on its superficial anatomical course in the neck. **Why it is correct:** The EJV is formed by the union of the **posterior division of the retromandibular vein** and the **posterior auricular vein**. It begins near the angle of the mandible, descends obliquely across the **superficial surface of the sternocleidomastoid (SCM) muscle**, and runs deep to the **platysma muscle** and the superficial fascia. It eventually pierces the investing layer of deep cervical fascia to drain into the subclavian vein. **Why the other options are incorrect:** * **Retromandibular Vein:** This vein is formed within the parotid gland (deep to the SCM origin) by the maxillary and superficial temporal veins. It divides into anterior and posterior divisions before reaching the surface of the SCM. * **Anterior Jugular Vein:** This vein descends near the midline of the neck, anterior to the SCM, within the suprasternal space (Space of Burns). * **Posterior Auricular Vein:** This vein runs behind the auricle and joins the retromandibular vein to *form* the EJV; it does not cross the SCM independently in this manner. **High-Yield NEET-PG Pearls:** 1. **Surface Anatomy:** The EJV serves as an "internal manometer" for estimating **Jugular Venous Pressure (JVP)**, though the Internal Jugular Vein (IJV) is preferred for accuracy. 2. **Nerve Association:** The **Great Auricular Nerve** (C2, C3) runs parallel and posterior to the EJV on the surface of the SCM. 3. **Clinical Risk:** If the EJV is severed where it pierces the fascia, the fascia holds the vein open, potentially leading to a fatal **air embolism** due to negative intrathoracic pressure.

Q: Why do vocal cords appear pale?

Absence of submucosa and blood vessels.. The vocal cords (true vocal folds) appear pearly white or pale during laryngoscopy, a classic anatomical feature that distinguishes them from the surrounding pinkish laryngeal mucosa. [1] ### **Explanation of the Correct Answer** The pale appearance is primarily due to the **absence of a submucosal layer** and a **sparse blood supply**. In most parts of the respiratory tract, the mucosa is loosely attached to underlying structures by a vascular submucosa. However, at the vocal folds, the stratified squamous epithelium is firmly bound to the underlying vocal ligament. The lack of loose areolar tissue (submucosa) and the relative avascularity of the dense connective tissue underneath prevent the red hue of blood from showing through, resulting in a pale, white appearance. [1] ### **Analysis of Incorrect Options** * **Option A:** While the vocalis muscle lies deep to the cord, the cord itself is a ligamentous structure. Muscles are highly vascular; if the cords were primarily muscle without the overlying ligamentous cover, they would appear red. * **Option B & D:** These are incorrect because the vocal cords **do** have a mucosal lining (stratified squamous epithelium). The absence of mucosa would imply an ulcerated or raw surface, which is pathological. ### **High-Yield NEET-PG Pearls** * **Epithelium:** The true vocal cords are lined by **stratified squamous non-keratinized epithelium** (to withstand mechanical stress), while the rest of the larynx is mostly respiratory epithelium (pseudostratified ciliated columnar). * **Reinke’s Space:** This is a potential space between the epithelium and the vocal ligament. Accumulation of fluid here leads to **Reinke’s Edema**, often seen in smokers. * **Lymphatic Drainage:** The true vocal cords have **no lymphatic drainage**, which is why localized glottic cancer has a better prognosis (late metastasis) compared to supraglottic cancer. [1]

Q: Which of the following muscles is NOT supplied by the recurrent laryngeal nerve?

Cricothyroid. The nerve supply of the laryngeal muscles is a high-yield topic in NEET-PG Anatomy. To master this, remember the "Rule of All but One." ### **1. Why Cricothyroid is the Correct Answer** All intrinsic muscles of the larynx are supplied by the **Recurrent Laryngeal Nerve (RLN)**, except for the **Cricothyroid muscle**. The cricothyroid is supplied by the **External Laryngeal Nerve**, which is a branch of the Superior Laryngeal Nerve (derived from the Vagus nerve, CN X). * **Functional Concept:** The cricothyroid is the only intrinsic muscle located on the *outside* of the larynx. It acts as a tensor of the vocal cords by tilting the thyroid cartilage forward. ### **2. Analysis of Incorrect Options** The following muscles are all located internally and are supplied by the **Recurrent Laryngeal Nerve** [1]: * **A. Posterior cricoarytenoid:** Known as the "Safety muscle of the larynx" because it is the **only abductor** of the vocal cords. * **B. Thyroarytenoid:** Relaxes the vocal folds; its medial fibers form the Vocalis muscle. * **C. Lateral cricoarytenoid:** Acts as the primary adductor of the vocal cords. ### **3. High-Yield Clinical Pearls for NEET-PG** * **Sensory Supply:** Above the vocal folds is supplied by the **Internal Laryngeal Nerve**; below the vocal folds is supplied by the **Recurrent Laryngeal Nerve**. * **Injury to External Laryngeal Nerve:** Occurs during Superior Thyroid Artery ligation (Thyroidectomy). It results in a loss of high-pitched voice and vocal fatigue. * **Injury to Recurrent Laryngeal Nerve:** Occurs during Inferior Thyroid Artery ligation [1]. Unilateral injury causes hoarseness; bilateral injury can cause respiratory distress due to the cords remaining in a paramedian position [2]. * **The "Safety Muscle":** If the Posterior Cricoarytenoid (supplied by RLN) is paralyzed, the airway cannot be opened (abducted) [2].

Q: Which laryngeal cartilage is elastic?

Epiglottis. **Explanation:** The laryngeal skeleton consists of nine cartilages: three single (Thyroid, Cricoid, Epiglottis) and three paired (Arytenoid, Corniculate, Cuneiform). These are classified based on their histological composition into **Hyaline** and **Elastic** types. **Why Epiglottis is Correct:** The **Epiglottis** is composed of **Elastic Cartilage**. This histological property provides the flexibility required for the epiglottis to bend posteriorly during deglutition, covering the laryngeal inlet to prevent aspiration. Unlike hyaline cartilage, elastic cartilage contains a dense network of elastic fibers and **does not undergo calcification or ossification** with age. **Analysis of Incorrect Options:** * **Thyroid (Option D):** This is the largest laryngeal cartilage and is made of **Hyaline Cartilage**. It frequently undergoes ossification after the age of 25, a feature often visible on X-rays. * **Corniculate and Cuneiform (Options B & C):** These are small, paired cartilages. While they are also **Elastic**, the question typically seeks the primary single cartilage (Epiglottis) in a standard single-best-answer format. However, if this were a multiple-choice "select all" question, these would also be correct. *Note: In most NEET-PG patterns, Epiglottis is the high-yield representative for elastic cartilage.* **NEET-PG High-Yield Pearls:** 1. **Hyaline Cartilages:** Thyroid, Cricoid, and the majority of the Arytenoid (except the apex and vocal process). 2. **Elastic Cartilages:** Epiglottis, Corniculate, Cuneiform, and the **Apex of the Arytenoid**. 3. **Clinical Fact:** Hyaline cartilages (Thyroid/Cricoid) can be seen on imaging in older adults due to calcification, whereas the Epiglottis remains radiolucent unless diseased. 4. **Vocal Process:** The vocal process of the arytenoid is hyaline, but the apex is elastic.

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

Cricothyroid. **Explanation:** The nerve supply of the laryngeal muscles follows a very specific "rule of thumb" in anatomy, which is a frequent target for NEET-PG questions. **1. Why Cricothyroid is correct:** All intrinsic muscles of the larynx are supplied by the **Recurrent Laryngeal Nerve (RLN)**, with one notable exception: the **Cricothyroid muscle**. This muscle is supplied by the **External Laryngeal Nerve** (a branch of the Superior Laryngeal Nerve). * **Functional Concept:** The cricothyroid is the only tensor of the vocal cords. It tilts the thyroid cartilage forward, lengthening and tensing the vocal folds to raise the pitch of the voice. **2. Why the other options are incorrect:** * **Posterior cricoarytenoid (Option A):** Known as the "safety muscle of the larynx" because it is the only **abductor** of the vocal cords. It is supplied by the RLN [1]. * **Lateral cricoarytenoid (Option B):** Acts as an adductor of the vocal cords. It is supplied by the RLN [1]. * **Thyroarytenoid (Option C):** Acts as a relaxor of the vocal cords. It is supplied by the RLN [1]. **Clinical Pearls for NEET-PG:** * **Surgery Link:** During thyroidectomy, the **External Laryngeal Nerve** is at risk during the ligation of the **Superior Thyroid Artery** (as they run close together). Damage results in a weak, husky voice and inability to produce high-pitched sounds. * **RLN Injury:** The RLN is related to the **Inferior Thyroid Artery** [2]. Unilateral injury causes hoarseness; bilateral injury can cause respiratory distress due to the cords remaining in a paramedian position [1]. * **Sensory Supply:** Above the vocal cords is supplied by the Internal Laryngeal Nerve; below the vocal cords is supplied by the Recurrent Laryngeal Nerve.

Q: Where are Delphic nodes present in the body?

Pretracheal. The **Delphic nodes** are a specific group of **prelaryngeal** lymph nodes located on the cricothyroid membrane, situated just above the isthmus of the thyroid gland [1], [2]. In clinical anatomy, they are considered a subset of the **pretracheal lymph nodes** (Level VI of the cervical lymph nodes) [2]. **Why the correct answer is right:** * **Pretracheal (Option A):** Delphic nodes are located anterior to the larynx and upper trachea [1]. They receive lymphatic drainage from the subglottic region of the larynx and the thyroid gland [2]. Their name "Delphic" is derived from the Oracle of Delphi, as their enlargement is often the first "omen" or sign of malignancy in the thyroid or larynx. **Why the other options are wrong:** * **Paratracheal (Option B):** These nodes lie along the sides of the trachea (recurrent laryngeal nerve chain). While also part of Level VI, they are distinct from the midline Delphic nodes [1]. * **Supraclavicular (Option C):** These are Level Vb/Virchow’s nodes located in the supraclavicular fossa, primarily draining thoracic and abdominal viscera. * **Posterior triangle (Option D):** This region contains Level V nodes (spinal accessory chain), which are located behind the sternocleidomastoid muscle. **High-Yield Clinical Pearls for NEET-PG:** * **Level VI Nodes:** This "central compartment" includes the prelaryngeal (Delphic), pretracheal, and paratracheal nodes [1], [2]. * **Clinical Significance:** Enlargement of Delphic nodes is highly suggestive of **papillary thyroid carcinoma** or **laryngeal squamous cell carcinoma**. * **Drainage:** They primarily drain the subglottis, pyriform sinus, and thyroid isthmus; they subsequently drain into the deep cervical nodes [2].

Question 1

A knife wound to the neck damages the posterior cord of the brachial plexus. Which of the following muscles would be most likely to be paralyzed?

Accepted Answer

Deltoid

Answer

Flexor carpi ulnaris

Answer

Flexor digitorum superficialis

Answer

Flexor pollicis brevis

Question 2

What structures pass between the superior and middle constrictor muscles of the pharynx?

Accepted Answer

Glossopharyngeal nerve and stylopharyngeus muscle

Answer

Superior laryngeal vessels and internal laryngeal nerve

Answer

Stylopharyngeus muscle and superior laryngeal vessels

Answer

Internal laryngeal nerve and stylopharyngeus muscle

Question 3

A person receives a laceration along the anterior border of the trapezius muscle in the neck. Subsequently, the point of his shoulder (scapula) sags, and he has difficulty fully abducting his arm. What nerve appears to have been severed?

Accepted Answer

Accessory nerve (Cranial Nerve XI)

Answer

Axillary nerve

Answer

Dorsal scapular nerve

Answer

Greater occipital nerve

Question 4

Which of the following is true about the vertebral artery?

Accepted Answer

It enters the skull through the foramen magnum.

Answer

It is a branch of the thyrocervical trunk.

Answer

It unites to form the posterior cerebral artery.

Answer

It is a small artery.

Question 5

Which of the following veins crosses the superficial surface of the sternocleidomastoid muscle directly beneath the platysma muscle?

Accepted Answer

External jugular

Answer

Retromandibular

Answer

Anterior jugular

Answer

Posterior auricular

Question 6

Why do vocal cords appear pale?

Accepted Answer

Absence of submucosa and blood vessels.

Answer

Vocal cords are muscle and lack a rich blood vessel network.

Answer

Absence of mucosa and blood vessels.

Answer

Absence of mucosa with blood vessels.

Question 7

Which of the following muscles is NOT supplied by the recurrent laryngeal nerve?

Accepted Answer

Cricothyroid

Answer

Posterior cricoarytenoid

Answer

Thyroarytenoid

Answer

Lateral cricoarytenoid

Question 8

Which laryngeal cartilage is elastic?

Accepted Answer

Epiglottis

Answer

Corniculate

Answer

Cuneiform

Answer

Thyroid

Question 9

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

Accepted Answer

Cricothyroid

Answer

Posterior cricoarytenoid

Answer

Lateral cricoarytenoid

Answer

Thyroarytenoid

Question 10

Where are Delphic nodes present in the body?

Accepted Answer

Pretracheal

Answer

Paratracheal

Answer

Supraclavicular

Answer

Posterior triangle

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Neck — MCQs

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