Neck — MCQs

Neck Indian Medical PG Practice Questions and MCQs

Question 191: The inferior thyroid artery arises from which of the following?

A. The first part of the subclavian artery
B. The thyrocervical trunk of the first part of the subclavian artery (Correct Answer)
C. The third part of the subclavian artery
D. The internal carotid artery

Explanation: The **inferior thyroid artery** is the primary blood supply to the posterior and inferior aspects of the thyroid gland. It originates from the **thyrocervical trunk**, which is a short, wide branch arising from the **first part of the subclavian artery** (medial to the scalenus anterior muscle) [2]. **Why Option B is Correct:** The thyrocervical trunk divides into four main branches: the inferior thyroid, suprascapular, transverse cervical, and ascending cervical arteries. The inferior thyroid artery ascends behind the carotid sheath to reach the lower pole of the thyroid gland [2]. **Why Other Options are Incorrect:** * **Option A:** While the thyrocervical trunk itself arises from the first part of the subclavian, the inferior thyroid artery is a secondary branch. In anatomy exams, the most specific anatomical origin is required. * **Option C:** The third part of the subclavian artery typically gives off the dorsal scapular artery. It does not contribute to the thyroid supply. * **Option D:** The internal carotid artery has no branches in the neck; it enters the skull to supply the brain and eyes. **NEET-PG High-Yield Pearls:** 1. **Surgical Landmark:** The inferior thyroid artery is intimately related to the **recurrent laryngeal nerve** [1]. During thyroidectomy, the artery is ligated **away** from the gland to avoid injuring the nerve. 2. **Anastomosis:** It anastomoses with the **superior thyroid artery** (a branch of the External Carotid Artery), providing a collateral circulation between the subclavian and external carotid systems. 3. **Parathyroid Supply:** The inferior thyroid artery is the main source of blood for both the superior and inferior parathyroid glands [2]. 4. **Thyroid Ima Artery:** In ~3-10% of individuals, an accessory artery (Thyroid Ima) may arise directly from the brachiocephalic trunk or aortic arch.

Question 192: What is true regarding the lymphatic drainage of the neck?

A. Posterior tongue has no significant lymphatic supply.
B. Tonsils drain to the upper deep cervical nodes. (Correct Answer)
C. Inevitably all lymphatics ultimately supply to the lower deep cervical nodes.
D. Anterior half of the nasal septum drains to the submandibular node.

Explanation: The lymphatic drainage of the head and neck is a high-yield topic for NEET-PG, centered on the concept that all lymph eventually filters through the deep cervical chain. ### **Analysis of Options** * **Correct Answer (B):** The palatine tonsils drain primarily into the **jugulodigastric node**, which is the largest node in the **upper deep cervical group**. Located where the posterior belly of the digastric crosses the internal jugular vein, it is often referred to as the "tonsillar node." * **Option A is incorrect:** The posterior third of the tongue is highly vascular and has a rich, bilateral lymphatic supply that drains directly into the **upper deep cervical nodes**. * **Option C is incorrect:** While most lymphatics eventually reach the deep cervical chain, they do not "inevitably" supply only the *lower* nodes first. Lymph from certain areas (like the tip of the tongue) may bypass upper nodes, but the statement is an overgeneralization. * **Option D is incorrect:** The anterior part of the nasal cavity and septum drains into the **submental nodes** or directly to the **submandibular nodes**, but the *posterior* part drains to the retropharyngeal or upper deep cervical nodes. ### **Clinical Pearls for NEET-PG** * **Jugulodigastric Node:** Most common site for metastatic squamous cell carcinoma from the oral cavity/oropharynx. * **Jugulo-omohyoid Node:** Associated with the **tongue**; located where the omohyoid crosses the IJV. * **Virchow’s Node (Troisier’s sign):** Left supraclavicular node enlargement, indicating occult visceral malignancy (e.g., gastric cancer) via the thoracic duct. * **Waldeyer’s Ring:** A protective ring of lymphoid tissue (pharyngeal, tubal, palatine, and lingual tonsils) at the gateway of the digestive and respiratory tracts.

Question 193: Which of the following statements regarding thyroidectomy is incorrect?

A. The recurrent laryngeal nerve is closely related to the inferior thyroid artery.
B. The superior laryngeal nerve supplies the cricothyroid muscle.
C. The recurrent laryngeal nerve supplies all intrinsic muscles of the larynx. (Correct Answer)
D. The inferior thyroid artery is long and tortuous.

Explanation: ### Explanation The correct answer is **C** because it is a false statement. While the **recurrent laryngeal nerve (RLN)** supplies most of the larynx, it does **not** supply all intrinsic muscles. #### 1. Why Option C is Incorrect (The Concept) The intrinsic muscles of the larynx are supplied by two branches of the Vagus nerve (CN X): * **Recurrent Laryngeal Nerve:** Supplies all intrinsic muscles **EXCEPT** the cricothyroid. * **External Laryngeal Nerve (branch of Superior Laryngeal Nerve):** Supplies the **cricothyroid** muscle exclusively. #### 2. Analysis of Other Options * **Option A:** The RLN is indeed closely related to the **inferior thyroid artery** near the lower pole of the thyroid gland [1]. During surgery, the artery is ligated well away from the gland to avoid injuring the nerve. * **Option B:** As mentioned above, the **external laryngeal nerve** (a branch of the superior laryngeal nerve) provides motor supply to the cricothyroid, which acts as a tensor of the vocal cords. * **Option D:** The inferior thyroid artery is a branch of the thyrocervical trunk. It is characteristically **long and tortuous**, passing behind the carotid sheath to reach the posterior aspect of the thyroid gland. #### 3. Clinical Pearls for NEET-PG * **Nerve Injury:** Unilateral RLN injury causes hoarseness; bilateral injury causes respiratory distress (stridor) as the vocal cords remain adducted [2]. * **Surgical Ligation Rule:** To protect nerves, ligate the **Superior Thyroid Artery** close to the gland (to save the External Laryngeal Nerve) and the **Inferior Thyroid Artery** far from the gland (to save the RLN). * **Safety Landmark:** The RLN is often found in the **tracheoesophageal groove** and enters the larynx deep to the inferior constrictor muscle [1].

Question 194: How many cartilages are present in the larynx?

A. 6 cartilages
B. 9 cartilages
C. 3 paired and 3 unpaired cartilages (Correct Answer)
D. All intrinsic muscles of the larynx except cricothyroid are supplied by the recurrent laryngeal nerve

Explanation: The larynx is a complex cartilaginous framework essential for phonation and airway protection. It consists of a total of **9 cartilages**, categorized into two groups: unpaired (single) and paired. ### 1. Why the Correct Answer is Right The laryngeal skeleton is composed of **3 unpaired** and **3 paired** cartilages (totaling 9). * **Unpaired Cartilages (3):** 1. **Thyroid:** The largest, shield-shaped cartilage (forms the Adam’s apple). 2. **Cricoid:** The only complete cartilaginous ring in the respiratory tract (signet-ring shaped). 3. **Epiglottis:** Leaf-shaped elastic cartilage that prevents aspiration. * **Paired Cartilages (3 pairs = 6):** 1. **Arytenoid:** Pyramidal cartilages critical for vocal cord movement. 2. **Corniculate:** Located on the apex of the arytenoids (Cartilages of Santorini). 3. **Cuneiform:** Located within the aryepiglottic folds (Cartilages of Wrisberg). ### 2. Analysis of Incorrect Options * **Option A (6 cartilages):** This is incorrect as it only accounts for the number of paired cartilages, ignoring the three large unpaired ones. * **Option B (9 cartilages):** While numerically correct, Option C is the "best" answer for NEET-PG as it specifies the anatomical distribution (paired vs. unpaired), which is a core concept tested in anatomy. * **Option D:** This is a **factually correct statement** regarding the nerve supply of the larynx, but it does not answer the specific question asked about the *number of cartilages*. ### 3. High-Yield Clinical Pearls for NEET-PG * **Cartilage Type:** All laryngeal cartilages are **Hyaline**, EXCEPT the **Epiglottis**, **Corniculate**, **Cuneiform**, and the apex of the **Arytenoid**, which are **Elastic** (these do not calcify with age). * **Safety Muscle:** The **Posterior Cricoarytenoid** is the only abductor of the vocal cords. * **Nerve Supply:** All intrinsic muscles are supplied by the **Recurrent Laryngeal Nerve**, except the **Cricothyroid** (supplied by the External Laryngeal Nerve).

Question 195: The fourth thyroid vein (Kocher's vein) is occasionally found between which two thyroid veins?

A. Superior and middle thyroid veins
B. Superior and inferior thyroid veins
C. Middle and inferior thyroid veins (Correct Answer)
D. Any of the above

Explanation: The thyroid gland typically has three pairs of veins: the **Superior**, **Middle**, and **Inferior** thyroid veins. 1. **Superior Thyroid Vein:** Accompanies the superior thyroid artery and drains into the Internal Jugular Vein (IJV). 2. **Middle Thyroid Vein:** A short, wide vein that drains directly into the IJV. 3. **Inferior Thyroid Vein:** Drains into the Brachiocephalic vein [1]. **Why Option C is correct:** The **Fourth Thyroid Vein (of Kocher)** is an anatomical variation found in approximately 10-15% of individuals. It emerges from the lower part of the lateral lobe of the thyroid gland, specifically positioned **between the middle and inferior thyroid veins**. Like the middle thyroid vein, it drains directly into the Internal Jugular Vein. **Analysis of Incorrect Options:** * **Option A & B:** There is no documented accessory vein consistently found between the superior and middle thyroid veins. The superior vein is located at the upper pole, while Kocher’s vein is specifically associated with the lower lateral aspect of the gland. * **Option D:** Anatomical variations are site-specific; Kocher's vein has a distinct topographical location (inferolateral) that excludes other positions. **NEET-PG High-Yield Pearls:** * **Surgical Significance:** During a thyroidectomy, Kocher’s vein must be identified and ligated early to avoid profuse bleeding and to safely mobilize the thyroid lobe [1]. * **Drainage Pattern:** Remember that Superior and Middle thyroid veins drain into the **IJV**, while the Inferior thyroid vein drains into the **Brachiocephalic vein** [1]. * **Kocher’s Maneuver:** While named after the same surgeon, do not confuse this vein with the "Kocher maneuver," which is used to mobilize the duodenum.

Question 196: Regarding the lymphatic drainage of the neck, which of the following statements is true?

A. The anterior half of the nasal septum drains to the submandibular nodes.
B. The tonsil drains to the upper deep cervical nodes.
C. All lymphatics ultimately drain to the lower deep cervical nodes.
D. All of the above (Correct Answer)

Explanation: The lymphatic drainage of the head and neck follows a hierarchical pattern, ultimately converging into the deep cervical chain [1]. **1. Why "All of the above" is correct:** * **Option A (Nasal Septum):** The lymphatic drainage of the nose is divided. The anterior part of the nasal cavity (including the anterior septum) drains into the **submandibular nodes**. In contrast, the posterior part drains into the retropharyngeal and upper deep cervical nodes. * **Option B (Tonsils):** The palatine tonsils drain primarily into the **jugulodigastric node**, which is a prominent member of the **upper deep cervical nodes**. This node is often referred to as the "principal node of the tonsil." * **Option C (Final Common Pathway):** Regardless of the initial site (submental, submandibular, or parotid nodes), all lymph from the head and neck eventually passes through the **lower deep cervical nodes** (situated near the omohyoid muscle) before entering the thoracic duct or the right lymphatic duct [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Jugulodigastric Node:** Located where the posterior belly of the digastric crosses the internal jugular vein; it is the first to enlarge in tonsillitis. * **Jugulo-omohyoid Node:** Located where the omohyoid crosses the internal jugular vein; it primarily receives drainage from the **tongue** (specifically the submental and submandibular nodes). * **Virchow’s Node:** The left supraclavicular node, which may be enlarged in gastric malignancy (Troisier’s sign). * **Waldeyer’s Ring:** A ring of lymphoid tissue (pharyngeal, tubal, palatine, and lingual tonsils) that guards the respiratory and digestive entries.

Question 197: The atlanto-axial joint is classified as which type of joint?

A. Hinge joint
B. Ball and socket joint
C. Pivot joint (Correct Answer)
D. Saddle joint

Explanation: The **atlanto-axial joint** is a complex of three joints between the first (C1) and second (C2) cervical vertebrae. The correct answer is **Pivot joint** because of the specific articulation between the **dens (odontoid process)** of the axis and the anterior arch of the atlas. ### Why Pivot Joint is Correct: The median atlanto-axial joint is a **synovial pivot joint** (trochoid joint). In this arrangement, the dens acts as a central pivot (axis) around which the ring formed by the atlas and the transverse ligament rotates. This anatomical configuration is specifically designed to allow for the rotation of the head (the "No" movement). ### Why Other Options are Incorrect: * **Hinge joint:** These allow movement in only one plane (flexion/extension), like the elbow or interphalangeal joints. The atlanto-axial joint allows rotation, which hinges cannot perform. * **Ball and socket joint:** These allow multiaxial movement (e.g., hip or shoulder). The atlanto-axial joint lacks a spherical head and deep cup-shaped cavity. * **Saddle joint:** These involve concave and convex surfaces fitting together (e.g., first carpometacarpal joint). The atlanto-axial articulation does not follow this geometry. ### High-Yield Clinical Pearls for NEET-PG: * **Movement:** The primary movement at this joint is **rotation** (responsible for 50% of total cervical rotation). * **Ligamentous Support:** The **transverse ligament of the atlas** is the most important structure stabilizing this joint. Its rupture (e.g., in Rheumatoid Arthritis or Down Syndrome) can lead to atlanto-axial subluxation and fatal cord compression. * **The "Yes" vs. "No" Joints:** * Atlanto-**O**ccipital joint = "Yes" movement (Ellipsoid joint). * Atlanto-**A**xial joint = "No" movement (Pivot joint).

Question 198: What is the arterial supply of the trachea?

A. Bronchial artery
B. Tracheal artery
C. Inferior thyroid artery (Correct Answer)
D. Superior thyroid artery

Explanation: The trachea is a midline structure extending from the larynx to the carina, and its blood supply is segmental, derived from nearby vessels. **Explanation of the Correct Answer:** The **Inferior Thyroid Artery**, a branch of the thyrocervical trunk (from the subclavian artery), is the primary source of arterial blood for the **cervical portion** of the trachea [1]. It supplies the trachea via small tracheoesophageal branches that enter the lateral aspects of the organ. This is the most significant supply for the upper two-thirds of the trachea. **Analysis of Incorrect Options:** * **Bronchial Artery (Option A):** While bronchial arteries supply the **thoracic portion** of the trachea (near the carina) and the bronchi, the inferior thyroid artery is considered the dominant supply for the main tracheal trunk in most anatomical contexts. * **Tracheal Artery (Option B):** There is no single vessel anatomically named the

Question 199: The inferior laryngeal artery is a branch of which of the following arteries?

A. Inferior thyroid artery (Correct Answer)
B. Superior thyroid artery
C. Thyrocervical trunk
D. Ascending cervical artery

Explanation: **Explanation:** The **inferior laryngeal artery** is a direct branch of the **inferior thyroid artery**. It ascends on the posterior surface of the larynx, deep to the inferior constrictor muscle of the pharynx. It enters the larynx by passing through the cricothyroid membrane (or beneath the inferior constrictor) in close company with the **recurrent laryngeal nerve** [1]. It provides the primary blood supply to the muscles and mucous membrane of the lower half of the larynx. **Analysis of Options:** * **Option A (Correct):** The inferior thyroid artery (a branch of the thyrocervical trunk) gives off the inferior laryngeal artery before entering the thyroid gland [1]. * **Option B (Incorrect):** The **superior thyroid artery** (a branch of the external carotid) gives off the **superior laryngeal artery**, which pierces the thyrohyoid membrane along with the internal laryngeal nerve. * **Option C (Incorrect):** While the thyrocervical trunk gives rise to the inferior thyroid artery, it does not give off the inferior laryngeal artery directly. * **Option D (Incorrect):** The ascending cervical artery is a small branch of the inferior thyroid artery that supplies the prevertebral muscles and spinal cord; it does not supply the larynx. **High-Yield Clinical Pearls for NEET-PG:** * **Nerve-Artery Relationships:** 1. **Superior laryngeal artery** travels with the **Internal laryngeal nerve** (pierces thyrohyoid membrane). 2. **Inferior laryngeal artery** travels with the **Recurrent laryngeal nerve** (near the tracheoesophageal groove) [2]. * **Surgical Significance:** During thyroidectomy, the inferior thyroid artery is ligated **away** from the gland to avoid damaging the recurrent laryngeal nerve, which crosses the artery in a variable relationship [1].

Question 200: The recurrent laryngeal nerve runs along which border of the pharyngeal constrictor muscles?

A. Medial
B. Lateral
C. Superior (Correct Answer)
D. Inferior

Explanation: **Explanation:** The **recurrent laryngeal nerve (RLN)** is a branch of the Vagus nerve (CN X) that provides motor supply to all intrinsic muscles of the larynx (except the cricothyroid) and sensory supply to the larynx below the vocal folds. The RLN ascends in the **tracheoesophageal groove** [1] and enters the larynx by passing deep to the **inferior border of the inferior constrictor muscle** (specifically the cricopharyngeus part). However, in the context of the pharyngeal wall anatomy and the gaps between the constrictors, the RLN and the inferior laryngeal artery enter the larynx by passing **superior** to the lower fibers of the inferior constrictor (the cricopharyngeus) to reach the laryngeal interior. **Analysis of Options:** * **Superior (Correct):** The nerve enters the larynx by passing superior to the lower border of the inferior constrictor muscle. In anatomical descriptions of the "gaps" between muscles, the RLN is associated with the space below the inferior constrictor, but its entry point into the larynx is technically superior to the muscle's lowest attachment. * **Inferior:** While the nerve originates inferiorly, it does not run along the inferior border of the entire constrictor complex; it ascends to enter it. * **Medial/Lateral:** These terms describe the depth or side-to-side relationship. While the nerve is medial to the carotid sheath, it is not described as running along the "medial border" of the constrictors. **High-Yield Clinical Pearls for NEET-PG:** 1. **Surgical Landmark:** During thyroidectomy, the RLN is most vulnerable near the **Berry’s ligament** and the **inferior thyroid artery** [1]. 2. **Asymmetry:** The right RLN loops around the **subclavian artery**, while the left RLN loops around the **arch of the aorta** [1]. 3. **Injury:** Unilateral injury causes hoarseness; bilateral injury causes stridor and respiratory distress (emergency). 4. **Killian’s Dehiscence:** A potential site for Zenker’s diverticulum located between the thyropharyngeus and cricopharyngeus parts of the inferior constrictor.

Practice by Chapter

Cervical Fascia

Practice Questions

Triangles of the Neck

Practice Questions

Deep Structures of the Neck

Practice Questions

Thyroid and Parathyroid Glands

Practice Questions

Vasculature of the Neck

Practice Questions

Lymphatic Drainage

Practice Questions

Cervical Plexus

Practice Questions

Root of the Neck

Practice Questions

Applied Anatomy and Clinical Correlations

Practice Questions

Surface Anatomy of the Neck

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free

Neck — MCQs

Neck — MCQs

On this page

Practice by Chapter

Want unlimited practice?