Neck Practice Questions

Q: Which nerve supplies the vocal cords?

Recurrent laryngeal nerve. The nerve supply to the larynx is a high-yield topic for NEET-PG, primarily derived from the **Vagus nerve (CN X)** via its laryngeal branches. [1] ### **Explanation of the Correct Answer** The **Recurrent Laryngeal Nerve (RLN)** is the correct answer because it provides: 1. **Motor supply:** To all intrinsic muscles of the larynx **except** the cricothyroid. This includes the muscles that move the vocal cords (abductors, adductors, and relaxors). 2. **Sensory supply:** To the laryngeal mucosa **below** the level of the vocal cords. Since the RLN controls the muscles that manipulate the vocal cords (specifically the *posterior cricoarytenoid* for abduction and *lateral cricoarytenoid* for adduction), it is the functional nerve of the vocal cords. [1] ### **Why Other Options are Incorrect** * **External Laryngeal Nerve:** It supplies only the **cricothyroid muscle** (the "tenser" of the vocal cords). While it affects the pitch of the voice, it does not supply the vocal cords' primary intrinsic musculature or mucosa. * **Internal Laryngeal Nerve:** It is purely **sensory**. It supplies the laryngeal mucosa **above** the vocal cords (up to the epiglottis) and is responsible for the cough reflex. * **Vagus Nerve:** While the RLN is a branch of the Vagus, the question asks for the specific nerve. In anatomy exams, always choose the most distal/specific branch. ### **High-Yield Clinical Pearls** * **Unilateral RLN injury:** Results in hoarseness of voice as the vocal cord assumes a paramedian position. * **Bilateral RLN injury:** Can lead to inspiratory stridor and dyspnea because the vocal cords cannot abduct (open). * **Semon’s Law:** In progressive lesions of the RLN, abductor muscles (posterior cricoarytenoid) are paralyzed before adductor muscles. * **Surgery Link:** The RLN is most commonly injured during **Thyroidectomy** due to its close proximity to the inferior thyroid artery. [1]

Q: All of the following are spaces related to the larynx except:

Space of Gillette. The correct answer is **Space of Gillette** because it is a retropharyngeal space, not an intralaryngeal one. ### **Explanation of Options** * **Space of Gillette (Correct Answer):** This is a potential space located in the **retropharyngeal region**, specifically between the buccopharyngeal fascia and the prevertebral fascia. It contains the Nodes of Rouviere (lateral retropharyngeal nodes). Infections here can lead to retropharyngeal abscesses, which may bulge into the posterior pharyngeal wall. * **Space of Boyer (Incorrect):** This is the **pre-epiglottic space**. It is a wedge-shaped, fat-filled space located anterior to the epiglottis and posterior to the thyrohyoid membrane. It is clinically significant because it allows for the silent horizontal spread of supraglottic tumors. * **Space of Tucker (Incorrect):** This is the **paraglottic space**. It is a potential space lateral to the laryngeal ventricles, bounded by the thyroid cartilage laterally and the conus elasticus medially. It is a key pathway for the vertical spread of transglottic tumors. * **Reinke’s Space (Incorrect):** This is a subepithelial potential space of the **vocal folds** (between the epithelium and the vocal ligament). Accumulation of fluid here leads to "Reinke’s edema," commonly seen in chronic smokers. ### **High-Yield Clinical Pearls for NEET-PG** * **Pre-epiglottic space (Boyer)** involvement is a primary reason for performing a total laryngectomy in supraglottic cancers. * **Paraglottic space (Tucker)** involvement often results in vocal cord fixation. * **Retropharyngeal space (Gillette)** infections are most common in children due to the presence of the Nodes of Rouviere, which atrophy after age 4–5.

Q: The thyroidea ima artery is not a branch of which of the following?

Vertebral artery. ### Explanation The **thyroidea ima artery** is an anatomical variant present in approximately **3–10% of the population**. It is an accessory artery that supplies the thyroid gland, typically compensating for the absence or small size of the inferior thyroid arteries. **Why Vertebral Artery is the Correct Answer:** The thyroidea ima artery typically arises from midline or near-midline structures within the superior mediastinum or the root of the neck. The **vertebral artery** is a branch of the first part of the subclavian artery that ascends through the foramina transversaria of the cervical vertebrae. It is located too far laterally and posteriorly to give rise to the thyroidea ima, which must ascend anterior to the trachea to reach the thyroid isthmus. **Analysis of Other Options:** * **Brachiocephalic trunk (Innominate artery):** This is the **most common source** of the thyroidea ima artery. * **Arch of aorta:** The artery can arise directly from the arch, usually between the brachiocephalic trunk and the left common carotid. * **Subclavian artery:** It may occasionally arise from the right subclavian artery or the internal thoracic artery [1]. **High-Yield Clinical Pearls for NEET-PG:** 1. **Course:** It ascends on the **anterior surface of the trachea** to reach the lower border of the **thyroid isthmus**. 2. **Surgical Significance:** It is a major "danger" structure during emergency **tracheostomy** or thyroidectomy [1]. Accidental injury can lead to profuse hemorrhage that may retract into the mediastinum. 3. **Supply:** It primarily supplies the thyroid gland but can also give branches to the thymus (as the *thymica accessoria*). 4. **Embryology:** It represents a persistent developmental vessel from the aortic arches that failed to regress.

Q: When a large bolus of food is swallowed, the hyoid bone moves anteriorly to open the pharynx. The muscle responsible for this action is innervated by which of the following nerves?

C1 (ansa cervicalis). **Explanation:** The muscle responsible for the anterior movement of the hyoid bone (and consequently the larynx) to open the pharynx during swallowing is the **Geniohyoid**. 1. **Why A is correct:** The geniohyoid muscle originates from the inferior mental spine of the mandible and inserts into the hyoid bone. When it contracts, it pulls the hyoid bone anterosuperiorly, widening the pharynx to accommodate a food bolus. It is innervated by the **C1 nerve fibers** traveling via the **Hypoglossal nerve (CN XII)**. While it is technically "C1 via XII," in the context of NEET-PG, it is categorized under the C1/Ansa cervicalis complex. 2. **Why the others are wrong:** * **CN IX (Glossopharyngeal):** Innervates the Stylopharyngeus. While this muscle elevates the pharynx, it does not primarily drive the anterior displacement of the hyoid. * **Pharyngeal Plexus:** Formed by CN IX, X, and sympathetic fibers. It innervates most pharyngeal constrictors and palatal muscles (except Tensor Veli Palatini and Stylopharyngeus), which are involved in peristalsis, not anterior hyoid displacement. * **CN V3 (Mandibular nerve):** Innervates the Mylohyoid and the anterior belly of the digastric. While these elevate the hyoid, the specific "anterior" pull for pharyngeal opening is the hallmark of the Geniohyoid. **High-Yield NEET-PG Pearls:** * **C1 via CN XII:** Supplies two muscles—the **Geniohyoid** and the **Thyrohyoid**. * **Ansa Cervicalis (C1-C3):** Supplies the "SOS" muscles—**S**ternohyoid, **O**mohyoid, and **S**ternothyroid. * **Deglutition Tip:** The elevation and anterior displacement of the larynx under the tongue base is essential to protect the airway and open the esophagus.

Q: A 45-year-old woman presents with neck pain. A CT scan reveals a tumor in the left side of her oral cavity. Following a radical neck surgical procedure for tumor removal, the patient's left shoulder droops noticeably two months postoperatively. Physical examination reveals distinct weakness in turning her head to the right and impairment of abduction of her left upper limb to the level of the shoulder. Which of the following structures was most likely injured during the radical neck surgery?

Spinal accessory nerve. ### Explanation **1. Why the Spinal Accessory Nerve (CN XI) is correct:** The clinical presentation of **shoulder drooping** and **weakness in head rotation** is a classic sign of Spinal Accessory Nerve injury. * **Trapezius muscle:** CN XI provides motor innervation to the trapezius. Paralysis leads to drooping of the shoulder and an inability to abduct the arm above 90 degrees (as the trapezius is essential for upward rotation of the scapula). * **Sternocleidomastoid (SCM) muscle:** CN XI also innervates the SCM. Since the left SCM rotates the head to the *right*, an injury to the left nerve results in weakness when turning the head to the opposite side. * **Surgical Context:** The Spinal Accessory Nerve is highly vulnerable during radical neck dissections as it crosses the posterior triangle of the neck. **2. Why the other options are incorrect:** * **A. Suprascapular nerve:** Innervates the supraspinatus (initiates abduction) and infraspinatus. While injury affects abduction, it would not cause SCM weakness or shoulder drooping. * **B. Long thoracic nerve:** Innervates the serratus anterior. Injury causes "winging of the scapula," not a drooping shoulder or SCM deficit. * **D. Junction of C5-C6 (Erb’s Point):** Injury here (Erb’s Palsy) leads to the "waiter’s tip" deformity. While it affects abduction, it involves multiple muscles (deltoid, biceps, brachialis) and would not explain the SCM weakness. **3. NEET-PG Clinical Pearls:** * **Surface Anatomy:** The Spinal Accessory Nerve emerges at the junction of the upper 1/3rd and lower 2/3rds of the posterior border of the SCM. * **The "Shrug" Test:** Clinical testing for CN XI involves shrugging the shoulders against resistance (Trapezius) and turning the chin against resistance (SCM). * **Iatrogenic Injury:** The most common cause of CN XI injury is iatrogenic, specifically during lymph node biopsies in the posterior triangle or radical neck surgeries.

Q: Which muscle is supplied by the external branch of the superior laryngeal nerve?

Cricothyroid. **Explanation:** The nerve supply of the laryngeal muscles follows a very specific "rule of thumb" in anatomy, which is a high-yield concept for NEET-PG. **1. Why Cricothyroid is correct:** The **External Laryngeal Nerve** (a branch of the Superior Laryngeal Nerve) provides motor innervation to only one muscle: the **Cricothyroid** [1]. This muscle acts as a tensor of the vocal cords by tilting the thyroid cartilage forward. It is the only laryngeal muscle located on the external surface of the larynx, which explains why it is supplied by the external branch. **2. Why the other options are incorrect:** * **Thyroarytenoid, Posterior cricoarytenoid, and Lateral cricoarytenoid:** All intrinsic muscles of the larynx (except the cricothyroid) are supplied by the **Recurrent Laryngeal Nerve (RLN)**. * The **Posterior cricoarytenoid** is particularly important as it is the only abductor of the vocal cords ("safety muscle of the larynx"). **Clinical Pearls for NEET-PG:** * **Nerve Injury:** Injury to the external laryngeal nerve (often during thyroidectomy when ligating the superior thyroid artery) results in the inability to create high-pitched sounds due to loss of cricothyroid function (the "monotone voice") [1]. * **Sensory Supply:** The **Internal Laryngeal Nerve** provides sensory innervation to the larynx *above* the vocal folds, while the **Recurrent Laryngeal Nerve** provides sensory innervation *below* the vocal folds. * **Surgical Landmark:** The external laryngeal nerve travels in close proximity to the **superior thyroid artery**, whereas the recurrent laryngeal nerve is closely related to the **inferior thyroid artery** [1].

Q: Into which lymph node do the lymphatics of the tonsils primarily drain?

Jugulodigastric lymph node. The palatine tonsils are part of the Waldeyer’s ring and have a specific lymphatic drainage pattern that is frequently tested in NEET-PG. ### **Explanation of the Correct Answer** The **Jugulodigastric lymph node** (also known as the **Principal lymph node of the tonsil**) is the primary site for tonsillar drainage. It is located in the deep cervical chain, specifically where the posterior belly of the digastric muscle crosses the internal jugular vein. Because it is the first station to receive lymph from the palatine tonsils, it is the most common node to become enlarged and tender during acute tonsillitis. ### **Analysis of Incorrect Options** * **B. Jugulo-omohyoid lymph node:** This node is located where the omohyoid muscle crosses the internal jugular vein. It primarily receives drainage from the **tongue** (specifically the submental and submandibular nodes) and is not the primary station for the tonsils. * **C. Submandibular lymph node:** These nodes receive lymph from the front of the scalp, nose, cheeks, upper lip, and the lateral parts of the lower lip and tongue. * **D. Submental lymph node:** These nodes drain the tip of the tongue, the floor of the mouth, and the central part of the lower lip. ### **High-Yield Clinical Pearls for NEET-PG** * **Location:** The Jugulodigastric node belongs to the **Level II** cervical lymph nodes. * **Clinical Sign:** In clinical practice, a palpable, tender jugulodigastric node is a hallmark sign of **acute follicular tonsillitis**. * **Waldeyer’s Ring:** Remember that while the palatine tonsils drain to the jugulodigastric nodes, the pharyngeal tonsils (adenoids) drain primarily to the **retropharyngeal lymph nodes**.

Question 1

Which nerve supplies the vocal cords?

Accepted Answer

Recurrent laryngeal nerve

Answer

External laryngeal nerve

Answer

Internal laryngeal nerve

Answer

Vagus nerve

Question 2

Which of the following statements is FALSE regarding the anterior triangle of the neck?

Accepted Answer

Its superior boundary is the anterior belly of the digastric muscle.

Answer

Its posterior boundary is the anterior border of the Sternocleidomastoid muscle.

Answer

It is a part of the anterior triangle of the neck.

Answer

Its anteroinferior boundary is the superior belly of the Omohyoid muscle.

Question 3

Which of the following is the most common location of a branchial cyst?

Accepted Answer

Upper third of the anterior border of the sternocleidomastoid muscle

Answer

Upper third of the posterior border of the sternocleidomastoid muscle

Answer

Lower third of the posterior border of the sternocleidomastoid muscle

Answer

Lower third of the anterior border of the sternocleidomastoid muscle

Question 4

All of the following are spaces related to the larynx except:

Accepted Answer

Space of Gillette

Answer

Space of Boyer

Answer

Space of Tucker

Answer

Reinke's space

Question 5

The thyroidea ima artery is not a branch of which of the following?

Accepted Answer

Vertebral artery

Answer

Brachiocephalic trunk

Answer

Subclavian artery

Answer

Arch of aorta

Question 6

When a large bolus of food is swallowed, the hyoid bone moves anteriorly to open the pharynx. The muscle responsible for this action is innervated by which of the following nerves?

Accepted Answer

C1 (ansa cervicalis)

Answer

Cranial Nerve IX

Answer

Pharyngeal plexus

Answer

Cranial Nerve V3

Question 7

A 45-year-old woman presents with neck pain. A CT scan reveals a tumor in the left side of her oral cavity. Following a radical neck surgical procedure for tumor removal, the patient's left shoulder droops noticeably two months postoperatively. Physical examination reveals distinct weakness in turning her head to the right and impairment of abduction of her left upper limb to the level of the shoulder. Which of the following structures was most likely injured during the radical neck surgery?

Accepted Answer

Spinal accessory nerve

Answer

Suprascapular nerve

Answer

Long thoracic nerve

Answer

The junction of spinal nerves C5 and C6 of the brachial plexus

Question 8

Which muscle is supplied by the external branch of the superior laryngeal nerve?

Accepted Answer

Cricothyroid

Answer

Thyroarytenoid

Answer

Posterior cricoarytenoid

Answer

Cricoarytenoid

Question 9

Into which lymph node do the lymphatics of the tonsils primarily drain?

Accepted Answer

Jugulodigastric lymph node

Answer

Jugulo-omohyoid lymph node

Answer

Submandibular lymph node

Answer

Submental lymph node

Question 10

Which of the following statements regarding the parathyroid glands is INCORRECT?

Accepted Answer

The superior parathyroid gland develops from the third pharyngeal pouch.

Answer

The normal parathyroid gland weighs up to 50 mg.

Answer

The inferior parathyroid gland descends along with the thymus.

Answer

The superior parathyroid gland is more consistent in its position than the inferior gland.

Neck — MCQs

Neck — MCQs

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