Neck — MCQs

Neck Indian Medical PG Practice Questions and MCQs

Question 221: An angiogram of a man shows an occlusion of the Costocervical Trunk. This obstruction could produce a marked decrease in the blood flow in which of the following arteries?

A. Superior thoracic artery
B. Transverse cervical artery
C. Ascending cervical artery
D. Deep cervical artery (Correct Answer)

Explanation: The **Costocervical Trunk** is a short branch arising from the posterior aspect of the **second part of the subclavian artery** (on the right) or the first part (on the left). It travels posteriorly over the cervical pleura to the neck of the first rib, where it divides into two terminal branches: 1. **Deep Cervical Artery:** It passes backward between the transverse process of C7 and the first rib, ascending the back of the neck to anastomose with the descending branch of the occipital artery. 2. **Superior Intercostal Artery:** It descends in front of the necks of the first two ribs to provide the first and second posterior intercostal arteries. Therefore, an occlusion of the costocervical trunk directly compromises blood flow to the **Deep cervical artery**. **Analysis of Incorrect Options:** * **A. Superior thoracic artery:** This is the first branch of the **Axillary artery**, supplying the first and second intercostal spaces. * **B. Transverse cervical artery:** This is a branch of the **Thyrocervical trunk** (from the 1st part of the subclavian artery). * **C. Ascending cervical artery:** This is a small branch of the **Inferior thyroid artery** (which itself arises from the Thyrocervical trunk). **High-Yield NEET-PG Pearls:** * **Subclavian Artery Parts:** Divided by the **Scalenus Anterior** muscle. 1st part (medial), 2nd part (posterior/behind), 3rd part (lateral). * **Branches of 1st Part:** Vertebral artery, Internal thoracic artery, Thyrocervical trunk (VIT). * **Branches of 2nd Part:** Costocervical trunk. * **Branches of 3rd Part:** Dorsal scapular artery (variable). * **Collateral Circulation:** The anastomosis between the Deep Cervical artery and the Occipital artery is a vital link between the Subclavian and External Carotid systems.

Question 222: Glomus cells are found in which of the following?

A. Carotid body tumour
B. Thyroid carcinoma
C. Liver carcinoma
D. None of the above (Correct Answer)

Explanation: **Explanation:** The correct answer is **None of the above** because Glomus cells (Type I cells) are physiological components of the **normal Carotid Body**, not the tumors themselves. 1. **Understanding Glomus Cells:** Glomus cells are specialized chemoreceptors located in the carotid body (at the bifurcation of the common carotid artery) and the aortic bodies. They are derived from the **neural crest** and function to detect changes in arterial blood gas levels (primarily hypoxia, hypercapnia, and acidosis). 2. **Why Option A is Incorrect:** While a **Carotid Body Tumor (Paraganglioma)** arises from these cells, the tumor itself is a pathological neoplastic proliferation. In medical nomenclature, "Glomus cells" refers to the histological unit of the healthy organ. Furthermore, the question asks where the cells are "found"; while they are the cell of origin for the tumor, the tumor tissue is histologically organized into characteristic clusters called **Zellballen patterns**. 3. **Why Options B & C are Incorrect:** Thyroid carcinoma arises from follicular or parafollicular (C-cells) cells of the thyroid gland. Liver carcinoma (Hepatocellular carcinoma) arises from hepatocytes. Neither organ contains glomus chemoreceptor cells. **High-Yield Clinical Pearls for NEET-PG:** * **Location:** The Carotid Body is located in the adventitia of the carotid bifurcation. * **Innervation:** It is primarily supplied by the **Hering’s nerve**, a branch of the Glossopharyngeal nerve (CN IX). * **Histology:** Look for the **"Zellballen" pattern** (nests of chief cells surrounded by sustentacular cells) in pathology questions regarding paragangliomas. * **Lyre Sign:** On angiography, a carotid body tumor characteristically splayed the internal and external carotid arteries, known as the Lyre sign.

Question 223: During surgery for squamous cell carcinoma of the neck in a 56-year-old man, the surgeon encounters profuse bleeding from a deep cervical artery. Which of the following arteries must be ligated immediately to control the bleeding?

A. Costocervical trunk (Correct Answer)
B. Transverse cervical artery
C. Thyrocervical trunk
D. Inferior thyroid artery

Explanation: **Explanation:** The **deep cervical artery** is a direct branch of the **costocervical trunk**. To control profuse bleeding from this vessel, the parent trunk must be ligated. **1. Why Option A is Correct:** The costocervical trunk arises from the second part of the subclavian artery (on the right) or the first part (on the left). It divides into two main branches: * **Deep cervical artery:** Passes posteriorly above the T1 nerve to supply the deep muscles of the back of the neck. * **Superior intercostal artery:** Supplies the first two intercostal spaces. Since the deep cervical artery originates from this trunk, ligating the costocervical trunk is the most proximal and effective way to control the hemorrhage. **2. Why Other Options are Incorrect:** * **B. Transverse cervical artery:** This is a branch of the thyrocervical trunk. It supplies the trapezius and rhomboid muscles but does not give rise to the deep cervical artery. * **C. Thyrocervical trunk:** While it is a major branch of the first part of the subclavian artery, its primary branches are the inferior thyroid, suprascapular, and transverse cervical arteries. It does not supply the deep cervical artery. * **D. Inferior thyroid artery:** This is a branch of the thyrocervical trunk. It supplies the thyroid gland and gives off the ascending cervical artery, which is more superficial than the deep cervical artery. **High-Yield NEET-PG Pearls:** * **Subclavian Artery Parts:** Divided by the **scalenus anterior** muscle. * 1st Part: Vertebral, Internal thoracic, Thyrocervical trunk. * 2nd Part: Costocervical trunk (on the right). * 3rd Part: Dorsal scapular artery (variable). * **Deep Cervical Artery Anastomosis:** It anastomoses with the descending branch of the **occipital artery** (from the external carotid), providing a critical collateral channel between the subclavian and external carotid systems.

Question 224: Gillet's space indicates which of the following?

A. Prevertebral space
B. Paravertebral space
C. Retropharyngeal space (Correct Answer)
D. Peritonsillar space

Explanation: **Explanation:** **Gillet’s space** is a clinical and anatomical synonym for the **Retropharyngeal space**. It is a potential space located behind the pharynx, bounded anteriorly by the buccopharyngeal fascia and posteriorly by the prevertebral fascia (specifically the alar layer). It extends cranially from the base of the skull down to the superior mediastinum (at the level of T4/T2). **Why Option C is correct:** The retropharyngeal space contains loose areolar tissue and the **Nodes of Rouviere** (lateral retropharyngeal nodes). In children, infections from the nasopharynx can lead to suppurative lymphadenitis in Gillet’s space, resulting in a retropharyngeal abscess. **Why other options are incorrect:** * **Prevertebral space:** This lies posterior to the prevertebral fascia and anterior to the vertebral bodies. It extends from the skull base to the coccyx. Infections here usually arise from vertebral bodies (e.g., Pott’s disease). * **Paravertebral space:** This is a wedge-shaped area on either side of the vertebral column, primarily relevant in anesthesia for nerve blocks; it is not synonymous with Gillet’s space. * **Peritonsillar space:** This is the space between the capsule of the palatine tonsil and the superior constrictor muscle. Infection here leads to "Quinsy." **High-Yield Clinical Pearls for NEET-PG:** 1. **Danger Space:** Located between the alar fascia and the prevertebral fascia. It is called "danger" because it provides a direct conduit for infection to spread from the skull base to the **diaphragm/posterior mediastinum**. 2. **Retropharyngeal Abscess:** On a lateral X-ray of the neck, it is characterized by the widening of the prevertebral soft tissue shadow (normally <7mm at C2). 3. **Nodes of Rouviere:** These nodes usually atrophy after the age of 6, which is why retropharyngeal abscesses are more common in children.

Question 225: The larynx extends from which vertebral level?

A. C2-C7
B. C1-C4
C. C5-C6
D. C3-C6 (Correct Answer)

Explanation: **Explanation:** The larynx, also known as the "voice box," is a cartilaginous structure that serves as a vital air passage and the organ of phonation. In an adult, it extends from the **upper border of the epiglottis to the lower border of the cricoid cartilage**. **1. Why C3-C6 is correct:** The vertical extent of the larynx corresponds to the level of the **C3 to C6 vertebrae**. * **C3:** Level of the hyoid bone and the upper limit of the epiglottis. * **C4-C5:** Level of the thyroid cartilage (the "Adam’s apple"). * **C6:** Level of the cricoid cartilage, marking the termination of the larynx and the beginning of the trachea. **2. Analysis of Incorrect Options:** * **C2-C7 (A):** This range is too broad. C2 is the level of the axis (oropharynx), and C7 is well into the trachea. * **C1-C4 (B):** This corresponds more closely to the position of the pharynx and the upper cervical spine; the larynx begins lower. * **C5-C6 (C):** While the larynx occupies this space, it is incomplete as it misses the superior structures (epiglottis and hyoid) located at C3-C4. **3. NEET-PG High-Yield Pearls:** * **Pediatric Anatomy:** In infants, the larynx is situated much higher (approx. **C2-C3**) to allow simultaneous breathing and nursing. It descends to the adult position by puberty. * **The C6 Level:** This is a "critical level" in the neck. It marks the end of the larynx/pharynx and the start of the trachea/esophagus. It is also where the middle thyroid artery enters and the carotid tubercle (Chassaignac's tubercle) is located. * **Inlet vs. Outlet:** The laryngeal inlet faces the oropharynx, while the outlet is continuous with the trachea at the lower border of the cricoid.

Question 226: Which of the following statements about the left recurrent laryngeal nerve is true?

A. It is a pure motor nerve.
B. It supplies the cricothyroid muscle.
C. It arises from the vagus nerve as it crosses the first part of the subclavian artery.
D. It courses through the groove between the trachea and the esophagus. (Correct Answer)

Explanation: ### Explanation The **Recurrent Laryngeal Nerve (RLN)** is a branch of the Vagus nerve (CN X) with a distinct course and critical clinical significance in neck surgery. **Why Option D is Correct:** After looping under the arch of the aorta, the **left RLN** [1] ascends into the neck. It specifically travels superiorly within the **tracheoesophageal groove** (the sulcus between the trachea and esophagus) [2]. It eventually enters the larynx by passing deep to the lower border of the inferior constrictor muscle. **Analysis of Incorrect Options:** * **Option A:** The RLN is a **mixed nerve**. It provides motor supply to laryngeal muscles and sensory supply to the laryngeal mucosa **below** the level of the vocal cords. * **Option B:** The **cricothyroid** is the only intrinsic laryngeal muscle *not* supplied by the RLN; it is supplied by the **External Laryngeal Nerve**. The RLN supplies all other intrinsic muscles of the larynx. * **Option C:** This describes the **right RLN**, which loops around the first part of the right subclavian artery. The **left RLN** arises in the thorax and loops around the **arch of the aorta**, lateral to the ligamentum arteriosum [1]. **NEET-PG High-Yield Pearls:** * **Surgery Risk:** During thyroidectomy, the RLN is at risk near the **inferior thyroid artery**, where it may pass anterior, posterior, or between the arterial branches [1]. * **Ortner’s Syndrome:** Left RLN palsy caused by mechanical compression from a dilated left atrium (e.g., mitral stenosis). * **Lesion Effects:** Unilateral RLN injury leads to hoarseness of voice; bilateral injury can cause respiratory distress (stridor) as vocal cords remain in a paramedian position [3].

Question 227: At the bifurcation of the common carotid artery, where is the internal carotid artery located in relation to the external carotid artery?

A. Lateral to the external carotid artery. (Correct Answer)
B. Medial to the external carotid artery.
C. Posterior to the external carotid artery.
D. Anterior to the external carotid artery.

Explanation: The common carotid artery (CCA) typically bifurcates at the level of the upper border of the thyroid cartilage (C3-C4 vertebral level). At this point of origin, the **Internal Carotid Artery (ICA)** lies **posterolateral** to the **External Carotid Artery (ECA)**. 1. **Why Option A is correct:** Although the ICA eventually moves medially to enter the carotid canal at the base of the skull, at its immediate origin (the carotid bulb), it is situated lateral and slightly posterior to the ECA. This anatomical arrangement is a high-yield fact for surgical orientation during procedures like carotid endarterectomy [1]. 2. **Why Options B, C, and D are incorrect:** * **Medial/Anterior:** These describe the initial position of the **External Carotid Artery**. The ECA begins anteromedial to the ICA before coursing upwards and backwards. * **Posterior:** While the ICA has a posterior component to its position, "Lateral" is the primary descriptor used in standard anatomical texts (Gray’s Anatomy) to differentiate its starting position from the ECA. **NEET-PG High-Yield Pearls:** * **Branches:** The ICA has **no branches** in the neck. This is the most reliable way to distinguish it from the ECA during surgery. * **Carotid Sinus:** Located at the bifurcation (primarily involving the proximal ICA), it acts as a **baroreceptor** (pressure sensor) innervated by the Glossopharyngeal nerve (CN IX). * **Carotid Body:** A small, reddish-brown structure located posterior to the bifurcation; it acts as a **chemoreceptor** (sensing $O_2$, $CO_2$, and pH). * **Surface Anatomy:** The bifurcation corresponds to the level of the **disc between C3 and C4 vertebrae**.

Question 228: Which muscle does the spinal part of the accessory nerve supply?

A. Platysma
B. Sternocleidomastoid (Correct Answer)
C. Stylohyoid
D. Digastric

Explanation: ### Explanation The **Spinal Accessory Nerve (CN XI)** is a purely motor nerve that originates from the upper five or six cervical segments of the spinal cord. It enters the skull through the foramen magnum and exits via the **jugular foramen**. It provides motor innervation to two major muscles of the neck and back: the **Sternocleidomastoid (SCM)** and the **Trapezius**. * **Sternocleidomastoid (Correct):** The nerve pierces the deep surface of the SCM to supply it. This muscle is responsible for tilting the head to the same side and rotating the face to the opposite side. * **Platysma (Incorrect):** This is a muscle of facial expression located in the superficial fascia of the neck; it is supplied by the **Cervical branch of the Facial Nerve (CN VII)**. * **Stylohyoid (Incorrect):** This muscle is derived from the second branchial arch and is supplied by the **Facial Nerve (CN VII)**. * **Digastric (Incorrect):** This muscle has dual innervation. The anterior belly is supplied by the **Nerve to Mylohyoid (V3)**, while the posterior belly is supplied by the **Facial Nerve (CN VII)**. ### High-Yield Clinical Pearls for NEET-PG: * **Surface Anatomy:** The spinal accessory nerve is most vulnerable to injury in the **posterior triangle** of the neck (e.g., during lymph node biopsy). * **Clinical Testing:** Injury to CN XI results in "drooping of the shoulder" (Trapezius paralysis) and difficulty rotating the head to the *opposite* side against resistance (SCM paralysis). * **Plexus Contribution:** While CN XI provides motor supply, the **C2 and C3** spinal nerves provide proprioceptive fibers to the SCM, and **C3 and C4** provide proprioception to the Trapezius.

Question 229: During the excision of cervical lymph nodes, inadvertent injury to which nerve causes drooping of the shoulder?

A. Supraclavicular nerve
B. Suprascapular nerve
C. Spinal accessory nerve (Correct Answer)
D. Nerve to serratus anterior

Explanation: **Explanation:** The correct answer is **Spinal accessory nerve (CN XI)**. **1. Why it is correct:** The spinal accessory nerve (CN XI) exits the skull through the jugular foramen and descends to supply the sternocleidomastoid muscle. It then crosses the **posterior triangle of the neck**, where it lies superficially, covered only by skin and fascia [1]. It terminates by supplying the **trapezius muscle**. The trapezius is the primary muscle responsible for elevating the scapula and maintaining the shoulder's contour. Injury to CN XI during cervical lymph node biopsy or neck dissection leads to paralysis of the trapezius, resulting in **drooping of the shoulder**, inability to shrug, and difficulty in abducting the arm above the horizontal plane (due to loss of scapular rotation) [1]. **2. Why the other options are wrong:** * **Supraclavicular nerve:** These are cutaneous sensory nerves (C3-C4). Injury would cause sensory loss over the shoulder and upper chest, but no motor deficit or drooping. * **Suprascapular nerve:** Supplies the supraspinatus and infraspinatus. Injury causes weakness in initiating abduction and external rotation of the arm, but not shoulder drooping. * **Nerve to serratus anterior (Long thoracic nerve):** Injury leads to **"winging of the scapula"** (medial border protrudes), but the shoulder does not droop. **High-Yield Clinical Pearls for NEET-PG:** * **Surface Anatomy:** The spinal accessory nerve is most vulnerable at **Erb’s point** (middle of the posterior border of the sternocleidomastoid). * **Clinical Test:** Ask the patient to shrug their shoulders against resistance to test the trapezius (CN XI). * **Iatrogenic Injury:** Cervical lymph node biopsy in the posterior triangle is the most common cause of iatrogenic spinal accessory nerve palsy [1].

Question 230: The oropharynx lies against which cervical vertebra?

A. C1
B. C2 (Correct Answer)
C. C3
D. C4

Explanation: The pharynx is a muscular tube extending from the base of the skull to the lower border of the cricoid cartilage. For NEET-PG, it is essential to memorize the vertebral levels of its three subdivisions: **1. Why C2 is the correct answer:** The **oropharynx** is the middle portion of the pharynx, located posterior to the oral cavity. It extends from the soft palate above to the upper border of the epiglottis below. Anatomically, it lies anterior to the **C2 (Axis) and the upper part of the C3** vertebrae. In most standard anatomical texts and exam patterns, C2 is identified as the primary vertebral relation for the oropharynx. **2. Analysis of incorrect options:** * **C1 (Atlas):** This level corresponds to the **Nasopharynx**, which lies above the soft palate and extends from the base of the skull to C1. * **C3:** While the lower limit of the oropharynx reaches the upper border of C3, C2 is the more definitive landmark for the bulk of the oropharyngeal space. * **C4:** This level corresponds to the **Laryngopharynx** (Hypopharynx). The laryngopharynx extends from the upper border of the epiglottis (C3) down to the lower border of the cricoid cartilage (**C6**). **3. Clinical Pearls & High-Yield Facts:** * **Pharynx Extent:** Base of skull to **C6** (where it becomes the esophagus). * **Larynx Extent:** Typically **C3 to C6**. * **Retropharyngeal Space:** Located between the buccopharyngeal fascia and prevertebral fascia; it is a clinical "danger space" where infections can spread from the neck to the superior mediastinum. * **Killian’s Dehiscence:** A potential weak spot between the thyropharyngeus and cricopharyngeus muscles (at the C6 level), which is the site for **Zenker’s diverticulum**.

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Lymphatic Drainage

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