Neck — MCQs

Neck Indian Medical PG Practice Questions and MCQs

Question 231: A person is brought to an emergency department after experiencing sudden difficulty in breathing. A low tracheostomy is performed below the isthmus of the thyroid. Which of the following vessels may be encountered?

A. Inferior thyroid artery
B. Inferior thyroid vein (Correct Answer)
C. Costocervical trunk
D. Superior thyroid artery

Explanation: **Explanation:** In a **low tracheostomy** (performed below the isthmus of the thyroid gland, typically at the level of the 2nd to 4th tracheal rings), the surgeon must navigate the pretracheal space. The **inferior thyroid veins** arise from a venous plexus on the thyroid gland and descend in front of the trachea to drain into the left brachiocephalic vein [1]. Because of their midline position below the isthmus, they are the most likely vessels to be encountered and must be retracted or ligated to avoid hemorrhage [1]. **Analysis of Options:** * **Inferior thyroid vein (Correct):** These veins descend directly in front of the cervical trachea below the isthmus, making them vulnerable during midline surgical approaches [1]. * **Inferior thyroid artery (Incorrect):** This is a branch of the thyrocervical trunk. It approaches the thyroid gland from a **lateral** position and lies deep to the prevertebral fascia, not in the midline pretracheal path [1]. * **Superior thyroid artery (Incorrect):** This artery arises from the external carotid and enters the **upper pole** of the thyroid gland, well above the site of a low tracheostomy [2]. * **Costocervical trunk (Incorrect):** This is a branch of the second part of the subclavian artery located deep in the root of the neck, far from the tracheal midline. **Clinical Pearls for NEET-PG:** 1. **Thyroidea Ima Artery:** In 3–10% of individuals, this accessory artery arises from the brachiocephalic trunk or aortic arch and ascends in the midline to the isthmus. It is a high-yield "danger" vessel in low tracheostomies. 2. **Left Brachiocephalic Vein:** In children, this vein may ascend above the suprasternal notch, posing a risk during the procedure. 3. **Isthmus Level:** The thyroid isthmus usually covers the **2nd, 3rd, and 4th tracheal rings**. A high tracheostomy is done above it, and a low one below it.

Question 232: Which of the following is NOT a feature of the neck fascia?

A. Superficial fascia contains platysma, external and anterior jugular veins.
B. Pretracheal fascia extends as far as the fibrous pericardium.
C. Investing layer of deep cervical fascia lies deep to the parotid gland. (Correct Answer)
D. Prevertebral fascia extends from the base of the skull to the axilla.

Explanation: ### Explanation **1. Why Option C is the Correct Answer (The Concept):** The **investing layer of deep cervical fascia** does not lie deep to the parotid gland; rather, it **splits to enclose** it. As the fascia ascends from the neck to the face, it splits at the lower border of the parotid gland into a superficial and a deep lamella. * The **superficial lamella** (parotidomasseteric fascia) covers the gland and attaches to the zygomatic arch. * The **deep lamella** passes deep to the gland to attach to the base of the skull (tympanic plate and styloid process). Therefore, the statement that it lies "deep to the gland" is incomplete and technically incorrect in the context of its primary anatomical relationship. **2. Analysis of Other Options:** * **Option A:** Correct. The **superficial fascia** of the neck is a thin layer of subcutaneous tissue containing the **platysma muscle**, cutaneous nerves, and the **external and anterior jugular veins**. * **Option B:** Correct. The **pretracheal fascia** consists of a visceral layer. It descends into the superior mediastinum and blends with the **fibrous pericardium** of the heart. This is a common route for the spread of infections from the neck to the mediastinum. * **Option C:** Correct. The **prevertebral fascia** covers the prevertebral muscles. It extends laterally as the **axillary sheath**, surrounding the brachial plexus and axillary artery into the axilla. **3. High-Yield Clinical Pearls for NEET-PG:** * **Dangerous Space:** The retrovisceral space (between the buccopharyngeal and prevertebral fascia) is a conduit for infection to spread from the pharynx to the posterior mediastinum. * **Parotid Abscess:** Because the parotid fascia (from the investing layer) is dense and unyielding, inflammation/abscess of the parotid gland causes severe pain. * **Stylomandibular Ligament:** This is a thickening of the deep lamella of the investing fascia, separating the parotid gland from the submandibular gland.

Question 233: What is the most common site of a thyroglossal cyst?

A. Above the hyoid bone
B. Below the hyoid bone (Correct Answer)
C. At the hyoid bone
D. At the thyroid isthmus

Explanation: A **thyroglossal cyst** is the most common congenital midline neck swelling [1]. It develops from a persistent remnant of the **thyroglossal duct**, which marks the descent of the thyroid gland from the *foramen caecum* at the base of the tongue to its final position in the neck [2]. **Why "Below the Hyoid Bone" is correct:** During embryological descent, the thyroglossal duct passes anterior to, through, or posterior to the hyoid bone [2]. While a cyst can form anywhere along this tract, the **subhyoid location (below the hyoid bone)** is the most frequent site, accounting for approximately **65% of cases**. **Analysis of Incorrect Options:** * **Above the hyoid bone (Suprahyoid):** This is the second most common site (approx. 20-25%) but occurs less frequently than the subhyoid position. * **At the hyoid bone:** Though the duct is intimately related to the hyoid, cysts located exactly at the level of the bone are less common than those just below it. * **At the thyroid isthmus:** While cysts can occur near the isthmus (pre-laryngeal), this represents a smaller percentage of cases compared to the subhyoid region. **Clinical Pearls for NEET-PG:** 1. **Pathognomonic Sign:** The cyst moves upward on **protrusion of the tongue** [2] (due to its attachment to the foramen caecum via the duct) and on **deglutition** (swallowing). 2. **Surgical Management:** The procedure of choice is **Sistrunk’s Operation**, which involves excision of the cyst, the entire duct, and the **central part of the hyoid bone** to prevent recurrence. 3. **Ectopic Thyroid:** Always perform an ultrasound to confirm the presence of a normal thyroid gland, as the cyst may contain the patient's only functioning thyroid tissue [1].

Question 234: Which of the following is not an anatomical triangle of the anterior neck?

A. Digastric triangle
B. Subclavian triangle (Correct Answer)
C. Carotid triangle
D. Submental triangle

Explanation: The neck is divided into two primary regions by the **Sternocleidomastoid (SCM)** muscle: the **Anterior Triangle** and the **Posterior Triangle**. ### Why "Subclavian Triangle" is the Correct Answer The **Subclavian triangle** (also known as the **Supraclavicular** or **Omoclavicular triangle**) is a subdivision of the **Posterior Triangle**, not the anterior. It is bounded superiorly by the inferior belly of the omohyoid, inferiorly by the clavicle, and anteriorly by the posterior border of the SCM. Its primary content is the third part of the subclavian artery. ### Analysis of Incorrect Options (Anterior Triangle Subdivisions) The Anterior Triangle is bounded by the midline of the neck, the anterior border of the SCM, and the lower border of the mandible. It is further divided into: * **Digastric (Submandibular) Triangle:** Located between the two bellies of the digastric muscle and the mandible. It contains the submandibular gland and facial artery. * **Carotid Triangle:** Bounded by the superior belly of omohyoid, posterior belly of digastric, and SCM. It is high-yield because it contains the **Carotid Sheath** (Common Carotid artery, Internal Jugular vein, and Vagus nerve). * **Submental Triangle:** An unpaired triangle below the chin, bounded by the hyoid bone and the anterior bellies of the left and right digastric muscles. ### NEET-PG High-Yield Pearls * **Muscular Triangle:** The fourth subdivision of the anterior triangle; it contains the infrahyoid muscles and the thyroid gland. * **Occipital Triangle:** The larger subdivision of the posterior triangle (above the omohyoid), containing the **Spinal Accessory Nerve (CN XI)**. * **Nerve Point of the Neck:** Located at the posterior border of the SCM, where cutaneous branches of the cervical plexus emerge.

Question 235: At which border of the thyroid cartilage does the common carotid artery bifurcate?

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

Explanation: The bifurcation of the common carotid artery (CCA) is a high-yield anatomical landmark frequently tested in postgraduate medical exams. ### **Explanation of the Correct Answer** The common carotid artery typically bifurcates into the internal and external carotid arteries at the level of the **superior border of the thyroid cartilage**. In terms of vertebral levels, this corresponds to the **C3-C4 intervertebral disc** or the upper level of the **C4 vertebra**. At this point, the artery dilated to form the **carotid sinus** (a baroreceptor) and contains the **carotid body** (a chemoreceptor) in its posterior wall. ### **Analysis of Incorrect Options** * **B. Inferior Border:** This level (C6 vertebra) corresponds to the beginning of the trachea and esophagus, the cricoid cartilage, and where the Omohyoid muscle crosses the CCA. It is the site where the CCA enters the carotid sheath, not where it bifurcates. * **C & D. Lateral and Medial Borders:** These are descriptive anatomical surfaces of the thyroid gland and cartilage. The CCA ascends laterally to the thyroid gland within the carotid sheath, but these borders do not define the vertical level of bifurcation. ### **NEET-PG High-Yield Pearls** * **Vertebral Level:** Remember the "C4" rule for the carotid bifurcation. * **Surface Anatomy:** The bifurcation occurs at the level of the **greater horn of the hyoid bone** (slightly above the thyroid cartilage) or the superior thyroid notch. * **Carotid Triangle:** The bifurcation occurs within the carotid triangle, bounded by the superior belly of the omohyoid, the posterior belly of the digastric, and the anterior border of the sternocleidomastoid. * **Clinical Significance:** This is the site for carotid endarterectomy and where the carotid pulse is most easily palpated against the transverse processes of cervical vertebrae.

Question 236: The superior thyroid artery is anatomically related to which of the following nerves?

A. Recurrent laryngeal nerve
B. External laryngeal nerve (Correct Answer)
C. Internal laryngeal nerve
D. Chorda tympani nerve

Explanation: ### Explanation The **superior thyroid artery (STA)** is the first branch of the external carotid artery. Its anatomical relationship with the **external laryngeal nerve (ELN)** is a classic high-yield topic in head and neck anatomy. **Why the correct answer is right:** The ELN (a branch of the superior laryngeal nerve) descends on the inferior constrictor muscle, deep to the superior thyroid artery. As they approach the upper pole of the thyroid gland, the nerve and artery run in close proximity [3]. To avoid damaging the nerve during a thyroidectomy, the **superior thyroid artery must be ligated as close to the thyroid pole as possible**, where the nerve and artery tend to diverge [3]. **Why the incorrect options are wrong:** * **Recurrent laryngeal nerve (RLN):** This nerve is related to the **inferior thyroid artery** [1], [2]. During surgery, the inferior thyroid artery is ligated far from the gland to avoid injuring the RLN. * **Internal laryngeal nerve:** This nerve travels with the **superior laryngeal artery** (a branch of the STA) to pierce the thyrohyoid membrane. It provides sensory innervation above the vocal cords but is not the primary nerve related to the main trunk of the STA at the thyroid pole. * **Chorda tympani nerve:** This is a branch of the facial nerve (CN VII) involved in taste and submandibular/sublingual salivary secretion; it is located in the infratemporal fossa and middle ear, far from the thyroid gland. **Clinical Pearls for NEET-PG:** 1. **Injury to ELN:** Results in paralysis of the **cricothyroid muscle**, leading to an inability to tense the vocal cords [3]. Clinically, the patient presents with a **loss of high-pitched voice** and easy vocal fatigue (the "monotone voice"). 2. **Ligation Rule:** Ligate the **Superior** artery **Near** the gland; ligate the **Inferior** artery **Far** from the gland [3]. 3. **Nerve Supply:** The ELN is the only branch of the vagus nerve that supplies a laryngeal muscle (cricothyroid) externally; all other intrinsic muscles are supplied by the RLN.

Question 237: Which of the following structures is NOT found in the suprasternal space?

A. Jugular arch
B. Anterior jugular vein
C. Sternal head of sternocleidomastoid muscle
D. External jugular vein (Correct Answer)

Explanation: ### Explanation The **Suprasternal Space (Space of Burns)** is a small compartment formed by the splitting of the **investing layer of deep cervical fascia** above the manubrium sterni. It contains specific structures that are frequently tested in NEET-PG. #### Why External Jugular Vein (EJV) is the Correct Answer: The **External Jugular Vein** is a superficial structure that lies **superficial to the investing layer of deep cervical fascia** and runs across the sternocleidomastoid muscle. Since the suprasternal space is located *between* two layers of the investing fascia, the EJV remains outside this space. #### Analysis of Incorrect Options: * **Jugular Arch:** This is a transverse venous communication that connects the two anterior jugular veins within the suprasternal space. It is a key content. * **Anterior Jugular Vein:** The terminal portions of these veins enter the space before turning laterally to drain into the external jugular or subclavian veins. * **Sternal head of Sternocleidomastoid (SCM):** The investing fascia splits to enclose the SCM. The sternal heads of these muscles form the lateral boundaries of the suprasternal space. #### NEET-PG High-Yield Pearls: 1. **Contents of Suprasternal Space:** * Sternal heads of SCM. * Lower ends of Anterior Jugular Veins. * **Jugular venous arch.** * Interclavicular ligament. * Few lymph nodes and fatty tissue. 2. **Clinical Significance:** A tracheostomy performed too low can inadvertently damage the **jugular venous arch** within this space, leading to significant hemorrhage. 3. **Boundaries:** Anteriorly by the superficial layer and posteriorly by the deep layer of the investing fascia. *Note: None of the provided references contain anatomical data regarding the suprasternal space or cervical fascia.*

Question 238: Which neck swelling moves on swallowing?

A. Submandibular salivary gland
B. Thyroid gland (Correct Answer)
C. Supraclavicular lymph node
D. Sternomastoid tumour

Explanation: The **Thyroid gland** is the correct answer because of its unique anatomical relationship with the **Pretracheal fascia**. The thyroid gland is enclosed within the pretracheal layer of deep cervical fascia, which attaches the gland to the **cricoid cartilage** and the **oblique line of the thyroid cartilage**. During swallowing, the larynx and trachea are elevated by the suprahyoid muscles; because the thyroid is anchored to these laryngeal cartilages, it moves upward in unison with them. **Analysis of Incorrect Options:** * **Submandibular salivary gland:** While located in the neck, it is enclosed in the investing layer of deep cervical fascia and is not attached to the laryngeal framework. It moves with the jaw but not with deglutition. * **Supraclavicular lymph node (Virchow’s node):** These are located in the fatty tissue of the posterior triangle. They are not attached to the trachea or larynx and remain stationary during swallowing. * **Sternomastoid tumour:** This is a fibromatous growth within the sternocleidomastoid muscle (often seen in congenital torticollis). It moves with the muscle but is independent of the swallowing mechanism. **High-Yield NEET-PG Pearls:** 1. **Exceptions:** Two other structures move with swallowing: **Thyroglossal cysts** [1] (due to their attachment to the hyoid bone) and **Subhyoid bursitis**. 2. **The Tongue Protrusion Test:** A thyroglossal cyst moves upward both on swallowing *and* on protrusion of the tongue (due to its attachment to the foramen caecum via the tract) [1]. A thyroid swelling moves *only* on swallowing. 3. **Berry’s Ligament:** The posterior suspensory ligament of Berry fixes the thyroid lobes to the cricoid cartilage, further ensuring it moves with the larynx.

Question 239: The right common carotid artery arises from which of the following structures?

A. Right axillary artery
B. Arch of aorta
C. Brachiocephalic artery (Correct Answer)
D. Left subclavian artery

Explanation: The origin of the common carotid arteries is a classic high-yield anatomy topic, focusing on the asymmetry of the great vessels. [1] **1. Why the Correct Answer is Right:** The **Brachiocephalic artery** (also known as the innominate artery) is the first and largest branch of the arch of the aorta. It ascends to the level of the right sternoclavicular joint, where it bifurcates into the **right common carotid artery** and the right subclavian artery. This arrangement ensures the right side of the head, neck, and upper limb receives oxygenated blood. **2. Analysis of Incorrect Options:** * **A. Right axillary artery:** This is the continuation of the subclavian artery distal to the outer border of the first rib; it supplies the upper limb, not the neck. * **B. Arch of aorta:** While the **left** common carotid artery arises directly from the arch of the aorta (as the second branch), the right common carotid does not. * **D. Left subclavian artery:** This is the third branch of the aortic arch and supplies the left upper limb. **3. Clinical Pearls & High-Yield Facts for NEET-PG:** * **Asymmetry:** Remember the "3-2-1" rule for the aortic arch branches: 3 branches (Brachiocephalic, Left Common Carotid, Left Subclavian). [1] The right side has a shared trunk (Brachiocephalic), whereas the left side branches arise independently. * **Bifurcation Level:** The common carotid artery typically bifurcates into internal and external carotid arteries at the level of the **upper border of the thyroid cartilage (C4 level)**. * **Carotid Sinus:** Located at the bifurcation, it acts as a baroreceptor (innervated by CN IX). * **Surface Anatomy:** The origin of the brachiocephalic trunk is behind the center of the manubrium sterni. [1]

Question 240: Which of the following best describes the function of the cricothyroid muscle?

A. Abductor of vocal cords
B. Abductor of vocal cords
C. Tensor of vocal cords (Correct Answer)
D. Supplied by the recurrent laryngeal nerve

Explanation: Explanation: The **cricothyroid muscle** is unique among the laryngeal muscles and is a high-yield topic for NEET-PG. Its primary function is to tilt the thyroid cartilage forward and downward at the cricothyroid joint. This action increases the distance between the thyroid angle and the arytenoid cartilages, thereby **stretching and tensing the vocal cords**. This tension is essential for producing high-pitched sounds. **Analysis of Options:** * **A & B (Abductor of vocal cords):** These are incorrect. The **posterior cricoarytenoid** is the *only* abductor of the vocal cords (the "safety muscle of the larynx"). * **D (Supplied by the recurrent laryngeal nerve):** This is incorrect. The cricothyroid is the **only** intrinsic laryngeal muscle supplied by the **external laryngeal nerve** (a branch of the superior laryngeal nerve) [1]. All other intrinsic muscles are supplied by the recurrent laryngeal nerve [1]. **High-Yield NEET-PG Pearls:** 1. **Nerve Supply Rule:** All intrinsic muscles of the larynx are supplied by the Recurrent Laryngeal Nerve (RLN) **EXCEPT** the Cricothyroid (External Laryngeal Nerve) [1]. 2. **Action Rule:** All intrinsic muscles act as adductors (closing the glottis) **EXCEPT** the Posterior Cricoarytenoid (Abductor). 3. **Clinical Correlation:** Injury to the external laryngeal nerve (often during thyroid surgery) results in an inability to tense the vocal cords, leading to a **weak, husky voice** and loss of high-pitch frequency (important for singers). 4. **Emergency Airway:** The cricothyroid membrane, located between the thyroid and cricoid cartilages, is the site for an emergency **cricothyroidotomy**.

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?