Neck — MCQs

Neck Indian Medical PG Practice Questions and MCQs

Question 261: Foramen transversarium transmits all except:

A. Vertebral artery
B. Vertebral vein
C. Emissary vein (Correct Answer)
D. Inferior cervical ganglion

Explanation: The **foramen transversarium** is a characteristic feature of cervical vertebrae (C1–C7), located within the transverse processes. It serves as a protective conduit for vital neurovascular structures ascending to the cranial cavity. [1] ### **Explanation of the Correct Answer** **C. Emissary vein:** This is the correct answer because emissary veins typically pass through cranial foramina (like the parietal or mastoid foramina) to connect extracranial veins with intracranial dural venous sinuses. They do not pass through the foramen transversarium. ### **Analysis of Other Options** * **A. Vertebral artery:** This is the primary structure transmitted. It enters the foramen transversarium of **C6** and ascends through C1 before entering the foramen magnum. (Note: It does *not* pass through C7). * **B. Vertebral vein:** A plexus of veins accompanies the artery. Unlike the artery, the vertebral vein passes through the foramina of **all** cervical vertebrae, including **C7**. * **D. Inferior cervical ganglion:** Sympathetic nerves (the vertebral plexus) accompany the vertebral artery through the foramina. Specifically, the inferior cervical ganglion (or the Stellate ganglion) lies in close proximity to the C7 transverse process, and its postganglionic fibers ascend through the foramina. ### **High-Yield NEET-PG Pearls** * **C7 Exception:** The foramen transversarium of C7 is the smallest. It transmits the **vertebral vein** but **NOT the vertebral artery**. * **Vertebral Artery Origin:** It is the first branch of the first part of the Subclavian artery. * **Clinical Correlation:** Osteophytes (bone spurs) in the cervical spine can compress the foramen transversarium, leading to **Vertebrobasilar Insufficiency (VBI)**, characterized by dizziness upon turning the head.

Question 262: Which of the following statements is true regarding the muscles that control the vocal cords?

A. Two muscles adduct (close) the vocal cords.
B. One muscle abducts (opens) the vocal cords. (Correct Answer)
C. One muscle adjusts the length of the vocal cords.
D. One muscle adjusts the tension of the vocal cords.

Explanation: ### Explanation The intrinsic muscles of the larynx are responsible for controlling the position and tension of the vocal cords, which is critical for phonation and airway protection. **1. Why the Correct Answer is Right:** The **Posterior Cricoarytenoid (PCA)** is the **only** muscle that abducts (opens) the vocal cords. It originates from the posterior surface of the cricoid lamina and inserts into the muscular process of the arytenoid cartilage. By rotating the arytenoid cartilages laterally, it widens the rima glottidis. Because it is the sole muscle responsible for opening the airway, it is often referred to as the **"Safety Muscle of the Larynx."** **2. Analysis of Incorrect Options:** * **Option A:** There are **three** primary muscles involved in adduction (closing) of the vocal cords: the Lateral Cricoarytenoid, the Transverse Arytenoid, and the Oblique Arytenoid. * **Option C & D:** These options are inaccurate because multiple muscles influence the physical state of the cords. The **Cricothyroid** is the primary tensor (lengthens and tenses), while the **Thyroarytenoid** (specifically the Vocalis part) relaxes the cords. **3. High-Yield Clinical Pearls for NEET-PG:** * **Nerve Supply:** All intrinsic muscles of the larynx are supplied by the **Recurrent Laryngeal Nerve (RLN)**, *except* for the **Cricothyroid**, which is supplied by the **External Laryngeal Nerve**. * **Clinical Correlation:** Bilateral paralysis of the Posterior Cricoarytenoid (due to RLN injury) leads to acute airway obstruction because the vocal cords cannot abduct, necessitating an emergency tracheostomy. * **The "Vocalis":** This is the medial-most fiber of the thyroarytenoid muscle and is responsible for fine-tuning the tension during speech.

Question 263: The inferior thyroid artery is related to which of the following nerves?

A. Superior laryngeal nerve
B. Recurrent laryngeal nerve (Correct Answer)
C. Glossopharyngeal nerve
D. Hypoglossal nerve

Explanation: ### Explanation The **inferior thyroid artery (ITA)**, a branch of the thyrocervical trunk, is anatomically critical due to its intimate relationship with the **recurrent laryngeal nerve (RLN)** [1]. As the ITA approaches the lower pole of the thyroid gland, it crosses the RLN. This relationship is highly variable: the nerve may pass anterior to, posterior to, or between the branches of the artery [1]. Because of this proximity, the RLN is at high risk of injury during thyroidectomy, specifically when the ITA is being ligated. #### Analysis of Options: * **B. Recurrent laryngeal nerve (Correct):** The RLN ascends in the tracheoesophageal groove and intersects the ITA near the inferior pole of the thyroid [2]. This is the most significant surgical landmark in the region. * **A. Superior laryngeal nerve:** This nerve (specifically its external branch) is related to the **superior thyroid artery** at the upper pole of the thyroid gland, not the inferior thyroid artery [4]. * **C. Glossopharyngeal nerve (CN IX):** This nerve is located much higher in the neck, exiting the jugular foramen and supplying the posterior third of the tongue and pharynx. * **D. Hypoglossal nerve (CN XII):** This nerve runs superior to the hyoid bone to supply the muscles of the tongue and does not descend to the level of the inferior thyroid artery. #### High-Yield Clinical Pearls for NEET-PG: * **Surgical Rule:** To avoid nerve injury during thyroidectomy, the **superior thyroid artery** should be ligated **close to the gland** (to avoid the external laryngeal nerve), whereas the **inferior thyroid artery** should be ligated **far from the gland** (to avoid the recurrent laryngeal nerve) [4]. * **Nerve Injury:** Unilateral RLN injury causes hoarseness of voice; bilateral injury can cause life-threatening airway obstruction (stridor) [3]. * **Origin:** The ITA arises from the **thyrocervical trunk**, a branch of the first part of the subclavian artery.

Question 264: A 39-year-old man feels discomfort when moving his tongue, pharynx, and larynx. Physical examination indicates that muscles attached to the styloid process are paralyzed. Which of the following groups of cranial nerves are damaged?

A. Glossopharyngeal, trigeminal, and vagus nerves
B. Hypoglossal, vagus and facial nerves
C. Facial, glossopharyngeal, and hypoglossal nerves (Correct Answer)
D. Vagus, spinal accessory, and hypoglossal nerves

Explanation: ### Explanation The core of this question lies in identifying the **three muscles** that originate from the **styloid process** (the "Styloid Apparatus") and their respective nerve supplies. **1. Why Option C is Correct:** The styloid process serves as the origin for three muscles, each supplied by a different cranial nerve (CN): * **Stylohyoid:** Derived from the 2nd branchial arch; supplied by the **Facial nerve (CN VII)**. * **Stylopharyngeus:** Derived from the 3rd branchial arch; supplied by the **Glossopharyngeal nerve (CN IX)**. * **Styloglossus:** An extrinsic muscle of the tongue; supplied by the **Hypoglossal nerve (CN XII)**. Paralysis of these muscles explains the patient's discomfort during tongue movement (Styloglossus), swallowing/pharyngeal movement (Stylopharyngeus), and laryngeal elevation (Stylohyoid). Therefore, CN VII, IX, and XII must be damaged. **2. Analysis of Incorrect Options:** * **Option A:** The **Trigeminal nerve (CN V)** supplies muscles of mastication, not the styloid apparatus. * **Option B & D:** The **Vagus nerve (CN X)** supplies most muscles of the palate, pharynx, and larynx, but it does not directly supply any muscle originating from the styloid process. The **Spinal Accessory nerve (CN XI)** supplies the Trapezius and Sternocleidomastoid. **3. NEET-PG High-Yield Pearls:** * **The "Rule of 3s" for the Styloid Process:** It has 3 muscles (Stylohyoid, Stylopharyngeus, Styloglossus) and 3 ligaments (Stylohyoid, Stylomandibular, and the process itself). * **Eagle’s Syndrome:** Elongation of the styloid process or calcification of the stylohyoid ligament can compress CN IX, causing throat pain and dysphagia. * **Stylopharyngeus** is the **only** muscle supplied by the Glossopharyngeal nerve (CN IX). This is a frequent "single-best" question topic.

Question 265: Which of the following muscles forms the floor of the digastric triangle?

A. Mylohyoid (Correct Answer)
B. Geniohyoid
C. Stylohyoid
D. Sternohyoid

Explanation: ### Explanation The **Digastric Triangle** (also known as the submandibular triangle) is a key anatomical region in the neck. To identify its floor, one must visualize the muscles lying deep to the submandibular gland. **1. Why Mylohyoid is Correct:** The floor of the digastric triangle is formed by two muscles: the **mylohyoid** anteriorly and the **hyoglossus** posteriorly. The mylohyoid muscle acts as a structural diaphragm for the mouth, extending from the mylohyoid line of the mandible to the hyoid bone. Since the digastric triangle is located just below the body of the mandible, the mylohyoid naturally forms its primary floor. **2. Why the Other Options are Incorrect:** * **Geniohyoid:** This muscle lies **superior** (deep) to the mylohyoid. It is located within the floor of the mouth proper, not the floor of the digastric triangle. * **Stylohyoid:** This muscle forms part of the **posterior boundary** of the triangle (along with the posterior belly of the digastric), rather than the floor. * **Sternohyoid:** This is an infrahyoid "strap muscle" located in the **muscular triangle** of the neck, well below the level of the digastric triangle. **3. High-Yield Facts for NEET-PG:** * **Boundaries:** Superiorly by the base of the mandible; Anteroinferiorly by the anterior belly of digastric; Posteroinferiorly by the posterior belly of digastric. * **Contents:** The most important content is the **submandibular salivary gland**, the facial artery/vein, and the **hypoglossal nerve (CN XII)**. * **Nerve Supply:** Remember the "Rule of Two Bellies"—the anterior belly of digastric (and mylohyoid) is supplied by the **Nerve to Mylohyoid (V3)**, while the posterior belly (and stylohyoid) is supplied by the **Facial Nerve (CN VII)**.

Question 266: Which of the following statements is true regarding the longus colli muscle?

A. Its origin is in the occiput.
B. It is an extensor of the neck.
C. Its nerve supply is from spinal nerves C2-C6. (Correct Answer)
D. It inserts on cervical vertebrae C3-C6.

Explanation: The **Longus colli** is a deep prevertebral muscle of the neck, essential for stabilizing and moving the cervical spine. ### **Explanation of the Correct Option** **C. Nerve supply is from spinal nerves C2-C6:** The longus colli is supplied by the **anterior rami of the C2 to C6 spinal nerves**. This is a high-yield fact for NEET-PG, as prevertebral muscles are generally supplied by the ventral rami of the cervical nerves corresponding to their level of origin [1]. ### **Analysis of Incorrect Options** * **A. Origin is in the occiput:** This is incorrect. The longus colli does **not** reach the skull (occiput). It spans from the atlas (C1) down to the T3 vertebra [1]. Muscles that attach to the occiput include the *Longus capitis* and *Rectus capitis* group. * **B. Extensor of the neck:** This is incorrect. Located on the anterior aspect of the vertebral column, the longus colli acts as a **flexor** of the neck. It also assists in lateral flexion and rotation to the opposite side. * **D. Inserts on C3-C6:** While parts of the muscle involve these levels, this is an incomplete description of its complex structure. It consists of three parts (superior oblique, inferior oblique, and vertical), extending from the **anterior tubercle of C1 (atlas) to the body of T3** [1]. ### **High-Yield Clinical Pearls for NEET-PG** * **Prevertebral Fascia:** The longus colli lies deep to the prevertebral layer of the deep cervical fascia. * **Retropharyngeal Abscess:** Infections in the retropharyngeal space (located between the buccopharyngeal fascia and prevertebral fascia) can track down to the superior mediastinum, limited posteriorly by the longus colli. * **Sympathetic Chain:** The cervical sympathetic trunk lies directly on the longus colli muscle, medial to the carotid sheath.

Question 267: A tonsil bed is formed by the superior constrictor and styloglossus muscles. Which of the following is not a component of the tonsillar bed?

A. Submandibular salivary gland
B. Lateral pterygoid muscle (Correct Answer)
C. IX nerve
D. Styloid process

Explanation: The **tonsillar bed** is the structural foundation upon which the palatine tonsil rests. It is primarily formed by the **superior constrictor** and **styloglossus** muscles. Understanding its relations is high-yield for NEET-PG, as several vital structures lie just lateral to these muscles. ### Why Lateral Pterygoid is the Correct Answer The **lateral pterygoid muscle** is a muscle of mastication located in the **infratemporal fossa**, significantly superior and lateral to the oropharynx. It does not contribute to the tonsillar bed. In contrast, the **medial pterygoid** muscle is sometimes considered a distant lateral relation, but the lateral pterygoid is anatomically unrelated to the tonsillar fossa. ### Analysis of Other Options * **IX Nerve (Glossopharyngeal):** This is a critical component of the tonsillar bed. It descends lateral to the superior constrictor and provides sensory innervation to the posterior third of the tongue and the tonsillar mucosa. * **Styloid Process:** Along with its attached muscles (stylohyoid, stylopharyngeus, and styloglossus), the styloid process can form part of the lateral boundary of the bed, especially if it is elongated. * **Submandibular Salivary Gland:** The deep lobe of the submandibular gland lies in close proximity to the lower part of the tonsillar bed, separated only by the styloglossus and superior constrictor. ### NEET-PG Clinical Pearls * **Vascularity:** The main artery of the tonsil is the **tonsillar branch of the facial artery**. * **Post-Tonsillectomy Pain:** Referred ear pain (otalgia) occurs via the **glossopharyngeal nerve (CN IX)** due to shared innervation (Jacobson's nerve). * **Bleeding:** The most common cause of secondary hemorrhage after tonsillectomy is the **paratonsillar vein**. * **Eagle’s Syndrome:** Elongation of the styloid process (part of the bed) can cause persistent throat pain or foreign body sensation.

Question 268: Torticollis or Wryneck is due to involvement of which muscles?

A. Sternocleidomastoid and trapezius (Correct Answer)
B. Sternocleidomastoid and Platysma
C. Trapezius and sternohyoid
D. Trapezius and omohyoid

Explanation: **Explanation:** **Torticollis (Wryneck)** is a clinical condition characterized by an abnormal, asymmetrical head or neck position. It most commonly results from the shortening, fibrosis, or spasmodic contraction of the **Sternocleidomastoid (SCM)** muscle, often in conjunction with the **Trapezius**. **Why Option A is Correct:** The SCM and Trapezius share a common embryological origin (branchiomeric muscles from the 6th pharyngeal arch) and are both innervated by the **Spinal Accessory Nerve (CN XI)**. In congenital torticollis, fibrosis of the SCM causes the head to tilt *toward* the affected side and the chin to rotate *away* from it [1]. In spasmodic torticollis (cervical dystonia), both the SCM and the upper fibers of the Trapezius are frequently involved, leading to sustained lateral flexion and rotation of the neck. **Why Other Options are Incorrect:** * **Platysma (Option B):** A superficial muscle of facial expression (innervated by CN VII); it does not contribute to the structural rotation or tilting of the neck seen in torticollis. * **Sternohyoid & Omohyoid (Options C & D):** These are infrahyoid "strap" muscles. While they assist in depressing the hyoid bone and larynx, they are not primary rotators of the head and are not the pathological focus in Wryneck. **High-Yield Clinical Pearls for NEET-PG:** * **Congenital Torticollis:** Often due to a "sternomastoid tumor" (fibromatosis colli) resulting from birth trauma or intrauterine malposition [1]. * **Nerve Supply:** Both SCM and Trapezius receive motor supply from the **Spinal Accessory Nerve** and sensory (proprioception) from **C2, C3 (SCM)** and **C3, C4 (Trapezius)**. * **Spasmodic Torticollis:** Often treated with Botulinum toxin injections into the affected SCM or Trapezius.

Question 269: Which of the following structures is NOT related to the medial surface of the hyoglossus muscle?

A. Glossopharyngeal nerve
B. Stylohyoid ligament
C. Lingual artery
D. Hypoglossal nerve (Correct Answer)

Explanation: To master the anatomy of the submandibular region, it is essential to distinguish between structures passing **superficial (lateral)** and **deep (medial)** to the hyoglossus muscle, which serves as the key landmark of this area. ### **Explanation of the Correct Answer** **D. Hypoglossal nerve:** This is the correct answer because the hypoglossal nerve (CN XII) lies on the **lateral (superficial)** surface of the hyoglossus muscle. It travels along with the deep lingual vein and the submandibular duct in the plane between the mylohyoid and hyoglossus muscles. ### **Analysis of Incorrect Options** The following structures are located **medial (deep)** to the hyoglossus: * **A. Glossopharyngeal nerve (CN IX):** This nerve passes deep to the posterior border of the hyoglossus to reach the posterior third of the tongue. * **B. Stylohyoid ligament:** This ligament attaches to the lesser cornua of the hyoid bone, passing deep to the hyoglossus. * **C. Lingual artery:** This is the most important structure deep to the hyoglossus. It is separated from the lingual vein and hypoglossal nerve by the muscle itself, which acts as a surgical landmark to locate the artery. ### **High-Yield NEET-PG Pearls** * **Hyoglossus Relations:** * **Superficial/Lateral:** Lingual nerve, Submandibular ganglion, Submandibular duct, Hypoglossal nerve, and Deep lingual vein. * **Deep/Medial:** Lingual artery, Glossopharyngeal nerve, and Stylohyoid ligament. * **Mnemonic:** To remember the superficial structures, use **"Hi-LS"** (Hypoglossal, Lingual nerve, Submandibular duct/ganglion). * **Surgical Significance:** During surgery for lingual artery ligation, the hyoglossus muscle must be incised or retracted to access the artery, as the artery lies deep to it.

Question 270: Which of the following statements about the cartilage of the larynx is true?

A. The epiglottis is composed of hyaline cartilage.
B. The thyroid cartilage is composed of elastic cartilage.
C. The cricoid cartilage is composed of elastic cartilage.
D. The cuneiform and corniculate cartilages are composed of elastic cartilage. (Correct Answer)

Explanation: The cartilages of the larynx are classified based on their histological composition into **Hyaline** and **Elastic** types. This distinction is high-yield for NEET-PG as it determines which cartilages ossify with age. ### **1. Why Option D is Correct** The **cuneiform** and **corniculate** cartilages, along with the **epiglottis** and the **apices of the arytenoids**, are composed of **elastic cartilage**. Elastic cartilage contains a dense network of elastin fibers, providing the flexibility required for these structures to move during phonation and deglutition without undergoing calcification. ### **2. Analysis of Incorrect Options** * **Option A:** The **epiglottis** is composed of **elastic cartilage**, not hyaline. Its flexibility is essential for folding over the laryngeal inlet during swallowing to protect the airway. * **Option B:** The **thyroid cartilage** is the largest laryngeal cartilage and is composed of **hyaline cartilage**. * **Option C:** The **cricoid cartilage** (the only complete cartilaginous ring of the airway) is also composed of **hyaline cartilage**. ### **3. High-Yield Clinical Pearls** * **Ossification:** Hyaline cartilages (Thyroid, Cricoid, and the base of Arytenoids) tend to **ossify** as a person ages (usually starting after 25 years). This can make them visible on X-rays and more prone to fractures in the elderly. * **Elastic Cartilage Rule:** Remember the "3 Es" for elastic cartilage in the head and neck: **E**piglottis, **E**xternal Ear (pinna/auditory tube), and **E**xtra laryngeal cartilages (Corniculate and Cuneiform). * **Arytenoid Composition:** The arytenoid is unique; its **base is hyaline**, but its **vocal process and apex are elastic**.

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Lymphatic Drainage

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