Neck Practice Questions

Q: Virchow node represents involvement of which anatomical location?

Left supraclavicular lymph node. **Explanation:** **Virchow’s node** (also known as the signal node or Troisier’s sign) refers to an enlarged, firm, and non-tender **left supraclavicular lymph node**. **Why Option A is correct:** The anatomical basis for this finding lies in the lymphatic drainage pattern. The **thoracic duct**, which carries lymph from the majority of the body [1] (including the abdomen and pelvis), ascends through the posterior mediastinum and enters the venous system at the junction of the left internal jugular and subclavian veins. Because of this proximity, malignancies from the abdominal organs (most classically **gastric adenocarcinoma**) can metastasize via the thoracic duct to the left supraclavicular nodes [1]. **Why other options are incorrect:** * **Option B:** Subclavicular nodes are located below the clavicle and are typically associated with breast cancer or upper limb pathology, not the classic Virchow’s node presentation. * **Option C:** The right supraclavicular node receives drainage from the right thorax, head, and neck via the right lymphatic duct [2]. Enlargement here is more suggestive of primary lung or esophageal cancer. * **Option D:** A left paraumbilical lymph node is known as a **Sister Mary Joseph nodule**, which indicates umbilical metastasis from intra-abdominal or pelvic malignancies. **High-Yield Clinical Pearls for NEET-PG:** * **Troisier’s Sign:** The clinical finding of a palpable Virchow’s node, often the first sign of an occult visceral malignancy. * **Most Common Primary:** Gastric carcinoma (specifically the intestinal type) [1]. Other causes include pancreatic, testicular, and ovarian cancers. * **Differential:** Do not confuse this with **Irish’s node** (left anterior axillary node), also associated with gastric cancer.

Q: Which artery is related to the lower border of the posterior belly of the digastric muscle?

Occipital artery.. The **posterior belly of the digastric muscle** is a key landmark in the neck, serving as a boundary for the carotid, submandibular, and digastric triangles. ### Why Occipital Artery is Correct The **occipital artery** arises from the posterior aspect of the external carotid artery, near the level of the facial artery. As it courses backwards to reach the occipital region, it specifically runs **deep to and along the lower border of the posterior belly of the digastric muscle**. It then crosses the internal carotid artery, internal jugular vein, and the hypoglossal nerve (which hooks around it). ### Why Other Options are Incorrect * **Posterior auricular artery:** This artery arises just **above** the upper border of the posterior belly of the digastric. It runs upwards and backwards between the external acoustic meatus and the mastoid process. * **Palatine artery (Ascending palatine):** This is a branch of the facial artery. It ascends between the styloglossus and stylopharyngeus muscles to reach the base of the skull; it is not related to the lower border of the digastric. * **Ascending pharyngeal artery:** This is the smallest branch of the external carotid, arising from its medial aspect. It ascends vertically between the internal carotid artery and the pharynx, deep to the styloid process. ### High-Yield NEET-PG Pearls * **The "Hook":** The **hypoglossal nerve (CN XII)** hooks around the origin of the occipital artery at the lower border of the posterior belly of the digastric. * **Muscle Relations:** The posterior belly of the digastric is supplied by the **facial nerve**, while the anterior belly is supplied by the **nerve to mylohyoid** (branch of CN V3). * **Landmark:** The posterior belly of the digastric hides the origin of most branches of the external carotid artery, making it a vital surgical landmark in neck dissections.

Q: Which nerve supplies the intrinsic laryngeal muscles?

Recurrent laryngeal nerve. **Explanation:** The nerve supply to the larynx is a high-yield topic in NEET-PG, derived from the embryology of the 4th and 6th pharyngeal arches. **1. Why Recurrent Laryngeal Nerve (RLN) is correct:** The RLN (a branch of the Vagus nerve) is the primary motor nerve of the larynx [1]. It supplies **all the intrinsic muscles of the larynx**, with the sole exception of the cricothyroid muscle. It also provides sensory innervation to the laryngeal mucosa below the level of the vocal folds. **2. Analysis of Incorrect Options:** * **Internal Laryngeal Nerve:** This is a branch of the Superior Laryngeal Nerve (SLN). It is **purely sensory** and supplies the laryngeal mucosa above the vocal folds. It does not supply any muscles. * **External Laryngeal Nerve:** This is the other branch of the SLN. It is motor, but it **only supplies the Cricothyroid muscle** (the "tenser" of the vocal cords). * **Inferior Laryngeal Nerve:** While this is technically the terminal part of the RLN as it enters the larynx, "Recurrent Laryngeal Nerve" is the standard anatomical term used in exams to describe the nerve supplying the intrinsic muscles. **3. Clinical Pearls & High-Yield Facts:** * **The "Exception" Rule:** Remember: All intrinsic muscles are supplied by the RLN **except** the Cricothyroid (External Laryngeal Nerve). * **Safety Muscle:** The **Posterior Cricoarytenoid** is the only abductor of the vocal cords. Bilateral RLN injury leads to paralysis of this muscle, causing the cords to remain adducted, which can result in acute airway obstruction (stridor) [2]. * **Hoarseness:** Unilateral RLN injury (often during thyroid surgery) leads to hoarseness of voice [2]. * **Nerve Course:** The right RLN loops around the subclavian artery, while the left RLN loops around the arch of the aorta [1].

Q: Which of the following is NOT a branch of the first part of the subclavian artery?

Costocervical trunk. ### Explanation The subclavian artery is divided into three parts by the **scalenus anterior muscle**: the first part is medial to the muscle, the second part is posterior to it, and the third part is lateral to it. **Why the Correct Answer is Right:** * **Costocervical trunk (Option D):** On the **right side**, this is a branch of the **second part** of the subclavian artery. On the left side, it may occasionally arise from the first part, but for standard anatomical descriptions and NEET-PG purposes, it is classified as the branch of the second part. It further divides into the superior intercostal and deep cervical arteries. **Analysis of Incorrect Options:** * **Vertebral artery (Option A):** Arises from the first part. it ascends through the foramina transversaria of the C1–C6 vertebrae to supply the brain. * **Thyrocervical trunk (Option B):** Arises from the first part, just medial to the scalenus anterior. It gives off three main branches: Inferior thyroid, Suprascapular, and Transverse cervical arteries. * **Internal thoracic artery (Option C):** Arises from the inferior aspect of the first part. It descends into the thorax to supply the anterior chest wall and breast. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic for 1st Part Branches:** **VIT** (**V**ertebral, **I**nternal thoracic, **T**hyrocervical trunk). * **3rd Part:** Usually has no branches, but occasionally gives rise to the **Dorsal Scapular artery**. * **Subclavian Steal Syndrome:** Occurs due to proximal stenosis of the subclavian artery, leading to retrograde flow in the vertebral artery to supply the arm, causing "stolen" blood from the cerebral circulation. * **Right vs. Left:** The right subclavian arises from the brachiocephalic trunk, while the left arises directly from the arch of the aorta.

Q: Cervical sympathetic lesion causes all except:

Increased sweating. This question tests your knowledge of **Horner’s Syndrome**, which results from a lesion along the sympathetic pathway supplying the head, eye, and neck. ### **Explanation of the Correct Answer** The cervical sympathetic chain is responsible for stimulating the sweat glands of the face (**sudomotor function**). A lesion in this pathway leads to a **loss of sympathetic supply**, resulting in **Anhidrosis** (absence of sweating) on the affected side of the face. Therefore, "Increased sweating" is the correct answer as it is the opposite of what occurs in a cervical sympathetic lesion. [1] ### **Analysis of Incorrect Options** * **A. Miosis:** The sympathetic system normally causes pupillary dilation (via the dilator pupillae muscle). A lesion leads to unopposed parasympathetic action, resulting in a constricted pupil (**Miosis**). * **B. Ptosis:** Sympathetic fibers supply the **Superior Tarsal Muscle (Muller’s muscle)**, which helps keep the eyelid elevated. Paralysis of this muscle causes partial drooping of the eyelid (**Ptosis**). * **C. Enophthalmos:** The loss of sympathetic tone to the orbitalis muscle (smooth muscle in the floor of the orbit) creates an appearance of the eyeball being sunk back into the orbit (**Enophthalmos**). ### **Clinical Pearls for NEET-PG** * **The Classic Triad:** Horner’s syndrome is traditionally defined by the triad of **Ptosis, Miosis, and Anhidrosis**. * **Pancoast Tumor:** A common cause of Horner’s syndrome is an apical lung tumor compressing the stellate ganglion (C8-T1). [2] * **Vasodilation:** Patients may also present with facial flushing due to the loss of sympathetic vasoconstrictor tone. * **Ciliospinal Reflex:** This reflex (pupillary dilation in response to pain on the neck) is **absent** in Horner’s syndrome.

Q: A superficial incision on the posterior triangle of the neck leads to what functional deficit?

Difficulty in shrugging of the shoulder. ### Explanation **1. Why Option A is Correct:** The **Spinal Accessory Nerve (CN XI)** is the most superficial and vulnerable structure in the posterior triangle of the neck. It emerges from the posterior border of the sternocleidomastoid (SCM) muscle and crosses the floor of the triangle (on the levator scapulae) to reach the **trapezius** muscle. Because it lies immediately beneath the investing layer of deep cervical fascia, even a superficial incision or biopsy in this region can damage it. The trapezius is responsible for elevating the scapula; therefore, nerve injury leads to paralysis of the muscle, manifesting as **difficulty in shrugging the shoulder** and a "drooping" shoulder. **2. Analysis of Incorrect Options:** * **Option B:** Initial abduction (0–15°) is performed by the **Supraspinatus** nerve (Suprascapular nerve). This nerve is located deeper and more laterally, not typically affected by a superficial posterior triangle incision. * **Option C:** Rotating the face towards the *same* side is not a standard single-muscle action. The SCM rotates the face to the **opposite** side. While CN XI supplies the SCM, the nerve enters the SCM before reaching the posterior triangle; thus, a triangle incision usually spares SCM function. * **Option D:** Neck flexion is primarily performed by the bilateral action of the SCMs and prevertebral muscles, which are not the primary structures at risk in a superficial posterior triangle injury. **3. NEET-PG High-Yield Pearls:** * **Safe Zone:** To avoid the Spinal Accessory Nerve during procedures, stay in the inferior part of the triangle or the anterior portion. * **Nerve Course:** It enters the posterior triangle at the junction of the upper 1/3rd and middle 1/3rd of the posterior border of the SCM. * **Clinical Sign:** Damage to CN XI also results in an inability to abduct the arm above 90° (as the trapezius is required for upward rotation of the scapula).

Q: Which of the following nerves may be affected during submandibular gland excision, except?

Glossopharyngeal nerve. The submandibular gland is located in the submandibular triangle, and its surgical excision requires careful dissection to avoid damaging several closely related neurovascular structures. ### **Explanation of the Correct Answer** **D. Glossopharyngeal nerve (CN IX):** This is the correct answer because the glossopharyngeal nerve is located deep in the upper neck, passing between the superior and middle constrictor muscles to reach the posterior third of the tongue. It does not enter the submandibular triangle and is not at risk during routine submandibular gland excision. ### **Analysis of Incorrect Options** * **A. Lingual nerve:** This nerve lies superior to the submandibular gland and loops under the submandibular duct (Wharton’s duct). It is at high risk during the ligation of the duct. * **B. Hypoglossal nerve (CN XII):** This nerve forms the floor of the submandibular triangle (lying on the hyoglossus muscle) and is located deep to the gland. Damage leads to ipsilateral tongue deviation. * **C. Marginal mandibular nerve:** A branch of the facial nerve (CN VII), it runs superficial to the submandibular gland, just deep to the platysma. It is the most commonly injured nerve during the initial skin incision or retraction, leading to drooping of the corner of the mouth. ### **Clinical Pearls for NEET-PG** * **Safe Incision:** To protect the marginal mandibular nerve, the surgical incision is typically made **4 cm below the lower border of the mandible**. * **The "Double Crossing":** The lingual nerve crosses the submandibular duct twice (lateral to medial). * **Ganglion Connection:** The submandibular ganglion (parasympathetic) hangs from the lingual nerve and provides secretomotor supply to the gland.

Q: A 20-year-old man presents with a stab wound in the superior region of his neck. Radiographic examination shows no injury to major structures. Physical examination reveals loss of sensation from the skin over the angle of the jaw. Which of the following nerves is most likely injured?

Great auricular. ### Explanation The clinical presentation of sensory loss over the **angle of the jaw** following a superficial neck injury specifically points to an injury of the **Great Auricular Nerve**. **1. Why Great Auricular is Correct:** The Great Auricular nerve (C2, C3) is a branch of the **cervical plexus**. It emerges from the posterior border of the sternocleidomastoid muscle (at Erb’s point) and ascends vertically toward the parotid gland. It provides cutaneous innervation to: * The skin over the **angle of the mandible**. * The lower part of the auricle (earlobe). * The skin over the parotid gland. **2. Why the other options are incorrect:** * **Supraclavicular (C3, C4):** These nerves descend to supply the skin over the clavicle, the upper chest (down to the 2nd rib), and the shoulder (over the deltoid). * **Transverse cervical (C2, C3):** This nerve curves around the middle of the sternocleidomastoid and runs anteriorly to supply the skin of the **anterior triangle** of the neck. * **Greater occipital (C2 - posterior ramus):** This is a purely sensory nerve that supplies the skin of the **back of the scalp** up to the vertex. It is not part of the cervical plexus (which is formed by anterior rami). **3. NEET-PG High-Yield Pearls:** * **Erb’s Point (Punctum Nervosum):** Located at the midpoint of the posterior border of the sternocleidomastoid. This is where four cutaneous branches of the cervical plexus emerge: Lesser occipital, Great auricular, Transverse cervical, and Supraclavicular nerves. * **Mandibular Nerve Exception:** While the Trigeminal nerve (V3) supplies most of the face, the **angle of the jaw** is a classic "exception" area supplied by the spinal nerves (C2, C3 via the Great Auricular). * **Clinical Correlation:** The Great Auricular nerve is often involved in parotid surgeries or can be used as a nerve graft.

Question 1

Virchow node represents involvement of which anatomical location?

Accepted Answer

Left supraclavicular lymph node

Answer

Left subclavicular lymph node

Answer

Right supraclavicular lymph node

Answer

Left paraumbilical lymph node

Question 2

Which of the following statements regarding the nerve supply of the larynx is false?

Accepted Answer

The internal laryngeal branch provides sensory supply to the larynx below the vocal cords.

Answer

The external laryngeal nerve tenses the vocal cord.

Answer

The superior laryngeal nerve participates in Galen's anastomosis.

Answer

The recurrent laryngeal branch provides sensory supply to the larynx below the vocal cords.

Question 3

Which artery is related to the lower border of the posterior belly of the digastric muscle?

Accepted Answer

Occipital artery.

Answer

Posterior auricular artery.

Answer

Palatine artery.

Answer

Ascending pharyngeal artery.

Question 4

Which nerve supplies the intrinsic laryngeal muscles?

Accepted Answer

Recurrent laryngeal nerve

Answer

Internal laryngeal nerve

Answer

External laryngeal nerve

Answer

Inferior laryngeal nerve

Question 5

The superior cervical ganglion gives gray rami communicantes to which spinal nerve segments?

Accepted Answer

C1 - C4

Answer

C5 - C6

Answer

C7 - C8

Answer

None

Question 6

Which of the following is NOT a branch of the first part of the subclavian artery?

Accepted Answer

Costocervical trunk

Answer

Vertebral artery

Answer

Thyrocervical trunk

Answer

Internal thoracic artery

Question 7

Cervical sympathetic lesion causes all except:

Accepted Answer

Increased sweating

Answer

Miosis

Answer

Ptosis

Answer

Enophthalmos

Question 8

A superficial incision on the posterior triangle of the neck leads to what functional deficit?

Accepted Answer

Difficulty in shrugging of the shoulder

Answer

Difficulty in the initial phase of abduction

Answer

Difficulty in rotating the face towards the same side

Answer

Difficulty in flexion

Question 9

Which of the following nerves may be affected during submandibular gland excision, except?

Accepted Answer

Glossopharyngeal nerve

Answer

Lingual nerve

Answer

Hypoglossal nerve

Answer

Marginal mandibular division of facial nerve

Question 10

A 20-year-old man presents with a stab wound in the superior region of his neck. Radiographic examination shows no injury to major structures. Physical examination reveals loss of sensation from the skin over the angle of the jaw. Which of the following nerves is most likely injured?

Accepted Answer

Great auricular

Answer

Supraclavicular

Answer

Transverse cervical

Answer

Greater occipital

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Neck — MCQs

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