Neck Practice Questions

Q: All of the following are midline swellings in the neck, except?

Branchial cyst. The correct answer is **Branchial cyst** because it is a **lateral** neck swelling, not a midline one. **1. Why Branchial Cyst is the correct answer:** A branchial cyst (specifically from the second branchial cleft, which accounts for 95% of cases) typically presents as a painless, fluctuant swelling located at the **junction of the upper 1/3rd and lower 2/3rd of the anterior border of the sternocleidomastoid muscle**. Because it arises from remnants of the branchial apparatus during embryogenesis, its anatomical position is always lateral to the midline. **2. Why the other options are incorrect (Midline Swellings):** * **Thyroglossal Cyst:** The most common midline developmental cyst. It occurs anywhere along the descent of the thyroglossal duct (from the foramen caecum to the thyroid isthmus). A classic sign is that it **moves upward on protrusion of the tongue**. * **Sublingual Dermoid Cyst:** These occur due to the entrapment of ectoderm during the fusion of the first branchial arches in the midline. They typically present in the submental region or the floor of the mouth. * **Subhyoid Bursitis:** This is an inflammation of the bursa located between the posterior surface of the hyoid bone and the thyrohyoid membrane. It presents as a smooth, transverse midline swelling just below the hyoid bone. **High-Yield Clinical Pearls for NEET-PG:** * **Midline Swellings:** Submental lymph nodes, Ranula (plunging), Thyroglossal cyst, Dermoid cyst, Isthmus of thyroid, and Pre-laryngeal/Pre-tracheal lymph nodes. * **Lateral Swellings:** Branchial cyst, Cystic hygroma [1] (usually in the posterior triangle), Carotid body tumor, and Cervical lymphadenopathy. * **Mnemonic for Thyroglossal Cyst:** "Moves with Deglutition (swallowing) AND Tongue protrusion." (Goiter only moves with deglutition).

Q: Which of the following does NOT supply blood to the palatine tonsil?

Sphenopalatine artery. The palatine tonsil is a highly vascular lymphoid tissue located in the tonsillar fossa. Its blood supply is derived from branches of the **External Carotid Artery (ECA)**. ### **Why Sphenopalatine Artery is the Correct Answer** The **Sphenopalatine artery** is the terminal branch of the maxillary artery. It enters the nasal cavity through the sphenopalatine foramen to supply the nasal septum and turbinates. It does **not** descend low enough to contribute to the tonsillar blood supply. ### **Analysis of Other Options (The Arterial Supply)** The palatine tonsil receives blood from five main sources: 1. **Facial Artery (Option B):** Provides the **Tonsillar branch**, which is the **main/principal artery** of the tonsil. It also contributes via the Ascending palatine artery. 2. **Lingual Artery (Option A):** Supplies the tonsil through its **Dorsal lingual branches**. 3. **Ascending Pharyngeal Artery (Option C):** A direct branch of the ECA that supplies the superior pole. 4. **Maxillary Artery:** Supplies the tonsil via the **Descending palatine artery** (Greater palatine branch). ### **High-Yield Clinical Pearls for NEET-PG** * **Principal Artery:** The tonsillar branch of the **Facial Artery** is the most significant source of bleeding during surgery. * **Venous Drainage:** The **Paratonsillar vein** (external palatine vein) is the most common cause of primary hemorrhage following a tonsillectomy. * **Nerve Supply:** The **Glossopharyngeal nerve (CN IX)** provides sensory innervation. Referred otalgia (ear pain) during tonsillitis occurs because CN IX also supplies the middle ear via Jacobson’s nerve. * **Lymphatics:** The tonsils drain into the **Jugulodigastric node**, often referred to as the "Tonsillar lymph node."

Q: The carotid sheath contains all the following structures EXCEPT:

Phrenic nerve. The **carotid sheath** is a condensation of deep cervical fascia that extends from the base of the skull to the arch of the aorta. Understanding its contents is a high-yield topic for NEET-PG. ### Why Phrenic Nerve is the Correct Answer The **phrenic nerve** is not a content of the carotid sheath. It lies **posterior** to the sheath, embedded in the prevertebral fascia as it descends on the anterior surface of the scalenus anterior muscle [1]. While it is anatomically close, it remains outside the fascial compartment of the sheath. ### Analysis of Other Options * **Vagus Nerve (CN X):** This is a primary content, situated posteriorly in the groove between the artery and the vein [1]. * **Internal Carotid Artery (ICA):** The sheath contains the Common Carotid Artery (CCA) inferiorly and the ICA superiorly. Note: The External Carotid Artery (ECA) is **not** inside the sheath (except for its origin). * **Deep Cervical Lymph Nodes:** These are embedded within the connective tissue of the sheath, primarily along the internal jugular vein. ### NEET-PG High-Yield Pearls 1. **Mnemonic (VAN):** From medial to lateral, the contents are **V**agus nerve (posterior), **A**rtery (Common/Internal Carotid), and **N**erve (Internal Jugular Vein). 2. **Ansa Cervicalis:** The anterior wall of the carotid sheath contains the superior belly of the ansa cervicalis. 3. **Sympathetic Chain:** Like the phrenic nerve, the sympathetic trunk is **not** a content; it lies posterior to the sheath, embedded in prevertebral fascia. 4. **Clinical Significance:** The carotid sheath serves as a conduit for the spread of infections from the head and neck into the mediastinum.

Q: A 33-year-old male patient complains of severe pain when he tries to turn his neck. The physician realizes that the problem is in his pivot (trochoid) joint. Which of the following joints would most likely be examined?

Atlantoaxial joint. ### Explanation **Correct Answer: B. Atlantoaxial joint** The **atlantoaxial joint** is a classic example of a **pivot (trochoid) joint**. It consists of the articulation between the dens (odontoid process) of the axis (C2) and the anterior arch of the atlas (C1). In a pivot joint, a rounded process of bone rotates within a ring formed by another bone and a ligament. This specific joint is responsible for the rotation of the head (the "no" movement), which aligns with the patient's clinical presentation of pain when turning the neck. **Analysis of Incorrect Options:** * **A. Atlantooccipital joint:** This is a **condyloid (ellipsoid) joint** between the occipital condyles and the atlas. It primarily allows for flexion and extension (the "yes" movement), not rotation. * **C. Carpometacarpal joint:** The 1st CMC joint (thumb) is a **saddle (sellar) joint**. Other CMC joints are typically plane synovial joints. * **D. Proximal tibiofibular joint:** This is a **plane (gliding) synovial joint** that allows for slight movement during ankle dorsiflexion. **High-Yield Clinical Pearls for NEET-PG:** * **Pivot Joints in the Body:** There are only two primary examples: the **Median Atlantoaxial joint** and the **Radio-ulnar joints** (proximal and distal). * **Ligamentous Support:** The **transverse ligament of the atlas** is crucial for stabilizing the atlantoaxial joint; its rupture (e.g., in Rheumatoid Arthritis or Down Syndrome) can lead to atlantoaxial subluxation and spinal cord compression. * **Movement Mnemonic:** **A**tlanto-**O**ccipital = **O**K (Nodding/Yes); **A**tlanto-**A**xial = **O**round (Rotation/No).

Q: Laryngocele arises from herniation through which membrane?

Thyrohyoid membrane. **Explanation:** A **laryngocele** is an abnormal cystic expansion or herniation of the **saccule of the laryngeal ventricle**. The saccule is a blind pouch extending upward from the anterior part of the ventricle between the vestibular fold and the thyroid cartilage. 1. **Why Thyrohyoid Membrane is correct:** The saccule contains mucous glands. When the saccule becomes distended with air (often due to increased intra-laryngeal pressure, as seen in trumpet players or glassblowers), it can protrude superiorly. An **external laryngocele** specifically pierces the **thyrohyoid membrane** at the point where the superior laryngeal artery and the internal laryngeal nerve enter the larynx. It then presents as a reducible swelling in the neck that enlarges with the Valsalva maneuver. 2. **Why other options are incorrect:** * **Thyroid membrane:** This is a non-standard anatomical term; the relevant structure is the thyrohyoid membrane. * **Cricoepiglottic membrane:** This refers to the quadrangular membrane. While the saccule lies lateral to it, the herniation does not occur through this membrane to reach the neck. * **Cricovocal membrane (Conus Elasticus):** This membrane forms the lower part of the intrinsic laryngeal membranes (leading to the vocal cords). Herniation here would not result in a laryngocele. **Clinical Pearls for NEET-PG:** * **Internal Laryngocele:** Remains within the larynx, causing hoarseness or airway obstruction. * **External Laryngocele:** Pierces the thyrohyoid membrane; presents as a neck mass. * **Bryce’s Sign:** A gurgling sound heard on compression of the swelling (pathognomonic for laryngocele). * **Association:** In adults, always rule out **Squamous Cell Carcinoma** of the larynx obstructing the ventricular orifice.

Q: Which muscle is supplied by the ansa cervicalis?

Sternohyoid. **Explanation:** The **Ansa Cervicalis** is a loop of nerves from the cervical plexus (C1–C3) located in the carotid triangle. It is responsible for supplying the **infrahyoid muscles** (also known as "strap muscles"), which function to depress the hyoid bone and larynx. **Why Sternohyoid is Correct:** The ansa cervicalis supplies three out of the four infrahyoid muscles: the **Sternohyoid**, **Sternothyroid**, and **Omohyoid**. The superior belly of the omohyoid is supplied by the superior root (C1), while the inferior belly, sternohyoid, and sternothyroid are supplied by the inferior root/loop (C2–C3). Note: The fourth infrahyoid muscle, the *Thyrohyoid*, is supplied by C1 fibers traveling via the Hypoglossal nerve. **Why the other options are incorrect:** * **Mylohyoid (B):** This is a suprahyoid muscle supplied by the **Nerve to Mylohyoid**, a branch of the mandibular nerve (V3). * **Cricothyroid (C):** This is an intrinsic muscle of the larynx supplied by the **External Laryngeal Nerve** (a branch of the Vagus nerve). * **Stylohyoid (D):** This is a suprahyoid muscle supplied by the **Facial Nerve (CN VII)**. **High-Yield Facts for NEET-PG:** 1. **The C1 Exception:** Fibers from C1 supply both the **Thyrohyoid** and the **Geniohyoid** muscles, but they reach these muscles by "hitching a ride" with the Hypoglossal nerve (CN XII). 2. **Surgical Landmark:** The ansa cervicalis is usually found embedded in the anterior wall of the **carotid sheath**, overlying the internal jugular vein. 3. **Mnemonic:** To remember the muscles supplied by the ansa cervicalis, think **"SOS"** (Sternohyoid, Omohyoid, Sternothyroid).

Question 1

All of the following are midline swellings in the neck, except?

Accepted Answer

Branchial cyst

Answer

Sublingual dermoid cyst

Answer

Thyroglossal cyst

Answer

Subhyoid bursitis

Question 2

A patient presents with enlarged cervical lymph nodes and a malignant tumor of the cecum. Which of the following lymph nodes of the neck is most frequently associated with malignant tumors of the gastrointestinal tract?

Accepted Answer

Left supraclavicular lymph node

Answer

Left inferior deep cervical lymph node

Answer

Right inferior deep cervical lymph node

Answer

Right supraclavicular lymph node

Question 3

Which of the following does NOT supply blood to the palatine tonsil?

Accepted Answer

Sphenopalatine artery

Answer

Lingual artery

Answer

Facial artery

Answer

Ascending pharyngeal artery

Question 4

The carotid sheath contains all the following structures EXCEPT:

Accepted Answer

Phrenic nerve

Answer

Vagus nerve

Answer

Internal carotid artery

Answer

Deep cervical lymph nodes

Question 5

A 33-year-old male patient complains of severe pain when he tries to turn his neck. The physician realizes that the problem is in his pivot (trochoid) joint. Which of the following joints would most likely be examined?

Accepted Answer

Atlantoaxial joint

Answer

Atlantooccipital joint

Answer

Carpometacarpal joint

Answer

Proximal tibiofibular joint

Question 6

A 56-year-old woman presents with a 7-month history of an enlarging lump on the right side of her neck. Physical examination reveals a 3-cm nodule in the right upper neck, medial to the sternocleidomastoid muscle and lateral to the trachea, at the angle of the mandible. A CT scan shows a circumscribed, solid mass adjacent to the carotid bifurcation. Microscopic examination of the excised mass reveals nests of round cells with pink, granular cytoplasm. Immunohistochemical markers chromogranin and S-100 are positive. Electron microscopy shows neurosecretory granules in the tumor cell cytoplasm. The tumor recurs 1 year later and is re-excised. What is the most likely diagnosis?

Accepted Answer

Paraganglioma

Answer

Metastatic squamous cell carcinoma

Answer

Metastatic thyroid medullary carcinoma

Answer

Mucoepidermoid carcinoma

Question 7

What is the most common site of the internal opening of a branchial fistula?

Accepted Answer

Tonsillar fossa

Answer

Lateral nasopharyngeal wall

Answer

Fossa of Rosenmuller

Answer

Gingivolabial sulcus

Question 8

Which of the following statements is true about the atlanto-axial joint?

Accepted Answer

The atlanto-occipital joint permits flexion and extension movements.

Answer

The vertebral artery passes posterior to the foramen magnum.

Answer

The posterior longitudinal ligament does not pass through the spinal canal.

Answer

The atlanto-axial joint is an ellipsoid joint.

Question 9

Laryngocele arises from herniation through which membrane?

Accepted Answer

Thyrohyoid membrane

Answer

Thyroid membrane

Answer

Cricoepiglottic membrane

Answer

Cricovocal membrane

Question 10

Which muscle is supplied by the ansa cervicalis?

Accepted Answer

Sternohyoid

Answer

Mylohyoid

Answer

Cricothyroid

Answer

Stylohyoid

Neck — MCQs

Neck — MCQs

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