Neck — MCQs
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A patient presents with a history of swelling in the submandibular region and is diagnosed with a submandibular abscess. The incision to drain the abscess is placed 1 cm below the base of the mandible. What is the reason for this placement?
Level V lymph nodes include:
What nerve supplies the geniohyoid muscle?
All of the following are anterior branches of the external carotid artery except?
The thyrocervical trunk is a branch of which part of the subclavian artery?
A 46-year-old woman presents with a large mass in her lower anterior neck. Ultrasound reveals a benign thyroid tumor. During surgical removal, the superior thyroid artery is identified and used as a landmark to avoid damaging its small companion nerve. Which of the following nerves is most likely to accompany the superior thyroid artery?
What is true regarding Chassaignac's tubercle?
The ligament of Berry is formed by which anatomical structure?
Which of the following joints is involved in the side-to-side movement of the neck?
What forms the posterior boundary of the carotid triangle?
Neck Indian Medical PG Practice Questions and MCQs
Question 301: A patient presents with a history of swelling in the submandibular region and is diagnosed with a submandibular abscess. The incision to drain the abscess is placed 1 cm below the base of the mandible. What is the reason for this placement?
- A. The submandibular gland is located 1 cm below the mandible.
- B. It is difficult to incise directly along the margin of the mandible.
- C. The marginal mandibular nerve can be injured if the incision is made along the base of the mandible. (Correct Answer)
- D. To avoid injury to the cervical branch of the facial nerve.
Explanation: ### Explanation **1. Why the Correct Answer is Right:** The **marginal mandibular nerve** (a branch of the Facial Nerve, CN VII) is the primary structure at risk during surgeries in the submandibular region. Anatomically, this nerve often loops **below the lower border of the mandible** (up to 1–2 cm) as it traverses the submandibular triangle before ascending to supply the muscles of the lower lip (depressor anguli oris). To avoid accidental transection, surgical incisions for submandibular abscess drainage or gland excision are placed at least **1.5 to 2 cm below the base of the mandible**. This ensures the incision is made inferior to the nerve's lowest possible anatomical course. **2. Why the Incorrect Options are Wrong:** * **Option A:** While the gland is in this region, the placement of the incision is dictated by **nerve safety**, not the depth of the gland itself. * **Option B:** Incising along the margin is technically feasible but surgically contraindicated due to the high risk of nerve injury and poor cosmetic scarring. * **Option D:** The cervical branch of the facial nerve descends lower into the neck to supply the platysma. While it may be encountered, injury to the **marginal mandibular nerve** is clinically more significant as it leads to noticeable drooping of the corner of the mouth. **3. High-Yield Clinical Pearls for NEET-PG:** * **Nerve Course:** The marginal mandibular nerve runs deep to the platysma but superficial to the facial artery and vein. * **Clinical Sign of Injury:** Weakness of the **depressor anguli oris**, resulting in an asymmetrical smile and inability to evert the lower lip. * **Safe Incision Rule:** Always place submandibular incisions in a natural skin crease (Langer’s lines) at least two finger-breadths (approx. 3-4 cm) below the mandible for maximum safety in major dissections.
Question 302: Level V lymph nodes include:
- A. Pretracheal and prelaryngeal lymph nodes
- B. Mediastinal lymph nodes
- C. Lower jugular lymph nodes
- D. Posterior triangular lymph nodes (Correct Answer)
Explanation: The cervical lymph node classification (Memorial Sloan-Kettering Cancer Center system) divides the neck into six levels. This is a high-yield topic for NEET-PG. ### **Explanation of the Correct Answer** **Level V** nodes are located within the **posterior triangle** of the neck. This region is anatomically bounded anteriorly by the posterior border of the sternocleidomastoid (SCM) muscle, posteriorly by the anterior border of the trapezius muscle, and inferiorly by the clavicle. It includes the spinal accessory nodes, transverse cervical nodes, and supraclavicular nodes. ### **Analysis of Incorrect Options** * **Option A (Pretracheal/Prelaryngeal):** These belong to **Level VI** (Anterior Compartment nodes) [1]. Level VI extends from the hyoid bone superiorly to the suprasternal notch inferiorly [3]. * **Option B (Mediastinal):** These are classified as **Level VII** nodes, located below the suprasternal notch [2]. * **Option C (Lower jugular):** These are **Level IV** nodes. The deep cervical chain (internal jugular nodes) is divided into Level II (Upper), Level III (Middle), and Level IV (Lower), based on their relationship to the hyoid bone and cricoid cartilage [3]. ### **High-Yield Clinical Pearls for NEET-PG** * **Level I:** Submental (Ia) and Submandibular (Ib) nodes. * **Level II, III, IV:** Related to the Internal Jugular Vein. The landmark dividing Level II/III is the **hyoid bone**, and Level III/IV is the **cricoid cartilage** [3]. * **Boundary of Level V:** The posterior border of the SCM is the key landmark. * **Virchow’s Node:** A specific node in the left supraclavicular fossa (part of Level V) that, when enlarged (Troisier’s sign), suggests metastatic abdominal malignancy (e.g., gastric cancer).
Question 303: What nerve supplies the geniohyoid muscle?
- A. Anterior belly of digastric
- B. Posterior belly of digastric
- C. Geniohyoid (Correct Answer)
- D. Stapedius
Explanation: The **Geniohyoid** muscle is a suprahyoid muscle located superior to the mylohyoid. Its nerve supply is a high-yield topic because it is an anatomical exception. **Correct Answer: Geniohyoid (Nerve to Geniohyoid)** The geniohyoid is supplied by the **C1 spinal nerve fibers** via the **Hypoglossal nerve (CN XII)**. Although the nerve fibers travel physically with the hypoglossal nerve, they originate from the C1 ventral ramus. This is a unique arrangement shared only with the thyrohyoid muscle. **Analysis of Incorrect Options:** * **Anterior belly of digastric:** This muscle is derived from the first pharyngeal arch and is supplied by the **nerve to mylohyoid** (a branch of the mandibular nerve, V3). * **Posterior belly of digastric:** Derived from the second pharyngeal arch, it is supplied by the **facial nerve (CN VII)**. * **Stapedius:** This is the smallest skeletal muscle in the body, also derived from the second arch and supplied by the **facial nerve (CN VII)**. **High-Yield Clinical Pearls for NEET-PG:** * **C1 via CN XII Rule:** Remember the mnemonic "Two muscles are supplied by C1 via the Hypoglossal nerve: **Geniohyoid** and **Thyrohyoid**." * **Action:** The geniohyoid elevates the hyoid bone and carries it forward; it also helps depress the mandible when the hyoid is fixed. * **Mylohyoid vs. Geniohyoid:** The mylohyoid forms the anatomical floor of the mouth, while the geniohyoid lies immediately superior (deeper) to it. The mylohyoid is supplied by V3, whereas the geniohyoid is supplied by C1.
Question 304: All of the following are anterior branches of the external carotid artery except?
- A. Superior thyroid
- B. Lingual
- C. Facial
- D. Ascending pharyngeal (Correct Answer)
Explanation: ### Explanation The **External Carotid Artery (ECA)** is one of the two terminal branches of the common carotid artery. It provides the primary arterial supply to the structures of the neck, face, and scalp. To master this topic for NEET-PG, it is essential to categorize its eight branches based on their anatomical origin. **Why Ascending Pharyngeal is the correct answer:** The **Ascending Pharyngeal artery** is the smallest branch of the ECA. It arises from the **medial (deep) aspect** of the artery, not the anterior aspect. It ascends between the internal carotid artery and the pharynx to supply the pharyngeal wall, middle ear, and meninges. **Analysis of Incorrect Options (Anterior Branches):** The ECA gives off three distinct **anterior branches**: * **A. Superior Thyroid Artery:** The first branch of the ECA, arising near the level of the greater cornua of the hyoid bone. * **B. Lingual Artery:** Arises at the level of the hyoid bone; it is the primary supply to the tongue. * **C. Facial Artery:** Arises just above the lingual artery, often passing deep to the submandibular gland. **High-Yield Classification of ECA Branches:** To remember the branches, use the mnemonic: *"**S**ome **A**natomists **L**ike **F**reaking **O**ut **P**oor **M**edical **S**tudents"* 1. **Anterior:** Superior thyroid, Lingual, Facial. 2. **Posterior:** Occipital, Posterior auricular. 3. **Medial:** Ascending pharyngeal. 4. **Terminal:** Maxillary, Superficial temporal. **Clinical Pearls for NEET-PG:** * **Surgical Landmark:** The ECA is distinguished from the Internal Carotid Artery (ICA) in the neck because the **ECA has branches in the neck**, whereas the ICA has none. * **Ligation:** During surgery, the ECA is ligated distal to the superior thyroid artery to maintain collateral circulation to the thyroid gland.
Question 305: The thyrocervical trunk is a branch of which part of the subclavian artery?
- A. 1st part (Correct Answer)
- B. 2nd part
- C. 3rd part
- D. None of the above
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 (behind) it, and the third part is lateral to it. **1. Why the Correct Answer is Right (1st Part):** The first part of the subclavian artery gives off three major branches, often remembered by the mnemonic **VIT**: * **V:** Vertebral artery * **I:** Internal thoracic artery (Internal mammary) * **T: Thyrocervical trunk** The thyrocervical trunk is a short, wide vessel that further divides into the inferior thyroid, suprascapular, and transverse cervical arteries. **2. Why Incorrect Options are Wrong:** * **2nd Part:** This part typically gives off only one branch: the **costocervical trunk** (which divides into the superior intercostal and deep cervical arteries). *Note: On the left side, the costocervical trunk occasionally arises from the 1st part.* * **3rd Part:** This part is usually branchless, but it may occasionally give rise to the **dorsal scapular artery** (if it does not arise from the transverse cervical artery). **3. Clinical Pearls & High-Yield Facts for NEET-PG:** * **Inferior Thyroid Artery:** A branch of the thyrocervical trunk, it is closely related to the **recurrent laryngeal nerve**. During thyroidectomy, this artery is ligated far from the gland to avoid nerve injury [1]. * **Steal Syndrome:** Obstruction of the subclavian artery proximal to the origin of the vertebral artery (1st part) can lead to Subclavian Steal Syndrome. * **Surface Anatomy:** The subclavian artery becomes the axillary artery at the outer border of the first rib.
Question 306: A 46-year-old woman presents with a large mass in her lower anterior neck. Ultrasound reveals a benign thyroid tumor. During surgical removal, the superior thyroid artery is identified and used as a landmark to avoid damaging its small companion nerve. Which of the following nerves is most likely to accompany the superior thyroid artery?
- A. Cervical sympathetic trunk
- B. External branch of the superior laryngeal nerve (Correct Answer)
- C. Inferior root of the ansa cervicalis
- D. Internal branch of the superior laryngeal nerve
Explanation: ### Explanation The correct answer is **B. External branch of the superior laryngeal nerve.** **1. Why it is correct:** The **superior thyroid artery (STA)**, a branch of the external carotid artery, descends to the upper pole of the thyroid gland [2]. It is closely accompanied by the **external branch of the superior laryngeal nerve (EBSLN)** [2]. Crucially, as they approach the gland, the nerve lies medial to the artery [2]. To avoid damaging this nerve during a thyroidectomy, surgeons must ligate the superior thyroid artery as **close to the gland** as possible [2]. Damage to the EBSLN results in paralysis of the **cricothyroid muscle**, leading to an inability to tense the vocal cords, manifested clinically as a loss of high-pitched voice and easy vocal fatigue. **2. Why the other options are incorrect:** * **A. Cervical sympathetic trunk:** This lies posterior to the carotid sheath, resting on the prevertebral fascia. It is not a direct companion to the STA. * **C. Inferior root of the ansa cervicalis:** This is formed by fibers from C2 and C3 and is located superficial to or within the carotid sheath, supplying the infrahyoid (strap) muscles. * **D. Internal branch of the superior laryngeal nerve:** This nerve is purely sensory. It accompanies the **superior laryngeal artery** (a branch of the STA) to pierce the thyrohyoid membrane, but it does not descend to the thyroid pole with the main STA. **3. NEET-PG High-Yield Pearls:** * **Superior Thyroid Artery:** Ligate **near** the gland to save the External Laryngeal Nerve [2]. * **Inferior Thyroid Artery:** Ligate **away** from the gland to save the Recurrent Laryngeal Nerve (RLN) [1], [3]. * **Nerve Injury Effects:** * **EBSLN:** Loss of high pitch (the "Amelita Galli-Curci" nerve). * **Unilateral RLN:** Hoarseness of voice. * **Bilateral RLN:** Respiratory distress/stridor (emergency) [3].
Question 307: What is true regarding Chassaignac's tubercle?
- A. It is a landmark of the otic ganglion.
- B. It is seen in the occipital region of the skull.
- C. It is the anterior tubercle of the transverse process of the C6 vertebra. (Correct Answer)
- D. All the above.
Explanation: Explanation: Chassaignac’s tubercle, also known as the Carotid tubercle, is the prominent anterior tubercle of the transverse process of the C6 vertebra. Why Option C is Correct: The C6 transverse process has a particularly large anterior tubercle. It serves as a vital anatomical landmark because the common carotid artery can be compressed against it to control bleeding (though this carries risks of carotid sinus syncope). It also marks the level where the omohyoid muscle crosses the carotid sheath and where the inferior thyroid artery enters the thyroid gland [1]. Why Other Options are Incorrect: * Option A: The otic ganglion is a parasympathetic ganglion located in the infratemporal fossa, just below the foramen ovale. It has no anatomical relationship with the C6 vertebra or Chassaignac’s tubercle. * Option B: The occipital region contains landmarks like the external occipital protuberance (inion) and nuchal lines, but Chassaignac’s tubercle is strictly a cervical spine landmark. High-Yield Clinical Pearls for NEET-PG: 1. Stellate Ganglion Block: Chassaignac’s tubercle is the primary landmark for performing a stellate ganglion block. The needle is inserted at the level of C6 to avoid the vertebral artery, which enters the transverse foramen at this level. 2. Vertebral Artery Course: Remember that the vertebral artery usually enters the transverse foramen of C6, not C7. 3. Level Consistency: At the level of C6 (Chassaignac’s tubercle), other key structures include the cricoid cartilage, the junction of the larynx and trachea, and the junction of the pharynx and esophagus.
Question 308: The ligament of Berry is formed by which anatomical structure?
- A. Investing layer of the Deep Cervical fascia
- B. Pretracheal layer (Correct Answer)
- C. Prevertebral layer
- D. Pharyngobasilar fascia
Explanation: The **Ligament of Berry** (also known as the posterior suspensory ligament of the thyroid) is a condensation of the **Pretracheal layer** of the deep cervical fascia. It connects the posteromedial aspect of the thyroid gland’s lobes to the cricoid cartilage and the first two tracheal rings [1]. This attachment is clinically significant as it causes the thyroid gland to move upward during deglutition (swallowing). **Analysis of Options:** * **Option B (Correct):** The pretracheal fascia splits to enclose the thyroid gland. Its thickened posterior part forms the Ligament of Berry, anchoring the gland to the larynx and trachea [1]. * **Option A:** The **Investing layer** surrounds the entire neck and encloses the trapezius and sternocleidomastoid muscles, but it does not form the suspensory ligaments of the thyroid. * **Option C:** The **Prevertebral layer** covers the prevertebral muscles and forms the floor of the posterior triangle; it is located posterior to the retropharyngeal space. * **Option D:** The **Pharyngobasilar fascia** is a fibrous membrane between the muscular and mucous coats of the pharyngeal wall, attaching the pharynx to the base of the skull. **High-Yield Clinical Pearls for NEET-PG:** 1. **Recurrent Laryngeal Nerve (RLN):** The RLN usually passes deep (posterior) to the Ligament of Berry or through its fibers [1]. This makes the nerve highly vulnerable to injury during thyroidectomy when the ligament is being divided [1]. 2. **Thyroid Mobility:** Because the ligament attaches the gland to the respiratory skeleton, any mass within the thyroid (goiter/adenoma) will move superiorly during swallowing—a key diagnostic sign. 3. **Berry’s Ligament vs. Thyroid Capsule:** The ligament is a part of the *false capsule* (pretracheal fascia), not the true fibrous capsule of the gland.
Question 309: Which of the following joints is involved in the side-to-side movement of the neck?
- A. Atlanto-axial joint (Correct Answer)
- B. Atlanto-occipital joint
- C. Occipital-axial joint
- D. C6-C7 articulation
Explanation: The **Atlanto-axial joint** is a complex of three synovial joints (one median pivot and two lateral plane joints) between the Atlas (C1) and the Axis (C2). The **median atlanto-axial joint** is a pivot joint where the dens (odontoid process) of C2 acts as a vertical axis around which the atlas rotates. This specific articulation is responsible for approximately 50% of the total rotation of the neck, commonly referred to as the **"No" movement** (side-to-side rotation). ### Explanation of Options: * **A. Atlanto-axial joint (Correct):** As a pivot joint, it allows the atlas to rotate on the axis, facilitating horizontal rotation of the head. * **B. Atlanto-occipital joint:** This is an ellipsoid (condyloid) joint between the occipital condyles and the atlas. It primarily permits flexion and extension, known as the **"Yes" movement** (nodding). * **C. Occipital-axial joint:** There is no direct synovial articulation between the occipital bone and the axis. They are connected only via ligaments (e.g., Membrana tectoria, Alar, and Apical ligaments). * **D. C6-C7 articulation:** These are typical cervical vertebrae joints (symphysis between bodies and plane joints between facets). While they contribute to overall neck mobility, they do not specialize in the primary side-to-side rotational movement. ### High-Yield Clinical Pearls for NEET-PG: * **Alar Ligaments:** These "check ligaments" extend from the sides of the dens to the lateral margins of the foramen magnum and limit excessive rotation at the atlanto-axial joint. * **Transverse Ligament of Atlas:** This is the most important structure stabilizing the dens against the atlas. Rupture (common in Rheumatoid Arthritis or Down Syndrome) can lead to atlanto-axial subluxation and spinal cord compression. * **Jefferson Fracture:** A burst fracture of the Atlas (C1) caused by axial loading. * **Hangman’s Fracture:** A fracture through the pars interarticularis of the Axis (C2) due to hyperextension.
Question 310: What forms the posterior boundary of the carotid triangle?
- A. Superior belly of omohyoid
- B. Posterior belly of digastric
- C. Sternohyoid
- D. Sternocleidomastoid (Correct Answer)
Explanation: ### Explanation The **carotid triangle** is a highly significant anatomical space within the anterior triangle of the neck, containing major neurovascular structures. Its boundaries are defined by muscular landmarks: * **Posterior Boundary:** The **anterior border of the Sternocleidomastoid (SCM)**. This muscle serves as the primary landmark separating the anterior and posterior triangles of the neck. * **Anterosuperior Boundary:** The posterior belly of the digastric muscle. * **Anteroinferior Boundary:** The superior belly of the omohyoid muscle. * **Floor:** Formed by the thyrohyoid, hyoglossus, and the inferior and middle constrictor muscles of the pharynx. #### Analysis of Incorrect Options: * **A. Superior belly of omohyoid:** This forms the **anteroinferior** boundary of the carotid triangle. * **B. Posterior belly of digastric:** This forms the **anterosuperior** boundary. * **C. Sternohyoid:** This muscle is located more medially and forms part of the boundaries for the muscular triangle, not the carotid triangle. #### NEET-PG High-Yield Pearls: 1. **Contents:** The carotid triangle is famous for the **Carotid Sheath**, which contains the Common Carotid Artery (and its bifurcation), the Internal Jugular Vein, and the Vagus Nerve (CN X). 2. **Carotid Bifurcation:** Usually occurs at the level of the upper border of the thyroid cartilage (**C4 level**) within this triangle. 3. **Hypoglossal Nerve (CN XII):** Crosses both the internal and external carotid arteries superficially within this triangle. 4. **Ansa Cervicalis:** The superior root (descendens hypoglossi) is often found embedded in the anterior wall of the carotid sheath here.
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
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