Neck Practice Questions

Q: The tonsillar fossa is bounded anteriorly by which structure?

Palatoglossal fold. ### Explanation The **tonsillar fossa** (or tonsillar sinus) is the space between the diverging pillars of the soft palate that houses the palatine tonsil. Understanding its boundaries is high-yield for both anatomy and surgical procedures like tonsillectomy. **Correct Answer: D. Palatoglossal fold** The tonsillar fossa is bounded **anteriorly** by the **Palatoglossal arch (or fold)**, which contains the palatoglossus muscle. This fold marks the transition between the oral cavity and the oropharynx. **Analysis of Incorrect Options:** * **B. Palatopharyngeal fold:** This forms the **posterior boundary** of the tonsillar fossa. It contains the palatopharyngeus muscle. * **A. Pharyngobasilar fascia:** This forms the **immediate bed** (lateral boundary) of the tonsil, situated between the tonsil and the superior constrictor muscle. * **C. Buccopharyngeal fascia:** This covers the external surface of the superior constrictor muscle. It is lateral to the pharyngobasilar fascia and the muscular wall. **Clinical Pearls for NEET-PG:** 1. **The Tonsillar Bed:** From within outwards, the layers are: Tonsillar capsule → Loose areolar tissue (the site of dissection in tonsillectomy and where peritonsillar abscesses form) → Pharyngobasilar fascia → Superior constrictor muscle → Buccopharyngeal fascia. 2. **Blood Supply:** The main artery is the **Tonsillar branch of the Facial artery**. 3. **Nerve Supply:** Sensory supply is primarily via the **Glossopharyngeal nerve (CN IX)**. Referred otalgia (ear pain) during tonsillitis occurs because CN IX also supplies the middle ear via Jacobson’s nerve. 4. **Important Relation:** The **Glossopharyngeal nerve** and the **Facial artery** lie just lateral to the superior constrictor muscle, making them vulnerable during deep surgical dissection.

Q: Which is the narrowest part of the adult laryngeal airway?

Glottis. ***Glottis***- In adults, the **glottis** (the level of the true vocal cords) is the point of the smallest cross-sectional area in the larynx, crucial for regulating airflow and phonation [1].- This region is formed by the mobile **vocal folds** and the space between them (rima glottidis), making it the most critical constriction point. *Supraglottic region*- The **supraglottic region** (above the vocal folds) is generally wider than the glottis due to the location of the expansive **epiglottis** and aryepiglottic folds.- Its primary function is protective, and its diameter is larger than the narrow aperture created by the vocal cords. *Subglottic region*- While the **subglottic region** (at the level of the cricoid cartilage) is the narrowest part in *children*, in adults, its diameter usually exceeds that of the glottis [1].- It is supported by the complete ring of the **cricoid cartilage**, which provides a relatively unyielding but generally wider structure compared to the mucosal space between the vocal cords. *Trachea*- The **trachea** is positioned distal to the larynx and is markedly wider than any part of the laryngeal airway.- Its large diameter, maintained by **C-shaped cartilage rings**, ensures low resistance for air passage to the bronchi and lungs.

Q: Identify the structure marked as 'X' in the image below

Buccopharyngeal fascia. ***Buccopharyngeal fascia*** - This fascia is a subdivision of the **pretracheal layer** of the deep cervical fascia that encloses the pharynx, esophagus, and buccinator muscle. - The pointer 'X' correctly identifies this structure, which forms the anterior boundary of the **retropharyngeal space** located immediately posterior to the pharynx. *Prevertebral fascia* - This layer of deep cervical fascia encloses the **vertebral column** and the deep muscles of the neck (e.g., longus colli, scalene muscles). - It is located posterior to the **alar fascia** and forms the floor of the posterior triangle of the neck. *Pharyngobasilar fascia* - This is a strong fibrous sheet that forms the internal framework of the **pharyngeal wall**, situated between the mucous membrane and the muscular layer. - It is an **internal** structure and is not visible on the external surface of the pharynx as indicated in the image. *Alar fascia* - This is a thin fascial layer located between the **buccopharyngeal fascia** anteriorly and the **prevertebral fascia** posteriorly. - It subdivides the space behind the pharynx into the true **retropharyngeal space** and the more posterior **danger space**.

Q: A patient presents with loss of sensation on the posterior surface of the ear along with a lesion. Which structure is most likely involved?

Greater Auricular Nerve. ***Greater Auricular Nerve***- The **Greater Auricular Nerve (GAN)**, originating from the cervical plexus (C2, C3), provides sensory innervation to the **skin over the mastoid process** and the **posterior surface of the auricle (ear)**.- Damage (lesion involvement) to this nerve results specifically in **sensory loss (anesthesia)** in its distribution area, matching the patient's presentation.*Internal Jugular Vein*- This is a large deep vein responsible for major **venous drainage** of the head and neck, not sensory innervation.- Involvement would cause **venous congestion** or potentially severe complications related to thrombosis, not isolated sensory loss.*External Jugular Vein*- This is a superficial vein responsible for minor **venous drainage** of the face and head, running lateral to the sternocleidomastoid muscle.- Any compromise to this vein affects the circulatory system (**venous return**) and does not lead to sensory deficits.*External Carotid Artery*- This is a major artery supplying the extracranial structures of the head; its primary function is **blood supply (perfusion)**.- Lesions would typically cause signs of **ischemia** or hemorrhage in its distribution, not an isolated nerve-related sensory loss on the posterior ear.

Q: Identify the level of lymph nodes indicated in the marked region of the neck in the given anatomical image.

Level II. **Level II** - The arrow points to the **upper deep cervical lymph nodes**, also known as the **upper jugular nodes**, which correspond to **Level II** in the neck lymph node classification. - This level is located in the upper third of the neck, extending from the base of the skull down to the **hyoid bone**, and is a common site for metastasis from cancers of the oral cavity, pharynx, and larynx. *Level Ia* - **Level Ia** represents the **submental nodes**, located in the midline triangle between the anterior bellies of the digastric muscles and inferior to the chin. - The indicated region is lateral and superior to the location of **Level Ia**. *Level Ib* - **Level Ib** corresponds to the **submandibular nodes**, situated within the submandibular triangle, bounded by the mandible and the digastric muscles. - The arrow points to a region posterior and superior to the **submandibular triangle**. *Level IV* - **Level IV** represents the **lower deep cervical lymph nodes** or **lower jugular nodes**, located along the lower third of the internal jugular vein, extending from the cricoid cartilage down to the clavicle. - The marked area is in the upper part of the neck, significantly superior to **Level IV**.

Q: A middle-aged lady choked while eating fish and has associated symptoms of coughing, hoarseness of voice, and a foreign body sensation in the throat. On examination, the pyriform fossa is found to be inflamed. Which of the following nerves supplies this region?

Internal Laryngeal Nerve (ILN). ***Internal Laryngeal Nerve (ILN)*** - The **Internal Laryngeal Nerve** (sensory branch of **superior laryngeal nerve**, CN X) provides **sensory innervation to the pyriform fossa** and surrounding hypopharyngeal structures. - Fish bone impaction in the pyriform fossa irritates the **ILN**, causing **cough reflex**, **hoarseness**, and **foreign body sensation** as described in this case. *External Laryngeal Nerve (ELN)* - The **External Laryngeal Nerve** is primarily a **motor nerve** that supplies the **cricothyroid muscle** for vocal cord tensioning. - It provides **minimal sensory contribution** and does not innervate the mucosa of the pyriform fossa. *Glossopharyngeal Nerve* - The **Glossopharyngeal Nerve (CN IX)** provides sensory innervation to the **oropharynx** and **posterior third of tongue**, not the pyriform fossa. - The pyriform fossa is anatomically part of the **hypopharynx (laryngopharynx)**, which is supplied by branches of the **vagus nerve**, not CN IX. *Recurrent Laryngeal Nerve* - The **Recurrent Laryngeal Nerve** primarily provides **motor innervation** to intrinsic laryngeal muscles (except cricothyroid). - Its sensory distribution is limited to the **infraglottic larynx** (below vocal cords), not the pyriform fossa region.

Q: Which nerve marked as X innervates the carotid sinus?

Carotid sinus nerve. ***Carotid sinus nerve*** - The **carotid sinus nerve** (also known as Hering's nerve) is a branch of the **glossopharyngeal nerve (cranial nerve IX)** that specifically innervates the carotid sinus. - It transmits afferent (sensory) signals from the **baroreceptors** in the carotid sinus to the **medulla oblongata** to regulate blood pressure. *Aortic depressor nerve* - The **aortic depressor nerve** is a branch of the vagus nerve (cranial nerve X) that innervates the **aortic arch baroreceptors**. - While also involved in blood pressure regulation, its innervation site is the aorta, not the carotid sinus. *Inferior cervical cardiac nerve* - The **inferior cervical cardiac nerve** is part of the **sympathetic nervous system** originating from the inferior cervical ganglion. - It primarily transmits sympathetic efferent signals to the heart, influencing heart rate and contractility, not innervating baroreceptors. *Thoracic cardiac nerve* - **Thoracic cardiac nerves** are generally part of the **sympathetic trunk** and course to the heart. - Like the inferior cervical cardiac nerve, they are involved in cardiac regulation but do not specifically innervate the carotid sinus baroreceptors.

Q: Identify the marked parts in the given image.

X = Thyrocervical trunk, Y = Carotid sinus. ***X = Thyrocervical trunk, Y = Carotid sinus*** - The label 'X = Thyrocervical trunk' is explicitly given in the image, pointing to the origin of the **thyrocervical trunk** from the subclavian artery - The label 'Carotid sinus = Y' is also directly provided in the image, indicating the location of the **carotid sinus** at the bifurcation of the common carotid artery - The **carotid sinus** is a baroreceptor that monitors blood pressure *X = Costocervical trunk, Y = Carotid body* - The structure labeled 'X' is explicitly identified as the **thyrocervical trunk** in the provided diagram, not the costocervical trunk - The structure labeled 'Y' is clearly marked as the **carotid sinus**, not the carotid body (which is a chemoreceptor) *X = Internal carotid artery, Y = Carotid sinus* - The label 'X' in the image clearly points to the **thyrocervical trunk**, not the internal carotid artery - While 'Y' is correctly identified as the **carotid sinus**, the identification of X is incorrect *X = External carotid artery, Y = Carotid body* - The label 'X' identifies the **thyrocervical trunk**, not the external carotid artery - The structure marked 'Y' is specifically labeled as the **carotid sinus**, not the carotid body

Q: The following image shows:

A = Common carotid artery, B= Ansa cervicalis. ***A = Common carotid artery, B= Ansa cervicalis*** - Label A points to a large, prominent pulsating vessel, which in the neck is characteristic of the **common carotid artery**. This artery is a major blood supply to the head and neck. - Label B indicates a looping nerve structure lying superficial to the strap muscles, consistent with the **ansa cervicalis**, a nerve loop of the cervical plexus that innervates the infrahyoid muscles. *A = Internal jugular vein, B= Inferior thyroid veins* - The vessel at A is **thicker-walled** and more cylindrical, typical of an artery, not the typically thinner-walled and collapsed internal jugular vein in an embalmed specimen. - Label B shows a nerve plexus, not the typically more varied and often smaller caliber inferior thyroid veins. *A = External jugular vein, B= Ascending cervical artery* - The external jugular vein is more superficial and typically smaller than the vessel shown at A. - The ascending cervical artery is a branch of the inferior thyroid artery, much smaller and deeper than the structure indicated at B, which is clearly a nerve loop. *A = Vagus nerve, B= Sympathetic trunk* - While the vagus nerve does run in the carotid sheath alongside the common carotid artery, label A clearly shows a vascular structure (thicker, cylindrical), not a nerve. - The sympathetic trunk lies deeper and more posterior along the vertebral column, not in the superficial position shown at B. Additionally, B demonstrates the characteristic looping pattern of the ansa cervicalis, not the linear sympathetic trunk.

Question 1

The tonsillar fossa is bounded anteriorly by which structure?

Accepted Answer

Palatoglossal fold

Answer

Pharyngobasilar fascia

Answer

Palatopharyngeal fold

Answer

Buccopharyngeal fascia

Question 2

Which is the narrowest part of the adult laryngeal airway?

Accepted Answer

Glottis

Answer

Supraglottic region

Answer

Trachea

Answer

Subglottic region

Question 3

Identify the structure marked as 'X' in the image below

Accepted Answer

Buccopharyngeal fascia

Answer

Prevertebral fascia

Answer

Pharyngobasilar fascia

Answer

Alar fascia

Question 4

A patient presents with loss of sensation on the posterior surface of the ear along with a lesion. Which structure is most likely involved?

Accepted Answer

Greater Auricular Nerve

Answer

External Carotid Artery

Answer

External Jugular Vein

Answer

Internal Jugular Vein

Question 5

Identify the level of lymph nodes indicated in the marked region of the neck in the given anatomical image.

Accepted Answer

Level II

Answer

Level Ib

Answer

Level Ia

Answer

Level IV

Question 6

A 35-year-old man presents to the emergency department with a complaint of food stuck in his throat. On examination, a bone is seen in the left piriform recess. Which of the following is most likely to be impaired?

Accepted Answer

Gag reflex

Answer

Cough reflex

Answer

Salivation

Answer

Mastication

Question 7

A middle-aged lady choked while eating fish and has associated symptoms of coughing, hoarseness of voice, and a foreign body sensation in the throat. On examination, the pyriform fossa is found to be inflamed. Which of the following nerves supplies this region?

Accepted Answer

Internal Laryngeal Nerve (ILN)

Answer

External Laryngeal Nerve (ELN)

Answer

Glossopharyngeal Nerve

Answer

Recurrent Laryngeal Nerve

Question 8

Which nerve marked as X innervates the carotid sinus?

Accepted Answer

Carotid sinus nerve

Answer

Aortic depressor nerve

Answer

Inferior cervical cardiac nerve

Answer

Thoracic cardiac nerve

Question 9

Identify the marked parts in the given image.

Accepted Answer

X = Thyrocervical trunk, Y = Carotid sinus

Answer

X = Costocervical trunk, Y = Carotid body

Answer

X = Internal carotid artery, Y = Carotid sinus

Answer

X = External carotid artery, Y = Carotid body

Question 10

The following image shows:

Accepted Answer

A = Common carotid artery, B= Ansa cervicalis

Answer

A = Internal jugular vein, B= Inferior thyroid veins

Answer

A = External jugular vein, B= Ascending cervical artery

Answer

A = Vagus nerve, B= Sympathetic trunk

Neck — MCQs

Neck — MCQs

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