Neck Practice Questions

Q: What is the name of the marked blood vessel, which is a branch of external carotid artery?

Lingual artery. ***Correct: Lingual artery*** - The image shows a vessel branching off the anterior aspect of the **external carotid artery** and extending towards the tongue region, which is characteristic of the **lingual artery**. - This artery typically arises at the level of the **greater horn of the hyoid bone** and supplies the **tongue** and floor of the mouth. - The anterior projection and course towards the tongue region are key identifying features. *Incorrect: Superior thyroid artery* - The superior thyroid artery typically branches off the **external carotid artery** more inferiorly, often near its origin, and descends to supply the **thyroid gland**. - This vessel, in contrast, is marked higher up and projects anteriorly towards the tongue, not inferiorly towards the thyroid. *Incorrect: Ascending pharyngeal artery* - The **ascending pharyngeal artery** usually arises from the medial or posterior aspect of the external carotid artery as a small, slender branch. - It ascends vertically to supply the **pharynx**, prevertebral muscles, and middle ear, not showing the anterior horizontal course seen in the marked vessel. *Incorrect: Maxillary artery* - The maxillary artery is a terminal branch of the **external carotid artery** that originates behind the neck of the mandible, deep to the parotid gland at a higher level. - It has a complex course with many branches supplying deep structures of the face, but its origin is much more posterior and superior than the marked vessel.

Q: Important landmark in submandibular gland dissection is:

Posterior border of mylohyoid muscle. ***Posterior border of mylohyoid muscle*** - Lifting the **posterior border of the mylohyoid muscle** exposes the deep part of the submandibular gland and crucial structures like the **lingual nerve** and **Wharton's duct**. - This landmark serves as a critical guide during dissection, helping to protect adjacent nerves and vessels while ensuring complete gland removal. *Anterior belly of digastric muscle* - The anterior belly of the digastric muscle forms the anterior boundary of the **digastric triangle**, which contains the superficial portion of the submandibular gland. - While relevant for defining the superficial borders, it is not the key landmark for accessing the deep part of the gland or protecting vital structures during dissection. *Facial artery* - The **facial artery** is closely associated with the submandibular gland, usually looping over or through it, but it is not a primary surgical landmark for deeper dissection or critical structure identification. - It is often ligated or preserved during dissection due to its proximity, but its position can vary, making it less reliable as a consistent access guide. *Posterior belly of digastric muscle* - The posterior belly of the digastric muscle forms the posterior boundary of the digastric triangle. - It is relevant for defining the superficial boundaries of the gland but does not provide direct access or guide the deeper dissection of the submandibular gland or protection of critical associated nerves.

Q: Third part of vertebral artery is related to which of the following ?

Posterior arch of atlas (C1). ***Posterior arch of atlas (C1)*** - The **third part** of the vertebral artery emerges from the **transverse foramen of C1** and courses laterally and posteriorly around the **posterior arch of the atlas**. - This segment then pierces the **posterior atlanto-occipital membrane** and dura to enter the skull. *Transverse foramina of C2-C6 vertebrae* - This describes the typical course of the **second part** of the vertebral artery, which ascends through the transverse foramina of the cervical vertebrae from **C6 to C2**. - The third part's specific relation is to C1, not the lower cervical vertebrae. *Foramen magnum and intracranial course* - This refers to the **fourth part** of the vertebral artery, which enters the skull through the **foramen magnum** and then runs superiorly to join the other vertebral artery to form the basilar artery. - The third part is extra-cranial, occurring before entry into the skull. *Transverse foramen of C6 vertebra* - The **first part** of the vertebral artery courses superiorly from its origin, typically entering the transverse foramen of the **C6 vertebra**. - The third part is located much higher, at the level of the C1 vertebra.

Q: Inferior thyroid artery supplies which of the following structures? 1. Thyroid 2. Parathyroid 3. Esophagus 4. Thymus

1,2 and 3. ***1,2 and 3*** - The **inferior thyroid artery** is a branch of the **thyrocervical trunk** and supplies the **thyroid gland**, **parathyroid glands**, and the **cervical part of the esophagus** [1]. - It also gives branches to the **trachea** and **larynx** (via the inferior laryngeal artery). - These are the standard, consistently described structures supplied by this artery in anatomical texts. *1 and 2 only* - This option is incomplete as the inferior thyroid artery provides blood supply to more structures than just the thyroid and parathyroid glands. - It also supplies the **cervical portion of the esophagus** through its esophageal branches. *1,2 and 4 only* - This option is incorrect because the inferior thyroid artery does supply the **esophagus** (cervical part), which is missing from this option. - The **thymus** is primarily supplied by branches of the **internal thoracic artery**, not the inferior thyroid artery. *1,2,3 and 4* - This option is incorrect because the **thymus** is NOT a standard structure supplied by the inferior thyroid artery. - The thymus receives its blood supply primarily from the **internal thoracic artery** (anterior mediastinal branches) and sometimes from the **superior thyroid artery**. [1] - The inferior thyroid artery's distribution includes thyroid, parathyroid, esophagus, trachea, and larynx—but not the thymus.

Q: During a surgical procedure involving the posterior triangle of the neck, which of the following muscles forms its anterior boundary?

Sternocleidomastoid. ***Sternocleidomastoid*** - The **sternocleidomastoid muscle** forms the **anterior boundary** of the **posterior triangle of the neck**. - Its broad origin on the sternum and clavicle and insertion on the mastoid process help define this triangular region. *Scalene anterior* - The **scalene anterior muscle** is located deeper in the neck and is not a direct boundary of the posterior triangle. - This muscle is part of the **floor** of the posterior triangle, along with other prevertebral muscles, but does not form its anterior border. *Trapezius* - The **trapezius muscle** forms the **posterior boundary** of the posterior triangle of the neck, running from the nuchal line and thoracic vertebrae to the clavicle and scapula. - It would be incorrect to identify it as the anterior boundary. *Omohyoid* - The **inferior belly of the omohyoid muscle** crosses the posterior triangle, subdividing it into occipital and supraclavicular triangles. - It does not form one of the main borders of the entire posterior triangle.

Q: During a thyroidectomy, a surgeon must carefully identify and preserve the parathyroid glands. These glands are most commonly located posterior to which part of the thyroid gland?

Inferior poles. Detailed anatomical knowledge is crucial during thyroidectomy to ensure preservation of vital structures [1]. ***Inferior poles*** - The **inferior parathyroid glands** (parathyroid IV) are most commonly located posterior to the **inferior poles** of the thyroid gland [1]. - While they are more variable in position than superior glands and can descend into the thymus or mediastinum, the **most common location** is still posterior to the inferior poles [1]. - During thyroidectomy, these glands are frequently encountered in the inferior pole region and must be carefully preserved [1]. *Superior poles* - The **superior parathyroid glands** (parathyroid III) are typically found at the **middle-to-upper third** of the thyroid, near the cricothyroid junction, rather than directly at the superior poles. - While their position is more constant than inferior glands, they are not specifically located at the superior poles themselves. *Pyramidal lobe* - The **pyramidal lobe** is an embryological remnant extending superiorly from the thyroid isthmus. - It is not associated with parathyroid gland location, as parathyroids are distinct endocrine structures located on the posterior thyroid surface. *Middle third* - The **superior parathyroid glands** are often found near the middle third of the thyroid posteriorly. - However, when considering all four parathyroid glands (both superior and inferior pairs), the **inferior glands** at the inferior poles represent the most common overall location pattern.

Q: A 45-year-old male patient presents with difficulty swallowing and hoarseness that has progressively worsened over the past month. During physical examination, the physician notices that the patient's left vocal cord is paralyzed. The paralysis is most likely due to compression of which of the following nerves?

Left recurrent laryngeal nerve. ***Left recurrent laryngeal nerve*** - The **left recurrent laryngeal nerve** innervates all intrinsic muscles of the left larynx, except the cricothyroid muscle [1]. - Damage or compression of this nerve leads to **left vocal cord paralysis** and associated symptoms like hoarseness and difficulty swallowing (dysphagia). *Left superior laryngeal nerve* - The **superior laryngeal nerve** innervates the cricothyroid muscle, which is responsible for tensing the vocal cords. - Damage to this nerve primarily affects **pitch control** and would not typically cause complete vocal cord paralysis. *Left vagus nerve* - The **vagus nerve** gives rise to both the superior and recurrent laryngeal nerves [1]. - While damage to the main vagus nerve would cause vocal cord paralysis, the more specific finding of isolated vocal cord paralysis points to an issue with its branch, the recurrent laryngeal nerve [1]. *Right recurrent laryngeal nerve* - The **right recurrent laryngeal nerve** controls the intrinsic muscles of the right larynx. - Damage to this nerve would result in **right vocal cord paralysis**, not left vocal cord paralysis as described in the patient.

Q: Adam's apple in males is formed by the

Thyroid cartilage. ***Thyroid cartilage*** - The "Adam's apple" is anatomically known as the **laryngeal prominence**, which is formed by the anterior-most projection of the **thyroid cartilage**. - This prominence is typically more pronounced in males due to **hormonal influences** during puberty that lead to a larger larynx and vocal cords. *Hyoid bone* - The **hyoid bone** is a U-shaped bone located superior to the larynx that supports the tongue, but it does not form the "Adam's apple." - It is unique because it is the only bone in the human body not articulating with any other bone. *Epiglottis cartilage* - The **epiglottis** is a leaf-shaped elastic cartilage that covers the entrance to the larynx during swallowing to prevent food and liquid from entering the trachea. - It is positioned posterior to the thyroid cartilage and is not externally visible as the "Adam's apple." *Cricoid cartilage* - The **cricoid cartilage** is a complete ring of hyaline cartilage located inferior to the thyroid cartilage, forming the base of the larynx. - While it's a part of the larynx, it does not form the anterior projection known as the "Adam's apple."

Question 1

A 58-year-old male patient presents with halitosis, mild dysphagia and regurgitation of previous day's food. On radiological examination this is the presentation of the patient. What is the location of this presentation? (Recent NEET Pattern 2016-17)

Accepted Answer

Posterior segment of the pharynx along inferior pharyngeal constrictor muscle

Answer

Anterior segment of the pharynx along superior pharyngeal constrictor muscle

Answer

Posterior segment of the pharynx along superior pharyngeal constrictor muscle

Answer

Anterior segment of the pharynx along inferior pharyngeal constrictor muscle

Question 2

A 58-year-old male patient presents with halitosis, mild dysphagia and regurgitation of previous day food. Barium study is performed. Where is the location of this presentation?

Accepted Answer

Posterior segment of the esophagus along inferior pharyngeal constrictor muscle

Answer

Anterior segment of the esophagus along superior pharyngeal constrictor muscle

Answer

Posterior segment of the esophagus along superior pharyngeal constrictor muscle

Answer

Anterior segment of the esophagus along inferior pharyngeal constrictor muscle

Question 3

What is the name of the marked blood vessel, which is a branch of external carotid artery?

Accepted Answer

Lingual artery

Answer

Superior thyroid artery

Answer

Ascending pharyngeal artery

Answer

Maxillary artery

Question 4

Important landmark in submandibular gland dissection is:

Accepted Answer

Posterior border of mylohyoid muscle

Answer

Anterior belly of digastric muscle

Answer

Facial artery

Answer

Posterior belly of digastric muscle

Question 5

Third part of vertebral artery is related to which of the following ?

Accepted Answer

Posterior arch of atlas (C1)

Answer

Foramen magnum and intracranial course

Answer

Transverse foramen of C6 vertebra

Answer

Transverse foramina of C2-C6 vertebrae

Question 6

Inferior thyroid artery supplies which of the following structures?

1. Thyroid
2. Parathyroid
3. Esophagus
4. Thymus

Accepted Answer

1,2 and 3

Answer

1 and 2 only

Answer

1,2 and 4 only

Answer

1,2,3 and 4

Question 7

During a surgical procedure involving the posterior triangle of the neck, which of the following muscles forms its anterior boundary?

Accepted Answer

Sternocleidomastoid

Answer

Scalene anterior

Answer

Trapezius

Answer

Omohyoid

Question 8

During a thyroidectomy, a surgeon must carefully identify and preserve the parathyroid glands. These glands are most commonly located posterior to which part of the thyroid gland?

Accepted Answer

Inferior poles

Answer

Superior poles

Answer

Pyramidal lobe

Answer

Middle third

Question 9

A 45-year-old male patient presents with difficulty swallowing and hoarseness that has progressively worsened over the past month. During physical examination, the physician notices that the patient's left vocal cord is paralyzed. The paralysis is most likely due to compression of which of the following nerves?

Accepted Answer

Left recurrent laryngeal nerve

Answer

Left superior laryngeal nerve

Answer

Left vagus nerve

Answer

Right recurrent laryngeal nerve

Question 10

Adam's apple in males is formed by the

Accepted Answer

Thyroid cartilage

Answer

Hyoid bone

Answer

Epiglottis cartilage

Answer

Cricoid cartilage

Neck — MCQs

Neck — MCQs

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