Neck Practice Questions

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: 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: What is the correct nerve supply to the muscles labelled as A and B ?

A - Mandibular nerve, B - Facial nerve. ***A - Mandibular nerve, B - Facial nerve*** - Label A points to the **Masseter** muscle, which is supplied by the **Mandibular nerve (V3)** via the masseteric nerve. - Label B points to the **Platysma** muscle, which is a muscle of facial expression supplied by the **Facial nerve (VII)** via the cervical branch. *A - Facial nerve, B - Nerve to mylohyoid* - The **Masseter** (A) is a muscle of mastication supplied by the **Mandibular nerve (V3)**, not the facial nerve. - The **Nerve to mylohyoid** supplies the mylohyoid muscle and anterior belly of digastric, whereas B is the **Platysma** muscle supplied by the facial nerve. *A - Facial nerve, B - Spinal accessory nerve* - The **Facial nerve (VII)** supplies muscles of facial expression, not muscles of mastication like the **Masseter** (A). - The **Spinal accessory nerve (XI)** supplies the sternocleidomastoid and trapezius muscles; it does not supply the **Platysma** (B). *A - Spinal accessory nerve, B - Mandibular nerve* - The **Masseter** (A) is supplied by the **Mandibular nerve (V3)**, not the spinal accessory nerve (XI). - The **Platysma** (B) is supplied by the **Facial nerve (VII)**, not the mandibular nerve (V3).

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.

Q: Which structures are marked as $X$ and $Y$ ?

$X=$ Vertebral artery, $Y=$ Carotid sinus. ***Option: X = Vertebral artery, Y = Carotid sinus*** * **X** points to the **vertebral artery**, which arises from the subclavian artery and ascends through the transverse foramina of the cervical vertebrae (C1-C6). * **Y** points to the **carotid sinus**, a dilated area at the base of the internal carotid artery, containing baroreceptors that monitor blood pressure. *Option: X = Thyrocervical trunk, Y = Carotid sinus* * The **thyrocervical trunk** is a short, wide vessel arising from the subclavian artery, typically more medially located and not depicted as X in this image. * While Y is correctly identified as the carotid sinus, X is incorrectly identified. *Option: X = Innominate artery, Y = Aortic sinus* * The **innominate artery** (brachiocephalic artery) is the first branch of the aortic arch and does not extend as far laterally as X, which represents an artery supplying the cervical vertebrae. * The **aortic sinus** is located at the root of the aorta in the thorax, not in the neck region as indicated by Y. *Option: X = Internal mammary artery, Y = Carotid sinus* * The **internal mammary artery** (internal thoracic artery) branches from the subclavian artery and descends inferiorly deep to the sternum, not laterally as X is depicted. * While Y is correctly identified as the carotid sinus, X is incorrectly identified.

Q: Identify the anatomical structures-X, Y, Z of the neck depicted below in that order: (APPG 2015)

Anterior belly of digastric, Carotid triangle, Omohyoid. **Anterior belly of digastric, Carotid triangle, Omohyoid** - **X** points to the **anterior belly of the digastric muscle**, which forms the anterior boundary of the digastric triangle. - **Y** marks the location of the **carotid triangle**, bounded by the posterior belly of the digastric, the sternocleidomastoid, and the superior belly of the omohyoid. - **Z** indicates the **omohyoid muscle**, specifically its superior belly, which is visible in this anterior perspective of the neck musculature. *Anterior belly of digastric, Digastric triangle, Stylohyoid* - While **X is the anterior belly of the digastric**, Y is not pointing to the digastric triangle itself but rather a different anatomical region. - **Z is clearly not the stylohyoid muscle**, as the stylohyoid is a more superior and posterior muscle, typically associated with the styloid process. *Posterior belly of digastric, Digastric triangle, Platysma* - **X is incorrectly identified as the posterior belly of the digastric**; it is the anterior belly. The posterior belly is located more inferior and posterior. - **Z is not the platysma**, which is a broad, superficial muscle of facial expression covering the anterolateral aspect of the neck. *Posterior belly of digastric, Muscular triangle, Omohyoid* - **X is incorrectly identified as the posterior belly of the digastric**; it is the anterior belly of the digastric. - **Y is not the muscular triangle**, which is located more medially and inferiorly, bounded by the omohyoid, sternocleidomastoid, and the midline of the neck.

Q: The Superior and side view of the larynx is shown below. Identify the Abductor of the vocal cords.

B. **B** - **B** points to the **posterior cricoarytenoid muscle** in both views, which is the sole abductor of the vocal cords, responsible for opening the rima glottidis. - This muscle pulls the muscular processes of the arytenoid cartilages posteriorly, rotating them laterally and separating the vocal folds to allow airflow for breathing. *A* - In the side view, **A** points to the **cricoid cartilage**, a foundational cartilage of the larynx. - In the superior view, **A** points to the **epiglottis**, which covers the laryngeal inlet during swallowing, preventing food from entering the trachea. *C* - In the side view, **C** points to the **lateral cricoarytenoid muscle**, which is an adductor of the vocal cords, responsible for closing the rima glottidis. - In the superior view, **C** points to the **thyroarytenoid muscle** (or vocalic muscle, part of the thyroarytenoid), which shortens and relaxes the vocal cords, lowering the pitch of the voice. *D* - In the side view, **D** points to the **thyroid cartilage**, the largest laryngeal cartilage, forming the anterior and lateral walls of the larynx. - In the superior view, **D** points to the **transverse arytenoid muscle**, an adductor of the vocal cords, which closes the posterior part of the rima glottidis by approximating the arytenoid cartilages.

Q: What is the triangle shown in the figure known as?

Beahrs triangle. ***Beahrs triangle*** - This image illustrates the **Beahrs triangle**, an anatomical landmark used in thyroid surgery. - It is bounded by the **recurrent laryngeal nerve** (medially), the **common carotid artery** (laterally), and the **inferior thyroid artery** (superiorly). - It is crucial for identifying the **recurrent laryngeal nerve** and ensuring its preservation during thyroidectomy. *Joll's triangle* - This triangle is defined by the **common carotid artery** (medially), the **internal jugular vein** (laterally), and the **superior thyroid artery** (superiorly). - It is used as a landmark to identify the **recurrent laryngeal nerve** during thyroid surgery. - The nerve typically enters this triangle before ascending in the tracheoesophageal groove. *Lore's triangle* - This triangle is located in relation to the **thyroid gland** and is less commonly referenced in standard surgical anatomy. - It has significance in thyroid and laryngeal surgical approaches. *Berry's triangle* - **Berry's ligament** is a fibrous structure that attaches the thyroid gland to the cricoid cartilage and trachea. - **Berry's triangle** is not a commonly recognized anatomical landmark in thyroid surgery like the others listed. - The recurrent laryngeal nerve is at risk near Berry's ligament.

Q: The marking X represents which muscle? (DNB Pattern 2018)

Cricothyroid muscle. ***Cricothyroid muscle*** - The image displays the larynx, and the structure marked 'X' is located on the **anterior and lateral aspect of the cricoid cartilage**, inferior to the thyroid cartilage. This anatomical position corresponds to the **cricothyroid muscle**. - This muscle is responsible for **tensing the vocal cords**, which is crucial for pitch alteration during phonation. *Posterior cricoarytenoid* - The **posterior cricoarytenoid muscle** is located on the **posterior aspect of the cricoid cartilage** and is responsible for **abducting the vocal cords**. - It would not be visible in this anterior-lateral view where 'X' is marked. *Lateral cricoarytenoid* - The **lateral cricoarytenoid muscle** is situated **deep to the thyroid cartilage** and its fibers run from the lateral part of the cricoid to the muscular process of the arytenoid cartilage. - Its primary function is to **adduct the vocal cords**, and it would not be the superficial muscle indicated by 'X' in this view. *Lateral part of thyroarytenoid* - The **thyroarytenoid muscle** forms the bulk of the vocal folds and runs from the thyroid cartilage to the arytenoid cartilage, largely located **within the vocal cords**. - The structure marked 'X' is clearly positioned externally on the laryngeal framework, not within the vocal folds.

Question 1

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

Accepted Answer

Buccopharyngeal fascia

Answer

Prevertebral fascia

Answer

Pharyngobasilar fascia

Answer

Alar fascia

Question 2

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 3

What is the correct nerve supply to the muscles labelled as A and B ?

Accepted Answer

A - Mandibular nerve, B - Facial nerve

Answer

A - Facial nerve, B - Spinal accessory nerve

Answer

A - Spinal accessory nerve, B - Mandibular nerve

Answer

A - Facial nerve, B - Nerve to mylohyoid

Question 4

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 5

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

Question 6

Which structures are marked as $X$ and $Y$ ?

Accepted Answer

$X=$ Vertebral artery, $Y=$ Carotid sinus

Answer

$X=$ Thyrocervical trunk, $Y=$ Carotid sinus

Answer

$X=$ Innominate artery, $Y=$ Aortic sinus

Answer

$X=$ Internal mammary artery, $Y=$ Carotid sinus

Question 7

Identify the anatomical structures-X, Y, Z of the neck depicted below in that order: (APPG 2015)

Accepted Answer

Anterior belly of digastric, Carotid triangle, Omohyoid

Answer

Anterior belly of digastric, Digastric triangle, Stylohyoid

Answer

Posterior belly of digastric, Digastric triangle, Platysma

Answer

Posterior belly of digastric, Muscular triangle, Omohyoid

Question 8

The Superior and side view of the larynx is shown below. Identify the Abductor of the vocal cords.

Accepted Answer

B

Answer

A

Answer

C

Answer

D

Question 9

What is the triangle shown in the figure known as?

Accepted Answer

Beahrs triangle

Answer

Joll's triangle

Answer

Lore's triangle

Answer

Berry's triangle

Question 10

The marking X represents which muscle? (DNB Pattern 2018)

Accepted Answer

Cricothyroid muscle

Answer

Posterior cricoarytenoid

Answer

Lateral cricoarytenoid

Answer

Lateral part of thyroarytenoid

Neck — MCQs

Neck — MCQs

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