Neck Practice Questions

Q: Commonest site of branchial cyst:

Upper 1/3rd of sternomastoid on anterior border. ***Upper 1/3rd of sternomastoid on anterior border*** - The **second branchial cleft** anomaly (accounting for 90-95% of all branchial cysts) commonly develops along the **anterior border of the sternocleidomastoid muscle** in the upper third of the neck, at the junction of upper and middle thirds [2]. - This location corresponds to the embryological remnants of the **second branchial pouch and cleft**. - The cyst typically presents as a smooth, fluctuant, non-tender mass that may become infected. *Upper 1/3rd of sternomastoid on posterior border* - This location is less common for branchial cysts, which typically originate along the anterior border of the sternocleidomastoid. - Cysts in the posterior triangle of the neck are more often associated with other conditions, such as **cystic hygroma** or lymph node pathology [1]. *Lower 1/3rd of sternomastoid on posterior border* - Branchial cysts usually occur in the **upper third** to junction of upper and middle thirds of the neck due to the developmental anatomy of the **second branchial arch and pouch**. - Cysts found in the lower posterior aspect of the neck are less likely to be branchial cysts. *Lower 1/3rd of sternomastoid on anterior border* - While along the anterior border, branchial cysts are predominantly found in the **upper third** or at the junction of upper and middle thirds of the sternocleidomastoid muscle. - Lesions in this lower, anterior position might suggest alternative diagnoses such as a **thyroglossal duct cyst** if midline, or other cervical masses like **thyroid nodules** or lymphadenopathy.

Q: A neonate while suckling milk can respire without difficulty due to:

High larynx. ***High larynx*** - A neonate's **larynx** is positioned much higher in the neck compared to an adult, specifically near the **nasopharynx**. - This high position allows the **epiglottis** to overlap with the **soft palate**, creating a continuous air passage from the nose to the lungs even while milk is being swallowed in the oral cavity. *Small pharynx* - While neonates do have smaller anatomical structures, a "small pharynx" itself does not explain simultaneous breathing and suckling. - The critical factor is how the pharynx interacts with the larynx and soft palate, not just its size. *Soft palate* - The **soft palate** plays a crucial role by contacting the epiglottis, but it is its interaction with the high larynx that enables the dual function, not the soft palate in isolation. - The soft palate's ability to elevate and separate the oral and nasal cavities is important for swallowing, but its specific position relative to the larynx is key during suckling. *Small tongue* - A neonate's tongue is relatively large compared to the oral cavity, filling most of the space, which is actually beneficial for creating a seal around the nipple. - The size of the tongue does not directly account for the ability to respire during suckling; rather, it's about the **laryngeal positioning**.

Q: Which of the following is a potential space located between the pharynx and the prevertebral fascia?

Retropharyngeal space. ***Retropharyngeal space*** - This is a potential space in the neck located **behind the pharynx** and in front of the prevertebral fascia. - It is clinically significant as infections here can spread rapidly due to its communication with the **mediastinum**. *Parapharyngeal space* - The parapharyngeal space is located on the **side of the pharynx**, lateral to it, and is bordered by the medial pterygoid muscle, styloid process, and pharyngeal constrictors. - While adjacent, it is a distinct anatomical compartment from the retropharyngeal space. *Not a recognized anatomical space* - The retropharyngeal space is a well-defined and **clinically important anatomical space** in the neck. - Its recognition is crucial for understanding the spread of infections and managing deep neck space pathologies. *Peritonsillar space* - The peritonsillar space is located immediately **lateral to the palatine tonsil**, between the tonsillar capsule and the superior constrictor muscle. - Infections here lead to a **peritonsillar abscess** (quinsy), which is distinct from a retropharyngeal abscess.

Q: A 43 year old woman came with a large abscess in the middle of the right posterior triangle of the neck. The physician incised and drained the abscess. Five days later the patient noticed that she could not raise her right arm above her head to brush her hair. What is the cause

Injury to the spinal accessory nerve. ***Injury to the spinal accessory nerve*** - The **spinal accessory nerve (CN XI)** innervates the **sternocleidomastoid** and **trapezius muscles**. - Damage to this nerve, particularly during surgery in the posterior triangle of the neck, can lead to weakness in **shrugging the shoulders** and difficulty **abducting the arm above 90 degrees** (due to trapezius dysfunction). *Injury to the suprascapular nerve* - The **suprascapular nerve** innervates the **supraspinatus** and **infraspinatus muscles**, which are involved in the initial 0-15 degrees of abduction and external rotation, respectively. - Damage would primarily affect these movements, not the ability to extend the hand above the head (which involves arm elevation beyond 90 degrees). *Damage to the scalenus medius muscle* - The **scalenus medius muscle** is primarily involved in **neck flexion and lateral flexion**, and elevating the second rib during forced inspiration. - Damage to this muscle would not directly impair the ability to raise the arm overhead. *Infection spread to the shoulder joint* - While infection could cause pain and inflammation, leading to reduced range of motion, it's less likely to result in a **specific neurological deficit** observed shortly after an incision and drainage. - An infection spreading to the shoulder joint would present with **symptoms of septic arthritis** (e.g., severe pain, swelling, fever), which are not mentioned.

Q: Left-Right movement of skull occurs at:-

Atlanto-axial joint. ***Atlanto-axial joint*** - The **atlanto-axial joint** (between C1 and C2) is primarily responsible for **rotation of the head** (left-right movement), allowing for approximately 50-60 degrees of rotation. - This joint's structure, particularly the **pivot joint** formed by the dens of C2 and the atlas, facilitates this extensive rotational movement. *C6-C7* - The C6-C7 vertebral segment primarily contributes to **flexion, extension**, and some lateral bending of the neck. - It has limited capacity for **rotational movement** compared to the atlanto-axial joint. *C2-C3* - The C2-C3 vertebral segment contributes to general **neck mobility**, including flexion, extension, and lateral bending. - While there is some rotational component, it is significantly **less pronounced** than at the atlanto-axial joint. *Atlanto-occipital joint* - The **atlanto-occipital joint** (between C0 and C1) is primarily responsible for **flexion and extension** of the head, similar to nodding "yes." - It allows for very **limited rotation** of the head.

Q: The upward extension of thyroid swelling is prevented by which of the following structures

Pretracheal fascia. ***Pretracheal fascia*** - The **pretracheal fascia** is a deep cervical fascia layer that **envelops the thyroid gland** and is continuous with the fibrous capsule of the gland. - Due to its attachments, particularly to the **cricoid cartilage** and **recurrent laryngeal nerve sheath**, it anchors the thyroid gland and **restricts its upward movement** during swallowing. *Sternothyroid* - The **sternothyroid muscle** depresses the larynx and thyroid gland, but it does **not inherently prevent upward extension** of a thyroid swelling. - Its action is on the **movement of the larynx** and thyroid, rather than an anatomical barrier to swelling. *Thyrohyoid membrane* - The **thyrohyoid membrane** connects the thyroid cartilage to the hyoid bone and allows for movement between them, but it has no direct role in **preventing upward extension of a thyroid swelling**. - It is mainly involved in **laryngeal elevation** during swallowing. *Ligament of Berry* - The **ligament of Berry** (or lateral suspensory ligament) connects the thyroid gland to the **cricoid cartilage** and **trachea** [1]. - While it offers some stability to the thyroid gland, its primary role is to **anchor the gland posteriorly** rather than prevent the upward extension of a swelling [1].

Q: Which nerve passes between the superior and middle pharyngeal constrictor muscles?

Glossopharyngeal nerve. ***Glossopharyngeal nerve*** - The **glossopharyngeal nerve (CN IX)** passes between the **superior and middle pharyngeal constrictor muscles** along with the stylopharyngeus muscle. - After exiting the skull through the **jugular foramen**, it curves forward between these two constrictor muscles to reach the tongue and pharynx. - It provides **motor innervation** to the stylopharyngeus muscle and **sensory innervation** to the posterior third of the tongue and oropharynx. *Stylopharyngeus muscle* - While the **stylopharyngeus muscle** does pass between the superior and middle pharyngeal constrictors, it is a **muscle**, not a nerve. - The question specifically asks for a nerve, making this an incorrect answer despite its correct anatomical position. - This muscle is innervated by the glossopharyngeal nerve and elevates the pharynx during swallowing. *Superior laryngeal artery* - The **superior laryngeal artery** is a blood vessel, not a nerve. - It passes through the **thyrohyoid membrane** alongside the internal branch of the superior laryngeal nerve to supply the upper larynx. - It does not pass between the pharyngeal constrictor muscles. *Pharyngeal branch of vagus nerve* - The **pharyngeal branch of the vagus nerve** contributes to the pharyngeal plexus on the surface of the pharynx. - It typically lies on the **external surface** of the middle pharyngeal constrictor rather than passing between the constrictors. - It provides motor innervation to most pharyngeal muscles (except stylopharyngeus).

Q: During thyroidectomy, damage to which nerve leads to loss of high-pitched voice?

External branch of the superior laryngeal nerve. ***External branch of the superior laryngeal nerve*** - The **external branch of the superior laryngeal nerve** innervates the **cricothyroid muscle**, which is responsible for tensing the vocal cords. - Damage to this nerve paralyzes the cricothyroid muscle, leading to an inability to tense the vocal cords, resulting in a **monotonous voice** and **loss of high-pitched tones**. *Hypoglossal nerve* - The **hypoglossal nerve (CN XII)** controls the muscles of the **tongue**, affecting articulation and swallowing, but not vocal pitch directly. - Damage primarily causes **tongue deviation** and **difficulty with speech (dysarthria)** and swallowing. *Vagus nerve* - The **vagus nerve (CN X)** gives rise to both the **superior laryngeal nerve** and the **recurrent laryngeal nerve**. - While damage to the vagus nerve trunk would affect vocalization, the question specifically asks about loss of high-pitched voice, which points to a more localized injury to one of its branches. *Recurrent laryngeal nerve* - The **recurrent laryngeal nerve** innervates most of the intrinsic laryngeal muscles, including the **thyroarytenoid** and **posterior cricoarytenoid muscles**, primarily affecting vocal cord adduction and abduction. - Damage typically causes **hoarseness** due to vocal cord paralysis, and in severe cases, difficulty breathing, but it does not specifically lead to the *loss of high-pitched voice* as directly as superior laryngeal nerve damage.

Q: During a neck dissection, a surgeon inadvertently cuts a nerve that results in a deviation of the tongue. Which nerve is likely severed?

Hypoglossal nerve; weakness in tongue movement. ***Hypoglossal nerve; weakness in tongue movement*** - Damage to the **hypoglossal nerve (CN XII)** results in paralysis of the **intrinsic and extrinsic muscles of the tongue** on the ipsilateral side. - Unopposed action of the contralateral tongue muscles causes the tongue to deviate **towards the side of the lesion** when protruded. *Vagus nerve; loss of soft palate elevation* - The **vagus nerve (CN X)** innervates most muscles of the **soft palate, pharynx, and larynx**. - Injury to the vagus nerve causes issues like hoarseness, dysphagia, and a **uvula deviation away from the lesioned side**, due to paralysis of the ipsilateral palatoglossal and palatopharyngeal muscles. *Accessory nerve; shoulder droop* - The **accessory nerve (CN XI)** primarily innervates the **sternocleidomastoid** and **trapezius muscles**. - Damage to this nerve would lead to **weakness in head rotation, shrugging the shoulders**, and elevating the arm above 90 degrees. *Glossopharyngeal nerve; loss of taste sensation* - The **glossopharyngeal nerve (CN IX)** provides sensory innervation to the posterior third of the tongue for taste and general sensation, and motor innervation to the **stylopharyngeus muscle**. - A lesion would primarily result in **loss of taste and sensation on the posterior tongue**, and potentially difficulty swallowing, but not tongue deviation.

Q: Which vein drains the superior pole of the thyroid gland?

Superior thyroid vein. ***Superior thyroid vein*** - The **superior thyroid vein** specifically drains the **superior pole and anterior parts** of the thyroid gland. - It typically empties into the **internal jugular vein** and often accompanies the superior thyroid artery [1]. - Along with the middle and inferior thyroid veins, it forms part of the thyroid's venous drainage system. *Internal jugular vein* - While the internal jugular vein is a **major recipient** of thyroid venous drainage (receiving the superior and middle thyroid veins), it is not the drainage vessel directly from the gland itself. - It serves as a **main trunk** for several cervical and cranial veins. *Thyrocervical trunk* - The thyrocervical trunk is an **arterial branch** of the subclavian artery, not a venous structure. - It gives rise to the **inferior thyroid artery**, which supplies (not drains) the thyroid gland. - This is a common distractor testing knowledge of arterial vs. venous anatomy. *External jugular vein* - The external jugular vein primarily drains the **superficial structures of the head and neck**. - It does **not receive** direct drainage from the thyroid gland. - It empties into the subclavian vein.

Question 1

Commonest site of branchial cyst:

Accepted Answer

Upper 1/3rd of sternomastoid on anterior border

Answer

Upper 1/3rd of sternomastoid on posterior border

Answer

Lower 1/3rd of sternomastoid on posterior border

Answer

Lower 1/3rd of sternomastoid on anterior border

Question 2

A neonate while suckling milk can respire without difficulty due to:

Accepted Answer

High larynx

Answer

Small pharynx

Answer

Soft palate

Answer

Small tongue

Question 3

Which of the following is a potential space located between the pharynx and the prevertebral fascia?

Accepted Answer

Retropharyngeal space

Answer

Parapharyngeal space

Answer

Not a recognized anatomical space

Answer

Peritonsillar space

Question 4

A 43 year old woman came with a large abscess in the middle of the right posterior triangle of the neck. The physician incised and drained the abscess. Five days later the patient noticed that she could not raise her right arm above her head to brush her hair. What is the cause

Accepted Answer

Injury to the spinal accessory nerve

Answer

Injury to the suprascapular nerve

Answer

Damage to the scalenus medius muscle

Answer

Infection spread to the shoulder joint

Question 5

Left-Right movement of skull occurs at:-

Accepted Answer

Atlanto-axial joint

Answer

C6-C7

Answer

C2-C3

Answer

Atlanto-occipital joint

Question 6

The upward extension of thyroid swelling is prevented by which of the following structures

Accepted Answer

Pretracheal fascia

Answer

Sternothyroid

Answer

Thyrohyoid membrane

Answer

Ligament of berry

Question 7

Which nerve passes between the superior and middle pharyngeal constrictor muscles?

Accepted Answer

Glossopharyngeal nerve

Answer

Stylopharyngeus muscle

Answer

Superior laryngeal artery

Answer

Pharyngeal branch of vagus nerve

Question 8

During thyroidectomy, damage to which nerve leads to loss of high-pitched voice?

Accepted Answer

External branch of the superior laryngeal nerve

Answer

Hypoglossal nerve

Answer

Vagus nerve

Answer

Recurrent laryngeal nerve

Question 9

During a neck dissection, a surgeon inadvertently cuts a nerve that results in a deviation of the tongue. Which nerve is likely severed?

Accepted Answer

Hypoglossal nerve; weakness in tongue movement

Answer

Vagus nerve; loss of soft palate elevation

Answer

Accessory nerve; shoulder droop

Answer

Glossopharyngeal nerve; loss of taste sensation

Question 10

Which vein drains the superior pole of the thyroid gland?

Accepted Answer

Superior thyroid vein

Answer

Thyrocervical trunk

Answer

Internal jugular vein

Answer

External jugular vein

Neck — MCQs

Neck — MCQs

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