Neck — MCQs
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Killian dehiscence is associated with which muscle?
The thyrocervical trunk is a branch of which part of subclavian artery?
Which of the following laryngeal cartilage is hyaline?
Which nerve primarily supplies the cervical esophagus?
The joint that permits nodding of the head while saying "yes" is:
The fascia around the nerve bundle of the brachial plexus is derived from?
Laryngeal membranes are classified into extrinsic and intrinsic. Extrinsic membranes of the larynx are all, except:
Bezold's abscess is located in?
Which of the following is NOT true regarding the scalenus anterior muscle?
Which anatomical structure in the larynx contains the saccules?
Neck Indian Medical PG Practice Questions and MCQs
Question 391: Killian dehiscence is associated with which muscle?
- A. Superior constrictor
- B. Middle constrictor
- C. Inferior constrictor (Correct Answer)
- D. Cricopharyngeus
Explanation: ***Inferior constrictor*** - Killian dehiscence (Killian's triangle) is a **triangular area of weakness** in the posterior pharyngeal wall located **between** the **thyropharyngeus** (oblique fibers) and **cricopharyngeus** (horizontal fibers) portions of the **inferior constrictor muscle**. - This is the **weakest point** in the pharyngeal wall and is the site where **Zenker's diverticulum** (pharyngoesophageal pouch) develops. - Clinically, Killian dehiscence is associated with the **inferior constrictor muscle** as it represents a natural gap within this muscle's fiber arrangement. *Superior constrictor* - Located in the **upper pharynx**, extending from the skull base to the level of the hyoid bone. - Not related to Killian dehiscence, which occurs at the **pharyngoesophageal junction** (C5-C6 level). *Middle constrictor* - Situated **between the superior and inferior constrictors**, originating from the **hyoid bone**. - Contributes to the **middle pharyngeal wall** and is not involved in Killian dehiscence formation. *Cricopharyngeus* - While cricopharyngeus is one of the **two parts** of the inferior constrictor that bounds Killian dehiscence, the dehiscence is not within cricopharyngeus itself but rather in the **gap above it**. - Acts as the **upper esophageal sphincter** and forms the inferior boundary of the dehiscence.
Question 392: The thyrocervical trunk is a branch of which part of subclavian artery?
- A. 1st part (Correct Answer)
- B. 2nd part
- C. 3rd part
- D. 4th part
Explanation: ***1st part*** - The **thyrocervical trunk** is one of the three primary branches arising from the **first part** of the subclavian artery. - The first part lies medial to the **anterior scalene muscle**. *2nd part* - The **second part** of the subclavian artery gives rise to the **costocervical trunk**. - This part lies posterior to the **anterior scalene muscle**. *3rd part* - The **third part** of the subclavian artery typically has no branches or may give off the **dorsal scapular artery**. - This part lies lateral to the **anterior scalene muscle**. *4th part* - This option is incorrect as the **subclavian artery has only three parts**, divided by their relationship to the anterior scalene muscle. - There is no anatomical fourth part of the subclavian artery.
Question 393: Which of the following laryngeal cartilage is hyaline?
- A. Epiglottis
- B. Cricoid (Correct Answer)
- C. Cuneiform
- D. Corniculate
Explanation: Cricoid - The **cricoid cartilage** is a ring-shaped cartilage that forms the inferior part of the larynx and is composed of **hyaline cartilage**. - Hyaline cartilage provides **structural support** and is flexible, but it can also ossify with age. - Other laryngeal cartilages composed of hyaline cartilage include the **thyroid cartilage** and the **arytenoid cartilages**. *Epiglottis* - The **epiglottis** is composed of **elastic cartilage**, which allows it to be very flexible and bend easily to cover the laryngeal inlet during swallowing. - Elastic cartilage contains numerous elastic fibers in its matrix, giving it greater flexibility compared to hyaline cartilage. *Corniculate* - The **corniculate cartilages** are small, cone-shaped cartilages located at the apex of the arytenoid cartilages and are composed of **elastic cartilage**. - They contribute to the structure of the aryepiglottic folds and vocal fold movement. *Cuneiform* - The **cuneiform cartilages** are also small, rod-shaped cartilages embedded within the aryepiglottic folds and are composed of **elastic cartilage**. - They provide support to the aryepiglottic folds and help maintain the patency of the laryngeal aditus.
Question 394: Which nerve primarily supplies the cervical esophagus?
- A. Vagus (Correct Answer)
- B. Left recurrent laryngeal nerve
- C. Right recurrent laryngeal nerve
- D. Phrenic nerve
Explanation: ***Vagus*** - The **vagus nerve** (cranial nerve X) provides parasympathetic innervation to the entire esophagus, including the cervical portion, through its branches. - For the **cervical esophagus** specifically, the vagus nerve supplies it via the **recurrent laryngeal nerve branches**, which provide motor innervation to the striated muscle in this region. - The vagus is considered the primary nerve because the recurrent laryngeal nerves are its direct branches, and the vagus coordinates overall esophageal function throughout its length. *Left recurrent laryngeal nerve* - The **left recurrent laryngeal nerve** is a branch of the vagus nerve that provides motor innervation to both the intrinsic muscles of the **larynx** and the **cervical esophagus**. - While it does directly supply the cervical esophagus with motor fibers, it is anatomically a branch of the vagus nerve rather than an independent primary supply. - In this context, the parent nerve (vagus) is considered the primary supply. *Right recurrent laryngeal nerve* - The **right recurrent laryngeal nerve** is also a branch of the vagus nerve that supplies both the laryngeal muscles and contributes to **cervical esophageal innervation**. - Like the left recurrent laryngeal nerve, it is a branch rather than the primary nerve source. - Both recurrent laryngeal nerves work as vagal branches to innervate the cervical esophagus. *Phrenic nerve* - The **phrenic nerve** (arising from C3-C5) primarily innervates the **diaphragm**, controlling respiration. - It does not supply the cervical esophagus and has no role in esophageal motility.
Question 395: The joint that permits nodding of the head while saying "yes" is:
- A. Atlanto-axial joint
- B. Atlanto-occipital joint (Correct Answer)
- C. C2-C3 joint
- D. C3-C4 joint
Explanation: The joint that permits nodding of the head while saying "yes" is: ***Atlanto-occipital joint*** - This joint is formed by the **articulation** of the **superior articular facets** of the atlas (C1 vertebra) with the **occipital condyles** of the skull. - It is a **condyloid joint** that primarily permits flexion and extension, which are the main movements involved in nodding the head to say "yes." *Atlanto-axial joint* - This joint is located between the **atlas (C1)** and the **axis (C2)** vertebrae and is primarily responsible for the rotation of the head, as in shaking the head "no." [1] - It consists of three separate articulations: two **lateral atlanto-axial joints** and one **median atlanto-axial joint**, which is a pivot joint. *C2-C3 joint* - This refers to a typical **intervertebral joint** between the second and third cervical vertebrae. - These joints are **symphyses** formed by an **intervertebral disc** and allow for limited movements such as flexion, extension, lateral flexion, and rotation within the cervical spine segment, but not the primary "yes" motion. *C3-C4 joint* - Similar to the C2-C3 joint, this is an **intervertebral joint** between the third and fourth cervical vertebrae. - Its structure and function are consistent with other typical cervical intervertebral joints, allowing for general cervical spine movements rather than specific head nodding.
Question 396: The fascia around the nerve bundle of the brachial plexus is derived from?
- A. Superficial cervical fascia
- B. Pretracheal fascia
- C. Investing layer
- D. Prevertebral fascia (Correct Answer)
Explanation: ***Prevertebral fascia*** - The **brachial plexus** and the subclavian artery emerge between the **anterior and middle scalene muscles**. - As they exit the neck, they become surrounded by a tubular sheath derived from the **prevertebral fascia**, forming the **axillary sheath**. *Pretracheal fascia* - This fascia surrounds the **trachea**, esophagus, thyroid gland, and infrahyoid muscles. - It lies anterior to the vertebral column and has no direct involvement in forming the sheath around the brachial plexus. *Investing layer* - The investing layer of deep cervical fascia encircles the entire neck, enclosing the **sternocleidomastoid** and **trapezius muscles**. - While it's a superficial layer of deep cervical fascia, it does not specifically form the immediate sheath around the brachial plexus. *Superficial cervical fascia* - This layer is synonymous with the **subcutaneous tissue** of the neck and contains the platysma muscle. - It is superficial to the deep cervical fascia layers and does not contribute to the fibrous sheath of the brachial plexus.
Question 397: Laryngeal membranes are classified into extrinsic and intrinsic. Extrinsic membranes of the larynx are all, except:
- A. Thyrohyoid membrane
- B. Cricotracheal membrane
- C. Quadrangular membrane (Correct Answer)
- D. Cricothyroid membrane
Explanation: ***Quadrangular membrane*** - The quadrangular membrane is an **intrinsic laryngeal membrane**, forming the lateral wall of the upper larynx and extending between the epiglottis and the arytenoid cartilages. - It forms the **vestibular folds** (false vocal cords) at its inferior free margin. *Cricothyroid membrane* - The cricothyroid membrane is an **extrinsic laryngeal membrane** that connects the cricoid cartilage inferiorly to the thyroid cartilage superiorly. - It plays a crucial role in maintaining the integrity of the **laryngeal framework** and is the site for an emergency cricothyroidotomy. *Thyrohyoid membrane* - The thyrohyoid membrane is an **extrinsic laryngeal membrane** connecting the superior border of the thyroid cartilage to the posterior surface of the hyoid bone. - It is pierced by the superior laryngeal artery and nerve, carrying sensory fibers to the **laryngeal mucosa**. *Cricotracheal membrane* - The cricotracheal membrane is an **extrinsic laryngeal membrane** that connects the inferior border of the cricoid cartilage to the first tracheal ring. - It helps to anchor the larynx to the trachea and provides stability to the lower part of the **laryngeal complex**.
Question 398: Bezold's abscess is located in?
- A. Deep to sternocleidomastoid muscle (Correct Answer)
- B. Submandibular region
- C. Digastric triangle
- D. Infratemporal region
Explanation: ***Deep to sternocleidomastoid muscle*** - **Bezold's abscess** is a complication of acute **mastoiditis**, where infection erodes through the mastoid tip and spreads into the **sternocleidomastoid muscle** or surrounding cervical fascia. - This creates an abscess deep to the muscle, typically presenting as a swelling in the **upper neck**, inferior to the mastoid tip. *Submandibular region* - Abscesses in the **submandibular region** are usually associated with **odontogenic infections** or **sialadenitis** (inflammation of salivary glands). - This location is distinct from the mastoid and does not arise from complications of **mastoiditis**. *Diagastric triangle* - The **digastric triangle** is a part of the **anterior cervical triangle** and typically contains lymph nodes, submandibular gland, and parts of the facial artery. - While it is a neck region, Bezold's abscess specifically burrows **deep to the sternocleidomastoid**, which is not the primary anatomical definition of the digastric triangle. *Infratemporal region* - The **infratemporal region** is located below the temporal bone and contains structures like the pterygoid muscles, mandibular nerve, and maxillary artery. - Abscesses here are typically related to **deep facial infections** or spread from the parapharyngeal space, not directly from **mastoiditis**.
Question 399: Which of the following is NOT true regarding the scalenus anterior muscle?
- A. The subclavian vein passes posterior to it. (Correct Answer)
- B. It is attached to the tubercle of the first rib.
- C. It is not pierced by the phrenic nerve.
- D. It separates the subclavian vein from the subclavian artery.
Explanation: ***The subclavian vein passes posterior to it*** - This is FALSE. The **subclavian vein** passes **anterior** to the scalenus anterior muscle, not posterior to it. - The **subclavian artery** and **brachial plexus** pass **posterior** to the scalenus anterior muscle. - This anatomical relationship makes the scalenus anterior a crucial landmark for the neurovascular structures at the root of the neck. *It is attached to the tubercle of the first rib* - This is TRUE. The scalenus anterior muscle inserts on the **scalene tubercle** of the **first rib**. - This attachment is a key anatomical landmark for structures in the thoracic inlet. *It is not pierced by the phrenic nerve* - This is TRUE. The **phrenic nerve** (C3, C4, C5) descends on the **anterior surface** of the scalenus anterior muscle but does not pierce through it. - This relationship is clinically important for procedures involving the anterior scalene muscle. *It separates the subclavian vein from the subclavian artery* - This is TRUE. The **scalenus anterior muscle** acts as a crucial anatomical separator, with the **subclavian vein** passing **anterior** to it and the **subclavian artery** (along with the brachial plexus) passing **posterior** to it. - This separation defines the important neurovascular relationships in the root of the neck.
Question 400: Which anatomical structure in the larynx contains the saccules?
- A. Pyriform fossa
- B. Laryngeal ventricles (Correct Answer)
- C. Paraglottic space
- D. Vocal fold space
Explanation: ***Laryngeal ventricles*** - The **laryngeal ventricles** (also known as the ventricles of Morgagni) are recesses located between the true and false vocal folds. - The **saccules** are anterior extensions of these ventricles, containing numerous mucous glands that lubricate the vocal folds. *Paraglottic space* - The **paraglottic space** is a fat-filled region lateral to the laryngeal ventricles, extending superiorly to the aryepiglottic fold and inferiorly to the conus elasticus. - While it surrounds the ventricle, it does not *contain* the saccule; rather, the saccule invaginates into its superior aspect. *Pyriform fossa* - The **pyriform fossae** are bilateral recesses in the laryngopharynx, lateral to the laryngeal inlet. - They are part of the pharynx, not the intrinsic laryngeal structures, and serve as pathways for food and liquid bypass. *Vocal fold space* - The **vocal fold space** refers to the area encompassing the true vocal folds. - While the saccules are closely associated with the vocal folds, they are specifically housed within the laryngeal ventricles, which are distinct anatomical structures above the true vocal folds.
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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