Neck Practice Questions

Q: Which of the following muscles is not affected by paralysis of the recurrent laryngeal nerve?

Cricothyroid. ***Cricothyroid*** - This muscle is innervated by the **external branch of the superior laryngeal nerve**, not the recurrent laryngeal nerve. [1] - Its primary function is to **tense the vocal cords**, increasing the pitch of the voice. *Thyroarytenoid* - This muscle is responsible for **relaxing the vocal cords** and closing the rima glottidis. - It receives its innervation from the **recurrent laryngeal nerve**, so it would be affected by its paralysis. [1] *Lateral cricoarytenoid* - This muscle is a primary **adductor of the vocal cords**, closing the rima glottidis. - Its innervation is derived from the **recurrent laryngeal nerve**, making it susceptible to paralysis. [1] *Vocalis* - The vocalis muscle is an intrinsic laryngeal muscle that **adjusts the tension within the vocal folds** and is considered part of the thyroarytenoid muscle. - It is innervated by the **recurrent laryngeal nerve**, and its paralysis would impair vocal fold tension. [1]

Q: Chasaignac's tubercle is located at which anatomical site?

Carotid tubercle on C6 vertebra. ***Carotid tubercle on C6 vertebra*** - **Chasaignac's tubercle** is the prominent **anterior tubercle** of the transverse process of the **sixth cervical vertebra** (C6). - This anatomical landmark is significant because the **common carotid artery** can be compressed against it to control bleeding. *Erbs point* - **Erb's point** on the neck refers to a specific area where several nerves of the **brachial plexus** merge. - It is not a bony prominence like Chasaignac's tubercle, but rather a **neurological landmark** where damage can lead to Erb's palsy. *Found on 1st rib* - The **first rib** has an important bony projection called the **scalene tubercle**, where the **anterior scalene muscle** attaches. - While it is a cervical region bony landmark, it is distinct from Chasaignac's tubercle and serves different anatomical and clinical purposes related to thoracic outlet syndrome. *Medial condyle of humerus* - The **medial condyle of the humerus** is a distal part of the humerus in the elbow region, forming part of the elbow joint. - It is an important landmark for muscle attachments (e.g., common flexor origin) and the ulnar nerve, but it is located in the arm, far from the neck region where Chasaignac's tubercle is found.

Q: The lower border of the pharynx is the level of:

C6. ***C6*** - The **pharynx** extends from the base of the skull to the inferior border of the **cricoid cartilage** [1]. - This anatomical landmark, the inferior border of the **cricoid cartilage**, is located at the level of the **C6 vertebra** [1]. *C2* - The C2 vertebra, also known as the **axis**, is significantly higher than the lower border of the pharynx. - It is involved in head rotation and forms part of the **atlantoaxial joint**. *C3* - The C3 vertebra is located higher in the cervical spine and is associated with structures like the hyoid bone, but not the lower pharyngeal border. - It is the approximate level of the **hyoid bone** [1]. *C4* - The C4 vertebra is typically at the level of the superior border of the **thyroid cartilage**, which is still superior to the lower pharynx. - This level is also associated with the bifurcation of the common carotid artery.

Q: Killian's dehiscence is seen in:

Cricopharynx. ***Cricopharynx*** - Killian's dehiscence refers to a **triangular gap** in the posterior wall of the **pharynx**, specifically between the oblique fibers of the **thyropharyngeus muscle** and the transverse fibers of the **cricopharyngeus muscle**. - This anatomical weakness is the most common site for the formation of a **Zenker's diverticulum**, a pouch that can protrude through the pharyngeal wall. *Oropharynx* - The oropharynx is located between the **soft palate** and the **hyoid bone** and is primarily involved in swallowing and breathing. - It does not contain the specific muscular arrangement that creates Killian's dehiscence. *Nasopharynx* - The nasopharynx is the superior part of the pharynx, located behind the **nasal cavity** and extending to the **soft palate**. - Its primary function is in respiration, and it lacks the muscular structures associated with Killian's dehiscence. *Vocal cords* - The vocal cords are located within the **larynx**, inferior to the pharynx, and are essential for **phonation**. - They are unrelated to the muscular structures of the cricopharynx or the formation of Killian's dehiscence.

Q: Which muscle divides the neck into anterior and posterior triangles?

Sternocleidomastoid. ***Sternocleidomastoid*** - The **sternocleidomastoid muscle** runs obliquely across the neck from the mastoid process to the sternum and clavicle. - It serves as a crucial anatomical landmark, dividing the neck into the **anterior** and **posterior triangles**. *Platysma* - The **platysma** is a superficial muscle of facial expression located in the subcutaneous tissue of the neck. - It does not divide the neck into major anatomical triangles but rather covers the anterior and lateral aspects of the neck. *Digastric* - The **digastric muscle** is a suprahyoid muscle located in the anterior neck region. - It aids in jaw depression and elevation of the hyoid bone, but it is not responsible for dividing the neck into its main triangles. *Trapezius* - The **trapezius muscle** is a broad, flat muscle located in the posterior neck and upper back. - While it forms the posterior boundary of the posterior triangle, it does not divide the neck into anterior and posterior triangles itself.

Q: Cystic hygroma is typically found in which of the following locations?

Neck. ***Neck*** - Cystic hygromas are most commonly found in the **neck**, particularly in the **posterior cervical triangle** [1]. - They arise from congenital malformations of the **lymphatic system**, often near the jugular lymphatic sacs [1]. *Axilla* - While cystic hygromas can occur in the axilla, it is a **less common site** compared to the neck [1]. - Axillary involvement typically represents a **lymphatic malformation** in that region. *Mediastinum* - **Mediastinal cystic hygromas** are rare and can present with respiratory symptoms due to compression of thoracic structures [1]. - However, the neck is the **predominant location** for these lymphatic malformations. *Calf* - Cystic hygromas in the **calf** or other extremities are exceedingly rare, typically seen as part of generalized lymphatic malformations. - The most frequent presentation is a **soft, compressible mass** in the neck region [1].

Q: Which of the following statements about the pyriform fossa is incorrect?

The aryepiglottic fold does not form its medial border.. ***The aryepiglottic fold does not form its medial border.*** - This statement is **INCORRECT** because the **medial border** of the **pyriform fossa** is actually formed by the **aryepiglottic fold**. - The aryepiglottic fold extends from the arytenoid cartilage to the epiglottis, separating the piriform fossa from the laryngeal aditus. - This is a key anatomical landmark for understanding the boundaries of the pyriform fossa. *It is the most common site for cancer.* - This statement is also incorrect, but less definitively so from a pure anatomical standpoint. - While the **pyriform fossa** can be a site of **squamous cell carcinoma**, it is **not the most common site** for head and neck cancers. - The **oral cavity** and **oropharynx** are more frequent locations for head and neck cancers owing to a higher incidence of HPV-related and tobacco/alcohol-induced malignancies. *It has a rich nerve supply.* - This statement is **CORRECT**. - The **pyriform fossa** is indeed richly innervated by branches of the **internal laryngeal nerve**, a branch of the superior laryngeal nerve and vagus nerve. - This rich innervation makes it a sensitive area concerning foreign bodies and can elicit strong **gag reflexes** or pain. *It is present on either side of the laryngeal opening.* - This statement is **CORRECT** [1]. - The **pyriform fossae** (or piriform sinuses) are symmetrical depressions located on either side of the **laryngeal inlet** [1]. - These fossae serve as channels for food and liquids to pass into the esophagus, bypassing the airway.

Q: In an emergency tracheostomy, which structures are least likely to be damaged?

Inferior thyroid artery. ***Inferior thyroid artery*** - The **inferior thyroid artery** is typically located deep and lateral to the trachea, arising from the thyrocervical trunk and approaching the thyroid gland posteriorly [1]. - During emergency tracheostomy, the incision is made in the midline over the 2nd-4th tracheal rings, whereas this artery runs laterally at a lower level (typically around the 6th tracheal ring). - Its **deep and lateral anatomical position** makes it the least vulnerable structure among the options during a standard midline tracheostomy incision [1]. *Isthmus of the thyroid* - The **isthmus of the thyroid gland** crosses the trachea anteriorly, typically overlying the 2nd, 3rd, and 4th tracheal rings. - It lies directly in the path of an emergency tracheostomy incision and is frequently encountered, often requiring division or retraction to access the trachea. - This structure is **highly likely to be damaged** during the procedure. *Thyroid ima artery* - The **thyroid ima artery** is an inconsistent vessel, present in approximately 3-10% of individuals, arising from the brachiocephalic trunk or aortic arch. - When present, it ascends in the **midline** to supply the inferior pole of the thyroid gland, placing it directly in the path of the tracheostomy incision. - This vessel is **highly susceptible to injury** when present, potentially causing significant arterial bleeding. *Inferior thyroid vein* - The **inferior thyroid veins** drain the thyroid gland and form a venous plexus anterior to the trachea, superficial to the thyroid isthmus [1]. - This plexus lies in the **superficial surgical field** and is prone to injury during the midline cervical incision for tracheostomy. - Damage to these veins commonly occurs and can lead to significant venous bleeding [1].

Q: Which of the following is not a branch of the cervical plexus?

Suprascapular nerve. ***Suprascapular nerve*** - The **suprascapular nerve** originates from the **brachial plexus** (specifically the upper trunk), not the cervical plexus. - It primarily innervates the **supraspinatus** and **infraspinatus muscles**. *Lesser occipital nerve* - The **lesser occipital nerve** is a cutaneous branch of the **cervical plexus** (C2) that supplies the skin behind the ear. - It provides sensory innervation to the **scalp posterior to the auricle**. *Greater auricular nerve* - The **greater auricular nerve** is a branch of the **cervical plexus** (C2, C3) and provides sensory innervation to the skin over the parotid gland, mastoid process, and auricle. - It supplies sensation to the **external ear** and the **angle of the mandible**. *Supraclavicular nerve* - The **supraclavicular nerves** (C3, C4) are cutaneous branches of the **cervical plexus** that provide sensory innervation to the skin over the shoulder and upper chest. - They provide sensory innervation to the skin overlying the **clavicle** and the **pectoral region**.

Q: Fascia around the nerve bundles of the brachial plexus is derived from which structure?

Deep cervical fascia. ***Deep cervical fascia*** - The **brachial plexus** is enveloped by a fascial sheath known as the **axillary sheath**, which is a direct continuation of the **prevertebral layer of the deep cervical fascia**. - This fascial extension surrounds the neurovascular structures (subclavian/axillary artery and vein, and brachial plexus) as they exit the neck into the axilla. - The prevertebral fascia extends laterally from the cervical vertebrae to form this protective sheath. *Pretracheal fascia* - The **pretracheal fascia** (middle layer of deep cervical fascia) encloses the trachea, esophagus, and thyroid gland. - It lies anterior to the prevertebral fascia and does not extend laterally to surround the brachial plexus. *Prelaryngeal fascia* - This is not a standard anatomical term for a distinct fascial layer. - The larynx is covered by the investing layer and visceral components of the deep cervical fascia. *Carotid sheath* - The **carotid sheath** is a separate fascial compartment formed by contributions from all three layers of deep cervical fascia. - It encloses the common carotid artery, internal jugular vein, and vagus nerve—not the brachial plexus.

Question 1

Which of the following muscles is not affected by paralysis of the recurrent laryngeal nerve?

Accepted Answer

Cricothyroid

Answer

Lateral cricoarytenoid

Answer

Vocalis

Answer

Thyroarytenoid

Question 2

Chasaignac's tubercle is located at which anatomical site?

Accepted Answer

Carotid tubercle on C6 vertebra

Answer

Erbs point

Answer

Found on 1st rib

Answer

Medial condyle of humerus

Question 3

The lower border of the pharynx is the level of:

Accepted Answer

C6

Answer

C2

Answer

C3

Answer

C4

Question 4

Killian's dehiscence is seen in:

Accepted Answer

Cricopharynx

Answer

Oropharynx

Answer

Nasopharynx

Answer

Vocal cords

Question 5

Which muscle divides the neck into anterior and posterior triangles?

Accepted Answer

Sternocleidomastoid

Answer

Platysma

Answer

Digastric

Answer

Trapezius

Question 6

Cystic hygroma is typically found in which of the following locations?

Accepted Answer

Neck

Answer

Axilla

Answer

Mediastinum

Answer

Calf

Question 7

Which of the following statements about the pyriform fossa is incorrect?

Accepted Answer

The aryepiglottic fold does not form its medial border.

Answer

It has a rich nerve supply.

Answer

It is present on either side of the laryngeal opening.

Answer

It is the most common site for cancer.

Question 8

In an emergency tracheostomy, which structures are least likely to be damaged?

Accepted Answer

Inferior thyroid artery

Answer

Isthmus of the thyroid

Answer

Thyroid ima

Answer

Inferior thyroid vein

Question 9

Which of the following is not a branch of the cervical plexus?

Accepted Answer

Suprascapular nerve

Answer

Supraclavicular nerve

Answer

Lesser occipital nerve

Answer

Greater auricular nerve

Question 10

Fascia around the nerve bundles of the brachial plexus is derived from which structure?

Accepted Answer

Deep cervical fascia

Answer

Pretracheal fascia

Answer

Prelaryngeal fascia

Answer

Carotid sheath

Neck — MCQs

Neck — MCQs

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