Neck — MCQs

Neck Indian Medical PG Practice Questions and MCQs

Question 401: Which of the following muscles is not affected by paralysis of the recurrent laryngeal nerve?

A. Lateral cricoarytenoid
B. Vocalis
C. Thyroarytenoid
D. Cricothyroid (Correct Answer)

Explanation: ***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]

Question 402: Chasaignac's tubercle is located at which anatomical site?

A. Erbs point
B. Found on 1st rib
C. Medial condyle of humerus
D. Carotid tubercle on C6 vertebra (Correct Answer)

Explanation: ***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.

Question 403: The lower border of the pharynx is the level of:

A. C2
B. C3
C. C4
D. C6 (Correct Answer)

Explanation: ***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.

Question 404: Killian's dehiscence is seen in:

A. Oropharynx
B. Nasopharynx
C. Cricopharynx (Correct Answer)
D. Vocal cords

Explanation: ***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.

Question 405: Which muscle divides the neck into anterior and posterior triangles?

A. Platysma
B. Digastric
C. Trapezius
D. Sternocleidomastoid (Correct Answer)

Explanation: ***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.

Question 406: Cystic hygroma is typically found in which of the following locations?

A. Axilla
B. Mediastinum
C. Neck (Correct Answer)
D. Calf

Explanation: ***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].

Question 407: Which of the following statements about the pyriform fossa is incorrect?

A. It has a rich nerve supply.
B. It is present on either side of the laryngeal opening.
C. It is the most common site for cancer.
D. The aryepiglottic fold does not form its medial border. (Correct Answer)

Explanation: ***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.

Question 408: In an emergency tracheostomy, which structures are least likely to be damaged?

A. Isthmus of the thyroid
B. Thyroid ima
C. Inferior thyroid vein
D. Inferior thyroid artery (Correct Answer)

Explanation: ***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].

Question 409: Which of the following is not a branch of the cervical plexus?

A. Suprascapular nerve (Correct Answer)
B. Supraclavicular nerve
C. Lesser occipital nerve
D. Greater auricular nerve

Explanation: ***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**.

Question 410: What primarily prevents the upward movement of the thyroid gland?

A. Berry ligament (Correct Answer)
B. Pretracheal fascia
C. Sternothyroid muscle
D. Investing layer of the deep cervical fascia

Explanation: ***Berry ligament*** - The **Berry ligament (suspensory ligament of Berry)** is a thickening of the **pretracheal fascia** that firmly attaches the thyroid gland to the cricoid cartilage and the first two tracheal rings [1]. - This strong anatomical connection anchors the thyroid gland in place, preventing its excessive upward movement during swallowing [1]. *Pretracheal fascia* - The **pretracheal fascia** encloses the thyroid gland and extends from the hyoid bone to the thorax, investing the trachea and esophagus. - While it surrounds and offers some support to the thyroid, it is the specialized thickening known as the **Berry ligament** that provides the critical anchoring function against upward movement [1]. *Sternothyroid muscle* - The **sternothyroid muscle** is an infrahyoid muscle that depresses the thyroid cartilage and larynx. - Its primary action is to lower the larynx and hyoid bone, not to prevent the upward movement of the thyroid gland itself. *Investing layer of the deep cervical fascia* - The **investing layer of the deep cervical fascia** completely encircles the neck, enclosing the trapezius and sternocleidomastoid muscles and providing a general boundary for the neck contents. - It does not directly attach to the thyroid gland in a manner that would specifically restrict its upward movement; this function is performed by the Berry ligament [1].

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Cervical Fascia

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Triangles of the Neck

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Deep Structures of the Neck

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Thyroid and Parathyroid Glands

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Vasculature of the Neck

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Lymphatic Drainage

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Cervical Plexus

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Root of the Neck

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Applied Anatomy and Clinical Correlations

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Surface Anatomy of the Neck

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