Surface Anatomy of the Neck — MCQs
Which muscle divides the neck into anterior and posterior triangles?
The thyrocervical trunk is a branch of which part of subclavian artery?
Match the following: A) Glossopharyngeal nerve B) Spinal accessory nerve C) Facial nerve D) Mandibular nerve 1) Shrugging of shoulder 2) Touch sensation from the posterior one-third of the tongue 3) Chewing 4) Taste from the anterior two-thirds of the tongue
A 5-year-old child has a painless, midline neck swelling that moves with swallowing. What is the most likely diagnosis?
All of the following form the boundary of MacEwen's triangle except:
What is the primary function of the superior cervical ganglion?
Lymph node metastasis in neck is almost never seen with:
Joint involved in movement of head from left to right.
The fascia around the nerve bundle of the brachial plexus is derived from?
During a knife fight, a person is injured in the neck region and presents with weakness in raising the right arm above the head. On further examination, winging of the right scapula is noted. The injury has damaged:
Surface Anatomy of the Neck Indian Medical PG Practice Questions and MCQs
Question 1: 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 2: 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 3: Match the following: A) Glossopharyngeal nerve B) Spinal accessory nerve C) Facial nerve D) Mandibular nerve 1) Shrugging of shoulder 2) Touch sensation from the posterior one-third of the tongue 3) Chewing 4) Taste from the anterior two-thirds of the tongue
- A. A-3 , B-1 , C-4 , D-2
- B. A-2 , B-3 , C-4 , D-1
- C. A-4 , B-1 , C-2 , D-3
- D. A-2 , B-1 , C-4 , D-3 (Correct Answer)
Explanation: ***A-2 , B-1 , C-4 , D-3*** - **A) Glossopharyngeal nerve (CN IX)** is responsible for **general sensation and taste from the posterior one-third of the tongue** [1]. (2). - **B) Spinal Accessory nerve (CN XI)** innervates the **sternocleidomastoid** and **trapezius muscles**, which are involved in shrugging the shoulders (1). - **C) Facial nerve (CN VII)** carries **taste sensation from the anterior two-thirds of the tongue** [1] (4) via the chorda tympani. - **D) Mandibular nerve (V3)**, a branch of the trigeminal nerve, innervates the muscles of mastication, enabling **chewing** (3). *A-3 , B-1 , C-4 , D-2* - This option incorrectly associates the **glossopharyngeal nerve** with chewing, which is a function of the mandibular nerve (V3). - It also incorrectly associates the **mandibular nerve** with touch sensation from the posterior one-third of the tongue, which is a function of the glossopharyngeal nerve [1]. *A-2 , B-3 , C-4 , D-1* - This option incorrectly links the **spinal accessory nerve** with chewing; this nerve primarily controls shoulder and neck movements. - It also incorrectly assigns shrugging of the shoulder to the **mandibular nerve** instead of the spinal accessory nerve. *A-4 , B-1 , C-2 , D-3* - This choice incorrectly attributes **taste from the anterior two-thirds of the tongue** to the glossopharyngeal nerve, which supplies the posterior one-third [1]. - It also incorrectly links **touch sensation from the posterior one-third of the tongue** to the facial nerve, which is involved in taste from the anterior two-thirds [1].
Question 4: A 5-year-old child has a painless, midline neck swelling that moves with swallowing. What is the most likely diagnosis?
- A. Branchial cyst
- B. Dermoid cyst
- C. Thyroglossal duct cyst (Correct Answer)
- D. Thyroid nodule
Explanation: ***Thyroglossal duct cyst*** - A **midline neck swelling** that is **painless** and **moves with swallowing** or protrusion of the tongue is a classic presentation of a thyroglossal duct cyst. - This cyst develops from the **remnant of the embryonic thyroglossal duct**, connecting the thyroid gland to the tongue base. *Branchial cyst* - Typically presents as a **lateral neck mass**, usually anterior to the sternocleidomastoid muscle, not midline. - They are remnants of the **branchial arches** and are less likely to move with swallowing. *Dermoid cyst* - While dermoid cysts can occur in the neck and be midline, they are generally **not mobile with swallowing** because they are not attached to the hyoid bone or tongue. - They are congenital cysts formed from trapped skin elements. *Thyroid nodule* - A thyroid nodule would be located in the **lower anterior neck** over the thyroid gland, typically not as high as a thyroglossal duct cyst. - While it might move with swallowing, it is often firmer and may be associated with thyroid dysfunction or a history of radiation exposure, which is not mentioned here.
Question 5: All of the following form the boundary of MacEwen's triangle except:
- A. Temporal line
- B. Posterosuperior segment of bony external auditory canal
- C. Promontory (Correct Answer)
- D. Tangent drawn to the external auditory meatus
Explanation: ***Promontory*** - The **promontory** is a bony projection on the medial wall of the **middle ear cavity**, formed by the basal turn of the cochlea. - It is located deep to the tympanic membrane and is **not a boundary of MacEwen's triangle**, which is a superficial external bony landmark on the lateral surface of the temporal bone. - MacEwen's triangle is used surgically to locate the mastoid antrum, while the promontory is an internal middle ear structure. *Temporal line* - The **temporal line** (supramastoid crest, continuation of the posterior root of the zygoma) forms the **superior boundary** of MacEwen's triangle. - This is a key anatomical reference point for mastoid surgery. *Posterosuperior segment of bony external auditory canal* - The **posterosuperior margin of the external auditory meatus** forms the **anterior boundary** of MacEwen's triangle. - This boundary guides surgical dissection during mastoidectomy. *Tangent drawn to the external auditory meatus* - A **tangent drawn to the posterior margin of the external auditory meatus** forms the **posterior boundary** of MacEwen's triangle. - This is one of the three boundaries that define this important surgical landmark, also known as the **suprameatal triangle**.
Question 6: What is the primary function of the superior cervical ganglion?
- A. Is the largest cervical ganglion
- B. Supplies sympathetic fibers to the dilator pupillae muscle (Correct Answer)
- C. Deep petrosal nerve of pterygopalatine ganglion is derived from plexus around internal carotid artery
- D. Left superior cervical cardiac branch goes to deep cardiac plexus
Explanation: Supplies sympathetic fibers to the dilator pupillae muscle - The superior cervical ganglion is the primary source of postganglionic sympathetic fibers to the head and neck. - One of its key functions is providing sympathetic innervation to the dilator pupillae muscle [1] via the long ciliary nerves, causing mydriasis (pupil dilation) [2]. - This represents a clear physiological function of the ganglion in autonomic control of the eye. Is the largest cervical ganglion - While the superior cervical ganglion is indeed the largest of the three cervical sympathetic ganglia, this is an anatomical characteristic, not a function. - Size is a structural feature, not a physiological role. Left superior cervical cardiac branch goes to deep cardiac plexus - The superior cervical ganglion does contribute cardiac branches to the cardiac plexus for sympathetic innervation of the heart. - However, this describes an anatomical pathway rather than the primary function itself, and specifying "left" and "deep cardiac plexus" makes it overly specific rather than addressing overall function. Deep petrosal nerve of pterygopalatine ganglion is derived from plexus around internal carotid artery - The superior cervical ganglion does send postganglionic fibers forming a plexus around the internal carotid artery, which contributes to the deep petrosal nerve. - However, this is an anatomical derivation/pathway, not a functional description of what the ganglion does physiologically.
Question 7: Lymph node metastasis in neck is almost never seen with:
- A. Carcinoma vocal cords (Correct Answer)
- B. Supraglottic carcinoma
- C. Carcinoma of tonsil
- D. Papillary carcinoma thyroid
Explanation: ***Carcinoma vocal cords*** - The **vocal cords** are relatively poor in lymphatic drainage, which significantly reduces the likelihood of regional lymph node metastasis. - Due to this sparse lymphatic network, spread to cervical lymph nodes is rare, especially in early-stage disease. *Supraglottic carcinoma* - **Supraglottic** regions have a rich lymphatic network, leading to a high incidence of cervical lymph node metastasis, even in early stages. - Bilateral lymphatic drainage further increases the risk of nodal involvement. *Carcinoma of tonsil* - The **tonsils** are richly supplied with lymphatic vessels, making them prone to early and frequent metastasis to cervical lymph nodes. - Metastasis is often seen in levels II, III, and IV of the neck. *Papillary carcinoma thyroid* - **Papillary thyroid carcinoma** commonly metastasizes to regional lymph nodes, with documented rates as high as 30-80%. - Nodal metastasis can occur in the central compartment (level VI) and lateral neck (levels II-V).
Question 8: Joint involved in movement of head from left to right.
- A. Atlanto axial (Correct Answer)
- B. Atlanto occipital
- C. C2- C3 Joint
- D. C3- C4 Joint
Explanation: ***Atlanto axial*** - The **atlantoaxial joint** is responsible for the **rotation of the head**, allowing for movements such as shaking the head "no." - This joint is a **pivot joint** formed between the atlas (C1 vertebra) and the axis (C2 vertebra), specifically the **dens** of the axis articulating with the anterior arch of the atlas. *Atlanto occipital* - The **atlanto-occipital joint** primarily facilitates **flexion and extension of the head** (nodding "yes" movement). - This joint connects the **atlas (C1)** to the **occipital bone** of the skull. *C2- C3 Joint* - The **C2-C3 joint** is a typical **intervertebral joint** in the cervical spine. - While it contributes to overall cervical spine mobility, it does not primarily mediate the **rotational movement** of the head. *C3- C4 Joint* - The **C3-C4 joint** is another **intervertebral joint** in the cervical spine. - Its main roles include some degree of **flexion, extension, and lateral bending**, but it is not the primary joint for head rotation.
Question 9: 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 10: During a knife fight, a person is injured in the neck region and presents with weakness in raising the right arm above the head. On further examination, winging of the right scapula is noted. The injury has damaged:
- A. Long thoracic nerve of Bell
- B. Dorsal scapular nerve
- C. Suprascapular nerve
- D. Spinal accessory nerve (Correct Answer)
Explanation: ***Spinal accessory nerve*** - **Weakness in raising the arm above the head** and **winging of the scapula** are characteristic signs of **trapezius muscle dysfunction**, which is supplied by the **spinal accessory nerve (CN XI)**. - The trapezius is essential for **upward rotation of the scapula** during overhead arm abduction (>90°). - Injury to the spinal accessory nerve in the posterior triangle of the neck causes **lateral winging** of the scapula (inferior angle moves laterally), which is most prominent when attempting to raise the arm overhead. - The combination of **scapular winging** + **inability to abduct the arm above horizontal** is pathognomonic for trapezius paralysis. *Long thoracic nerve of Bell* - Damage to the long thoracic nerve causes paralysis of the **serratus anterior muscle**, leading to **medial winging** of the scapula (medial border lifts away from chest wall). - While scapular winging occurs, it is most prominent during **forward flexion** or **pushing movements** (e.g., push-ups, pushing against a wall), not specifically when raising the arm overhead. - Patients can usually still abduct the arm overhead, though with altered scapular mechanics. *Dorsal scapular nerve* - The dorsal scapular nerve innervates the **rhomboid major and minor muscles** and the **levator scapulae**. - Injury primarily causes difficulty **retracting the scapula** (pulling shoulders back) and weakness in shoulder elevation. - Does **not** cause scapular winging or significant weakness in overhead arm movement. *Suprascapular nerve* - The suprascapular nerve innervates the **supraspinatus** and **infraspinatus muscles**. - Damage causes weakness of shoulder **initiation of abduction** (first 15° by supraspinatus) and **external rotation** (infraspinatus). - Does **not** cause scapular winging, as these are rotator cuff muscles, not scapular stabilizers.
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