Vasculature of the Neck — MCQs
Vertebral arteries of both sides unite to form
Asymptomatic varicose veins would fall under which category of the CEAP classification system?
All of the following arteries are branches of ECA that supply nasal septum except:
The tributaries of the inferior vena cava include all of the following, except:
A 26-year-old male presents to the outpatient department with a discrete thyroid swelling. On neck ultrasound, an isolated cystic swelling of the gland is seen. What is the risk of malignancy associated with this finding?
Sitaram a 40-year old man, met with an accident and comes to emergency department with engorged neck veins, pallor, rapid pulse and chest pain Diagnosis is -
Lymphatic drainage of oropharynx is mainly through?
Ophthalmic artery is a branch of which part of the internal carotid artery?
In obstruction of the second part of the axillary artery, the anastomosis between which arteries will maintain the blood supply to the upper limb?
Which of the following represents a common variation in the arteries arising from the arch of the aorta?
Vasculature of the Neck Indian Medical PG Practice Questions and MCQs
Question 1: Vertebral arteries of both sides unite to form
- A. Anterior spinal artery
- B. Posterior spinal artery
- C. Medullary artery
- D. Basilar artery (Correct Answer)
Explanation: Basilar artery - The paired vertebral arteries ascend through the neck via the transverse foramina of cervical vertebrae and enter the skull through the foramen magnum. - At the level of the pontomedullary junction, the two vertebral arteries merge to form a single basilar artery. Anterior spinal artery - The anterior spinal artery is formed by the union of two small branches derived from each vertebral artery near their intracranial origin. - It supplies the anterior two-thirds of the spinal cord, running along the anterior median fissure. Posterior spinal artery - The posterior spinal arteries are typically two vessels, one arising from each vertebral artery (or less commonly from the posterior inferior cerebellar artery). - They supply the posterior one-third of the spinal cord and do not form a single major merged vessel in the brainstem. Medullary artery - There is no single major artery termed the "medullary artery" formed by the union of the vertebral arteries. - The medulla oblongata is supplied by branches directly from the vertebral arteries and the basilar artery, such as the posterior inferior cerebellar artery (PICA) and direct medullary branches.
Question 2: Asymptomatic varicose veins would fall under which category of the CEAP classification system?
- A. C1 (Telangiectasias or reticular veins)
- B. C2 (Varicose veins) (Correct Answer)
- C. C3 (Edema)
- D. C4 (Skin changes)
Explanation: ***C2 (Varicose veins)*** - The CEAP classification uses 'C' for clinical manifestations, with **C2 specifically indicating the presence of varicose veins**. - Since the patient has **asymptomatic varicose veins**, C2 accurately captures this clinical state without implying more severe complications. - Varicose veins are classified as C2 **regardless of whether they are symptomatic or asymptomatic**. *C1 (Telangiectasias or reticular veins)* - C1 refers to smaller veins, such as **telangiectasias (spider veins)** and **reticular veins**, which are distinct from the larger, tortuous varicose veins. - These are less prominent venous abnormalities compared to varicose veins. *C3 (Edema)* - C3 indicates the **presence of edema** due to venous insufficiency. - The question specifies **asymptomatic varicose veins** without mention of edema, making C3 incorrect. *C4 (Skin changes)* - C4 denotes **skin changes** related to chronic venous insufficiency, such as pigmentation, eczema, or lipodermatosclerosis. - These are more advanced signs of venous disease and are not present in a patient with only varicose veins without complications.
Question 3: All of the following arteries are branches of ECA that supply nasal septum except:
- A. Facial artery
- B. Superior labial artery
- C. Anterior ethmoidal artery (Correct Answer)
- D. Sphenopalatine artery
Explanation: ***Anterior ethmoidal artery*** - The **anterior ethmoidal artery** is a branch of the **ophthalmic artery**, which itself is a branch of the **internal carotid artery (ICA)**, not the external carotid artery (ECA). - It supplies the **upper anterior nasal septum** and lateral wall of the nasal cavity. *Facial artery* - The **facial artery** is a direct branch of the **external carotid artery (ECA)**. - It contributes to the blood supply of the nasal septum through its septal branches. *Superior labial artery* - The **superior labial artery** is a branch of the **facial artery**, meaning it indirectly originates from the **external carotid artery (ECA)**. - It sends a septal branch to supply the **anterior inferior part of the nasal septum**. *Sphenopalatine artery* - The **sphenopalatine artery** is a direct terminal branch of the **maxillary artery**, which is one of the terminal branches of the **external carotid artery (ECA)**. - It is the major blood supply to the **posterior nasal septum** and lateral wall, forming part of Kesselbach's plexus.
Question 4: The tributaries of the inferior vena cava include all of the following, except:
- A. Left renal vein
- B. Left gonadal vein (Correct Answer)
- C. Hepatic vein
- D. Right suprarenal vein
Explanation: ***Left gonadal vein*** - The **left gonadal vein** (either testicular or ovarian) drains into the **left renal vein** before reaching the inferior vena cava. - It is **NOT a direct tributary** of the IVC, which is why it is the correct answer to this "except" question. - This anatomical arrangement distinguishes it from the **right gonadal vein**, which drains directly into the IVC. *Left renal vein* - The **left renal vein** is a **direct and major tributary** of the inferior vena cava (IVC). - It receives blood from the **left gonadal vein** and the **left suprarenal vein** before emptying into the IVC. [1] - This vein crosses anterior to the aorta to reach the IVC. *Hepatic vein* - The **hepatic veins** (typically three major veins: right, middle, and left) drain blood from the liver **directly into the IVC**. - They are essential for returning filtered blood from the liver to the systemic circulation. [2] - These veins have a very short course before entering the IVC just below the diaphragm. *Right suprarenal vein* - The **right suprarenal vein** drains **directly into the IVC**, similar to the right gonadal vein. [3] - In contrast, the **left suprarenal vein** drains into the left renal vein (indirect tributary), following the same asymmetric pattern as the gonadal veins.
Question 5: A 26-year-old male presents to the outpatient department with a discrete thyroid swelling. On neck ultrasound, an isolated cystic swelling of the gland is seen. What is the risk of malignancy associated with this finding?
- A. 48%
- B. 12%
- C. 24%
- D. 3% (Correct Answer)
Explanation: ***3%*** - **Purely cystic thyroid nodules** (as described in this case with "isolated cystic swelling") have a **very low risk of malignancy**, typically **2-3%** or less. - According to **ATA guidelines** and **TIRADS classification**, purely cystic nodules are considered **low suspicion** lesions. - The cystic nature suggests a **benign process** such as a degenerated adenoma, colloid cyst, or simple cyst. - **Fine needle aspiration (FNA)** may still be considered if the nodule is >2 cm or has any suspicious solid components, but is often not required for purely cystic lesions. *48%* - This percentage is **significantly higher** than the actual malignancy risk for a purely cystic thyroid swelling. - Such a **high risk** would typically be associated with **solid nodules** exhibiting highly suspicious ultrasound features such as: - Microcalcifications - Irregular or spiculated margins - Taller-than-wide shape - Marked hypoechogenicity - Extrathyroidal extension *24%* - This percentage represents a **moderate to high risk** of malignancy, which is **not characteristic** of an isolated purely cystic thyroid swelling. - A risk in this range might be seen with: - **Mixed solid-cystic nodules** with predominantly solid components - Solid nodules with **intermediate suspicious features** on ultrasound *12%* - While lower than 24% or 48%, 12% is still **considerably higher** than the generally accepted malignancy risk for purely cystic thyroid nodules. - This risk level could be plausible for: - **Predominantly cystic nodules** with some eccentric solid components - Solid nodules with **mildly suspicious** features on ultrasound
Question 6: Sitaram a 40-year old man, met with an accident and comes to emergency department with engorged neck veins, pallor, rapid pulse and chest pain Diagnosis is -
- A. Pulmonary laceration (lung injury)
- B. Splenic rupture (abdominal trauma)
- C. Hemothorax (blood in the pleural cavity)
- D. Cardiac tamponade (fluid accumulation in the pericardium) (Correct Answer)
Explanation: ***Cardiac tamponade (fluid accumulation in the pericardium)*** - **Engorged neck veins (elevated JVP)**, **pallor** (due to decreased cardiac output), and a **rapid pulse** ("pulsus paradoxus" or tachycardia from compensatory mechanisms) in the context of trauma are classic signs of **cardiac tamponade**. - **Chest pain** can result from the acute compression of the heart, leading to reduced ventricular filling and cardiac output. *Pulmonary laceration (lung injury)* - A pulmonary laceration would primarily present with **respiratory distress**, **hemoptysis**, and potential **air leak syndromes** (e.g., pneumothorax), not typically engorged neck veins as a primary sign. - While it can cause chest pain and rapid pulse, it doesn't explain the combination of engorged neck veins and significant cardiovascular compromise seen here without other prominent respiratory symptoms. *Splenic rupture (abdominal trauma)* - Splenic rupture typically presents with **left upper quadrant abdominal pain**, **abdominal tenderness**, and signs of **hypovolemic shock** (pallor, rapid pulse, hypotension), but not generally engorged neck veins. - The primary location of trauma and symptoms would be abdominal, not chest pain and engorged neck veins. *Hemothorax (blood in the pleural cavity)* - A hemothorax would cause **chest pain**, **dyspnea**, **diminished breath sounds** on the affected side, and signs of **hypovolemic shock** if severe (pallor, rapid pulse). - However, it typically leads to **collapsed neck veins** due to hypovolemia, rather than engorged neck veins, unless there's a co-existing tension pneumothorax or cardiac tamponade.
Question 7: Lymphatic drainage of oropharynx is mainly through?
- A. Superficial cervical lymph nodes
- B. Submandibular nodes
- C. Jugulodigastric node (Correct Answer)
- D. Jugulo-omohyoid nodes
Explanation: ***Jugulodigastric node*** - The **jugulodigastric node** (also known as the principal node of Küttner) is the primary drainage site for infections and malignancies of the posterior third of the tongue and tonsils, which are key components of the oropharynx. - It is a prominent node within the **deep cervical lymph node** chain, specifically located in the superior deep cervical group. *Superficial cervical lymph nodes* - These nodes primarily drain the superficial structures of the neck, scalp, and ear, and are **not the main drainage pathway** for the oropharynx. - They form a chain along the external jugular vein. *Submandibular nodes* - The **submandibular nodes** mainly drain the anterior two-thirds of the tongue, gums, floor of the mouth, and anterior face. - While part of the oral cavity, they are **not the primary drainage** for the oropharynx itself. *Jugulo-omohyoid nodes* - The **jugulo-omohyoid node** is located lower in the deep cervical chain, near the intermediate tendon of the omohyoid muscle. - It is a key drainage node for the **anterior tongue**, but not the primary or main drainage for the entire oropharynx.
Question 8: Ophthalmic artery is a branch of which part of the internal carotid artery?
- A. Cavernous
- B. Cervical
- C. Petrous
- D. Cerebral (Correct Answer)
Explanation: ***Cerebral (Supraclinoid)*** - The **ophthalmic artery** is the first major branch of the **cerebral (supraclinoid/C6) segment** of the internal carotid artery. - It arises **immediately after** the ICA pierces the dura mater and exits the cavernous sinus, entering the **subarachnoid space**. - The ophthalmic artery enters the orbit through the **optic canal** alongside the optic nerve, supplying the eye and orbital structures. - This is the **most clinically important branch** arising from this segment before the terminal bifurcation into anterior and middle cerebral arteries. *Cavernous* - The **cavernous segment (C4)** courses through the cavernous sinus and gives rise to small branches like the **meningohypophyseal trunk** and **inferolateral trunk**. - These branches supply the pituitary gland, cranial nerves, and dura mater. - The ophthalmic artery does **NOT** arise from this segment; it arises after the ICA exits the cavernous sinus. *Cervical* - The **cervical segment (C1)** extends from the common carotid bifurcation to the entrance of the carotid canal at the skull base. - This segment typically has **no branches**, serving primarily as a conduit. - The ophthalmic artery arises much more superiorly, intracranially. *Petrous* - The **petrous segment (C2)** lies within the petrous part of the temporal bone in the carotid canal. - It gives rise to small branches like the **caroticotympanic** and **vidian arteries** that supply the middle ear and pterygoid canal. - The ophthalmic artery is not a branch of this segment.
Question 9: In obstruction of the second part of the axillary artery, the anastomosis between which arteries will maintain the blood supply to the upper limb?
- A. Dorsal scapular artery and subscapular artery (Correct Answer)
- B. Anterior and posterior circumflex humeral arteries
- C. Posterior circumflex humeral and circumflex scapular arteries
- D. Suprascapular and anterior circumflex humeral arteries
Explanation: Dorsal scapular artery and subscapular artery - This anastomosis forms part of the scapular anastomosis, which is crucial for collateral circulation around the shoulder joint and axillary artery. - The dorsal scapular artery (a branch of the subclavian artery, or occasionally the deep branch of the transverse cervical artery) connects with the subscapular artery (a branch of the third part of the axillary artery) and its circumflex scapular branch, bypassing the obstruction [1]. - This provides effective collateral circulation when the second part of the axillary artery is obstructed. Anterior and posterior circumflex humeral arteries - These arteries originate from the third part of the axillary artery and primarily supply the humeral head and surrounding shoulder joint [1]. - While they anastomose around the surgical neck of the humerus, they are distal to an obstruction in the second part of the axillary artery and do not provide an alternative blood supply around the obstruction. Posterior circumflex humeral and circumflex scapular arteries - The posterior circumflex humeral artery is distal to the obstruction, originating from the third part of the axillary artery. - Although the circumflex scapular artery (a branch of the subscapular artery) participates in the scapular anastomosis, its anastomosis with the posterior circumflex humeral artery would still be affected by an occlusion in the second part of the axillary artery as they are both branches distal to the obstruction. Suprascapular and anterior circumflex humeral arteries - The suprascapular artery (from the thyrocervical trunk) contributes to the scapular anastomosis and is proximal to the obstruction, supplying the supraspinatus and infraspinatus muscles. - However, the anterior circumflex humeral artery arises from the third part of the axillary artery and is distal to an obstruction in the second part, so their anastomosis would not effectively bypass the blockage.
Question 10: Which of the following represents a common variation in the arteries arising from the arch of the aorta?
- A. Absence of brachiocephalic trunk
- B. Left vertebral artery arising from the arch
- C. Presence of retroesophageal subclavian artery
- D. Left common carotid artery arising from brachiocephalic trunk (Correct Answer)
Explanation: ***Left common carotid artery arising from brachiocephalic trunk*** - Normally, the **brachiocephalic trunk** gives rise to the right subclavian and right common carotid arteries, while the left common carotid and left subclavian arteries arise directly from the aortic arch. - However, in this common variation (sometimes called a **bovine arch**), the left common carotid artery originates from the brachiocephalic trunk, reducing the number of direct branches from the arch to two. *Absence of brachiocephalic trunk* - The **brachiocephalic trunk** is one of the three major vessels normally arising from the aortic arch [1]. Its absence is a very rare and significant anomaly, not a common variation. - This would imply direct origins for the right subclavian and right common carotid arteries from the aortic arch, which is not typical. *Left vertebral artery arising from the arch* - The **left vertebral artery** typically arises from the first part of the **left subclavian artery**. - Its direct origin from the aortic arch is a known anatomical variant, but it is less common than the left common carotid artery arising from the brachiocephalic trunk. *Presence of retroesophageal subclavian artery* - A **retroesophageal subclavian artery** (usually the right subclavian artery) is a congenital anomaly where the artery takes an abnormal course behind the esophagus [1]. - While it is a recognized variant, it is considered less common than the "bovine arch" configuration.
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