Surgical Approaches to the Neck — MCQs
Which muscle divides the neck into anterior and posterior triangles?
What is the name of this technique for palpation of thyroid where a thumb is placed on the lateral side of trachea and patient is swallowing?
Post operative parotitis is caused by -
One of the most important complication of tracheostomy is:
Which anatomical structure is most commonly the target of incisions during major gynecological surgical procedures?
Shrugging of shoulder following neck surgery is due to injury to:
Surgical neck fracture leads to all EXCEPT
Treatment of resectable T4N0M0 stage of head and neck carcinoma is?
Supraomohyoid dissection is a type of?
Which of the following statements is true about branchial cysts?
Surgical Approaches to 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: What is the name of this technique for palpation of thyroid where a thumb is placed on the lateral side of trachea and patient is swallowing?
- A. Pizzilo method
- B. Lahey's method
- C. Crile method (Correct Answer)
- D. Kocher's test
Explanation: Crile method - The Crile method for thyroid palpation involves placing a thumb on one side of the trachea and gently pushing the thyroid lobe to the opposite side to better assess it during swallowing. - This technique helps to stabilize the gland and makes it easier to feel for nodules or enlargement. Pizzilo method - There is no widely recognized or standardized thyroid palpation technique called the Pizzilo method in medical literature. - This term is therefore incorrect in the context of thyroid examination. Lahey's method - Lahey's method for thyroid examination involves standing behind the patient and palpating the thyroid gland as the patient swallows, using both hands [1]. - It differs from the Crile method by typically using both hands from behind the patient, rather than focusing on a single thumb on the lateral side of the trachea [1]. Kocher's test - Kocher's test is primarily used to assess for exophthalmos in patients with Graves' disease, by observing the involuntary retraction of the upper eyelid when gazing downwards. - It is not a technique for the palpation of the thyroid gland itself.
Question 3: Post operative parotitis is caused by -
- A. E.coli
- B. Streptococcus
- C. Pneumococcus
- D. Staph aureus (Correct Answer)
Explanation: ***Staph aureus*** - **Staphylococcus aureus** is the most common cause of **acute suppurative (post-operative) parotitis** - Post-surgical conditions including **dehydration**, **poor oral hygiene**, **reduced salivary flow**, and **immunosuppression** facilitate **bacterial ascension** through Stensen's duct from the oral cavity - The bacterium proliferates in stagnant saliva, causing acute infection of the parotid gland *E.coli* - **Escherichia coli** is primarily associated with **gastrointestinal and urinary tract infections** - Rarely implicated in salivary gland infections and not a typical cause of post-operative parotitis *Streptococcus* - While **Streptococcal species** can cause various infections, they are less commonly associated with **acute bacterial parotitis** compared to **Staphylococcus aureus** - May occasionally cause parotitis but not the predominant organism in post-operative settings *Pneumococcus* - **Streptococcus pneumoniae** commonly causes **pneumonia, meningitis, and otitis media** - Rarely causes **acute suppurative parotitis** and is not typically associated with post-operative parotitis - When sialadenitis occurs, it usually affects different patient populations
Question 4: One of the most important complication of tracheostomy is:
- A. Hemorrhage
- B. Surgical emphysema
- C. Displacement of tube (Correct Answer)
- D. Recurrent laryngeal nerve palsy
Explanation: ***Displacement of tube*** - **Accidental decannulation** or displacement of the tracheostomy tube is considered one of the most serious and common complications, particularly in the immediate post-operative period. - This can lead to **loss of airway**, requiring immediate intervention to prevent severe hypoxia and potential brain injury or death. *Hemorrhage* - While hemorrhage can occur during or after tracheostomy, it is often a concern during the procedure or in the immediate postoperative period and is usually managed effectively. - Significant, life-threatening hemorrhage such as **tracheo-innominate fistula** is a rare but severe complication. *Surgical emphysema* - Surgical emphysema (subcutaneous emphysema) is a relatively common but usually benign complication that occurs when air leaks from the trachea into the subcutaneous tissues. - It typically resolves spontaneously and rarely poses a direct threat to the airway unless severe and rapidly progressive. *Recurrent laryngeal nerve palsy* - **Recurrent laryngeal nerve injury** is a rare complication of tracheostomy, as the nerve is usually well clear of the incision site in the neck. - While it can cause hoarseness or vocal cord paralysis, it typically does not present an immediate life-threatening situation or emergency comparable to airway compromise.
Question 5: Which anatomical structure is most commonly the target of incisions during major gynecological surgical procedures?
- A. Ovary
- B. Cervix
- C. Fallopian tube
- D. Uterus (Correct Answer)
Explanation: ***Uterus*** - The **uterus** is the primary anatomical target for many major gynecological procedures, such as **hysterectomy** (removal of the uterus) and **myomectomy** (removal of fibroids from the uterus). - These are among the most commonly performed major gynecological surgeries, making the uterus the most frequent target for incisions in gynecological practice. - In obstetric procedures, the uterus is also incised during **cesarean sections**, highlighting its central role in both obstetric and gynecologic surgery. *Ovary* - While ovaries are involved in gynecological surgery (e.g., **oophorectomy**, cystectomy), they are not as frequently the *primary* target for incisions as the uterus in the context of major procedures. - Ovarian surgeries are often performed for **cysts**, **tumors**, or in conjunction with hysterectomy, but are less common than uterine procedures. - Many ovarian procedures can be managed laparoscopically without major incisions. *Cervix* - The **cervix** is incised in procedures like **trachelectomy** for cervical cancer or during specific cervical cerclage procedures, but these are less frequent compared to surgeries involving the uterine body itself. - Many cervical procedures are considered minor (e.g., LEEP, cone biopsy) or are part of a larger uterine surgery. *Fallopian tube* - The **fallopian tubes** are primarily targeted for procedures like **salpingectomy** (removal of the tube, often for ectopic pregnancy or sterilization) or salpingostomy. - While significant, these procedures are generally less common than those involving the uterus and overall less frequently associated with major incisions compared to uterine procedures.
Question 6: Shrugging of shoulder following neck surgery is due to injury to:
- A. Vagus nerve
- B. Spinal accessory nerve (Correct Answer)
- C. Thoracodorsal nerve
- D. Bell's nerve
Explanation: Spinal accessory nerve - Injury to the spinal accessory nerve (cranial nerve XI) can lead to weakness or paralysis of the trapezius muscle, which is responsible for shrugging the shoulder. - Due to its superficial course in the posterior cervical triangle, it is vulnerable to iatrogenic injury during neck surgery, lymph node biopsies, or neck dissections. Thoracodorsal nerve - The thoracodorsal nerve innervates the latissimus dorsi muscle, which is involved in adduction, extension, and internal rotation of the arm [1]. - Injury to this nerve would primarily affect these arm movements, not shoulder shrugging. Bell's nerve - This term is often used to refer to the long thoracic nerve (nerve to serratus anterior). - Injury to the long thoracic nerve leads to scapular winging due to serratus anterior paralysis, but not directly to impaired shoulder shrugging. Vagus nerve - The vagus nerve (cranial nerve X) has widespread functions including innervation of the pharynx, larynx, and thoracic/abdominal viscera. - Injury to the vagus nerve typically causes symptoms like dysphagia, hoarseness, or autonomic dysfunction, unrelated to shoulder movement.
Question 7: Surgical neck fracture leads to all EXCEPT
- A. Deltoid muscle palsy
- B. Weakness of abduction
- C. Teres minor palsy
- D. Teres major palsy (Correct Answer)
Explanation: ***Teres major palsy*** - The **teres major** muscle is innervated by the **lower subscapular nerve** (C5-C7). - A surgical neck fracture of the humerus typically injures the **axillary nerve**, which does not innervate the teres major. *Deltoid muscle palsy* - The **axillary nerve**, which innervates the **deltoid muscle**, is commonly injured in a surgical neck fracture due to its proximity. - Injury to the axillary nerve would result in **deltoid muscle palsy**, leading to weakness in shoulder abduction and external rotation. *Weakness of abduction* - The **deltoid muscle** is the primary abductor of the arm after the initial 15 degrees, and it is innervated by the **axillary nerve**. - A surgical neck fracture carries a high risk of **axillary nerve injury**, compromising deltoid function and causing significant weakness in abduction. *Teres minor palsy* - The **teres minor muscle** is innervated by the **axillary nerve**, which is vulnerable in surgical neck fractures. - Palsy of the teres minor would impair **external rotation** of the shoulder.
Question 8: Treatment of resectable T4N0M0 stage of head and neck carcinoma is?
- A. Radiotherapy alone
- B. Surgery and Radiotherapy (Correct Answer)
- C. Chemoradiation
- D. Surgery alone
Explanation: ***Surgery and Radiotherapy*** - For **resectable T4N0M0 head and neck carcinoma**, the standard treatment is **surgical resection** of the primary tumor followed by **adjuvant radiotherapy**. - This approach achieves optimal **local control** for advanced primary tumors without nodal involvement. - **Adjuvant radiotherapy** is essential for T4 tumors due to high risk of microscopic residual disease and local recurrence. - Surgery allows for complete tumor removal with negative margins, while radiotherapy addresses subclinical disease. *Radiotherapy alone* - Radiotherapy alone is **insufficient as monotherapy** for T4 tumors due to the large tumor burden and extensive local invasion. - Single modality radiation cannot reliably achieve adequate tumor control for advanced primary lesions. - Generally reserved for early-stage disease or patients unfit for surgery. *Chemoradiation* - **Definitive chemoradiation** is an alternative for **unresectable T4 tumors** or when organ preservation is desired (e.g., laryngeal cancer). - For **resectable** T4N0M0 disease, surgery with adjuvant RT is preferred as it provides better local control and allows pathological staging. - Chemoradiation may be used postoperatively if high-risk features are found (positive margins, perineural invasion, extranodal extension). - In this **N0 case with resectable tumor**, upfront surgery is the preferred initial approach. *Surgery alone* - While surgical resection is crucial for T4 tumors, **surgery alone is inadequate** due to high risk of locoregional recurrence. - T4 classification indicates extensive local invasion, necessitating **adjuvant radiotherapy** to eradicate microscopic disease. - Combined modality treatment (surgery + RT) significantly improves local control and survival compared to surgery alone.
Question 9: Supraomohyoid dissection is a type of?
- A. Selective neck dissection (Correct Answer)
- B. Modified radical neck dissection
- C. Radical neck dissection
- D. Posterolateral dissection
Explanation: ***Selective neck dissection*** - **Supraomohyoid dissection** specifically refers to a type of selective neck dissection, characterized by the removal of lymph node levels **I, II, and III**. - This procedure is commonly performed for early-stage oral cavity cancers due to their typical lymphatic spread patterns. *Modified radical neck dissection* - This dissection preserves one or more **non-lymphatic structures** (e.g., sternocleidomastoid muscle, internal jugular vein, spinal accessory nerve) that are typically removed in a radical neck dissection. - It involves a broader range of lymph node levels (typically **I-V**) compared to a supraomohyoid dissection. *Radical neck dissection* - This is a more extensive procedure involving the removal of all lymph node groups (levels **I-V**), along with the **sternocleidomastoid muscle**, **internal jugular vein**, and **spinal accessory nerve**. - It is reserved for advanced neck disease due to its significant morbidity. *Posterolateral dissection* - **Posterolateral neck dissection** is a term not commonly used within the standard classification of neck dissections (radical, modified radical, selective). - Lymphatic dissection is typically categorized based on anatomical levels rather than a general directional term like posterolateral.
Question 10: Which of the following statements is true about branchial cysts?
- A. Branchial cysts are more common in males than females.
- B. They mostly arise from the second branchial cleft. (Correct Answer)
- C. Surgical intervention is not always necessary.
- D. They can cause dysphagia and hoarseness if infected.
Explanation: ***They mostly arise from the second branchial cleft.*** - **Second branchial cleft cysts** are the most common type, accounting for approximately **95%** of all branchial anomalies. - They typically present as a smooth, fluctuant mass along the **anterior border of the sternocleidomastoid muscle** at the junction of the upper and middle third of the neck. - These cysts result from **incomplete obliteration** of the second branchial cleft during embryonic development. *Branchial cysts are more common in males than females.* - Branchial cysts have **no significant sex predilection**, affecting males and females with roughly equal frequency. - The overall incidence is relatively rare, with most cases presenting in late childhood or early adulthood. *Surgical intervention is not always necessary.* - **Complete surgical excision** is the **definitive treatment** and is strongly recommended for all branchial cysts. - Indications for surgery include: prevention of **recurrent infections**, risk of **abscess formation**, elimination of cosmetic concerns, and removal due to potential (though rare) **malignant transformation**. - While very small asymptomatic cysts may occasionally be observed, this carries significant risk of future complications, making surgery the standard of care in clinical practice. *They can cause dysphagia and hoarseness if infected.* - While an **infected branchial cyst** causes local inflammatory signs (pain, swelling, warmth, erythema), it **rarely causes dysphagia or hoarseness** unless exceptionally large. - These symptoms would require the cyst to compress the **pharynx** (dysphagia) or involve the **recurrent laryngeal nerve** (hoarseness), which is uncommon even with infection. - The primary presentation of infected cysts includes **tender neck mass** with overlying skin changes and possible **abscess formation**.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free