Neck Practice Questions

Q: Which of the following is NOT a suprahyoid muscle?

Omohyoid. The muscles of the neck are primarily categorized based on their relationship to the hyoid bone into **Suprahyoid** and **Infrahyoid** groups. ### 1. Why Omohyoid is the Correct Answer The **Omohyoid** is an **Infrahyoid muscle** (also known as "strap muscles"). These muscles are located inferior to the hyoid bone and function to depress it during swallowing and speech. The Omohyoid is unique because it consists of two bellies (superior and inferior) connected by an intermediate tendon, extending from the scapula to the hyoid bone. ### 2. Analysis of Incorrect Options (Suprahyoid Muscles) The suprahyoid muscles are located superior to the hyoid bone and function to elevate it. * **Mylohyoid (B):** Forms the floor of the oral cavity; it is a classic suprahyoid muscle. * **Geniohyoid (C):** Located superior to the mylohyoid, it pulls the hyoid bone anterosuperiorly. * **Digastric (D):** Like the omohyoid, it has two bellies (anterior and posterior), but it is located above the hyoid, making it a suprahyoid muscle. ### 3. High-Yield Clinical Pearls for NEET-PG * **Mnemonic for Suprahyoid Muscles:** "**M**y **G**ravy **S**ays **D**elicious" (**M**ylohyoid, **G**eniohyoid, **S**tylohyoid, **D**igastric). * **Mnemonic for Infrahyoid Muscles:** "**TOSS**" (**T**hyrohyoid, **O**mohyoid, **S**ternohyoid, **S**ternothyroid). * **Innervation Fact:** All infrahyoid muscles are supplied by the **Ansa Cervicalis (C1-C3)**, *except* the Thyrohyoid, which is supplied by C1 via the Hypoglossal nerve. * **Digastric Nerve Supply:** This is a frequent exam favorite—the Anterior belly is supplied by the Nerve to Mylohyoid (CN V3), while the Posterior belly is supplied by the Facial Nerve (CN VII).

Q: Which of the following is a branch of the third part of the subclavian artery?

Dorsal scapular artery. The subclavian artery is divided into three parts by the **scalenus anterior muscle**: the first part is medial, the second part is posterior, and the third part is lateral to the muscle. ### **Explanation of the Correct Answer** **B. Dorsal Scapular Artery:** This is the most common branch of the **third part** of the subclavian artery. It passes through the brachial plexus to supply the levator scapulae and rhomboid muscles. *Note:* In about 30% of individuals, it arises as a deep branch of the transverse cervical artery (from the thyrocervical trunk); however, for NEET-PG purposes, it is classically taught as the branch of the third part. ### **Analysis of Incorrect Options** * **A. Thyrocervical Trunk:** Arises from the **first part** of the subclavian artery. It further divides into the inferior thyroid, suprascapular, and transverse cervical arteries. * **C. Vertebral Artery:** Arises from the **first part** (superior aspect). it ascends through the foramina transversaria of the cervical vertebrae to enter the cranial cavity. * **D. Internal Thoracic Artery:** Arises from the **first part** (inferior aspect). It descends behind the costal cartilages to supply the anterior chest wall and breast. ### **High-Yield NEET-PG Pearls** * **Mnemonic for Branches:** * **1st Part:** **V**ertebral, **I**nternal thoracic, **T**hyrocervical trunk (**VIT**). * **2nd Part:** **C**ostocervical trunk (**C**). * **3rd Part:** **D**orsal scapular artery (**D**). * **The Second Part:** Usually gives off only the **Costocervical trunk** (which divides into the superior intercostal and deep cervical arteries). * **Clinical Correlation:** The third part of the subclavian artery is the most superficial and can be compressed against the first rib to control bleeding in the upper limb.

Q: All of the following are structures found in the anterior triangle of the neck EXCEPT:

Subclavian artery. Explanation: The neck is divided into two major triangles by the **Sternocleidomastoid (SCM) muscle**: the Anterior Triangle (anterior to SCM) and the Posterior Triangle (posterior to SCM). **Why Option B is Correct:** The **Subclavian artery** is a major structure of the **Posterior Triangle**. Specifically, the third part of the subclavian artery is found in the **Supraclavicular (Omoclavicular) triangle**, which is the lower subdivision of the posterior triangle. The first and second parts are located deep to the SCM and scalenus anterior, but they do not enter the anterior triangle. **Analysis of Incorrect Options:** * **A. Digastric muscle:** Both the anterior and posterior bellies of the digastric muscle are key landmarks in the anterior triangle. The posterior belly forms the boundary between the Carotid and Digastric triangles. * **C. Muscular triangle contents:** This is a subdivision of the anterior triangle. It contains the infrahyoid "strap" muscles (sternohyoid, sternothyroid) and the thyroid/parathyroid glands. * **D. Submental triangle contents:** This is a midline subdivision of the anterior triangle located between the two anterior bellies of the digastric muscles. It contains submental lymph nodes and small veins. **NEET-PG High-Yield Pearls:** * **Boundaries of Anterior Triangle:** Anterior border of SCM, midline of the neck, and lower border of the mandible. * **Subdivisions:** Digastric (Submandibular), Carotid, Muscular, and Submental triangles. * **Key Content:** The **Common Carotid Artery** bifurcates into Internal and External Carotid arteries within the Carotid triangle (part of the anterior triangle). * **Posterior Triangle Contents:** Subclavian artery (3rd part), Brachial plexus (trunks), Spinal accessory nerve (CN XI), and EJV.

Q: Which vein connects the External and Internal Jugular vein?

Oblique Jugular vein. ### Explanation The **Oblique Jugular vein** (also known as the vein of Kocher) is a small, inconsistent vein that descends across the superficial surface of the sternocleidomastoid muscle. It serves as a direct communication channel, draining from the **Internal Jugular Vein (IJV)** into the **External Jugular Vein (EJV)**. #### Analysis of Options: * **Oblique Jugular vein (Correct):** It is the specific anatomical bridge between the IJV and EJV. It is often considered a remnant of the primitive cephalic vein system. * **Posterior External Jugular vein:** This vein drains the skin and superficial muscles of the back of the scalp and neck, eventually emptying into the EJV. It does not connect to the IJV. * **Anterior Jugular vein:** This vein begins near the hyoid bone and descends in the anterior neck. It usually drains into the EJV or the subclavian vein, but it does not serve as a primary connection between the IJV and EJV. * **Transverse cervical vein:** This is a tributary that typically drains into the EJV. It carries blood from the trapezius and surrounding structures but is not a connecting vessel to the IJV. #### NEET-PG High-Yield Pearls: * **EJV Formation:** Formed by the union of the **Posterior division of the Retromandibular vein** and the **Posterior Auricular vein**. * **IJV Formation:** It is a continuation of the **Sigmoid sinus** at the jugular foramen. * **Clinical Significance:** The Oblique Jugular vein can be a source of unexpected bleeding during superficial neck dissections or when performing central venous pressure (CVP) manometry via the EJV. * **Surface Anatomy:** The EJV crosses the Sternocleidomastoid muscle obliquely, while the Oblique Jugular vein crosses it to link the deep and superficial systems.

Q: Which structure can be felt at the inferior part of the medial border of the sternocleidomastoid muscle?

Common carotid artery. ### Explanation **Correct Answer: B. Common carotid artery** The **Common Carotid Artery (CCA)** is the primary vascular structure located within the carotid sheath, situated deep to the **medial border of the sternocleidomastoid (SCM) muscle**. In the lower part of the neck (the inferior portion of the SCM), the artery is relatively superficial before it bifurcates at the level of the upper border of the thyroid cartilage (C4). Clinicians use the medial border of the SCM as a landmark to palpate the carotid pulse or to perform internal jugular vein cannulation. **Analysis of Incorrect Options:** * **A. Subclavian artery:** This artery is located in the **supraclavicular fossa**, passing posterior to the scalenus anterior muscle. It is felt deep in the root of the neck, lateral to the SCM, rather than along its medial border. * **C. Internal mammary (Internal thoracic) artery:** This is a branch of the first part of the subclavian artery. It descends behind the costal cartilages inside the thoracic cage and is not palpable in the neck. * **D. Maxillary artery:** This is a terminal branch of the external carotid artery located within the **infratemporal fossa**. It is deep to the mandible and far superior to the inferior border of the SCM. **High-Yield Clinical Pearls for NEET-PG:** * **Chassaignac’s Tubercle:** The CCA can be compressed against the prominent anterior tubercle of the **C6 transverse process** (Chassaignac’s tubercle) to control bleeding. * **Carotid Triangle:** The CCA bifurcates within the carotid triangle, which is bounded by the superior belly of the omohyoid, the posterior belly of the digastric, and the anterior (medial) border of the SCM. * **Surface Anatomy:** The CCA follows a line connecting the sternoclavicular joint to a point midway between the angle of the mandible and the mastoid process.

Q: All of the following are spaces related to the larynx except:

Space of Gillette. The correct answer is **Space of Gillette** because it is a retropharyngeal space, not an intralaryngeal one. ### **Explanation of Options** * **Space of Gillette (Correct Answer):** This is a potential space located in the **retropharyngeal region**, specifically between the buccopharyngeal fascia and the prevertebral fascia. It contains the Nodes of Rouviere (lateral retropharyngeal nodes). Infections here can lead to retropharyngeal abscesses, which may bulge into the posterior pharyngeal wall. * **Space of Boyer (Incorrect):** This is the **pre-epiglottic space**. It is a wedge-shaped, fat-filled space located anterior to the epiglottis and posterior to the thyrohyoid membrane. It is clinically significant because it allows for the silent horizontal spread of supraglottic tumors. * **Space of Tucker (Incorrect):** This is the **paraglottic space**. It is a potential space lateral to the laryngeal ventricles, bounded by the thyroid cartilage laterally and the conus elasticus medially. It is a key pathway for the vertical spread of transglottic tumors. * **Reinke’s Space (Incorrect):** This is a subepithelial potential space of the **vocal folds** (between the epithelium and the vocal ligament). Accumulation of fluid here leads to "Reinke’s edema," commonly seen in chronic smokers. ### **High-Yield Clinical Pearls for NEET-PG** * **Pre-epiglottic space (Boyer)** involvement is a primary reason for performing a total laryngectomy in supraglottic cancers. * **Paraglottic space (Tucker)** involvement often results in vocal cord fixation. * **Retropharyngeal space (Gillette)** infections are most common in children due to the presence of the Nodes of Rouviere, which atrophy after age 4–5.

Q: The thyroidea ima artery is not a branch of which of the following?

Vertebral artery. ### Explanation The **thyroidea ima artery** is an anatomical variant present in approximately **3–10% of the population**. It is an accessory artery that supplies the thyroid gland, typically compensating for the absence or small size of the inferior thyroid arteries. **Why Vertebral Artery is the Correct Answer:** The thyroidea ima artery typically arises from midline or near-midline structures within the superior mediastinum or the root of the neck. The **vertebral artery** is a branch of the first part of the subclavian artery that ascends through the foramina transversaria of the cervical vertebrae. It is located too far laterally and posteriorly to give rise to the thyroidea ima, which must ascend anterior to the trachea to reach the thyroid isthmus. **Analysis of Other Options:** * **Brachiocephalic trunk (Innominate artery):** This is the **most common source** of the thyroidea ima artery. * **Arch of aorta:** The artery can arise directly from the arch, usually between the brachiocephalic trunk and the left common carotid. * **Subclavian artery:** It may occasionally arise from the right subclavian artery or the internal thoracic artery [1]. **High-Yield Clinical Pearls for NEET-PG:** 1. **Course:** It ascends on the **anterior surface of the trachea** to reach the lower border of the **thyroid isthmus**. 2. **Surgical Significance:** It is a major "danger" structure during emergency **tracheostomy** or thyroidectomy [1]. Accidental injury can lead to profuse hemorrhage that may retract into the mediastinum. 3. **Supply:** It primarily supplies the thyroid gland but can also give branches to the thymus (as the *thymica accessoria*). 4. **Embryology:** It represents a persistent developmental vessel from the aortic arches that failed to regress.

Question 1

Which of the following is NOT a suprahyoid muscle?

Accepted Answer

Omohyoid

Answer

Mylohyoid

Answer

Geniohyoid

Answer

Digastric

Question 2

A 43-year-old male presented with a submandibular region mass, diagnosed as acinic cell carcinoma after ultrasound and biopsy. Following staging and attempted excision, the patient noticed deviation of his tongue to the affected side post-surgery. Which of the following nerves is most likely to have been damaged?

Accepted Answer

Hypoglossal nerve

Answer

Lingual nerve

Answer

Auriculotemporal nerve

Answer

Facial Nerve

Question 3

Which of the following is a branch of the third part of the subclavian artery?

Accepted Answer

Dorsal scapular artery

Answer

Thyrocervical trunk

Answer

Vertebral artery

Answer

Internal thoracic artery

Question 4

All of the following are structures found in the anterior triangle of the neck EXCEPT:

Accepted Answer

Subclavian artery

Answer

Digastric muscle

Answer

Muscular triangle contents

Answer

Submental triangle contents

Question 5

Which vein connects the External and Internal Jugular vein?

Accepted Answer

Oblique Jugular vein

Answer

Posterior External Jugular vein

Answer

Anterior Jugular vein

Answer

Transverse cervical vein

Question 6

Which structure can be felt at the inferior part of the medial border of the sternocleidomastoid muscle?

Accepted Answer

Common carotid artery

Answer

Subclavian artery

Answer

Internal mammary artery

Answer

Maxillary artery

Question 7

Which of the following statements is FALSE regarding the anterior triangle of the neck?

Accepted Answer

Its superior boundary is the anterior belly of the digastric muscle.

Answer

Its posterior boundary is the anterior border of the Sternocleidomastoid muscle.

Answer

It is a part of the anterior triangle of the neck.

Answer

Its anteroinferior boundary is the superior belly of the Omohyoid muscle.

Question 8

Which of the following is the most common location of a branchial cyst?

Accepted Answer

Upper third of the anterior border of the sternocleidomastoid muscle

Answer

Upper third of the posterior border of the sternocleidomastoid muscle

Answer

Lower third of the posterior border of the sternocleidomastoid muscle

Answer

Lower third of the anterior border of the sternocleidomastoid muscle

Question 9

All of the following are spaces related to the larynx except:

Accepted Answer

Space of Gillette

Answer

Space of Boyer

Answer

Space of Tucker

Answer

Reinke's space

Question 10

The thyroidea ima artery is not a branch of which of the following?

Accepted Answer

Vertebral artery

Answer

Brachiocephalic trunk

Answer

Subclavian artery

Answer

Arch of aorta

Neck — MCQs

Neck — MCQs

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