Neck Practice Questions

Q: The lingual artery is a branch of which artery?

External carotid artery. The **External Carotid Artery (ECA)** is the primary source of arterial supply to the head and neck structures outside the cranium. The **lingual artery** is its second anterior branch, arising at the level of the greater cornua of the hyoid bone. It provides the essential blood supply to the tongue, sublingual gland, and the floor of the mouth. ### Why the other options are incorrect: * **Internal Carotid Artery (ICA):** This artery typically has no branches in the neck. It enters the skull through the carotid canal to supply the brain and the eyes (via the ophthalmic artery). * **Subclavian Artery:** This artery supplies the upper limbs and gives off branches like the vertebral artery and thyrocervical trunk, but it does not directly give rise to the lingual artery. * **Maxillary Artery:** This is one of the two terminal branches of the ECA (the other being the superficial temporal artery). While it supplies deep structures of the face and teeth, it is not the origin of the lingual artery. ### High-Yield Clinical Pearls for NEET-PG: * **Course:** The lingual artery is divided into three parts by the **hyoglossus muscle**. * **Lesser’s Triangle:** This is a surgical landmark used to locate the lingual artery; it is bounded by the two bellies of the digastric muscle and the hypoglossal nerve. * **Mnemonic for ECA branches:** "**S**ome **A**ttic **L**ife **F**orce **M**ay **P**ossibly **O**verpower **S**tudents" (Superior thyroid, Ascending pharyngeal, **Lingual**, Facial, Maxillary, Posterior auricular, Occipital, Superficial temporal).

Q: Which of the following is NOT a branch of the first part of the subclavian artery?

Costocervical trunk. ### Explanation The subclavian artery is divided into three parts by the **scalenus anterior muscle**: the first part is medial to the muscle, the second part is posterior to it, and the third part is lateral to it. **Why the Correct Answer is Right:** * **Costocervical trunk (Option D):** On the **right side**, this is a branch of the **second part** of the subclavian artery. On the left side, it may occasionally arise from the first part, but for standard anatomical descriptions and NEET-PG purposes, it is classified as the branch of the second part. It further divides into the superior intercostal and deep cervical arteries. **Analysis of Incorrect Options:** * **Vertebral artery (Option A):** Arises from the first part. it ascends through the foramina transversaria of the C1–C6 vertebrae to supply the brain. * **Thyrocervical trunk (Option B):** Arises from the first part, just medial to the scalenus anterior. It gives off three main branches: Inferior thyroid, Suprascapular, and Transverse cervical arteries. * **Internal thoracic artery (Option C):** Arises from the inferior aspect of the first part. It descends into the thorax to supply the anterior chest wall and breast. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic for 1st Part Branches:** **VIT** (**V**ertebral, **I**nternal thoracic, **T**hyrocervical trunk). * **3rd Part:** Usually has no branches, but occasionally gives rise to the **Dorsal Scapular artery**. * **Subclavian Steal Syndrome:** Occurs due to proximal stenosis of the subclavian artery, leading to retrograde flow in the vertebral artery to supply the arm, causing "stolen" blood from the cerebral circulation. * **Right vs. Left:** The right subclavian arises from the brachiocephalic trunk, while the left arises directly from the arch of the aorta.

Q: A superficial incision on the posterior triangle of the neck leads to what functional deficit?

Difficulty in shrugging of the shoulder. ### Explanation **1. Why Option A is Correct:** The **Spinal Accessory Nerve (CN XI)** is the most superficial and vulnerable structure in the posterior triangle of the neck. It emerges from the posterior border of the sternocleidomastoid (SCM) muscle and crosses the floor of the triangle (on the levator scapulae) to reach the **trapezius** muscle. Because it lies immediately beneath the investing layer of deep cervical fascia, even a superficial incision or biopsy in this region can damage it. The trapezius is responsible for elevating the scapula; therefore, nerve injury leads to paralysis of the muscle, manifesting as **difficulty in shrugging the shoulder** and a "drooping" shoulder. **2. Analysis of Incorrect Options:** * **Option B:** Initial abduction (0–15°) is performed by the **Supraspinatus** nerve (Suprascapular nerve). This nerve is located deeper and more laterally, not typically affected by a superficial posterior triangle incision. * **Option C:** Rotating the face towards the *same* side is not a standard single-muscle action. The SCM rotates the face to the **opposite** side. While CN XI supplies the SCM, the nerve enters the SCM before reaching the posterior triangle; thus, a triangle incision usually spares SCM function. * **Option D:** Neck flexion is primarily performed by the bilateral action of the SCMs and prevertebral muscles, which are not the primary structures at risk in a superficial posterior triangle injury. **3. NEET-PG High-Yield Pearls:** * **Safe Zone:** To avoid the Spinal Accessory Nerve during procedures, stay in the inferior part of the triangle or the anterior portion. * **Nerve Course:** It enters the posterior triangle at the junction of the upper 1/3rd and middle 1/3rd of the posterior border of the SCM. * **Clinical Sign:** Damage to CN XI also results in an inability to abduct the arm above 90° (as the trapezius is required for upward rotation of the scapula).

Q: A 20-year-old man presents with a stab wound in the superior region of his neck. Radiographic examination shows no injury to major structures. Physical examination reveals loss of sensation from the skin over the angle of the jaw. Which of the following nerves is most likely injured?

Great auricular. ### Explanation The clinical presentation of sensory loss over the **angle of the jaw** following a superficial neck injury specifically points to an injury of the **Great Auricular Nerve**. **1. Why Great Auricular is Correct:** The Great Auricular nerve (C2, C3) is a branch of the **cervical plexus**. It emerges from the posterior border of the sternocleidomastoid muscle (at Erb’s point) and ascends vertically toward the parotid gland. It provides cutaneous innervation to: * The skin over the **angle of the mandible**. * The lower part of the auricle (earlobe). * The skin over the parotid gland. **2. Why the other options are incorrect:** * **Supraclavicular (C3, C4):** These nerves descend to supply the skin over the clavicle, the upper chest (down to the 2nd rib), and the shoulder (over the deltoid). * **Transverse cervical (C2, C3):** This nerve curves around the middle of the sternocleidomastoid and runs anteriorly to supply the skin of the **anterior triangle** of the neck. * **Greater occipital (C2 - posterior ramus):** This is a purely sensory nerve that supplies the skin of the **back of the scalp** up to the vertex. It is not part of the cervical plexus (which is formed by anterior rami). **3. NEET-PG High-Yield Pearls:** * **Erb’s Point (Punctum Nervosum):** Located at the midpoint of the posterior border of the sternocleidomastoid. This is where four cutaneous branches of the cervical plexus emerge: Lesser occipital, Great auricular, Transverse cervical, and Supraclavicular nerves. * **Mandibular Nerve Exception:** While the Trigeminal nerve (V3) supplies most of the face, the **angle of the jaw** is a classic "exception" area supplied by the spinal nerves (C2, C3 via the Great Auricular). * **Clinical Correlation:** The Great Auricular nerve is often involved in parotid surgeries or can be used as a nerve graft.

Q: Parotid capsule is derived from which anatomical structure?

Deep cervical fascia. **Explanation:** The parotid gland is enclosed in a tough, fibrous capsule known as the **parotid fascia**. This capsule is derived from the **investing layer of the deep cervical fascia**. As the investing layer ascends from the neck to the face, it splits at the lower border of the parotid gland to enclose it. * The **superficial lamina** (thick and strong) extends upwards to attach to the zygomatic arch. * The **deep lamina** (thin) extends to the base of the skull (tympanic plate and styloid process). A specific thickening of this deep lamina between the styloid process and the angle of the mandible forms the **stylomandibular ligament**, which separates the parotid gland from the submandibular gland. **Analysis of Options:** * **Option A (Superficial cervical fascia):** This contains the platysma and cutaneous nerves but does not form organ capsules. * **Option C & D:** These are incorrect because the capsule is exclusively a specialization of the investing layer of the deep cervical fascia. **High-Yield Facts for NEET-PG:** 1. **Pain in Mumps:** The parotid capsule is unyielding and richly innervated by the **great auricular nerve (C2, C3)**. Inflammation (as in mumps) causes extreme pain due to the stretching of this tight fascia. 2. **Parotid Abscess:** Because the superficial lamina is very dense, parotid abscesses rarely point to the skin; instead, they may erode through the thinner deep lamina into the pharyngeal space. 3. **Nerve Relation:** The facial nerve passes through the gland but stays **superficial** to the retromandibular vein and external carotid artery.

Q: What is the lower border of the pharynx at the level of?

C6. **Explanation:** The pharynx is a muscular tube that serves as a common passage for both air and food. It extends from the base of the skull down to the lower border of the **cricoid cartilage**, which corresponds to the **C6 vertebral level**. At this point, the pharynx continues as the esophagus, and the larynx continues as the trachea. **Why C6 is the Correct Answer:** The C6 level is a critical anatomical landmark in the neck. It marks: 1. The junction where the pharynx becomes the **esophagus**. 2. The junction where the larynx becomes the **trachea**. 3. The level of the **cricoid cartilage**. 4. The site where the middle thyroid artery and inferior thyroid artery enter the thyroid gland. **Analysis of Incorrect Options:** * **C2:** This level corresponds to the axis vertebra and the upper part of the oropharynx. * **C3:** This level corresponds to the hyoid bone and the beginning of the epiglottis. * **C4:** This level marks the upper border of the thyroid cartilage and the bifurcation of the **Common Carotid Artery** into internal and external branches. **High-Yield Clinical Pearls for NEET-PG:** * **Length:** The pharynx is approximately 12–14 cm long. * **Narrowest Point:** The pharyngo-esophageal junction (at C6) is the narrowest part of the entire digestive tract (excluding the appendix). * **Killian’s Dehiscence:** Located between the thyropharyngeus and cricopharyngeus muscles (at the level of C6), this is a weak area prone to the formation of **Zenker’s diverticulum**. * **Vertebral Levels:** Remember the "C6 rule"—it is the level for the end of the pharynx, end of the larynx, and the beginning of the esophagus and trachea.

Q: A young singer presents with vocal difficulties and an inability to abduct the vocal cords during quiet breathing. Which of the following muscles is most likely paralyzed?

Posterior cricoarytenoid muscle. The core concept tested here is the functional anatomy of the laryngeal muscles. The **Posterior Cricoarytenoid (PCA)** muscle is the **only abductor** of the vocal cords. It originates from the posterior surface of the cricoid lamina and inserts into the muscular process of the arytenoid cartilage. When it contracts, it rotates the arytenoid cartilages laterally, widening the rima glottidis. Paralysis of the PCA leads to the inability to abduct the cords, which can cause respiratory distress as the airway remains narrowed. **Analysis of Incorrect Options:** * **Vocalis muscle:** A part of the thyroarytenoid muscle, its primary role is to adjust the tension (relaxing the vocal ligament) and fine-tune the pitch. * **Cricothyroid muscle:** Known as the "tuner" of the larynx, it tilts the cricoid cartilage to **tense and elongate** the vocal cords. It is the only laryngeal muscle supplied by the **External Laryngeal Nerve**. * **Oblique arytenoid muscle:** Along with the transverse arytenoid, this muscle acts as an **adductor**, closing the posterior part of the rima glottidis. **NEET-PG High-Yield Pearls:** * **"Safety Muscle of the Larynx":** The Posterior Cricoarytenoid is frequently referred to by this name because it keeps the airway open. * **Nerve Supply:** All intrinsic muscles of the larynx are supplied by the **Recurrent Laryngeal Nerve (RLN)**, *except* the Cricothyroid [1]. Injuries to the RLN can result in a vocal cord remaining in a midline or paramedian position due to loss of abduction [1]. * **Semon’s Law:** In progressive RLN injury, abductor fibers (PCA) are typically injured before adductor fibers, leading to a dangerous midline position of the cords.

Question 1

The lingual artery is a branch of which artery?

Accepted Answer

External carotid artery

Answer

Internal carotid artery

Answer

Subclavian artery

Answer

Maxillary artery

Question 2

The superior cervical ganglion gives gray rami communicantes to which spinal nerve segments?

Accepted Answer

C1 - C4

Answer

C5 - C6

Answer

C7 - C8

Answer

None

Question 3

Which of the following is NOT a branch of the first part of the subclavian artery?

Accepted Answer

Costocervical trunk

Answer

Vertebral artery

Answer

Thyrocervical trunk

Answer

Internal thoracic artery

Question 4

A superficial incision on the posterior triangle of the neck leads to what functional deficit?

Accepted Answer

Difficulty in shrugging of the shoulder

Answer

Difficulty in the initial phase of abduction

Answer

Difficulty in rotating the face towards the same side

Answer

Difficulty in flexion

Question 5

A 20-year-old man presents with a stab wound in the superior region of his neck. Radiographic examination shows no injury to major structures. Physical examination reveals loss of sensation from the skin over the angle of the jaw. Which of the following nerves is most likely injured?

Accepted Answer

Great auricular

Answer

Supraclavicular

Answer

Transverse cervical

Answer

Greater occipital

Question 6

Parotid capsule is derived from which anatomical structure?

Accepted Answer

Deep cervical fascia

Answer

Superficial cervical fascia

Answer

Both superficial and deep cervical fascia

Answer

Neither superficial nor deep cervical fascia

Question 7

During surgical removal of the tongue, which part of the lingual artery is ligated before it gives any branches to the tongue or tonsils?

Accepted Answer

First

Answer

Second

Answer

Third

Answer

Fourth

Question 8

A 43-year-old male presented with a mass in the submandibular region. After ultrasound and biopsy, he was diagnosed with acinic cell carcinoma. Staging excision was attempted. Following the surgery, his tongue deviated to the affected side. Which of the following nerves could have been damaged?

Accepted Answer

Hypoglossal nerve

Answer

Lingual nerve

Answer

Auriculotemporal nerve

Answer

Facial nerve

Question 9

What is the lower border of the pharynx at the level of?

Accepted Answer

C6

Answer

C2

Answer

C3

Answer

C4

Question 10

A young singer presents with vocal difficulties and an inability to abduct the vocal cords during quiet breathing. Which of the following muscles is most likely paralyzed?

Accepted Answer

Posterior cricoarytenoid muscle

Answer

Vocalis muscle

Answer

Cricothyroid muscle

Answer

Oblique arytenoid muscle

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