Neck Practice Questions

Q: Lymphatic drainage of the thyroid gland is mainly?

Deep cervical nodes. Deep cervical nodes - The thyroid gland is primarily drained by lymphatic vessels that accompany the superior and inferior thyroid arteries, ultimately leading to the deep cervical lymph nodes [1]. - These nodes are located along the internal jugular vein (levels III, IV, and VI including prelaryngeal/Delphian nodes) and play a crucial role in filtering lymph from the thyroid [1]. Superficial cervical nodes - These nodes are located along the external jugular vein and primarily drain superficial structures of the neck and lower ear region. - They are not involved in the direct lymphatic drainage of the thyroid gland. Submandibular nodes - The submandibular nodes drain structures from the oral cavity, face, and submandibular gland. - Lymphatic flow from the thyroid does not typically pass through these nodes. Submental nodes - The submental nodes are located under the chin and drain the central part of the lower lip, chin, and floor of the mouth. - They are geographically distant and not directly connected to the lymphatic drainage pathways of the thyroid gland.

Q: What is the action of the sternocleidomastoid muscle when acting unilaterally?

Tilts the head to the same side. ***Tilts the head to the same side*** When acting unilaterally, the **sternocleidomastoid muscle** produces two key movements: - **Lateral flexion (tilt)** of the head and neck towards the **ipsilateral (same) side** - **Rotation** of the head to the **contralateral (opposite) side** When **both sternocleidomastoid muscles contract bilaterally**, they produce **flexion of the neck**. *Arises from sternum and clavicle* - While anatomically correct (sternal head from manubrium, clavicular head from medial 1/3 of clavicle), this describes the **origin**, not the **action** of the muscle. *Motor supply by spinal accessory nerve* - The **spinal accessory nerve (CN XI)** does provide motor innervation, but this describes the **nerve supply**, not the **action** of the muscle. *Inserts on mastoid process* - While correct (inserts on mastoid process and superior nuchal line), this describes the **insertion**, not the **action** of the muscle.

Q: What is the primary tensor of the vocal cords?

Cricothyroid. ***Cricothyroid*** - The **cricothyroid muscle** is the principal tensor of the vocal cords, responsible for stretching and thinning them. - It achieves this by tilting the **thyroid cartilage** forward relative to the **cricoid cartilage**, increasing the distance between the **thyroid** and **arytenoid cartilages**. *Lateral Cricoarytenoid* - This muscle primarily functions as an **adductor** of the vocal cords, bringing them together. - It rotates the **arytenoid cartilages** medially, closing the **rima glottidis**. *Thyroarytenoids* - The **thyroarytenoid muscles** are located within the vocal cords and primarily act to **shorten and relax** the vocal cords. - They also contribute to **adduction** and can internally tense the vocal folds, but their main role is *not* primary tension. *Posterior cricoarytenoids* - The **posterior cricoarytenoid muscles** are the *only* muscles responsible for **abducting** (opening) the vocal cords. - They rotate the **arytenoid cartilages** laterally, thus widening the **rima glottidis**.

Q: Which thickened nerve is shown in the image?

Lesser occipital nerve. ***Lesser occipital nerve*** - The nerve shown in the image is the **lesser occipital nerve**, which originates from the **ventral rami of C2 and C3**. - It ascends along the **posterior border of the sternocleidomastoid muscle** and supplies sensation to the skin of the lateral scalp posterior to the auricle. - Its **superficial course** and characteristic location make it identifiable in the surgical field shown. - The lesser occipital nerve can be thickened in cases of **nerve entrapment, neuroma formation, or chronic irritation**. *Third occipital nerve* - The third occipital nerve is a branch of the **dorsal ramus of C3** (medial branch) and is the smallest of the occipital nerves. - It innervates the skin of the **lower occipital region** and supplies the C2-C3 zygapophyseal joint. - It follows a deeper course compared to the nerve shown in the image. *Greater occipital nerve* - The greater occipital nerve arises from the **dorsal ramus of C2** and is the largest occipital nerve. - It pierces the **semispinalis capitis** and **trapezius** muscles, emerging medial to the occipital artery. - It provides sensory innervation to the **scalp up to the vertex** and is the most common nerve involved in **occipital neuralgia**. - Its course is more **medial** than the nerve shown in the image, typically running closer to the midline. *Greater auricular nerve* - This nerve arises from the **ventral rami of C2 and C3** at Erb's point and ascends on the surface of the sternocleidomastoid muscle. - It provides sensory innervation to the skin over the **parotid gland, mastoid process, and both surfaces of the auricle**. - Its course is more **anterior and inferior** compared to the occipital nerves, making it distinguishable from the nerve shown in the image.

Q: What is the typical anatomical location of the parathyroid glands in relation to the thyroid gland?

Posterior aspect of the thyroid gland. ***Posterior aspect of the thyroid gland*** - The parathyroid glands are typically small, pea-sized endocrine glands located on the **posterior surface** of the thyroid gland [1] - There are usually **four parathyroid glands** (two superior and two inferior pairs) embedded within the thyroid capsule or closely apposed to its posterior lobes - This posterior positioning provides protection and maintains close anatomical relationship with the thyroid *Anterior aspect of the thyroid gland* - The anterior surface of the thyroid is covered by strap muscles (sternohyoid, sternothyroid) and skin [2] - Parathyroid glands are **not located anteriorly** as this would make them more vulnerable and less protected *Lateral aspect of the thyroid gland* - The lateral aspects of the thyroid lobes are adjacent to the carotid sheath structures - Parathyroid glands are not positioned laterally but remain on the **posterior surface** *Superior aspect of the thyroid gland* - While superior parathyroid glands are near the superior poles, their position is primarily **posterior**, not sitting directly on top [1] - The inferior parathyroid glands are located near the inferior poles, also on the posterior surface [1]

Q: Joint involved in movement of head from left to right.

Atlanto axial. ***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.

Q: Which of the following is not an extrinsic laryngeal membrane?

Quadrangular membrane. **Quadrangular membrane** - The quadrangular membrane is an **intrinsic laryngeal membrane**, originating and inserting within the larynx itself, forming the false vocal cords and epiglottic folds. - It does not connect the larynx to external structures like the hyoid bone or trachea. *Hyoepiglottic ligament* - This is an **extrinsic laryngeal ligament** that connects the anterior surface of the epiglottis to the body of the hyoid bone. - It helps anchor the epiglottis to a structure outside the larynx. *Cricotracheal membrane* - The cricotracheal membrane is an **extrinsic laryngeal membrane** connecting the inferior border of the cricoid cartilage of the larynx to the first tracheal ring. - It forms the connection between the larynx and the trachea, an external structure. *Thyrohyoid membrane* - This is an **extrinsic laryngeal membrane** that connects the superior border of the thyroid cartilage of the larynx to the first tracheal ring. - It provides a broad connection between the larynx and the hyoid bone, an external laryngeal structure.

Q: Distance of cricopharynx from incisor teeth

Approximately 15 cm. ***Approximately 15 cm*** - The **cricopharynx** (upper esophageal sphincter at C6 level), which is the narrowest part of the pharynx, is typically located about **15 cm** from the incisor teeth in adults. - This anatomical landmark is crucial in procedures such as **endoscopy**, **intubation**, and **nasogastric tube insertion** to avoid injury. *22 cm* - This distance corresponds to the level of the **aortic arch** (second physiological narrowing of the esophagus). - This is where the aorta crosses anterior to the esophagus, creating the broncho-aortic constriction. *27 cm* - A distance of 27 cm from the incisor teeth corresponds to the level where the **left main bronchus** crosses the esophagus (third physiological narrowing). - This is well beyond the location of the **cricopharynx** and represents the mid-esophageal region. *40 cm* - This measurement represents the approximate total length of the **esophagus**, reaching the **gastroesophageal junction** at the level of the **diaphragmatic hiatus** (cardia of the stomach). - The **cricopharynx** is at the very beginning of this path, much closer to the incisors.

Question 1

The key to the root of the neck is the scalenus anterior muscle. Which among the following is the MOST CLINICALLY SIGNIFICANT relationship of the scalenus anterior?

Accepted Answer

The phrenic nerve runs anterior to it but does not pierce it.

Answer

The phrenic nerve pierces it.

Answer

Inserts into scalene tubercle on 1st rib

Answer

Separates subclavian artery from subclavian vein

Question 2

Lymphatic drainage of the thyroid gland is mainly?

Accepted Answer

Deep cervical nodes

Answer

Superficial cervical nodes

Answer

Submandibular nodes

Answer

Submental nodes

Question 3

What is the action of the sternocleidomastoid muscle when acting unilaterally?

Accepted Answer

Tilts the head to the same side

Answer

Arises from sternum and clavicle

Answer

Motor supply by spinal accessory nerve

Answer

Inserts on mastoid process

Question 4

What is the primary tensor of the vocal cords?

Accepted Answer

Cricothyroid

Answer

Lateral Cricoarytenoid

Answer

Thyroarytenoids

Answer

Posterior cricoarytenoids

Question 5

Which thickened nerve is shown in the image?

Accepted Answer

Lesser occipital nerve

Answer

Third occipital nerve

Answer

Greater auricular nerve

Answer

Greater occipital nerve

Question 6

What is the typical anatomical location of the parathyroid glands in relation to the thyroid gland?

Accepted Answer

Posterior aspect of the thyroid gland

Answer

Anterior aspect of the thyroid gland

Answer

Lateral aspect of the thyroid gland

Answer

Superior aspect of the thyroid gland

Question 7

Joint involved in movement of head from left to right.

Accepted Answer

Atlanto axial

Answer

Atlanto occipital

Answer

C2- C3 Joint

Answer

C3- C4 Joint

Question 8

Which of the following is not an extrinsic laryngeal membrane?

Accepted Answer

Quadrangular membrane

Answer

Hyoepiglottic ligament

Answer

Cricotracheal membrane

Answer

Thyrohyoid membrane

Question 9

The sternocleidomastoid muscle is examined by

Accepted Answer

Turning the head towards the opposite side to assess the muscle on that side

Answer

Shrugging of shoulder

Answer

Overhead abduction

Answer

Turning the head towards the same side to assess the muscle on that side

Question 10

Distance of cricopharynx from incisor teeth

Accepted Answer

Approximately 15 cm

Answer

22 cm

Answer

27 cm

Answer

40 cm

Neck — MCQs

Neck — MCQs

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