Neck Practice Questions

Q: All of the following nerves may be injured during the excision of the submandibular salivary gland except:

Spinal accessory nerve. The submandibular gland is located in the **submandibular triangle**, and its surgical excision requires a precise understanding of the surrounding neurovascular structures to avoid iatrogenic injury. ### Why the Spinal Accessory Nerve is the Correct Answer The **Spinal Accessory Nerve (CN XI)** is located in the **posterior triangle** of the neck. It emerges from the posterior border of the sternocleidomastoid muscle and travels toward the trapezius. Because it is anatomically distant and separated by the deep cervical fascia from the submandibular triangle, it is not at risk during a standard submandibular gland excision. ### Why the Other Options are Wrong The following nerves are in close proximity to the gland and are frequently encountered during surgery: * **Marginal Mandibular Nerve (Branch of CN VII):** This nerve runs superficial to the submandibular gland, just deep to the platysma. It is the most commonly injured nerve during this procedure, leading to drooping of the corner of the mouth. * **Lingual Nerve:** This nerve lies deep to the gland and is connected to it via the submandibular bundle [1]. It must be carefully separated from the gland's upper pole. * **Hypoglossal Nerve (CN XII):** This nerve forms the floor of the submandibular triangle. It lies deep to the tendon of the digastric muscle and the submandibular gland. ### NEET-PG High-Yield Clinical Pearls * **Hayes Martin Maneuver:** To protect the marginal mandibular nerve, the incision is made 2 cm below the lower border of the mandible, and the facial vein is ligated and retracted superiorly to "lift" the nerve out of the surgical field. * **Nerve Relationship:** The lingual nerve "loops" under the submandibular duct (Wharton’s duct) from lateral to medial. * **Structures in the Submandibular Triangle:** The facial artery (deep to the gland) and facial vein (superficial to the gland) are also key surgical landmarks.

Q: A baby can breathe and suck simultaneously. This is facilitated by which anatomical feature?

Highly placed larynx. **Explanation:** The ability of a neonate to breathe and suckle simultaneously is a unique developmental adaptation. In infants, the **larynx is positioned high** in the neck (at the level of C2–C4 vertebrae), whereas in adults, it descends to the level of C3–C6. In this high position, the **epiglottis can overlap with the soft palate**. This creates a continuous "internal snorkel" or airway from the nasopharynx to the larynx, while the liquid bolus (milk) passes laterally through the piriform recesses into the esophagus. This anatomical separation of the respiratory and digestive pathways prevents aspiration during continuous feeding. **Analysis of Options:** * **B. Wide, short tongue:** While an infant’s tongue is relatively large for the oral cavity (aiding in the sucking reflex), it does not facilitate the separation of air and food pathways. * **C. Short soft palate:** On the contrary, the soft palate must be long enough to make contact with the epiglottis to create the necessary seal for simultaneous breathing. * **D. Short pharynx:** The infant pharynx is indeed shorter, but the functional advantage for breathing while feeding is specifically due to the **vertical relationship** (high position) of the larynx, not the overall length of the pharynx. **NEET-PG High-Yield Pearls:** * **Vertebral Levels:** Infant larynx (C2–C4); Adult larynx (C3–C6). * **Descent:** The larynx begins its descent around age 2, which is also when the potential for speech resonance increases but the ability to breathe and swallow simultaneously is lost. * **Narrowest Part:** The narrowest part of the pediatric airway is the **Cricoid cartilage** (until age 8–10), whereas in adults, it is the **Rima Glottidis**.

Q: The submandibular gland is divided into superficial and deep parts by which muscle?

Mylohyoid. ### Explanation **Correct Answer: C. Mylohyoid** The **mylohyoid muscle** is known as the "diaphragm of the mouth." It acts as the key anatomical landmark that divides the submandibular gland into a large superficial part and a small deep part. The gland is "U-shaped," wrapping around the posterior free border of the mylohyoid muscle. * The **superficial part** lies in the submandibular triangle (below the muscle). * The **deep part** lies in the floor of the mouth (above the muscle), extending forward to the sublingual gland. **Analysis of Incorrect Options:** * **A. Digastric:** The two bellies of the digastric muscle (along with the mandible) form the boundaries of the submandibular triangle where the gland is located, but they do not divide the gland itself. * **B. Geniohyoid:** This muscle lies superior to the mylohyoid and forms part of the floor of the mouth. It is medial to the deep part of the submandibular gland but does not divide it. * **D. Stylohyoid:** This muscle passes superficial to the carotid arteries and attaches to the hyoid bone; it relates to the posterior pole of the gland but has no role in its structural division. **High-Yield Clinical Pearls for NEET-PG:** * **Wharton’s Duct:** The submandibular duct emerges from the **deep part** of the gland and runs forward on the hyoglossus muscle. * **Nerve Relations:** The **lingual nerve** loops under Wharton’s duct (from lateral to medial) – "The nerve loops under the duct." * **Bimanual Palpation:** Because the gland wraps around the mylohyoid, it is best examined by placing one finger inside the mouth and the other under the jaw. * **Secretions:** The submandibular gland is a **mixed** gland (predominantly serous) and is the most common site for salivary stones (**Sialolithiasis**) due to its upward ductal course and viscous secretions.

Q: Which of the marked structures A, B, C, or D in the illustration represents the vagus nerve?

C. ***C*** - The **vagus nerve (CN X)** runs within the **carotid sheath** in the neck, positioned **posteriorly** between the common carotid artery and internal jugular vein. - It descends from the **jugular foramen** through the neck alongside the major vascular structures, making option C the correct anatomical location. *A* - This structure likely represents the **internal jugular vein**, which is positioned **anterolaterally** within the carotid sheath. - The internal jugular vein is **larger** and more **superficial** compared to the vagus nerve's posterior position. *B* - This structure most likely represents the **common carotid artery**, located **anteromedially** within the carotid sheath. - The carotid artery has a **pulsatile nature** and **arterial wall thickness** that distinguishes it from the thin vagus nerve. *D* - This structure could represent the **sympathetic chain** or **phrenic nerve**, which run more **laterally** or **superficially** in the neck. - These structures are located **outside the carotid sheath** and have different anatomical relationships compared to the vagus nerve.

Q: Which of the following structures is NOT present on the medial surface of the submandibular gland?

Facial artery. The submandibular gland is a large salivary gland located in the submandibular triangle. It is divided into superficial and deep lobes by the posterior border of the mylohyoid muscle. Understanding its relations is high-yield for NEET-PG. **Explanation of the Correct Answer:** The **Facial artery** is **NOT** present on the medial surface. Instead, it is a key relation of the **lateral (inferolateral) surface** of the gland. The artery grooves the posterosuperior part of the gland, loops over the base of the mandible, and then ascends onto the face. **Analysis of Incorrect Options (Medial Relations):** The medial surface of the submandibular gland is related to three muscles and several neurovascular structures: * **A. Mylohyoid:** Forms the anterior part of the medial relation. * **C. Hyoglossus:** Forms the posterior part of the medial relation. * **D. Styloglossus:** Also relates to the posterior part of the medial surface. * *Other medial relations include:* The submandibular ganglion, lingual nerve, hypoglossal nerve, and the deep lobe of the gland itself. **NEET-PG High-Yield Pearls:** 1. **Facial Artery vs. Vein:** The facial **artery** is related to the gland (lateral surface), but the facial **vein** and the cervical branch of the facial nerve lie superficial to the gland (on the investing layer of deep cervical fascia). 2. **Wharton’s Duct:** The submandibular duct emerges from the medial surface and is crossed laterally by the lingual nerve ("Triple relation" or "Looping" of the nerve). 3. **Nerve Supply:** Secretomotor fibers arise from the **superior salivatory nucleus** (CN VII), travel via the chorda tympani, and synapse in the **submandibular ganglion**.

Q: Which of the following is an extrinsic membrane of the larynx?

Thyrohyoid membrane. ### Explanation The membranes and ligaments of the larynx are classified into two groups: **Extrinsic** and **Intrinsic**. **1. Why the Thyrohyoid Membrane is Correct:** Extrinsic membranes connect the laryngeal cartilages to structures outside the larynx (such as the hyoid bone or the trachea). The **Thyrohyoid membrane** connects the upper border of the thyroid cartilage to the hyoid bone. It is a fibroelastic membrane pierced by the **internal laryngeal nerve** and the **superior laryngeal artery**, a high-yield anatomical landmark. **2. Why the Other Options are Incorrect:** Intrinsic membranes connect the laryngeal cartilages to each other, forming the internal framework of the larynx. * **Quadrangular Membrane (A):** An intrinsic membrane extending between the epiglottis and arytenoid cartilages. Its free lower margin forms the **vestibular ligament** (false vocal cord). * **Cricothyroid Membrane (C):** An intrinsic membrane connecting the cricoid and thyroid cartilages. * **Conus Elasticus (D):** Also known as the cricovocal membrane, this is the lower part of the intrinsic fibroelastic membrane. Its free upper margin forms the **vocal ligament** (true vocal cord). **Clinical Pearls for NEET-PG:** * **Cricothyroidotomy:** Performed through the median cricothyroid ligament (part of the intrinsic membrane) for emergency airway access. * **Internal laryngeal Nerve:** Injury during thyroid surgery (while piercing the thyrohyoid membrane) leads to loss of sensation above the vocal cords, increasing the risk of aspiration. The recurrent laryngeal nerve relations are also critical during such surgeries [1]. * **Vocal Cord Structure:** Remember that the **Vocalis muscle** and **Vocal ligament** (from conus elasticus) form the true vocal folds.

Question 1

All of the following nerves may be injured during the excision of the submandibular salivary gland except:

Accepted Answer

Spinal accessory nerve

Answer

Lingual nerve

Answer

Mandibular branch of facial nerve

Answer

Hypoglossal nerve

Question 2

What is the most common site of the internal opening of a branchial fistula?

Accepted Answer

Tonsillar fossa

Answer

Lateral nasopharyngeal wall

Answer

Fossa of Rosenmuller

Answer

Gingivolabial sulcus

Question 3

Which of the following statements is true about the atlanto-axial joint?

Accepted Answer

The atlanto-occipital joint permits flexion and extension movements.

Answer

The vertebral artery passes posterior to the foramen magnum.

Answer

The posterior longitudinal ligament does not pass through the spinal canal.

Answer

The atlanto-axial joint is an ellipsoid joint.

Question 4

A baby can breathe and suck simultaneously. This is facilitated by which anatomical feature?

Accepted Answer

Highly placed larynx

Answer

Wide, short tongue

Answer

Short soft palate

Answer

Short pharynx

Question 5

The submandibular gland is divided into superficial and deep parts by which muscle?

Accepted Answer

Mylohyoid

Answer

Digastric

Answer

Geniohyoid

Answer

Stylohyoid

Question 6

Which of the marked structures A, B, C, or D in the illustration represents the vagus nerve?

Accepted Answer

C

Answer

A

Answer

B

Answer

D

Question 7

Which of the following structures is NOT present on the medial surface of the submandibular gland?

Accepted Answer

Facial artery

Answer

Mylohyoid

Answer

Hyoglossus

Answer

Styloglossus

Question 8

Which of the following is an extrinsic membrane of the larynx?

Accepted Answer

Thyrohyoid membrane

Answer

Quadrangular membrane

Answer

Cricothyroid membrane

Answer

Conus elasticus

Question 9

Which of the following statements about the larynx is false?

Accepted Answer

The external laryngeal nerve supplies all laryngeal muscles except the cricothyroid.

Answer

It has 9 cartilages: 3 paired and 3 unpaired.

Answer

It extends from the C3 to C6 vertebrae.

Answer

The cricothyroid muscle is a tensor of the vocal cord.

Question 10

Which muscles are tensors of the vocal cords?

Accepted Answer

Cricothyroid and internal thyroarytenoid

Answer

Posterior cricothyroid, internal interarytenoid

Answer

Lateral cricothyroid, internal interarytenoid

Answer

Thyroarytenoid, internal interarytenoid

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