Neck Questions PDF

**1.** A 28-year-old patient presents with neck pain after a fall from a height. Imaging shows an injury to the atlas (C1). Which of the following statements about the atlas vertebra is **TRUE** and helps in understanding the extent of his injury? A) It has a vertebral body and a dens that articula...

**1.** A 28-year-old patient presents with neck pain after a fall from a height. Imaging shows an injury to the atlas (C1). Which of the following statements about the atlas vertebra is **TRUE** and helps in understanding the extent of his injury? A) It has a vertebral body and a dens that articulates with the axis (C2). B) It lacks a vertebral body and articulates with the dens of the axis, stabilized by the transverse ligament of the atlas. C) It has a bifid spinous process connected by the nuchal ligament. D) It has transverse foramina that transmit the vertebral artery in all cervical vertebrae including C7. **Answer:** **B) It lacks a vertebral body and articulates with the dens of the axis, stabilized by the transverse ligament of the atlas.** --- **2.** A 60-year-old man is scheduled for carotid artery surgery due to significant stenosis. Knowing the vertebral level where the common carotid artery bifurcates is crucial for the surgeon. At which vertebral level does this bifurcation occur? A) C1–C2 B) C3–C4 C) C5–C6 D) T1 **Answer:** **B) C3–C4** --- **3.** A patient complains of chronic neck pain exacerbated by flexion and extension. An MRI reveals a strain of a ligament unique to the cervical spine. Which ligament is this, serving as a continuation of the supraspinous ligament? A) Anterior longitudinal ligament B) Posterior longitudinal ligament C) Nuchal ligament D) Ligamentum flavum **Answer:** **C) Nuchal ligament** --- **4.** A patient experiences difficulty in tongue movements after neck surgery. Damage to the nerve fibers innervating which muscle, supplied by the C1 root via the hypoglossal nerve, may be responsible for his symptoms? A) Mylohyoid B) Geniohyoid C) Stylohyoid D) Sternothyroid **Answer:** **B) Geniohyoid** --- **5.** A patient presents with numbness and weakness in the upper limb. Thoracic outlet syndrome is suspected due to compression of the subclavian artery. Between which two muscles does the subclavian artery pass that could be causing this compression? A) Anterior and middle scalene muscles B) Middle and posterior scalene muscles C) Omohyoid and sternocleidomastoid muscles D) Anterior scalene and sternocleidomastoid muscles **Answer:** **A) Anterior and middle scalene muscles** --- **6.** After parotid gland surgery, a patient complains of numbness over the angle of the mandible. Injury to which nerve, providing sensory innervation to this area, is most likely responsible? A) Lesser occipital nerve (C2) B) Great auricular nerve (C2–C3) C) Transverse cervical nerve (C2–C3) D) Supraclavicular nerve (C3–C4) **Answer:** **B) Great auricular nerve (C2–C3)** --- **7.** A patient involved in a diving accident presents with neck pain and neurological deficits. Imaging reveals a Jefferson fracture of C1 with lateral mass displacement. Which of the following statements is **TRUE** regarding this injury? A) It involves a fracture of the dens of the axis (C2). B) It is commonly associated with vertebral artery damage due to lateral mass compression. C) It affects only the posterior arch of the atlas (C1). D) It is the least common type of cervical spine injury. **Answer:** **B) It is commonly associated with vertebral artery damage due to lateral mass compression.** --- **8.** During a neck dissection for lymph node biopsy, the surgeon identifies a muscle that divides the posterior triangle into occipital and supraclavicular triangles. Which muscle is this? A) Sternocleidomastoid B) Trapezius C) Omohyoid D) Platysma **Answer:** **C) Omohyoid** --- **9.** A patient with a large thyroid goiter reports difficulty swallowing solid foods. Compression of which structure is most likely responsible for his dysphagia? A) Larynx B) Trachea C) Esophagus D) Superior vena cava **Answer:** **C) Esophagus** --- **10.** A surgeon planning a neck procedure must avoid injuring structures within the carotid sheath. Which of the following structures is **NOT** enclosed within the carotid sheath? A) Internal jugular vein B) Vagus nerve (CN X) C) Ansa cervicalis D) Phrenic nerve **Answer:** **D) Phrenic nerve** --- **11.** A patient with chronic obstructive pulmonary disease relies on accessory muscles for breathing. Which muscle, acting as an accessory muscle of respiration and innervated by spinal nerves C3–C4, assists in elevating the first rib during inspiration? A) Anterior scalene B) Middle scalene C) Posterior scalene D) Sternocleidomastoid **Answer:** **B) Middle scalene** --- **12.** A patient presents with difficulty shrugging the shoulders and turning the head against resistance following neck surgery. Damage to which cranial nerve would affect both the sternocleidomastoid and trapezius muscles? A) Glossopharyngeal nerve (CN IX) B) Accessory nerve (CN XI) C) Hypoglossal nerve (CN XII) D) Vagus nerve (CN X) **Answer:** **B) Accessory nerve (CN XI)** --- **13.** A patient suffers a spinal cord injury at the level of C5. Knowing the origins of the phrenic nerve is crucial. Which of the following statements about the cervical plexus is **FALSE** in this context? A) It is formed by the ventral rami of C1–C4 spinal nerves. B) The phrenic nerve arises from C3–C5. C) It contains both cutaneous and muscular branches. D) The ansa cervicalis supplies some infrahyoid muscles. **Answer:** **B) The phrenic nerve arises from C3–C5.** **Explanation:** While the phrenic nerve does arise from C3–C5, the cervical plexus only includes C1–C4, making this statement false in the context of the cervical plexus. --- **14.** A patient with rheumatoid arthritis develops neck instability due to ligament laxity. The transverse ligament of the atlas is crucial in preventing which of the following, thereby maintaining atlantoaxial stability? A) Excessive extension of the neck B) Posterior displacement of the dens C) Anterior displacement of the atlas on the axis D) Compression of the vertebral artery **Answer:** **C) Anterior displacement of the atlas on the axis** --- **15.** A patient experiences a high-impact trauma resulting in a fracture involving the dens. The dens (odontoid process) is a characteristic feature of which cervical vertebra? A) Atlas (C1) B) Axis (C2) C) C3 D) C7 **Answer:** **B) Axis (C2)** --- **16.** After dental surgery involving the mandibular molars, a patient has difficulty elevating the floor of the mouth. Damage to which muscle, innervated by the inferior alveolar nerve, is most likely responsible? A) Mylohyoid B) Digastric (anterior belly) C) Geniohyoid D) Stylohyoid **Answer:** **A) Mylohyoid** --- **17.** During placement of an axillary block for anesthesia, understanding the extensions of neck fascia is important. Which fascia layer extends laterally to form the axillary sheath? A) Superficial cervical fascia B) Pretracheal fascia C) Prevertebral fascia D) Investing layer of deep cervical fascia **Answer:** **C) Prevertebral fascia** --- **18.** A patient exhibits signs of vertebrobasilar insufficiency. The vertebral artery passes through the transverse foramina of which cervical vertebrae that should be focused on during imaging? A) All cervical vertebrae (C1–C7) B) C1–C6 C) C3–C7 D) C1–C7, except C7 **Answer:** **B) C1–C6** --- **19.** During thyroid surgery, it is important to preserve muscles innervated by the ansa cervicalis. Which muscle, having two bellies connected by an intermediate tendon and innervated by the ansa cervicalis, fits this description? A) Omohyoid B) Digastric C) Sternothyroid D) Stylohyoid **Answer:** **A) Omohyoid** --- **20.** An anesthesiologist performs an interscalene brachial plexus block for shoulder surgery. The anesthetic is injected between which two muscles? A) Anterior and middle scalene muscles B) Middle and posterior scalene muscles C) Sternocleidomastoid and anterior scalene muscles D) Omohyoid and sternohyoid muscles **Answer:** **A) Anterior and middle scalene muscles** --- **21.** A clinician examines the anterior triangle of the neck for lymphadenopathy. Which of the following is **NOT** a boundary of the anterior triangle? A) Anterior border of sternocleidomastoid B) Midline of the neck C) Mandible D) Clavicle **Answer:** **D) Clavicle** --- **22.** During neck surgery, care must be taken to preserve the superior root of the ansa cervicalis. The superior root is formed by fibers from which cervical spinal nerve? A) C1 B) C2 C) C3 D) C4 **Answer:** **A) C1** --- **23.** In carotid endarterectomy, the surgeon must be cautious of a cranial nerve piercing the carotid sheath. Which structure is pierced by the glossopharyngeal nerve (CN IX) as it descends in the neck? A) Thyrohyoid B) Stylopharyngeus C) Carotid sheath D) Middle pharyngeal constrictor **Answer:** **C) Carotid sheath** --- **24.** A patient with a large substernal goiter raises their arms and experiences facial flushing and neck vein distention (Pemberton's sign). Compression of which structure by the enlarged thyroid is responsible? A) Esophagus B) Trachea C) Superior vena cava D) Recurrent laryngeal nerve **Answer:** **C) Superior vena cava** --- **25.** After surgery near the angle of the mandible, a patient has difficulty depressing the mandible. Damage to which nerve, innervating the posterior belly of the digastric muscle, is suspected? A) Inferior alveolar nerve B) Facial nerve (CN VII) C) Glossopharyngeal nerve (CN IX) D) Hypoglossal nerve (CN XII) **Answer:** **B) Facial nerve (CN VII)** --- **26.** A patient presents with impaired elevation of the larynx during swallowing. Which muscle, not innervated by the ansa cervicalis but by C1 via the hypoglossal nerve, might be dysfunctional? A) Sternohyoid B) Sternothyroid C) Thyrohyoid D) Omohyoid **Answer:** **C) Thyrohyoid** --- **27.** When inserting a central venous catheter via the subclavian vein, understanding its anatomical relations is crucial. Which of the following statements about the subclavian vein in the neck is **TRUE**? A) It passes posterior to the anterior scalene muscle. B) It lies directly anterior to the subclavian artery. C) It is a content of the carotid sheath. D) It passes between the anterior and middle scalene muscles. **Answer:** **B) It lies directly anterior to the subclavian artery.** --- **28.** A patient presents with symptoms indicative of C8 nerve root compression. The spinal nerve C8 emerges between which vertebrae? A) C6 and C7 B) C7 and T1 C) C8 and T1 D) C7 and C8 **Answer:** **B) C7 and T1** --- **29.** A deep neck infection threatens to spread into the mediastinum. Which structure forms the posterior boundary of the retropharyngeal space, influencing the potential spread? A) Prevertebral fascia B) Buccopharyngeal fascia C) Alar fascia D) Investing layer of deep cervical fascia **Answer:** **A) Prevertebral fascia** --- **30.** A patient with Down syndrome is evaluated for neck instability due to ligament laxity. Damage to which ligament would most likely result in atlantoaxial instability? A) Anterior longitudinal ligament B) Nuchal ligament C) Transverse ligament of the atlas D) Ligamentum flavum **Answer:** **C) Transverse ligament of the atlas** --- **31.** Following a neck injury, a patient complains of numbness behind the ear. The lesser occipital nerve provides cutaneous innervation to which area that might explain his symptoms? A) Skin over the clavicle B) Skin over the anterior neck C) Skin over the mastoid process and posterior ear D) Skin over the shoulder **Answer:** **C) Skin over the mastoid process and posterior ear** --- **32.** In surgeries involving the brachial plexus or subclavian vessels, which muscle serves as an important landmark for identifying and protecting neural structures? A) Platysma B) Sternocleidomastoid C) Anterior scalene D) Middle scalene **Answer:** **C) Anterior scalene** --- **33.** A patient presents with a palpable mass in the lower anterior neck. Knowing the anatomical subdivisions, which structure found within the muscular triangle of the neck is likely enlarged? A) Submandibular gland B) Thyroid gland C) Carotid artery bifurcation D) Hypoglossal nerve (CN XII) **Answer:** **B) Thyroid gland** --- **34.** During spinal surgery for decompression, hypertrophy of a ligament connecting the laminae of adjacent vertebrae is noted. Which ligament is this? A) Anterior longitudinal ligament B) Posterior longitudinal ligament C) Ligamentum flavum D) Interspinous ligament **Answer:** **C) Ligamentum flavum** --- **35.** During a physical examination, a physician palpates a prominent spinous process at the back of the neck. Which cervical vertebra has this feature and does not transmit the vertebral artery through its transverse foramen? A) C3 B) C5 C) C6 D) C7 **Answer:** **D) C7** --- **36.** During neck surgery, identifying a muscle that originates from the scapula and inserts onto the hyoid bone is important. Which muscle is this? A) Omohyoid B) Sternohyoid C) Thyrohyoid D) Stylohyoid **Answer:** **A) Omohyoid** --- **37.** In anterior cervical spine surgery, the surgeon must be cautious of a nerve descending on the anterior surface of the anterior scalene muscle. Which nerve is this? A) Vagus nerve (CN X) B) Phrenic nerve C) Accessory nerve (CN XI) D) Hypoglossal nerve (CN XII) **Answer:** **B) Phrenic nerve** --- **38.** A patient with a cervical spinal cord injury at C7 exhibits weakness in accessory respiratory muscles. Which muscle, innervated by spinal nerves C6–C8, is likely affected? A) Anterior scalene B) Middle scalene C) Posterior scalene D) Sternocleidomastoid **Answer:** **C) Posterior scalene** --- **39.** A patient presents with numbness in the little finger and ulnar side of the hand. In the cervical spine, how many spinal nerves are present, and how are they distributed relative to the vertebrae to explain this symptom? A) Seven spinal nerves, exiting below their corresponding vertebrae B) Eight spinal nerves, with C8 exiting above C7 vertebra C) Eight spinal nerves, with C8 exiting below C7 vertebra D) Seven spinal nerves, exiting above their corresponding vertebrae **Answer:** **C) Eight spinal nerves, with C8 exiting below C7 vertebra** --- **40.** An infection within a specific fascia layer may spread along the muscles it encloses. The investing layer of deep cervical fascia encloses which of the following muscles? A) Sternocleidomastoid and trapezius B) Omohyoid and sternohyoid C) Scalenes and levator scapulae D) Digastric and mylohyoid **Answer:** **A) Sternocleidomastoid and trapezius** --- These questions integrate clinical scenarios directly into the question stems, testing both anatomical knowledge and its clinical application, suitable for a medical student's exam preparation.