Head and Neck (Triangles, Vasculature, Glands, Pharynx, Larynx) MCQs

Anatomy · 72 free questions with answers & explanations.

1. During thyroidectomy, the recurrent laryngeal nerve is at risk. Which muscle is NOT paralyzed if the nerve is severed?
2. A deep cervical lymph node biopsy along the internal jugular vein reveals metastatic squamous carcinoma. The jugulodigastric node in the upper deep cervical group most commonly drains which primary site?
3. The carotid sheath contains all of the following EXCEPT:
4. A patient presents with inability to open the jaw (trismus) and the pterygoid plate region is involved. Which muscle occupies the infratemporal fossa and closes the jaw?
5. The only abductor of the vocal folds, whose paralysis leads to stridor and respiratory distress, is which muscle?
6. A surgeon performing thyroidectomy inadvertently damages the external laryngeal nerve. The MOST specific functional deficit expected is:
7. A 35-year-old presents with a painless, compressible, transilluminable swelling in the anterior triangle of the neck that enlarges on Valsalva manoeuvre and on crying. The swelling does not move with swallowing or tongue protrusion. The MOST likely diagnosis based on these anatomical features is:
8. During carotid endarterectomy, the surgeon stimulates the carotid sinus and causes bradycardia and hypotension. The afferent limb of this reflex is carried by which nerve to the brainstem?
9. A 60-year-old with longstanding hypertension is found on CT to have a calcified atherosclerotic plaque at the bifurcation of the common carotid artery. At which vertebral level does this bifurcation typically occur as a surface anatomy landmark?
10. A patient develops hoarseness after thyroid surgery. The surgeon inadvertently ligated the inferior thyroid artery close to the gland. Which nerve is most at risk due to its anatomical relationship with this artery?
11. The piriform fossa in the laryngopharynx is an important anatomical landmark for foreign body lodgement. Which nerve runs submucosally in the lateral wall of the piriform fossa and can be anaesthetised topically for rigid laryngoscopy?
12. During a superficial parotidectomy, the surgeon identifies the main trunk of the facial nerve. What is the most reliable surgical landmark for locating the main trunk of the facial nerve?
13. Killian's dehiscence (pharyngeal dimple) is a weak spot between Thyropharyngeus and Cricopharyngeus components of the inferior pharyngeal constrictor, through which pharyngeal pouches (Zenker diverticulum) may herniate. Which two muscle components form this dehiscence?
14. During thyroidectomy, the inferior thyroid artery must be carefully managed to avoid injuring the recurrent laryngeal nerve (RLN). The right RLN loops around which structure before ascending in the tracheoesophageal groove?
15. Pharyngeal pouch (Zenker's diverticulum) occurs as a mucosal herniation through a triangular dehiscence between the thyropharyngeus and cricopharyngeus portions of the inferior pharyngeal constrictor. This dehiscence is called:
16. The external laryngeal nerve, a branch of the superior laryngeal nerve from CN X, supplies which muscle of the larynx?
17. In Ludwig's angina (bilateral submandibular space infection), the infection spreads preferentially because the mylohyoid muscle acts as a barrier. Pus below the mylohyoid spreads into which space?
18. During thyroidectomy, the recurrent laryngeal nerve (RLN) is most at risk at which specific anatomical point in its course?
19. A patient with a parotid gland tumor develops ipsilateral facial palsy. The facial nerve exits the stylomastoid foramen and enters the parotid gland, dividing into which named branches that can be remembered by the mnemonic 'Two Zombies Bit My Chin'?
20. Killian's dehiscence is a potential weak area in the pharyngeal wall through which a Zenker's diverticulum protrudes. Between which two muscles does this dehiscence occur?
21. In laryngeal framework surgery for unilateral vocal cord paralysis, a Type I thyroplasty medialization implant is placed through which of the following spaces?
22. During total thyroidectomy, a patient post-operatively has a hoarse voice but can still raise the pitch. Which nerve is most likely injured and what structure does it supply?
23. Frey's syndrome (gustatory sweating) following parotidectomy occurs due to aberrant regeneration of which nerve fibers to sweat glands of the skin overlying the parotid?
24. A patient with a posterior triangle lymph node biopsy develops inability to abduct the shoulder beyond 90 degrees with winging of the shoulder. Which nerve is at risk in the posterior triangle of the neck?
25. A 5-year-old child presents with a midline neck swelling that moves upward on protrusion of the tongue and swallowing. The swelling has a sinus opening at the base of the tongue. The most likely embryological remnant is:
26. During a thyroidectomy, the surgeon identifies the external branch of the superior laryngeal nerve (EBSLN). Injury to this nerve would most characteristically result in which vocal change?
27. A patient develops acute neck swelling following dental extraction of the lower second molar. Imaging shows spread of infection below the mylohyoid muscle to the submandibular and parapharyngeal space. This is called Ludwig's angina. The mylohyoid muscle acts as a barrier between which two spaces?
28. The Killian's dehiscence (pharyngeal dehiscence) is a weak area between which two muscle components of the inferior pharyngeal constrictor, and is clinically relevant as the site of pharyngeal pouch (Zenker's diverticulum) formation?
29. A 40-year-old is undergoing neck dissection. The surgeon identifies a nerve in the posterior triangle of the neck that runs superficially and supplies sensation to the skin of the lower face, pinna, and angle of jaw. Which nerve is this?
30. During total thyroidectomy, the recurrent laryngeal nerve is at risk of injury near the ligament of Berry. Which ligament is this, and what is the specific surgical importance of the RLN's relationship to it?
31. A patient with a parotid abscess develops a spread of infection to the parapharyngeal space. Which anatomical barrier is breached to allow this spread?
32. A 35-year-old singer presents with a breathy, whispering voice after a motor vehicle accident. Laryngoscopy shows the right vocal fold is paralysed in the abducted (paramedian) position. Examination reveals no other cranial nerve deficits. Which specific branch of which nerve is most likely injured?
33. Killian's dehiscence is a potential weak area in the posterior pharyngeal wall where a pharyngeal pouch (Zenker's diverticulum) may herniate. Between which two muscle components does this dehiscence occur?
34. During thyroidectomy, a surgeon identifies and preserves the external laryngeal nerve (external branch of superior laryngeal nerve). Inadvertent injury to this nerve would cause which specific clinical deficit?
35. Pharyngeal arches contribute to the development of specific head and neck structures. The cartilage of the 3rd pharyngeal arch forms which adult structure?
36. A 35-year-old presents with a painless lateral neck swelling that moves on swallowing and ascends on tongue protrusion. It is located at the level of the hyoid bone, lateral to the midline, along the anterior border of the sternocleidomastoid. The MOST likely diagnosis is:
37. The piriform fossa (piriform recess) in the laryngopharynx is an important site for lodgment of foreign bodies. Which nerve runs in the mucosa of the piriform fossa and can cause referred otalgia when involved by hypopharyngeal carcinoma?
38. During total thyroidectomy, the recurrent laryngeal nerve (RLN) is at risk. At what point is the RLN most vulnerable to inadvertent ligation?
39. A 40-year-old with a large parotid pleomorphic adenoma undergoes parotidectomy. The nerve most at risk of injury during superficial parotidectomy is the facial nerve. At what anatomical landmark is the facial nerve trunk most reliably found?
40. The piriform fossa (pyriform recess) of the laryngopharynx has clinical significance because foreign bodies can lodge here. Which nerve is vulnerable to injury from sharp objects lodged in the piriform fossa?
41. Killian's dehiscence (Killian's triangle) is a weak area in the posterior pharyngeal wall through which a pharyngeal pouch (Zenker's diverticulum) herniates. This dehiscence lies between which two muscular components?
42. The danger space (space 4) in the neck extends from the skull base to the posterior mediastinum and is bounded anteriorly by the alar fascia and posteriorly by the prevertebral fascia. Infection in this space can spread directly to the:
43. The piriform fossa (sinus) is a recess of the laryngopharynx lateral to the aryepiglottic fold. Foreign bodies lodging here or tumours in this region may damage a nerve running in the mucosa of the piriform fossa. This nerve is:
44. In total thyroidectomy, the parathyroid glands are at risk. The superior parathyroid gland develops from which pharyngeal pouch and is therefore more constant in position?
45. During parotidectomy, the facial nerve (CN VII) is most reliably identified at the tympanomastoid fissure between the pointer landmark. The 'pointer' (tragal pointer) indicates that the facial nerve trunk lies approximately how deep to the pointer tip?
46. Killian's dehiscence (Killian's triangle) is a muscular gap in the pharyngeal wall through which a pharyngeal pouch (Zenker's diverticulum) herniates. It is located between which two muscle components?
47. The internal laryngeal nerve (branch of superior laryngeal nerve) enters the larynx through the thyrohyoid membrane and provides sensory innervation to the laryngeal mucosa down to the level of the vocal folds. It travels with which vessel?
48. The carotid sheath in the neck contains which three structures and is traversed by which cranial nerve?
49. During thyroidectomy, the recurrent laryngeal nerve is most vulnerable at which location in its course?
50. During thyroidectomy, the external branch of the superior laryngeal nerve (EBSLN) is at risk. Damage to this nerve causes which specific functional deficit?
51. The deep lobe of the parotid gland lies medial to the stylomandibular ligament and the facial nerve divides it from the superficial lobe. During parotidectomy, identifying the main trunk of the facial nerve is performed by locating it at which landmark?
52. In the carotid triangle, the carotid body and carotid sinus lie at the bifurcation of the common carotid artery. Which nerve carries afferent impulses from the carotid body chemoreceptors to the brainstem?
53. The posterior belly of the digastric muscle and the stylohyoid muscle form the superior boundary of the digastric (carotid) triangle. Within this triangle, which structure is most superficially located?
54. A patient undergoes a right total thyroidectomy. Postoperatively, the voice is hoarse and the right vocal cord is fixed in the paramedian position. The left vocal cord is normal. The most likely damaged nerve is the:
55. Frey syndrome (auriculotemporal nerve syndrome) after parotidectomy involves gustatory sweating because parasympathetic secretomotor fibres aberrantly reinnervate sweat glands of the skin. What is the normal postganglionic course of these parasympathetic fibres to the parotid gland?
56. During a radical neck dissection, the surgeon identifies the ansa cervicalis on the anterior surface of the internal jugular vein. This loop is formed by contributions from which cervical nerve roots?
57. Transection of the external branch of the superior laryngeal nerve (EBSLN) during thyroid surgery produces which specific deficit?
58. In an angiogram of the head and neck, the carotid sinus is located at the bifurcation of the common carotid artery. Which nerve carries the afferent limb of the carotid sinus reflex (baroreceptor) to the brainstem?
59. During total thyroidectomy, the recurrent laryngeal nerve (RLN) is at highest risk of injury near the Berry's ligament. The right RLN has which different anatomical course compared to the left RLN that makes it more unpredictable in this region?
60. The posterior triangle of the neck contains the accessory nerve (CN XI) and the roots of the brachial plexus. The accessory nerve crosses the posterior triangle to innervate which muscle, and its injury at this site produces which clinical sign?
61. Killian's dehiscence (pharyngeal pouch, Zenker's diverticulum) is a herniation through a weak area in the posterior pharyngeal wall. This dehiscence is bounded by:
62. During thyroid surgery, the recurrent laryngeal nerve (RLN) is most at risk at which specific anatomical point?
63. The parotid gland is predominantly related to the facial nerve. Which layer of deep cervical fascia forms the parotid fascia and contributes to 'parotid space'?
64. A posterior fossa craniotomy damages the glossopharyngeal nerve (CN IX). Which specific reflex is MOST reliably lost?
65. The pharyngeal constrictors have three muscular gaps ('gaps in the pharyngeal wall'). What structure passes through the gap between the superior and middle constrictor?
66. A thyroglossal cyst always lies in close relationship to which anatomical structure, and at what vertebral level does the hyoid bone develop during descent of the thyroid?
67. The submental triangle, a subdivision of the anterior triangle of the neck, is bounded by which structures and contains which primary content?
68. A patient presents with inability to close the left eye, drooping of the left angle of the mouth, and loss of the left nasolabial fold. There is no forehead sparing. The lesion is most likely at:
69. A thyroid surgeon performing a total thyroidectomy must preserve the external branch of the superior laryngeal nerve. Injury to this nerve would most likely cause:
70. Frey's syndrome (gustatory sweating) is a recognized complication of parotidectomy. What is the underlying mechanism?
71. A patient involved in a road traffic accident presents with cerebrospinal fluid (CSF) rhinorrhea and anosmia. Which bony structure is most likely fractured?
72. During a radical neck dissection for oral cancer, the surgeon preserves a nerve running along the posterior border of sternocleidomastoid and supplying trapezius. Injury to this nerve would cause: