Anatomy, MBBS Second Year. This chapter is split into 2 topics and has
60 practice questions. The topics covered are listed below, followed by
10 free sample questions from the chapter.
Topics in this chapter
Site, formation and branches of the cervical sympathetic chain36 questions
Ansa subclavia, stellate ganglion and Horner's syndrome24 questions
Sample questions: HN 42. The cervical sympathetic chain
10 sample questions with the correct answer and an explanation. Try to answer each one before reading the explanation.
Q1. Which examples of 'along nerves' and 'vascular' branches are illustrated?
A. Temporal and zygomatic branches
B. Pharyngeal branches (along nerves) and cardiac branches (with the vascular route along the inferior thyroid and subclavian arteries)(correct answer)
C. Only cardiac branches
D. Only pharyngeal branches
Answer: B.The cervical sympathetic chain gives pharyngeal branches (distributed along nerves) and cardiac branches (associated with the vascular route, related to the inferior thyroid and subclavian arteries).
Q2. Which three types of target does the sympathetic chain influence in the head and neck?
A. Blood vessels (vasoconstriction), glands (secretomotor) and smooth muscle (e.g., the eye and its lids)(correct answer)
B. Only skeletal muscles
C. Only the salivary glands
D. Only the thyroid gland
Answer: A.The cervical sympathetic chain supplies blood vessels (vasoconstrictor), glands (secretomotor, e.g., sweat glands) and smooth muscle (including the dilator pupillae and Muller's muscle of the eyelid).
Q3. Which statement about the cervical sympathetic chain is correct?
A. It lies inside the carotid sheath
B. It has four ganglia
C. It lies behind the carotid sheath, is formed of the superior, middle and inferior ganglia, and branches by three routes (along nerves, along arteries and direct), with pharyngeal and cardiac branches among its distributions(correct answer)
D. It branches only directly
Answer: C.Cervical sympathetic chain: site — behind the carotid sheath; formation — 3 ganglia (superior, middle, inferior); branches — three routes (along nerves, along arteries/vascular, direct), including pharyngeal and cardiac branches.
Q4. Which statement summarises the cervical sympathetic chain?
A. It has only one ganglion
B. It lies behind the carotid sheath, comprises the superior, middle and inferior ganglia, distributes by three routes (along nerves, along arteries, direct) and supplies pharyngeal and cardiac branches (among others)(correct answer)
C. It is part of the parasympathetic nervous system
D. It lies in the midline anterior to the trachea
Answer: B.Cervical sympathetic chain: site — behind the carotid sheath; formation — superior, middle and inferior ganglia; branches — three routes (along nerves, along arteries/vascular, direct); examples — pharyngeal and cardiac branches.
Q5. Which comparison of the ansa subclavia and the ansa cervicalis is correct?
A. Both are parts of the sympathetic chain
B. The ansa subclavia supplies the infrahyoid muscles
C. The ansa subclavia connects the middle and inferior sympathetic ganglia, while the ansa cervicalis supplies the infrahyoid muscles(correct answer)
D. The ansa cervicalis connects sympathetic ganglia
Answer: C.Ansa subclavia — a sympathetic loop connecting the middle and inferior cervical ganglia (related to the subclavian artery). Ansa cervicalis — the loop supplying the infrahyoid muscles (except the thyrohyoid).
Q6. Why does ptosis in Horner's syndrome appear as 'incomplete' ptosis?
A. Because the tarsus is damaged
B. Because only the sympathetically supplied smooth muscle part of the levator (Muller's muscle) is affected, while the striated part (oculomotor nerve) remains functional(correct answer)
C. Because the orbicularis oculi overacts
D. Because the whole levator is paralysed
Answer: B.Sympathetic paralysis affects only Muller's muscle (the smooth-muscle part of the levator), so the ptosis is incomplete — the striated part supplied by the oculomotor nerve still lifts the lid.
Q7. Which statement about the ansa subclavia, stellate ganglion and Horner's syndrome is correct?
A. Horner's syndrome causes complete ptosis with mydriasis
B. The ansa subclavia connects the middle and inferior ganglia, the stellate ganglion is the fused inferior cervical and first thoracic ganglia, and a lesion of the cervical sympathetic chain causes Horner's syndrome (incomplete ptosis, miosis, anhidrosis and enophthalmos)(correct answer)
C. The ansa subclavia is the fused inferior cervical and T1 ganglia
D. The stellate ganglion connects the middle and inferior ganglia
Answer: B.Ansa subclavia — loop connecting the middle and inferior cervical ganglia; stellate ganglion — fused inferior cervical and first thoracic ganglia; lesion of the chain — Horner's syndrome (incomplete ptosis, miosis, anhidrosis, enophthalmos).
Q8. Which comparison of the four signs of Horner's syndrome with their mechanisms is correct?
A. Miosis — sphincter pupillae; ptosis — orbicularis oculi
B. Anhidrosis — vasodilation; enophthalmos — exophthalmos
D. Ptosis — levator palpebrae superioris; miosis — sphincter pupillae
Answer: C.Signs and mechanisms: incomplete ptosis — paralysis of Muller's muscle; miosis — paralysis of the dilator pupillae; anhidrosis — paralysis of the sweat glands; enophthalmos — sunken eyeball.
Q9. Which statement summarises the cervical sympathetic chain and its lesion?
A. The chain lies behind the carotid sheath with superior, middle and inferior ganglia; the ansa subclavia connects the middle and inferior ganglia and the stellate ganglion is the fused inferior cervical and first thoracic ganglia; its lesion causes Horner's syndrome — incomplete ptosis, miosis, anhidrosis and enophthalmos(correct answer)
B. It lies inside the carotid sheath
C. Its lesion causes complete ptosis with mydriasis
D. It has two ganglia
Answer: A.Cervical sympathetic chain: site — behind the carotid sheath; ganglia — superior, middle and inferior; ansa subclavia — connects the middle and inferior ganglia; stellate ganglion — fused inferior cervical and first thoracic ganglia; lesion — Horner's syndrome (incomplete ptosis, miosis, anhidrosis, enophthalmos).
Q10. Why is visual acuity preserved in Horner's syndrome?
A. Because only the sympathetic supply is affected (Muller's muscle, dilator pupillae and sweat glands), while the optic nerve and retinal pathway are unaffected(correct answer)
B. Because the ciliary muscle is sympathetically supplied
C. Because the retina receives sympathetic fibres
D. Because the optic nerve is part of the sympathetic chain
Answer: A.Horner's syndrome affects the sympathetic supply (Muller's muscle producing ptosis, the dilator pupillae producing miosis, and the sweat glands producing anhidrosis) with enophthalmos, but the optic nerve and retinal pathway are unaffected, so visual acuity is preserved.