Functional Endoscopic Sinus Surgery Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Functional Endoscopic Sinus Surgery. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Functional Endoscopic Sinus Surgery Indian Medical PG Question 1: A lady comes to OPD after fall from scooty. Her vitals are stable. She is having continuous, clear watery discharge from nose after 2 days. This is most likely a feature of?
- A. CSF rhinorrhoea (Correct Answer)
- B. Acute respiratory infection
- C. Rhinitis
- D. Middle cranial fossa fracture
Functional Endoscopic Sinus Surgery Explanation: ***CSF rhinorrhoea***
- **Clear watery discharge** appearing **two days after head trauma** (fall from scooty) is highly suggestive of **cerebrospinal fluid (CSF) rhinorrhoea**.
- This occurs due to a breach in the **skull base**, allowing CSF to leak from the subarachnoid space into the nasal cavity.
*Acute respiratory infection*
- An acute respiratory infection typically presents with symptoms like **fever, cough**, and **nasal discharge** that is often thicker and discolored, not clear and watery.
- The onset of discharge two days after trauma without other signs of infection also makes this less likely.
*Rhinitis*
- Rhinitis involves inflammation of the nasal mucosa, leading to watery discharge, sneezing, and congestion.
- However, the traumatic etiology and the specific timing of the discharge make **CSF leak** a more pertinent diagnosis than simple rhinitis.
*Middle cranial fossa fracture*
- While a **middle cranial fossa fracture** can cause CSF leakage, the discharge from the nose (rhinorrhoea) typically originates from an **anterior cranial fossa fracture**.
- A middle cranial fossa fracture is more commonly associated with **otorrhoea** (CSF leakage from the ear) if the temporal bone is involved.
Functional Endoscopic Sinus Surgery Indian Medical PG Question 2: A nasal surgery was carried out with the incision shown in the image. What was the procedure likely carried out?
- A. Submucosal resection (SMR)
- B. FESS (Functional Endoscopic Sinus Surgery)
- C. Open rhinoplasty (Correct Answer)
- D. Caldwell-Luc's procedure
Functional Endoscopic Sinus Surgery Explanation: ***Open rhinoplasty***
- The image displays a **transcolumellar incision** (typically inverted V or W-shaped), which is the hallmark approach for **open rhinoplasty**.
- This incision allows for direct visualization of the underlying nasal cartilages and bones, enabling precise reshaping of the nose.
*Submucosal resection (SMR)*
- SMR is a procedure to correct a **deviated nasal septum** by removing cartilage or bone from beneath the mucoperichondrial flaps.
- It involves an **intranasal incision**, usually along the septal mucosa, not an external transcolumellar incision.
*FESS (Functional Endoscopic Sinus Surgery)*
- FESS is a minimally invasive procedure used to treat **chronic sinusitis** and other sinus conditions.
- It is performed entirely **endoscopically through the nostrils**, with no external incisions on the nasal columella.
*Caldwell-Luc's procedure*
- This procedure accesses the **maxillary sinus** through an incision in the upper gum beneath the lip.
- It is used for drainage of the maxillary sinus or removal of foreign bodies/tumors, and does not involve an external nasal incision.
Functional Endoscopic Sinus Surgery Indian Medical PG Question 3: Which of the following is not a complication of maxillary sinus lavage and insufflation?
- A. Orbital injury
- B. Epistaxis
- C. Facial nerve injury (Correct Answer)
- D. Air embolism
Functional Endoscopic Sinus Surgery Explanation: ***Facial nerve injury***
- The **facial nerve (CN VII)** passes through the parotid gland and temporal bone, far from the maxillary sinus.
- There is no anatomical proximity or procedural mechanism during maxillary sinus lavage and insufflation that would put the facial nerve at risk of injury.
*Air embolism*
- **Insufflation of air** into the maxillary sinus, especially under pressure, can lead to air entering the bloodstream if a blood vessel is inadvertently punctured.
- This can result in a serious and potentially fatal **air embolism**, particularly if the air reaches the cerebral circulation.
*Orbital injury*
- The **medial wall of the maxillary sinus** is in close proximity to the orbit, separated by thin bone.
- During lavage, excessive force or incorrect angulation of instruments can perforate this thin bone, leading to **orbital complications** such as periorbital hematoma or injury to orbital contents.
*Epistaxis*
- During the procedure, the **mucosa of the nasal cavity** or the sinus itself can be traumatized by the instruments used for lavage.
- This local trauma to the rich blood supply of these areas can easily cause **nasal bleeding (epistaxis)**.
Functional Endoscopic Sinus Surgery Indian Medical PG Question 4: During functional endoscopic sinus surgery the position of the patient is
- A. Lateral
- B. Lithotomy
- C. Reverse Trendelenburg (Correct Answer)
- D. Trendelenburg
Functional Endoscopic Sinus Surgery Explanation: ***Reverse Trendelenburg***
- This position helps to reduce **venous congestion** in the surgical field, which is crucial for maintaining clear visibility during **functional endoscopic sinus surgery (FESS)**.
- It minimizes **bleeding** by allowing gravity to drain blood away from the head and neck, improving surgical precision and safety.
*Trendelenburg*
- This position involves tilting the patient with the head lower than the feet, which would increase **venous pressure** in the head and neck.
- Increased venous congestion would lead to significant **bleeding**, severely impairing visibility during FESS.
*Lateral*
- The lateral position is generally used for procedures involving the **side of the body**, such as kidney surgery or lung procedures.
- It does not provide the optimal ergonomic access or venous drainage benefits required for **endoscopic sinus surgery**.
*Lithotomy*
- The lithotomy position is characterized by the patient lying on their back with hips and knees flexed and supported, primarily used for **pelvic or perineal procedures**.
- This position is entirely inappropriate for **head and neck surgery** as it does not allow proper access to the sinus area.
Functional Endoscopic Sinus Surgery Indian Medical PG Question 5: Where is a nasal antrostomy typically created following a Caldwell-Luc procedure?
- A. Above the inferior turbinate
- B. Beneath the superior turbinate
- C. Above the superior turbinate
- D. Beneath the inferior turbinate (Correct Answer)
Functional Endoscopic Sinus Surgery Explanation: ***Beneath the inferior turbinate***
- The **Caldwell-Luc procedure** addresses chronic inflammatory disease of the **maxillary sinus**, and the creation of a nasal antrostomy beneath the inferior turbinate is a crucial step for **drainage and ventilation**.
- This access point allows permanent communication between the maxillary sinus and the nasal cavity, facilitating healing and preventing recurrence of disease.
*Above the inferior turbinate*
- Creating an opening above the inferior turbinate would likely involve the **middle meatus** or other structures, which is not the standard location for a drainage antrostomy in a Caldwell-Luc procedure.
- This area is usually reserved for procedures involving the **ethmoid or frontal sinuses**, not the maxillary sinus in this specific context.
*Beneath the superior turbinate*
- The superior turbinate is located much higher in the nasal cavity, and an opening beneath it would drain into the superior meatus.
- This area is associated with the **sphenoid sinus** and posterior ethmoid cells, not the primary drainage of the maxillary sinus.
*Above the superior turbinate*
- There is no anatomical space or structure typically addressed directly above the superior turbinate for maxillary sinus drainage.
- This would be an anatomically incorrect and surgically inaccessible approach for creating a permanent drainage pathway from the maxillary sinus.
Functional Endoscopic Sinus Surgery Indian Medical PG Question 6: FESS means:
- A. Flexible endoscopic sinus surgery
- B. Functional endoscopic sinus surgery (Correct Answer)
- C. Fibroscopic endoscopic sinus surgery
- D. Frontal endoscopic sinus surgery
Functional Endoscopic Sinus Surgery Explanation: ***Functional endoscopic sinus surgery***
- **FESS** is a minimally invasive surgical technique used to treat **chronic sinusitis** and other sinus conditions.
- The goal of FESS is to restore normal sinus function and ventilation by removing obstructions and diseased tissue.
*Flexible endoscopic sinus surgery*
- This term is incorrect; while FESS uses endoscopes, they are generally rigid, not flexible, for better visualization and instrumentation.
- **Flexible endoscopes** are more commonly used for procedures like bronchoscopy or colonoscopy.
*Fibroscopic endoscopic sinus surgery*
- The term **fibroscopic** is typically associated with scopes employing fiber optics but is not the correct full form of the acronym FESS.
- This option incorrectly modifies the standard medical terminology for this procedure.
*Frontal endoscopic sinus surgery*
- While FESS can be performed on the **frontal sinuses**, this option is too specific and does not represent the complete and correct expansion of the acronym.
- FESS encompasses procedures on all paranasal sinuses, not just the frontal sinus.
Functional Endoscopic Sinus Surgery Indian Medical PG Question 7: All of the following are treatments for multiple bilateral ethmoidal polyps except which of the following?
- A. Intranasal ethmoidectomy
- B. Extranasal ethmoidectomy
- C. Caldwell Luc Surgery (Correct Answer)
- D. Functional endoscopic sinus surgery
Functional Endoscopic Sinus Surgery Explanation: ***Caldwell Luc Surgery***
- This procedure accesses the **maxillary sinus** through an incision in the gingivobuccal sulcus, primarily used for maxillary sinus pathology.
- It is **not the primary treatment** for ethmoidal polyps, which are located in the ethmoid sinuses.
*Intranasal ethmoidectomy*
- This is a common and effective surgical approach to remove ethmoidal polyps, involving access through the **nostrils**.
- It allows for direct visualization and removal of polyps within the ethmoid labyrinth.
*Extranasal ethmoidectomy*
- This surgical approach involves an external incision (e.g., Lynch-Howarth incision) to access the ethmoid sinuses.
- It is typically reserved for **extensive or complicated ethmoid disease** or in cases where intranasal approaches are insufficient.
*Functional endoscopic sinus surgery*
- This is the **gold standard** for treating chronic rhinosinusitis with polyps, including ethmoidal polyps.
- It uses an endoscope to visualize and remove polyps while preserving healthy mucosa and restoring normal sinus drainage and ventilation.
Functional Endoscopic Sinus Surgery Indian Medical PG Question 8: What is the treatment of choice for ethmoidal polyps?
- A. Functional Endoscopic sinus surgery with polypectomy (Correct Answer)
- B. Intranasal ethmoidectomy
- C. Transantral ethmoidectomy
- D. Extranasal ethmoidectomy
Functional Endoscopic Sinus Surgery Explanation: ***Functional Endoscopic sinus surgery with polypectomy***
- This is the **gold standard treatment** for ethmoidal polyps, as it allows for **direct visualization** and complete removal of polyps while preserving healthy mucosa.
- It also enables restoration of normal sinus ventilation and drainage, which helps prevent recurrence.
*Intranasal ethmoidectomy*
- This is an **older technique** that is performed blindly and carries a higher risk of complications, such as **orbital or intracranial injury**, compared to endoscopic approaches.
- It often results in incomplete polyp removal, leading to a higher rate of recurrence.
*Transantral ethmoidectomy*
- This approach, also known as the **Caldwell-Luc procedure**, is primarily used for diseases of the **maxillary sinus** and is not the preferred method for isolated ethmoidal polyps.
- It is a more invasive external approach with risks including facial swelling, pain, and damage to dental nerves.
*Extranasal ethmoidectomy*
- This is a more invasive **external approach** involving an incision on the face and is generally reserved for extensive or complicated cases, such as **tumors or severe trauma**, not for routine polyp removal.
- It carries risks of visible scarring and longer recovery times, making it less favorable than endoscopic techniques.
Functional Endoscopic Sinus Surgery Indian Medical PG Question 9: A child has ptosis and poor levator function. What surgery will you do?
- A. Frontalis suspension surgery (Correct Answer)
- B. Mullerectomy
- C. Levator muscle resection
- D. Fasanella Servat surgery
Functional Endoscopic Sinus Surgery Explanation: ***Frontalis suspension surgery***
- This procedure is indicated for **severe ptosis** with **poor levator function** (typically <4-5 mm), as the levator muscle is too weak to provide adequate lift.
- The surgery uses the **frontalis muscle** (forehead muscle) to elevate the eyelid, connecting the tarsus to the frontalis muscle, allowing the patient to open their eye by raising their eyebrows.
*Levator muscle resection*
- **Levator muscle resection** is performed when there is **fair to good levator function** (typically >5-6 mm), but not for poor function.
- The surgery aims to shorten and strengthen the existing levator muscle to improve eyelid lift.
*Mullerectomy*
- A **mullerectomy** is suitable for **mild ptosis** (1-2 mm) with **good levator function** while utilizing the Müller's muscle.
- It is performed when the ptosis is responsive to **phenylephrine drops**, which stimulate Müller's muscle.
*Fasanella Servat surgery*
- **Fasanella Servat surgery** is indicated for **mild ptosis** and relies on the resection of the **tarsus** and conjunctiva, along with Müller's muscle.
- This procedure is generally not performed in children due to potential long-term effects on the tarsal plate and lash line.
Functional Endoscopic Sinus Surgery Indian Medical PG Question 10: The following test is done for the evaluation of:
- A. Abnormality of nasal valve (Correct Answer)
- B. Cheek tenderness in maxillary sinusitis
- C. Severity of proptosis
- D. Skin pinch for dehydration
Functional Endoscopic Sinus Surgery Explanation: ***Abnormality of nasal valve***
- The image demonstrates the **Cottle test**, where fingers are placed on the cheek lateral to the nose and gently pulled laterally to open the **internal nasal valve**.
- If breathing improves with this maneuver, it indicates **nasal valve dysfunction** or collapse, helping diagnose nasal obstruction.
*Cheek tenderness in maxillary sinusitis*
- Assessment of **maxillary sinusitis** involves direct palpation over the maxillary sinus area below the eye, not lateral traction on the cheek.
- **Tenderness on palpation** would be elicited by pressing directly over the sinus, not by pulling the cheek laterally as shown.
*Severity of proptosis*
- **Proptosis** (exophthalmos) is measured using an **exophthalmometer** to quantify eyeball protrusion.
- The lateral traction maneuver shown has no relevance to assessing **ocular protrusion** or orbital pathology.
*Skin pinch for dehydration*
- The **skin turgor test** for dehydration involves pinching skin on the back of the hand, forearm, or abdomen, not the cheek area.
- **Poor skin turgor** is assessed by delayed return of pinched skin to normal position, which is not the technique demonstrated.
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