Diseases of the Nose and Paranasal Sinuses Practice Questions

Q: In a 60-year-old adult, which of the following diseases causes expansile maxillary lesions?

Paget's disease. **Explanation:** The correct answer is **Paget’s Disease (Osteitis Deformans)**. In Paget’s disease, there is a localized disorder of bone remodeling characterized by excessive bone resorption followed by disorganized and excessive bone formation. In the head and neck, it commonly affects the skull and the maxilla. In an **elderly patient (typically >50-60 years)**, Paget’s disease is a classic cause of progressive, painless, bilateral **expansile enlargement of the maxilla**. This often leads to a "lion-like" facial appearance (leontiasis ossea) and causes widening of the alveolar ridges, resulting in ill-fitting dentures—a classic clinical sign in NEET-PG questions. **Why other options are incorrect:** * **Acromegaly:** While it causes bony overgrowth due to excess Growth Hormone, it primarily affects the **mandible** (prognathism) and the frontal bone (frontal bossing), rather than causing isolated expansile maxillary lesions. * **Fibrous Dysplasia:** This also causes expansile bone lesions where normal bone is replaced by fibrous tissue. However, it is primarily a disease of the **young (children and adolescents)**. In a 60-year-old, Paget’s is statistically and clinically more probable. * **Rickets:** This is a disease of vitamin D deficiency in **children** leading to soft bones and skeletal deformities; it does not cause expansile maxillary masses in adults. **High-Yield Clinical Pearls for NEET-PG:** * **Paget’s Disease:** Look for "Cotton wool" appearance on X-ray, elevated Serum Alkaline Phosphatase (with normal Calcium/Phosphate), and a risk of malignant transformation to Osteosarcoma (1%). * **Fibrous Dysplasia:** Look for "Ground glass" appearance on CT and "Chinese letter" patterns on histology. * **Maxillary Expansion:** If unilateral and in a younger patient, consider an Antrochoanal polyp or Benign tumors; if bilateral and elderly, think Paget’s.

Q: A patient presents with a nasal polypoidal mass and subcutaneous nodules on the skin. What is the most likely diagnosis?

Rhinosporidiosis. **Explanation:** The correct diagnosis is **Rhinosporidiosis**, a chronic granulomatous infection caused by *Rhinosporidium seeberi*. While primarily known for causing friable, strawberry-like nasal polyps, it can spread hematogenously to involve the skin, presenting as **subcutaneous nodules** or verrucous lesions. This systemic dissemination is a high-yield clinical feature often tested in NEET-PG. **Why the other options are incorrect:** * **Zygomycosis (Mucormycosis):** This is an aggressive, angioinvasive fungal infection typically seen in uncontrolled diabetics. It presents with black eschar, rapid tissue necrosis, and orbital involvement, rather than chronic subcutaneous nodules. * **Sporotrichosis:** Known as "Rose gardener’s disease," it typically presents with a primary skin ulcer and linear lymphocutaneous nodules. While it involves the skin, it rarely presents as a primary nasal polypoidal mass. * **Aspergillosis:** In the nose, this usually presents as a non-invasive fungal ball (mycetoma) or allergic fungal rhinosinusitis (AFRS). It does not typically manifest with subcutaneous skin nodules. **Clinical Pearls for NEET-PG:** * **Causative Agent:** *Rhinosporidium seeberi* (now classified as a Mesomycetozoea, not a true fungus). * **Classic Appearance:** Leaf-like, vascular, "strawberry" polyp with white dots (sporangia) on the surface. * **Histology:** Large, thick-walled **sporangia** containing thousands of **endospores** (diagnostic). * **Epidemiology:** Common in South India (Tamil Nadu, Kerala) and Sri Lanka; associated with bathing in stagnant pond water. * **Treatment:** Wide surgical excision with cautery of the base; **Dapsone** is used to prevent recurrence.

Q: All of the following are true of septoplasty for deviated nasal septum (DNS) except?

Mucoperichondrium is stripped off. ### Explanation **Septoplasty** is a conservative surgical procedure aimed at correcting a deviated nasal septum (DNS) while preserving as much septal framework as possible. **Why Option B is the Correct Answer (The False Statement):** In Septoplasty, the mucoperichondrium/mucoperiosteum is **elevated on only one side** (unilateral flap). The flap on the opposite side is kept intact to maintain the blood supply to the septal cartilage. In contrast, **Submucous Resection (SMR)** involves stripping the mucoperichondrium from **both sides** (bilateral flaps), which increases the risk of septal perforation and "saddle nose" deformity. **Analysis of Other Options:** * **Option A:** DNS causing nasal obstruction, headache (Sluder’s neuralgia), or sinusitis is the primary indication for septoplasty. * **Option C:** It is preferably done after **17–18 years** of age (once mid-facial growth is complete). However, in modern practice, "conservative septoplasty" can be performed in children if the obstruction is severe, though the general rule for exams remains 16–18 years. * **Option D:** Septoplasty is indicated in epistaxis if a septal spur is causing localized drying/crusting or if the deviation prevents access to a bleeding vessel for cauterization. **High-Yield Clinical Pearls for NEET-PG:** * **Killian’s Incision:** Used in SMR (placed 5mm behind the caudal border). * **Freer’s Incision:** Used in Septoplasty (placed at the caudal border/hemitransfixion). * **Cottle’s Operation:** A sophisticated version of septoplasty addressing all four areas of the septum. * **Complication:** The most common complication of septal surgery is a **septal hematoma**, which, if untreated, leads to a septal abscess and subsequent saddle nose deformity.

Q: Which of the following is common about tumors of the Peripheral Nervous System (PNS) and Nasal Cavity?

Melanoma can occur.. ### Explanation **1. Why the Correct Answer is Right:** Mucosal Melanoma is a rare but aggressive malignancy that can arise from both the **nasal cavity** and the **paranasal sinuses (PNS)**. These tumors originate from melanocytes located in the respiratory mucosa of the sinonasal tract. While they represent only about 1% of all melanomas, they are a significant diagnostic consideration in these regions because they often present at an advanced stage with a poor prognosis. **2. Why the Other Options are Incorrect:** * **Option A (Squamous Cell Carcinoma - SCC):** While SCC is the most common malignancy of the **maxillary sinus**, it is not the most common tumor of the **nasal cavity** (where inverted papilloma is the most common benign tumor and SCC is common but not the "unifying" commonality in the context of this specific comparative question). * **Options B & D (Adenoid Cystic Carcinoma):** This is the most common **minor salivary gland tumor** of the sinonasal tract. While it occurs in both the PNS and nasal cavity, it is less frequent overall than SCC. It is characterized by perineural invasion and a "Swiss-cheese" pattern on histology, but it is not the defining commonality intended by this question. **3. Clinical Pearls for NEET-PG:** * **Most common site for Sinonasal SCC:** Maxillary Sinus (80%), followed by the Ethmoid Sinus. * **Occupational Risk:** Woodworkers (hardwood dust) have a significantly increased risk of **Adenocarcinoma** (specifically the ethmoid sinus). * **Inverted Papilloma:** Arises from the lateral wall of the nose; it is locally aggressive and has a 10% risk of malignant transformation into SCC. * **Esthesioneuroblastoma:** A neurogenic tumor arising from the olfactory epithelium in the roof of the nasal cavity (Kallmann’s area). * **Melanoma Presentation:** Often presents with epistaxis and nasal obstruction; look for "pigmented mass" on endoscopy, though 10-20% can be amelanotic.

Q: Pott's puffy tumor is related to which of the following conditions?

Pyogenic infection of frontal sinus. **Explanation:** **Pott’s Puffy Tumor** is a clinical entity characterized by a **subperiosteal abscess** of the frontal bone associated with underlying **osteomyelitis**. 1. **Why Option C is Correct:** The condition most commonly arises as a complication of an acute **pyogenic infection of the frontal sinus**. The infection spreads from the sinus to the frontal bone via direct extension or through the **valveless diploic veins** (Breschet’s veins). This leads to osteomyelitis and the formation of a fluctuant, "puffy" swelling on the forehead. Despite the name, it is not a neoplastic "tumor" but an inflammatory mass. 2. **Why Other Options are Incorrect:** * **Option A:** An infected cell in the middle turbinate is known as an infected **Concha Bullosa**, which typically causes nasal obstruction or localized pain but does not lead to frontal bone abscesses. * **Option B:** While Sir Percivall Pott (who first described the condition) is also associated with Pott’s disease (spinal TB), Pott’s Puffy Tumor is strictly a **pyogenic** (usually *Staphylococcus* or *Streptococcus*) complication, not tuberculous. * **Option C:** Cavernous sinus thrombosis is a dreaded intracranial complication of facial or sinus infections, but it involves the venous sinuses of the brain, not a subperiosteal forehead swelling. **Clinical Pearls for NEET-PG:** * **Etiology:** Most common in adolescents due to increased diploic vein vascularity. * **Diagnosis:** **Contrast-enhanced CT (CECT)** is the gold standard to visualize the bone erosion and abscess. * **Complications:** High risk of intracranial spread, leading to **epidural abscess** or meningitis. * **Management:** Requires urgent IV antibiotics and surgical drainage (often via Trephination or FESS).

Q: What is the most effective medical treatment for nasal polyps?

Topical steroids. **Explanation:** Nasal polyps are non-neoplastic, edematous masses of the sinonasal mucosa, typically resulting from chronic inflammation (often associated with Th2-mediated eosinophilic infiltration). **Why Topical Steroids are the Correct Answer:** Topical corticosteroids (e.g., Fluticasone, Mometasone) are the **first-line medical treatment** for nasal polyps. They work by reducing mucosal inflammation, decreasing the size of the polyps, and improving symptoms like nasal obstruction and anosmia. They act by inhibiting cytokine release and reducing eosinophil survival within the polypoid tissue. **Analysis of Incorrect Options:** * **A. Topical decongestants:** These provide temporary relief by vasoconstriction but do not treat the underlying inflammatory pathology. Prolonged use ( >5-7 days) leads to **rhinitis medicamentosa**. * **B. Antihistamines:** These are only beneficial if the patient has concurrent allergic rhinitis. They have no direct effect on shrinking established polypoid tissue. * **D. NSAIDs:** These are generally avoided, especially in patients with **Samter’s Triad** (Aspirin sensitivity, Asthma, and Nasal Polyposis), as they can exacerbate symptoms. **High-Yield Clinical Pearls for NEET-PG:** * **Medical Management:** If topical steroids fail, a short course of **systemic steroids** (e.g., Prednisolone) is the most effective "medical polypectomy." * **Surgical Management:** The procedure of choice for refractory cases is **FESS (Functional Endoscopic Sinus Surgery)**. * **Samter’s Triad (Aspirin-Exacerbated Respiratory Disease):** A classic exam favorite consisting of Nasal Polyps + Bronchial Asthma + Aspirin Sensitivity. * **Unilateral Polyp:** Always rule out malignancy or Inverted Papilloma; in children, consider an Encephalocele or Antrochoanal polyp.

Q: The transillumination test was commonly performed to diagnose infection of which paranasal sinus?

Both maxillary and frontal sinuses. **Explanation:** The **Transillumination Test** is a traditional clinical bedside procedure used to assess the aeration of the paranasal sinuses. It relies on the principle that a healthy, air-filled sinus allows light to pass through its walls, whereas a sinus filled with fluid, pus, or a thickened mucosal lining (as seen in sinusitis) will appear opaque. **Why the correct answer is D:** The test is specifically applicable to the **Maxillary** and **Frontal** sinuses because they are located superficially, allowing light to be transmitted through the overlying skin or oral cavity. * **Maxillary Sinus:** A light source is placed inside the mouth (over the hard palate) with the lips closed. A normal sinus shows a crescent of light below the eye and a pupillary glow. * **Frontal Sinus:** The light source is placed against the medial floor of the supraorbital ridge. A normal sinus shows a glow on the forehead. **Why other options are incorrect:** * **Sphenoid and Ethmoid Sinuses:** These are deep-seated sinuses located centrally in the skull base. They are surrounded by thick bone and other anatomical structures, making them inaccessible for transillumination. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard:** While transillumination was common in the past, **Non-Contrast CT (NCCT) of the Paranasal Sinuses** is now the gold standard for diagnosing sinusitis. * **Limitations:** The test has high false-positive rates due to variations in bony thickness (e.g., sinus hypoplasia). * **Dark Room Requirement:** The test must be performed in a completely darkened room to be effective. * **Clinical Sign:** Absence of light transmission is termed "opacity," suggesting pathology like acute sinusitis or a tumor.

Q: Cottle's test is used to diagnose which of the following conditions?

Deviated nasal septum. **Explanation:** **Cottle’s Test** is a clinical maneuver used to evaluate **nasal valve stenosis**, which is often a functional consequence of a **Deviated Nasal Septum (DNS)**. 1. **Why Option A is Correct:** The nasal valve is the narrowest part of the nasal airway. In patients with DNS or caudal septal deviation, this area becomes further compromised. During the test, the cheek is pulled laterally away from the midline while the patient breathes quietly. If this action opens the nasal valve and the patient reports a **significant improvement in the ease of breathing**, the test is considered **positive**. This indicates that the obstruction is at the level of the nasal valve, frequently due to septal deviation. 2. **Why Other Options are Incorrect:** * **Rhinosporidiosis:** This is a granulomatous infection caused by *Rhinosporidium seeberi*, typically presenting as a friable, strawberry-like polypoid mass. Diagnosis is clinical and confirmed by biopsy (sporangia). * **Antrochoanal Polyp:** This is a solitary mass arising from the maxillary sinus. Diagnosis is made via anterior rhinoscopy, posterior rhinoscopy, and CT imaging showing a dumbbell-shaped mass. * **Allergic Rhinitis:** This is an inflammatory condition characterized by sneezing, itching, and watery rhinorrhea. Diagnosis is based on history, physical exam (pale/boggy turbinates), and IgE/skin prick tests. **High-Yield Clinical Pearls for NEET-PG:** * **Nasal Valve:** Formed by the lower edge of the upper lateral cartilage, the septum, and the anterior end of the inferior turbinate. * **Modified Cottle’s Test:** Uses a cotton-tipped applicator or ear speculum to push the lateral wall of the valve internally; it is more specific for identifying the exact site of collapse. * **False Positives:** Can occur in patients with alar collapse or facial nerve paralysis.

Question 1

What is the most common cause of unilateral epistaxis in a 5-year-old child?

Accepted Answer

Foreign body

Answer

Polyp

Answer

Atrophic rhinitis

Answer

Maggot infestation

Question 2

In a 60-year-old adult, which of the following diseases causes expansile maxillary lesions?

Accepted Answer

Paget's disease

Answer

Acromegaly

Answer

Fibrous Dysplasia

Answer

Rickets

Question 3

A patient presents with a nasal polypoidal mass and subcutaneous nodules on the skin. What is the most likely diagnosis?

Accepted Answer

Rhinosporidiosis

Answer

Zygomycosis

Answer

Sporotrichosis

Answer

Aspergillosis

Question 4

All of the following are true of septoplasty for deviated nasal septum (DNS) except?

Accepted Answer

Mucoperichondrium is stripped off

Answer

Indicated in septal deviation

Answer

Preferably done after 16 years of age

Answer

May be indicated in some cases of epistaxis

Question 5

Which of the following is common about tumors of the Peripheral Nervous System (PNS) and Nasal Cavity?

Accepted Answer

Melanoma can occur.

Answer

Squamous cell carcinoma is the most common type.

Answer

Adenoid cystic carcinoma is the most common type.

Answer

Adenoid cystic carcinoma.

Question 6

Which of the following is used to treat nasal myiasis?

Accepted Answer

Chloroform water

Answer

Turpentine

Answer

Betadine

Answer

Chlorhexidine Gluconate

Question 7

Pott's puffy tumor is related to which of the following conditions?

Accepted Answer

Pyogenic infection of frontal sinus

Answer

Infected cell in middle turbinate

Answer

Tuberculous sinusitis

Answer

Cavernous sinus thrombosis

Question 8

What is the most effective medical treatment for nasal polyps?

Accepted Answer

Topical steroids

Answer

Topical decongestant nasal drops

Answer

Antihistamines

Answer

Non-steroid anti-inflammatory drugs (NSAIDs)

Question 9

The transillumination test was commonly performed to diagnose infection of which paranasal sinus?

Accepted Answer

Both maxillary and frontal sinuses

Answer

Maxillary sinus

Answer

Frontal sinus

Answer

Sphenoid sinus

Question 10

Cottle's test is used to diagnose which of the following conditions?

Accepted Answer

Deviated nasal septum

Answer

Rhinosporidiosis

Answer

Antrochoanal polyp

Answer

Allergic rhinitis

Diseases of the Nose and Paranasal Sinuses — MCQs

Diseases of the Nose and Paranasal Sinuses — MCQs

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