Diseases of the Nose and Paranasal Sinuses Practice Questions

Q: A child presents with recurrent epistaxis following a fall. Examination reveals a septal hematoma. What is the appropriate management for a septal hematoma?

Incision and drainage. **Explanation:** **Septal hematoma** is a collection of blood between the nasal septal cartilage and its overlying mucoperichondrium, usually following trauma. **Why Option A is Correct:** The management of choice is **immediate incision and drainage (I&D)**. The septal cartilage depends entirely on the overlying perichondrium for its blood supply (via diffusion). A hematoma creates a physical barrier that strips the perichondrium away, leading to **avascular necrosis** of the cartilage. If left untreated, this results in a **Saddle Nose Deformity** or a septal abscess. Following drainage, bilateral nasal packing is essential to prevent re-accumulation of blood. **Why Other Options are Incorrect:** * **B. Observation:** This is contraindicated. Delay in treatment leads to irreversible cartilage destruction within 48–72 hours. * **C. Pressure bandage:** While pressure is needed post-drainage (via nasal packing), a simple external pressure bandage cannot evacuate the internal collection or prevent necrosis. * **D. Topical antibiotic ointment:** While systemic antibiotics are given to prevent secondary infection (septal abscess), topical ointment alone does not address the mechanical pressure of the hematoma. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Sign:** A soft, fluctuant, reddish/purplish bulge on the septum that does not shrink with topical vasoconstrictors (unlike turbinate hypertrophy). * **Complications:** 1. Septal Abscess (most common early complication), 2. Saddle Nose Deformity (due to necrosis of the *cartilaginous* vault), 3. Septal perforation. * **Site of Incision:** A small horizontal/hemitransfixion incision is made at the most dependent part.

Q: Which investigation is the investigation of choice for recurrent sinusitis?

CT scan. **Explanation:** The investigation of choice for recurrent or chronic sinusitis is a **Non-Contrast Computed Tomography (NCCT) of the Paranasal Sinuses (PNS)**. **1. Why CT Scan is the Correct Answer:** CT is considered the "gold standard" because it provides superior bony detail and anatomical resolution. It is essential for evaluating the **Osteomeatal Complex (OMC)**, the critical area where the maxillary, ethmoid, and frontal sinuses drain. In recurrent sinusitis, CT helps identify anatomical variations (e.g., deviated nasal septum, Concha bullosa, or Haller cells) that predispose a patient to repeated infections. It is also the mandatory "road map" used by surgeons before performing Functional Endoscopic Sinus Surgery (FESS). **2. Why Other Options are Incorrect:** * **X-ray PNS (Waters and Caldwell views):** While historically used for screening acute sinusitis (showing air-fluid levels), they are inadequate for recurrent cases. They suffer from the superimposition of bony structures and cannot visualize the ethmoid air cells or the OMC effectively. * **MRI:** While MRI is excellent for soft tissue, it is not the first-line investigation for routine recurrent sinusitis. It is reserved for suspected **complications**, such as intracranial extension, orbital cellulitis, or fungal sinusitis (where it shows a characteristic "signal void"). **Clinical Pearls for NEET-PG:** * **Best View for Maxillary Sinus:** Waters View (Occipitomental). * **Best View for Frontal Sinus:** Caldwell View (Occipitofrontal). * **Most common sinus involved in adults:** Maxillary sinus. * **Most common sinus involved in children:** Ethmoid sinus. * **Investigation of choice for Fungal Sinusitis:** MRI (to check for dural invasion).

Q: A two-year-old child with a history of purulent nasal discharge and fever presents with conjunctival congestion and edema. His temperature is 102-103°F and WBC count is 12,000/mm³. The culture of eye discharge was negative. X-ray shows opacification of the ethmoid sinus. Which of the following should be the next step in evaluating this patient?

CT scan. **Explanation:** The clinical presentation of a young child with fever, purulent nasal discharge, and ethmoid sinus opacification, now progressing to conjunctival congestion and edema, is highly suggestive of **Orbital Complications of Acute Sinusitis**. In children, the ethmoid sinus is the most commonly involved sinus due to its proximity to the orbit, separated only by the thin *lamina papyracea*. **Why CT Scan is the correct next step:** The primary goal is to differentiate between **Preseptal Cellulitis** (managed medically) and **Orbital Cellulitis/Abscess** (which may require surgical intervention). A **Contrast-Enhanced CT (CECT) of the Paranasal Sinuses and Orbit** is the gold standard investigation. It helps identify the stage of the disease (Chandler’s Classification), detects subperiosteal abscesses, and guides surgical planning if drainage is required. **Analysis of Incorrect Options:** * **B & C (Urine/Blood Culture):** While blood cultures are often performed in febrile children, they are not the immediate "next step" to evaluate the anatomical extent of an orbital emergency. Urine culture is irrelevant to a localized ENT infection. * **D (Repeat Eye Culture):** Eye discharge cultures are frequently negative because the infection is deep to the conjunctiva (within the orbital tissues). Repeating a negative test delays life-saving imaging. **NEET-PG Clinical Pearls:** * **Chandler’s Classification:** Stage I (Preseptal), Stage II (Orbital Cellulitis), Stage III (Subperiosteal Abscess), Stage IV (Orbital Abscess), Stage V (Cavernous Sinus Thrombosis). * **Red Flags:** Proptosis, restricted extraocular movements, and loss of vision indicate progression beyond Stage I and necessitate urgent CT. * **Most common sinus involved:** Ethmoid (in children); Frontal (in adults).

Q: What is the most common site of osteoma?

Frontal sinus. **Explanation:** **Osteoma** is the most common benign tumor of the paranasal sinuses. It is a slow-growing, encapsulated, and highly differentiated bone tumor. **Why Frontal Sinus is Correct:** The **frontal sinus** is the most common site for paranasal sinus osteomas (accounting for approximately 75–80% of cases), followed by the ethmoid sinus. These tumors typically arise at the junction of the ethmoid and frontal bones. Most are asymptomatic and discovered incidentally on imaging, though they can cause symptoms if they obstruct the frontonasal duct, leading to frontal sinusitis or a mucocele. **Why Other Options are Incorrect:** * **Ethmoid Sinus:** This is the second most common site. While frequent, it occurs significantly less often than in the frontal sinus. * **Maxillary Sinus:** Osteomas in the maxillary sinus are relatively rare compared to the frontal and ethmoid regions. * **Sphenoid Sinus:** This is the least common site for an osteoma. **Clinical Pearls for NEET-PG:** * **Gardner’s Syndrome:** If a patient presents with multiple osteomas (especially of the mandible), always consider Gardner’s Syndrome (a triad of colonic polyposis, soft tissue tumors, and multiple osteomas). * **Radiological Appearance:** On CT, they appear as a characteristic "ivory-hard," well-circumscribed, densely radiopaque mass. * **Management:** Small, asymptomatic osteomas are managed by observation ("wait and watch"). Surgical excision (e.g., Lynch-Howarth or endoscopic approach) is indicated only if the tumor is symptomatic, enlarging, or causing complications like mucocele or proptosis.

Q: In which stage of syphilis is the nose commonly involved?

Tertiary. **Explanation:** The nose is most commonly and severely involved in the **Tertiary stage** of syphilis. In this stage, the characteristic lesion is the **Gumma**, a chronic granulomatous reaction. * **Why Tertiary is correct:** Tertiary syphilis involves the nasal bones (specifically the bony septum) and the bridge of the nose. The gummatous process leads to extensive necrosis and destruction of the osteochondral framework. This results in the classic **"Saddle Nose" deformity** due to the collapse of the nasal bridge. Perforation of the bony septum is a hallmark of tertiary syphilis (unlike tuberculosis, which typically affects the cartilaginous septum). * **Why Primary is incorrect:** Primary syphilis involves a painless chancre. While it can occur on the external nose or vestibule via direct inoculation, it is extremely rare. * **Why Secondary is incorrect:** Secondary syphilis typically presents with systemic symptoms like skin rashes and lymphadenopathy. Nasal involvement is rare but may manifest as persistent rhinitis (snuffles) or mucous patches. * **Why "Equally involved" is incorrect:** The pathological impact on the nose is disproportionately higher and more clinically significant in the tertiary stage. **High-Yield Clinical Pearls for NEET-PG:** 1. **Congenital Syphilis:** Presents with **"Snuffles"** (purulent/bloody nasal discharge) in the early stage and **Saddle Nose** in the late stage. 2. **Bony vs. Cartilaginous:** Syphilis attacks the **bony septum**; Lupus/Tuberculosis attacks the **cartilaginous septum**. 3. **Diagnosis:** Screening is done via VDRL/RPR; confirmation via FTA-ABS (Treponemal test). 4. **Treatment:** Long-acting Penicillin (Benzathine Penicillin G) remains the drug of choice.

Q: What is the best surgical treatment for chronic maxillary sinusitis?

Fiberoptic endoscopic sinus surgery. **Explanation:** The management of chronic maxillary sinusitis has evolved significantly with the understanding of the **Osteomeatal Complex (OMC)**. **1. Why Fiberoptic Endoscopic Sinus Surgery (FESS) is the Correct Answer:** FESS is currently the **gold standard** and treatment of choice. The underlying medical concept is the restoration of **mucociliary clearance**. In health, the maxillary sinus drains superiorly through its natural ostium into the middle meatus. FESS is a physiological surgery that focuses on widening the natural ostium and clearing obstructions in the OMC, allowing the sinus to drain and ventilate naturally while preserving the sinus mucosa. **2. Why the other options are incorrect:** * **Repeated Antral Washout:** This is a conservative, temporary procedure. It provides symptomatic relief by removing pus but does not address the underlying anatomical obstruction or the diseased OMC. * **Caldwell-Luc’s Operation:** Once the standard, it is now reserved for specific cases (e.g., fungal balls, orbital floor fractures, or failed FESS). It is a non-physiological approach that involves creating a permanent window in the inferior meatus and removing the sinus lining, which often leads to complications like facial numbness or cheek swelling. * **Horgan’s Operation:** This is a transantral approach to the ethmoid sinuses via a Caldwell-Luc incision. It is largely obsolete in the era of endoscopy. **Clinical Pearls for NEET-PG:** * **Primary goal of FESS:** To restore the natural ventilation and drainage of the sinuses. * **Messerklinger Technique:** The specific endoscopic technique used to address the OMC. * **First-line treatment:** Always medical management (antibiotics, steroids, saline rinses) for 3–4 weeks before considering surgery. * **CT Scan (PNS):** The investigation of choice before performing FESS to map the anatomy and extent of disease.

Question 1

A child presents with recurrent epistaxis following a fall. Examination reveals a septal hematoma. What is the appropriate management for a septal hematoma?

Accepted Answer

Incision and drainage

Answer

Observation

Answer

Pressure bandage

Answer

Topical antibiotic ointment

Question 2

Which investigation is the investigation of choice for recurrent sinusitis?

Accepted Answer

CT scan

Answer

MRI

Answer

X-ray PNS Waters view

Answer

X-ray PNS Cadwells view

Question 3

Which of the following arteries is NOT ligated in a case of epistaxis?

Accepted Answer

Internal carotid artery

Answer

Anterior ethmoidal artery

Answer

Maxillary artery

Answer

External carotid artery

Question 4

Which of the following statements is NOT true about a mucocele?

Accepted Answer

The orbit is pushed backwards and downwards in a frontal sinus mucocele

Answer

Most common in the frontal sinus

Answer

Complication of chronic sinusitis

Answer

In ethmoid sinus mucocele, the orbit is pushed laterally

Question 5

A two-year-old child with a history of purulent nasal discharge and fever presents with conjunctival congestion and edema. His temperature is 102-103°F and WBC count is 12,000/mm³. The culture of eye discharge was negative. X-ray shows opacification of the ethmoid sinus. Which of the following should be the next step in evaluating this patient?

Accepted Answer

CT scan

Answer

Urine culture

Answer

Blood culture

Answer

Repeat culture of eye discharge

Question 6

What is the most common site of osteoma?

Accepted Answer

Frontal sinus

Answer

Maxillary sinus

Answer

Ethmoid sinus

Answer

Sphenoid sinus

Question 7

For juvenile angiofibroma confined to the nasal cavity, what is the preferred surgical approach?

Accepted Answer

Transnasal endoscopic

Answer

Transpalatal

Answer

Lateral rhinotomy

Answer

Transmaxillary

Question 8

A 11-year-old boy presented with a history of 'cold' for 20 days. He now has a fever of 39.2°C, purulent anterior nasal discharge, facial pain, anosmia, and a cough. Examination of the nose after topical decongestants reveals pus in the middle meatus. What is the most likely diagnosis?

Accepted Answer

Maxillary sinusitis

Answer

Brain abscess

Answer

Streptococcal throat infection

Answer

Sphenoid sinusitis

Question 9

In which stage of syphilis is the nose commonly involved?

Accepted Answer

Tertiary

Answer

Primary

Answer

Secondary

Answer

Equally involved in all stages

Question 10

What is the best surgical treatment for chronic maxillary sinusitis?

Accepted Answer

Fiberoptic endoscopic sinus surgery

Answer

Repeated antral washout

Answer

Caldwell-Luc's operation

Answer

Horgan's operation

Diseases of the Nose and Paranasal Sinuses — MCQs

Diseases of the Nose and Paranasal Sinuses — MCQs

On this page

Practice by Chapter

Want unlimited practice?