Diseases of the Nose and Paranasal Sinuses Practice Questions

Q: A 15-year-old female presents with nasal obstruction and occasional profuse epistaxis for last 8 weeks. Nasal speculum view and histopathology of resected lesion is given. All are correct about the diagnosis except:

Best cultured on nasal inoculation in hamster. *Best cultured on nasal inoculation in hamster* - This statement is **incorrect** because *Rhinosporidium seeberi*, the causative agent of rhinosporidiosis (which is indicated by the images and clinical presentation), is an **uncultivable organism** in artificial media or animal models. - Its complex life cycle and specific host requirements make *in vitro* or *in vivo* culture challenging and largely unsuccessful. *Multiple fungal spherules embedded in stroma of connective tissue* - The histopathology image clearly shows characteristic **spherules** of varying sizes, containing numerous endospores, embedded within the connective tissue stroma, which is typical for rhinosporidiosis. - These spherules represent different stages of the organism's life cycle. *Infection originates from stagnant water* - *Rhinosporidium seeberi* is commonly found in **stagnant water** (rivers, ponds) and is often associated with swimming, bathing, or working in such environments. - Exposure to contaminated water is the primary mode of transmission for this rare chronic granulomatous disease. *Surgical excision is best treatment* - **Surgical excision** of the mass with electrocoagulation of the base is considered the most effective treatment for rhinosporidiosis to prevent recurrence. - Anti-fungal medications like dapsone may be used as an adjunct to reduce recurrence rates.

Q: Identify the surgical procedure being performed in the image shown below.

Caldwell Luc operation. ***Caldwell Luc operation*** - The image shows an **incision in the gingivobuccal sulcus** above the upper incisor/canine teeth, reflecting the periosteum to access the anterior wall of the maxillary sinus, which is characteristic of the Caldwell-Luc operation. - This procedure involves creating an opening into the **maxillary antrum** to remove diseased tissue, often visualized through the anterior sinus wall as depicted in the right panel. *Inferior meatal antrostomy* - An inferior meatal antrostomy involves creating an opening in the **lateral nasal wall**, specifically beneath the inferior turbinate, to drain the maxillary sinus. - The approach in the image, through the oral cavity, is inconsistent with an inferior meatal antrostomy. *Proof puncture* - **Proof puncture** (also known as antral washout) is a diagnostic and therapeutic procedure where a needle is inserted into the maxillary sinus, typically through the inferior meatus, to aspirate contents and irrigate. - It does not involve a large surgical incision in the gingiva or removal of bone as shown in the image. *Superior meatal antrostomy* - The superior meatus is an anatomical space in the nasal cavity positioned **above the superior turbinate**. - A superior meatal antrostomy would access the posterior ethmoid cells or sphenoid sinus, not the maxillary sinus through an oral approach, and is not a standard procedure for maxillary sinus issues.

Q: An 8-year-old boy presents with recurrent episodes of epistaxis. Histopathological specimen of the excised lesion is shown below. All are correct about this condition except:

Holman-Miller sign is always present in all cases. ***Holman-Miller sign*** - The **Holman-Miller sign** (anterior bowing of the posterior wall of the maxillary antrum) is a helpful **radiological finding** in JNA but is **NOT always present** in all cases. - This sign is **supportive** when present but is not **pathognomonic** or universally found, making any claim of universal presence incorrect. *Frog face deformity* - **Frog face deformity** is indeed a characteristic physical finding in advanced **juvenile nasopharyngeal angiofibroma (JNA)** cases. - Results from significant **tumor extension** and **facial bone remodeling** due to mass effect, pushing facial structures forward and outward. *Management of emergency bleeding with adrenaline soaked gauze* - **Adrenaline-soaked gauze** is a valid emergency management approach for **epistaxis** in JNA due to its **vasoconstrictor** properties. - Provides temporary **hemostasis** while definitive treatment is planned, though systemic effects like **hypertension** must be monitored. *Radowski stage IIIB involves cavernous sinus extension* - The **Radkowski staging system** for JNA correctly classifies **Stage IIIB** as involving **cavernous sinus** extension. - This advanced staging is clinically significant for **surgical planning** and prognosis due to involvement of critical neurovascular structures.

Q: A 10-year-old child is brought with complaints of daily headache and nasal stuffiness. He also has paroxysms of sneezing daily. Nasal examination shows a lesion as shown in the image. All are true about the condition shown except?

Antrochoanal polyp grows towards anterior choana. ***Antrochoanal polyp grows towards anterior choana*** - An **antrochoanal polyp** originates from the maxillary sinus and typically grows towards the **posterior choana** and into the nasopharynx, not the anterior choana. - Polyps usually grow unilaterally and do not spread to the anterior choana. *Nasal polyp in right nostril* - The image clearly shows a **pinkish, edematous mass** protruding from the patient's right nostril, consistent with a nasal polyp. - The child's symptoms of **nasal stuffiness, headache, and sneezing** are also characteristic of nasal polyps. *Stage IV polyp goes up to floor of nose* - The **Lund-Mackay staging system** or similar classification systems for nasal polyps categorize Stage IV polyps as those that **obstruct the entire nasal cavity** or protrude outside the nostril, which matches the visual presentation in the image. - While not specifically mentioning the "floor of the nose" as a distinct stage element, a Stage IV polyp signifies extensive growth throughout the nasal cavity. *Krause nasal snare is used for removal of polyps* - A **Krause nasal snare** is a common surgical instrument used in polypectomy for the removal of larger nasal polyps. - It works by looping around the base of the polyp and excising it, often under local anesthesia.

Q: The following test is done for the evaluation of:

Abnormality of nasal valve. ***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.

Q: The CT scan of paranasal sinuses shows:

Haller cells. ***Haller cells*** - The image shows **pneumatized ethmoid air cells** located inferior to the orbit and lateral to the maxillary sinus ostium (arrows), which are characteristic of Haller cells. - These ethmoid cells, also known as **infraorbital ethmoid cells**, can narrow the maxillary sinus ostium, potentially contributing to **recurrent sinusitis**. *Agger nasi cells* - **Agger nasi cells** are the most anterior ethmoid cells, located in the lacrimal bone, anterior and lateral to the frontal recess. - They are typically situated at the level of the frontal sinus ostium, not inferior to the orbit. *Onodi cells* - **Onodi cells** are sphenoethmoidal air cells that extend posteriorly and laterally over the sphenoid sinus, in close proximity to the optic nerve. - Their location is **posterior and superior** to the structures shown in the image, making them incorrectly identified here. *Frontoethmoid cells* - **Frontoethmoid cells** can be a broad category, but specifically refer to ethmoid cells that extend into the frontal sinus or drain into the frontal recess. - While they are ethmoid cells, the specific location shown in the image (inferior to the orbit and maxillary sinus ostium) is more precisely described as Haller cells.

Q: A 65-year-old lady presents with soft swelling on her left supra-orbital area which she says is always warm to touch. She has been taking Ayurvedic treatment for these swellings for the last 6 months. What is the probable diagnosis?

Pott's puffy tumor. ***Pott's puffy tumor*** - This condition is characterized by a **subperiosteal abscess** and osteomyelitis of the frontal bone, often presenting as a **tender, edematous forehead swelling** that feels warm to the touch. - It typically results from a complication of **frontal sinusitis** and can lead to intracranial complications if untreated. *Osteoid osteoma* - This is a **benign bone tumor** characterized by localized pain, typically worse at night and relieved by NSAIDs. - While it affects bone, it usually presents as a **hard, non-enlarging mass** and does not typically involve infection or diffuse swelling like the described case. *Follicular carcinoma thyroid* - This is a **malignant thyroid cancer** that typically presents as a thyroid nodule or mass in the neck, occasionally with distant metastases. - It does not present as a warm, soft swelling on the **supra-orbital area** and is unrelated to frontal bone pathology. *Malignant fibrous histiocytoma* - This is a type of **soft tissue sarcoma** that can occur in various locations, including bone or soft tissues of the head and neck. - While it can present as a mass, it is not typically associated with the **warmth and inflammatory signs** indicative of infection, nor does it specifically localize to the supra-orbital region with the mentioned characteristics.

Q: A patient complains of pain and boggy swelling in the frontal region which is warm and tender. He also complains of drowsiness at times. What is the diagnosis?

Pott's puffy tumor. **Pott's puffy tumor** * **Pott's puffy tumor** is characterized by a focal osteomyelitis of the frontal bone, often complicated by a subperiosteal abscess. The description of **pain and boggy swelling in the frontal region, which is warm and tender**, perfectly matches this condition. * The complication of **drowsiness** indicates potential epidural or intracranial extension of the infection, which is a common and severe consequence of Pott's puffy tumor. *Pyogenic granuloma* * A pyogenic granuloma is a **benign vascular lesion** of the skin or mucous membranes. * While it can be warm and tender, it typically presents as an **eruptive, solitary, red papule or nodule** that bleeds easily, and it does not typically cause boggy swelling in the frontal bone or drowsiness. *Orbital cellulitis* * Orbital cellulitis presents with **pain, swelling, redness, and warmth around the eye,** often with proptosis and ophthalmoplegia. * While it is a serious infection, the primary swelling in this case is described in the **frontal region**, not specifically confined to the orbit, and the specific feature of a "boggy" swelling over bone is more indicative of a frontal bone osteomyelitis. *Cavernous sinus thrombosis* * Cavernous sinus thrombosis is characterized by **headache, painful ophthalmoplegia, proptosis, and vision loss**, often with fever and altered mental status. * While **drowsiness** can be a feature, the presentation lacks the prominent **orbital signs** and localizing frontal boggy swelling specific to the described case; instead, it would typically present predominantly with signs related to cranial nerve involvement and venous congestion of the orbit.

Question 1

A 15-year-old female presents with nasal obstruction and occasional profuse epistaxis for last 8 weeks. Nasal speculum view and histopathology of resected lesion is given. All are correct about the diagnosis except:

Accepted Answer

Best cultured on nasal inoculation in hamster

Answer

Multiple fungal spherules embedded in stroma of connective tissue

Answer

Infection originates from stagnant water

Answer

Surgical excision is best treatment

Question 2

Identify the surgical procedure being performed in the image shown below.

Accepted Answer

Caldwell Luc operation

Answer

Inferior meatal antrostomy

Answer

Proof puncture

Answer

Superior meatal antrostomy

Question 3

All are contraindications to the procedure shown below except:

Accepted Answer

Antral cyst

Answer

Acute maxillary sinusitis

Answer

Fractured maxilla

Answer

Children less than 3 years

Question 4

An 8-year-old boy presents with recurrent episodes of epistaxis. Histopathological specimen of the excised lesion is shown below. All are correct about this condition except:

Accepted Answer

Holman-Miller sign is always present in all cases

Answer

Frog face deformity can occur in advanced cases

Answer

Emergency bleeding can be managed with adrenaline-soaked gauze

Answer

Radkowski stage IIIB involves cavernous sinus extension

Question 5

A 10-year-old child is brought with complaints of daily headache and nasal stuffiness. He also has paroxysms of sneezing daily. Nasal examination shows a lesion as shown in the image. All are true about the condition shown except?

Accepted Answer

Antrochoanal polyp grows towards anterior choana

Answer

Nasal polyp in right nostril

Answer

Stage IV polyp goes up to floor of nose

Answer

Krause nasal snare is used for removal of polyps

Question 6

The volume of the balloons shown in epistaxis balloon is: (Recent NEET Pattern 2016-17)

Accepted Answer

72. (d)

Answer

73. (b)

Answer

74. (b)

Answer

75. (c)

Question 7

The following test is done for the evaluation of:

Accepted Answer

Abnormality of nasal valve

Answer

Cheek tenderness in maxillary sinusitis

Answer

Severity of proptosis

Answer

Skin pinch for dehydration

Question 8

The CT scan of paranasal sinuses shows:

Accepted Answer

Haller cells

Answer

Agger nasi cells

Answer

Onodi cells

Answer

Frontoethmoid cells

Question 9

A 65-year-old lady presents with soft swelling on her left supra-orbital area which she says is always warm to touch. She has been taking Ayurvedic treatment for these swellings for the last 6 months. What is the probable diagnosis?

Accepted Answer

Pott's puffy tumor

Answer

Osteoid osteoma

Answer

Follicular carcinoma thyroid

Answer

Malignant fibrous histiocytoma

Question 10

A patient complains of pain and boggy swelling in the frontal region which is warm and tender. He also complains of drowsiness at times. What is the diagnosis?

Accepted Answer

Pott's puffy tumor

Answer

Pyogenic granuloma

Answer

Orbital cellulitis

Answer

Cavernous sinus thrombosis

Diseases of the Nose and Paranasal Sinuses — MCQs

Diseases of the Nose and Paranasal Sinuses — MCQs

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