Diseases of the Nose and Paranasal Sinuses Practice Questions

Q: All of the following are causes of perforation of the cartilaginous part of the nasal septum except?

Syphilis. ***Syphilis*** - **Syphilis** typically causes perforation of the **bony part** of the nasal septum, particularly the vomer and perpendicular plate of the ethmoid bone, due to chronic granulomatous inflammation. - The cartilaginous septum is generally less affected by syphilis in terms of perforation, although early mucosal involvement can occur. *Trauma* - **Trauma** (e.g., nose picking, septal surgery, foreign body insertion) is a common cause of **perforation of the cartilaginous nasal septum**. - Such injuries can lead to localized necrosis and subsequent perforation due to disruption of the blood supply to the septal cartilage. *Tuberculosis* - **Tuberculosis** can cause **granulomatous inflammation** and necrosis, leading to perforation of the **cartilaginous nasal septum**. - This is part of extrapulmonary tuberculosis and can present with chronic nasal obstruction and discharge. *Leprosy* - **Leprosy** (Hansen's disease) is known to cause severe destruction of nasal structures due to chronic inflammation, including perforation of the **cartilaginous nasal septum**. - The specific bacteria cause granulomatous lesions that erode the cartilage over time.

Q: Which of the following statements about vasomotor rhinitis is false?

It is an infective condition. ***It is an infective condition*** - **Vasomotor rhinitis** is a **non-allergic, non-infectious** condition of the nasal passages. - Its pathophysiology involves **autonomic nervous system dysfunction** affecting nasal blood vessels, not microbial infection. *It primarily presents with nasal congestion and rhinorrhea* - This statement is **true** because classic symptoms of vasomotor rhinitis include persistent or intermittent **nasal congestion** and **rhinorrhea** (runny nose). - These symptoms result from the dysregulation of the autonomic control over nasal vasculature and glands. *It involves autonomic dysfunction of nasal blood vessels* - This statement is **true** and describes the core mechanism of vasomotor rhinitis, where the **parasympathetic nervous system** is relatively overactive, leading to vasodilation and increased glandular secretions. - This dysfunction causes the characteristic symptoms without an allergic or infectious trigger. *It is triggered by non-allergic stimuli like weather changes and strong odors* - This statement is **true** as patients with vasomotor rhinitis often report symptoms triggered by **environmental irritants** such as strong perfumes, temperature changes, humidity fluctuations, or even emotional stress. - These triggers differentiate it clinically from allergic rhinitis.

Q: Which of the following statements about vasomotor rhinitis is NOT true?

It is caused by an allergic reaction. ***It is caused by an allergic reaction.*** - Vasomotor rhinitis, also known as nonallergic rhinitis, is characterized by symptoms similar to allergic rhinitis but is **not mediated by an allergic reaction** or an IgE-mast cell response. - Its etiology is related to the **dysregulation of the autonomic nervous system**, specifically an imbalance in the vascular tone of nasal blood vessels, rather than an allergic trigger. *It is due to parasympathetic overactivity* - **Parasympathetic overactivity** is a recognized underlying mechanism in vasomotor rhinitis, leading to increased vascular permeability and glandular secretion. - This overactivity results in symptoms such as **nasal congestion**, rhinorrhea, and sneezing, mimicking allergic rhinitis without an identifiable allergen. *Resistant cases may need cryotherapy* - For severe and **medically refractory cases** of vasomotor rhinitis, **cryotherapy** (specifically cryoablation of the posterior nasal nerve) can be a treatment option. - This procedure targets the nerves responsible for parasympathetic outflow to the nasal mucosa, thereby reducing symptoms like rhinorrhea and congestion. *It may lead to hypertrophic rhinitis* - Chronic inflammation and vascular engorgement associated with long-standing vasomotor rhinitis can lead to **mucosal hypertrophy**, particularly of the inferior turbinates. - This condition, known as **hypertrophic rhinitis**, can exacerbate nasal obstruction and may require surgical intervention to improve airflow.

Q: What is the treatment of choice for Deviated Nasal Septum (DNS) in adults?

Septoplasty. ***Septoplasty*** - **Septoplasty** is the surgical procedure of choice to correct a deviated nasal septum by **realigning the cartilage and bone** in the septum. - It is performed to improve nasal airflow and address symptoms like **nasal obstruction** or recurrent sinusitis. *Medical management with decongestants* - **Decongestants** provide temporary relief from nasal congestion but do not correct the underlying **anatomical deviation** of the septum. - Prolonged use of decongestants can lead to **rhinitis medicamentosa**, a rebound congestion. *Observation* - **Observation** is not an appropriate long-term solution for symptomatic DNS as the **anatomical deviation** will persist and symptoms are unlikely to improve spontaneously. - Patients with significant symptoms impacting their quality of life require active intervention rather than just monitoring. *Turbinoplasty* - **Turbinoplasty** is a procedure to reduce the size of the **turbinates**, which are bony structures in the nasal cavity that can contribute to nasal obstruction. - While it can be performed concurrently with septoplasty, it does not correct the **deviated septum itself**.

Q: Which of the following is a predisposing factor for nasal myiasis?

Atrophic rhinitis. ***Atrophic rhinitis*** - **Atrophic rhinitis** leads to thinning and drying of the nasal mucosa, creating a favorable environment for **fly larvae (maggots)** to infest. - The **crusting and foul odor** associated with atrophic rhinitis can attract flies, making the nasal cavity susceptible to myiasis. *Allergic rhinitis* - Characterized by **inflammation and watery discharge** due to allergen exposure. It does not create the tissue damage or conducive environment for myiasis. - While it causes nasal symptoms, it generally **does not involve tissue necrosis** or open lesions that would attract flies for oviposition. *Vasomotor rhinitis* - Involves **non-allergic triggers** causing nasal congestion, sneezing, and runny nose, often due to autonomic nervous system dysfunction. - There is **no tissue destruction or mucosal atrophy** that would predispose to myiasis. *Rhinitis medicamentosa* - Results from **overuse of topical decongestant sprays**, leading to rebound congestion and chronic inflammation. - While it causes nasal irritation, it does **not typically involve the extensive mucosal damage or open wounds** that attract flies for myiasis.

Q: Most common sinus to be involved in acute sinusitis?

Maxillary. ***Maxillary*** - The **maxillary sinuses** are the largest paranasal sinuses and are the most commonly involved in acute sinusitis due to their anatomical position and drainage characteristics. - Their ostia (drainage openings) are located on the superior aspect of the sinus, which can make drainage difficult when the patient is upright, leading to stasis of secretions and increased susceptibility to infection. *Ethmoid* - The ethmoid sinuses are a group of small air cells located between the eyes and are the second most commonly infected in sinusitis. - While frequently involved, especially in children, they are not as commonly affected as the maxillary sinuses in the general adult population with acute sinusitis. *Sphenoid* - The sphenoid sinuses are located deep within the skull, behind the eyes, and are the least commonly involved in acute sinusitis. - Inflammation here can be serious due to proximity to important structures like the optic nerves and carotid arteries, but it's not the most frequent site of infection. *Frontal* - The frontal sinuses are located in the forehead and are less commonly involved in acute sinusitis compared to the maxillary and ethmoid sinuses. - Their development is not complete until adolescence, and they are typically drained via the frontonasal duct, which can become easily obstructed.

Q: All are seen in Samters triad except?

Bacterial infection. ***Bacterial infection*** - **Samter's triad**, also known as aspirin-exacerbated respiratory disease (AERD), consists of **asthma**, **nasal polyps**, and **aspirin sensitivity** (or NSAID sensitivity) [1]. - **Bacterial infection** is not a component of Samter's triad, although patients with nasal polyps may be more prone to secondary bacterial sinusitis. *Asthma* - **Asthma** is one of the three main components of Samter's triad, typically becoming more symptomatic after aspirin ingestion [1]. - Patients experience **bronchoconstriction** and worsening respiratory symptoms. *Nasal polyp* - **Nasal polyps** are a characteristic feature of Samter's triad, often extensive and recurrent [1]. - They contribute to nasal obstruction and chronic rhinosinusitis. *Aspirin sensitivity* - **Aspirin sensitivity** (or NSAID sensitivity) is the third key component, where ingestion of aspirin or other NSAIDs triggers severe respiratory reactions [1]. - This sensitivity is due to an abnormal arachidonic acid metabolism pathway involving **leukotrienes**.

Q: All are major symptoms of sinusitis except?

Halitosis. ***Halitosis*** - While **halitosis** (bad breath) can be a symptom associated with sinusitis due to post-nasal drip and bacterial overgrowth, it is generally considered a **minor symptom** or a secondary effect rather than one of the primary, defining features. - Major symptoms focus on those directly caused by inflammation and obstruction of the sinuses. *Nasal blockage* - **Nasal blockage** or congestion is a cardinal symptom of sinusitis, resulting from inflammation and swelling of the nasal and sinus mucosa. - It often leads to difficulty breathing through the nose and contributes to a feeling of fullness. *Facial congestion* - **Facial congestion** or pressure is a key symptom of sinusitis, caused by the buildup of fluid and inflammation within the sinus cavities. - This symptom can manifest as pain or pressure around the eyes, cheeks, and forehead. *Anosmia* - **Anosmia**, or the loss of smell, is a significant symptom of sinusitis, particularly chronic sinusitis. - It occurs due to the inflammation and obstruction of the nasal passages, preventing odorants from reaching the olfactory receptors.

Q: What imaging study is typically required before endoscopic sinus surgery?

CT of PNS. ***CT of PNS*** - A **CT scan of the paranasal sinuses** is crucial prior to endoscopic sinus surgery for detailed anatomical mapping. - It helps identify **key anatomical landmarks**, variations, and the extent of disease, minimizing surgical risks. *MRI of paranasal sinus* - **MRI** is generally reserved for evaluating **soft tissue abnormalities**, such as tumors, fungal infections, or intracranial extension. - It provides less detail regarding **bony anatomy** and is not the primary imaging modality for surgical planning in routine cases. *Mucociliary clearing testing* - **Mucociliary clearing tests** assess the function of the **mucociliary escalator** in the nasal cavity and sinuses. - These tests are primarily diagnostic for conditions like **primary ciliary dyskinesia** and do not provide anatomical detail for surgical guidance. *Acoustic tests* - **Acoustic tests** are typically used to assess **hearing function** in the ear. - They have **no relevance** to the anatomical evaluation of the paranasal sinuses or planning for endoscopic sinus surgery.

Question 1

All of the following are causes of perforation of the cartilaginous part of the nasal septum except?

Accepted Answer

Syphilis

Answer

Tuberculosis

Answer

Leprosy

Answer

Trauma

Question 2

Which of the following statements about vasomotor rhinitis is false?

Accepted Answer

It is an infective condition

Answer

It primarily presents with nasal congestion and rhinorrhea

Answer

It involves autonomic dysfunction of nasal blood vessels

Answer

It is triggered by non-allergic stimuli like weather changes and strong odors

Question 3

All of the following are true about nasal myiasis except which of the following?

Accepted Answer

Nasal myiasis is typically asymptomatic

Answer

Common in vasomotor rhinitis

Answer

Nasal myiasis can cause intense nasal irritation.

Answer

Meningitis may occur in severe nasal myiasis.

Question 4

Which of the following statements about vasomotor rhinitis is NOT true?

Accepted Answer

It is caused by an allergic reaction

Answer

It is due to parasympathetic overactivity

Answer

Resistant cases may need cryotherapy

Answer

It may lead to hypertrophic rhinitis

Question 5

What is the treatment of choice for Deviated Nasal Septum (DNS) in adults?

Accepted Answer

Septoplasty

Answer

Medical management with decongestants

Answer

Observation

Answer

Turbinoplasty

Question 6

Which of the following is a predisposing factor for nasal myiasis?

Accepted Answer

Atrophic rhinitis

Answer

Allergic rhinitis

Answer

Vasomotor rhinitis

Answer

Rhinitis medicamentosa

Question 7

Most common sinus to be involved in acute sinusitis?

Accepted Answer

Maxillary

Answer

Ethmoid

Answer

Sphenoid

Answer

Frontal

Question 8

All are seen in Samters triad except?

Accepted Answer

Bacterial infection

Answer

Nasal polyp

Answer

Aspirin sensitivity

Answer

Asthma

Question 9

All are major symptoms of sinusitis except?

Accepted Answer

Halitosis

Answer

Nasal blockage

Answer

Facial congestion

Answer

Anosmia

Question 10

What imaging study is typically required before endoscopic sinus surgery?

Accepted Answer

CT of PNS

Answer

MRI of paranasal sinus

Answer

Acoustic tests

Answer

Mucociliary clearing testing

Diseases of the Nose and Paranasal Sinuses — MCQs

Diseases of the Nose and Paranasal Sinuses — MCQs

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