NEET-PG 2013 - ENT Practice Questions

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: Posterior epistaxis occurs from:

Woodruff's plexus. ***Woodruff's plexus*** - **Woodruff's plexus** is a collection of large, often friable veins located on the **posterior aspect of the lateral wall of the nasal cavity**, making it the most common anatomical site for **posterior epistaxis**. - Bleeding from this plexus is typically more severe and difficult to control than anterior epistaxis due to the larger vessel size and posterior location. - Located in the **posterolateral nasal cavity** near the posterior end of the inferior turbinate. *Kiesselbach's plexus* - **Kiesselbach's plexus** (also known as Little's area) is located on the **anterior nasal septum** and is the most common site for **anterior epistaxis**. - This is an anastomotic network of vessels from multiple arterial sources in the anterior nasal cavity. - Bleeding from this plexus is usually less severe and often responds to local pressure or cauterization. *Sphenopalatine artery* - The **sphenopalatine artery** is the terminal branch of the maxillary artery and is the primary arterial supply to the posterior nasal cavity. - While it supplies the area where posterior epistaxis occurs, the venous **Woodruff's plexus** is the specific anatomical structure most commonly associated with posterior epistaxis. - The sphenopalatine artery may require ligation or embolization in severe posterior epistaxis cases. *Little's area* - **Little's area** is another name for **Kiesselbach's plexus** and is located on the **anterior nasal septum**, primarily responsible for anterior epistaxis. - This area is highly vascularized by anastomoses of the anterior ethmoidal, sphenopalatine, greater palatine, superior labial, and septal branches of arteries. - Prone to bleeding from minor trauma, digital manipulation, or mucosal dryness.

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: In which condition is mulberry nasal mucosa typically observed?

Lupus vulgaris. ***Lupus vulgaris*** - **Mulberry nasal mucosa** is a **pathognomonic finding** in **lupus vulgaris**, a form of cutaneous tuberculosis affecting the nasal mucosa. - The mucosa shows characteristic **reddish-brown, soft nodules** that resemble mulberries, with a typical **apple-jelly appearance on diascopy**. - Lesions are **persistent, slowly progressive**, and may cause destruction of the nasal cartilage if untreated. *Vasomotor rhinitis* - **Vasomotor rhinitis** (non-allergic rhinitis) presents with **pale, bluish, or boggy nasal mucosa**, not the mulberry appearance. - Caused by **autonomic nervous system dysregulation**, leading to nasal congestion and rhinorrhea triggered by non-allergic stimuli. - The mucosal changes are **diffusely edematous** rather than nodular. *Atrophic rhinitis* - **Atrophic rhinitis** involves progressive atrophy of the nasal mucosa and underlying bone. - Mucosa appears **pale, dry, smooth, and shiny** with thick crusts (ozena in secondary form). - Wide nasal cavities with paradoxical nasal obstruction, **not mulberry-like nodular changes**. *Allergic rhinitis* - **Allergic rhinitis** typically shows **pale, edematous, bluish-gray mucosa** with watery discharge. - Caused by **IgE-mediated hypersensitivity** to environmental allergens. - Mucosa may appear **boggy but not nodular or mulberry-like**.

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.

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 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 is the investigation of choice for nasopharyngeal angiofibroma?

Contrast-enhanced CT. ***Contrast-enhanced CT*** - A **contrast-enhanced CT** scan is the investigation of choice for **nasopharyngeal angiofibroma** due to its ability to clearly delineate the extent of the tumor, its vascularity, and its bony involvement. - The contrast highlights the **highly vascular nature** of the angiofibroma, which is crucial for surgical planning and embolization. *X-ray* - **X-rays** provide limited detail of soft tissue structures and mass lesions in the complex anatomy of the nasopharynx. - They are generally not sensitive enough to characterize a tumor like **angiofibroma** or determine its exact extent. *Plain CT* - A **plain CT** (non-contrast CT) can show soft tissue masses and bony erosion but lacks the ability to assess the **vascularity** of the tumor. - Without contrast, it's difficult to differentiate the tumor from surrounding tissues or identify its blood supply, which is critical for **angiofibroma** management. *MRI* - While **MRI** offers excellent soft tissue contrast and is valuable for assessing intracranial extension or perineural spread, **contrast-enhanced CT** is generally preferred as the primary imaging modality for angiofibroma. - **CT with contrast** is superior for demonstrating **bony erosion** and the characteristic **vascularity** of this tumor.

Q: What is the characteristic feature of ethmoidal polyps?

Typically recurrent. ***Typically recurrent*** - Ethmoidal polyps, especially those associated with **chronic rhinosinusitis** with nasal polyps, have a high tendency to **recur** even after surgical removal. - This recurrence is due to the underlying inflammatory process in the ethmoid sinuses and represents their most characteristic clinical feature. - Recurrence rates can reach **20-30%** even after functional endoscopic sinus surgery (FESS). *Usually multiple* - While ethmoidal polyps are often **multiple**, this is a common descriptive feature rather than their most characteristic pathological tendency. - Their multiplicity contributes to nasal obstruction and other symptoms but does not distinguish them as uniquely as their recurrence rate. *Can occur in children* - Though less common than in adults, **ethmoidal polyps can occur in children**, particularly in association with conditions like cystic fibrosis or primary ciliary dyskinesia. - However, nasal polyps in children are **rare** and should prompt investigation for underlying systemic conditions. *Can be associated with infections* - While chronic rhinosinusitis with polyps can be complicated by **bacterial infections**, the polyps themselves are primarily an inflammatory response, not directly caused by infections in most cases of ethmoidal polyps. - Their primary association is with chronic inflammation and not solely with acute or chronic infections.

Question 1

All are seen in Samters triad except?

Accepted Answer

Bacterial infection

Answer

Nasal polyp

Answer

Aspirin sensitivity

Answer

Asthma

Question 2

Posterior epistaxis occurs from:

Accepted Answer

Woodruff's plexus

Answer

Kiesselbach's plexus

Answer

Sphenopalatine artery

Answer

Little's area

Question 3

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 4

In which condition is mulberry nasal mucosa typically observed?

Accepted Answer

Lupus vulgaris

Answer

Vasomotor rhinitis

Answer

Atrophic rhinitis

Answer

Allergic rhinitis

Question 5

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

Question 6

Most common sinus to be involved in acute sinusitis?

Accepted Answer

Maxillary

Answer

Ethmoid

Answer

Sphenoid

Answer

Frontal

Question 7

All are major symptoms of sinusitis except?

Accepted Answer

Halitosis

Answer

Nasal blockage

Answer

Facial congestion

Answer

Anosmia

Question 8

What is the investigation of choice for nasopharyngeal angiofibroma?

Accepted Answer

Contrast-enhanced CT

Answer

Plain CT

Answer

X-ray

Answer

MRI

Question 9

What is the characteristic feature of ethmoidal polyps?

Accepted Answer

Typically recurrent

Answer

Usually multiple

Answer

Can occur in children

Answer

Can be associated with infections

Question 10

Which of the following statements about acute retropharyngeal abscess is true?

Accepted Answer

Acute retropharyngeal abscess is often due to lymphadenitis.

Answer

Treatment often involves incision and drainage.

Answer

Acute retropharyngeal abscess is common in adults.

Answer

Swelling typically occurs unilaterally.

NEET-PG 2013 — ENT