Which of the following is not a feature of ethmoidal polyp?
All of the following are treatments for multiple bilateral ethmoidal polyps except which of the following?
What is the treatment of choice for ethmoidal polyps?
The artery which leads to bleeding in Woodruff's area is?
Intrathecal fluorescein with endoscopic visualization is useful in diagnosis of?
All of the following are causes of perforation of the cartilaginous part of the nasal septum except?
Which of the following statements about malignant otitis externa is true?
Which of the following is NOT a feature of a nasal foreign body?
All of the following are true about nasal myiasis except which of the following?
Which of the following is not typically associated with enlarged adenoids?
NEET-PG 2015 - ENT NEET-PG Practice Questions and MCQs
Question 11: Which of the following is not a feature of ethmoidal polyp?
- A. Common in adults
- B. Commonly bilateral
- C. Associated with chronic rhinosinusitis
- D. Commonly found as a single polyp (Correct Answer)
Explanation: ***Commonly found as a single polyp*** - **Ethmoidal polyps** are typically **multiple** and bilateral, originating from the ethmoid sinuses. - They rarely present as a single, isolated polyp, which is more characteristic of antrochoanal polyps. - This is the key distinguishing feature that makes this statement INCORRECT. *Common in adults* - **Ethmoidal polyps** are indeed **more prevalent in adults** than in children. - Peak incidence occurs between 30-50 years of age. - Their incidence tends to increase with age, often associated with chronic rhinosinusitis. *Commonly bilateral* - **Ethmoidal polyps** almost invariably present as **bilateral polyps**, involving both sides of the nasal cavity. - This bilateral nature is a key differentiating feature from antrochoanal polyps, which are typically unilateral. - Bilateral presentation is one of the hallmark characteristics of ethmoidal polyps. *Associated with chronic rhinosinusitis* - **Ethmoidal polyps** are strongly associated with **chronic rhinosinusitis with nasal polyposis (CRSwNP)**. - They arise from chronic mucosal inflammation of the ethmoid sinuses. - Often associated with conditions like aspirin-exacerbated respiratory disease (AERD/Samter's triad) and non-allergic eosinophilic inflammation.
Question 12: All of the following are treatments for multiple bilateral ethmoidal polyps except which of the following?
- A. Intranasal ethmoidectomy
- B. Extranasal ethmoidectomy
- C. Caldwell Luc Surgery (Correct Answer)
- D. Functional endoscopic sinus surgery
Explanation: ***Caldwell Luc Surgery*** - This procedure accesses the **maxillary sinus** through an incision in the gingivobuccal sulcus, primarily used for maxillary sinus pathology. - It is **not the primary treatment** for ethmoidal polyps, which are located in the ethmoid sinuses. *Intranasal ethmoidectomy* - This is a common and effective surgical approach to remove ethmoidal polyps, involving access through the **nostrils**. - It allows for direct visualization and removal of polyps within the ethmoid labyrinth. *Extranasal ethmoidectomy* - This surgical approach involves an external incision (e.g., Lynch-Howarth incision) to access the ethmoid sinuses. - It is typically reserved for **extensive or complicated ethmoid disease** or in cases where intranasal approaches are insufficient. *Functional endoscopic sinus surgery* - This is the **gold standard** for treating chronic rhinosinusitis with polyps, including ethmoidal polyps. - It uses an endoscope to visualize and remove polyps while preserving healthy mucosa and restoring normal sinus drainage and ventilation.
Question 13: What is the treatment of choice for ethmoidal polyps?
- A. Functional Endoscopic sinus surgery with polypectomy (Correct Answer)
- B. Intranasal ethmoidectomy
- C. Transantral ethmoidectomy
- D. Extranasal ethmoidectomy
Explanation: ***Functional Endoscopic sinus surgery with polypectomy*** - This is the **gold standard treatment** for ethmoidal polyps, as it allows for **direct visualization** and complete removal of polyps while preserving healthy mucosa. - It also enables restoration of normal sinus ventilation and drainage, which helps prevent recurrence. *Intranasal ethmoidectomy* - This is an **older technique** that is performed blindly and carries a higher risk of complications, such as **orbital or intracranial injury**, compared to endoscopic approaches. - It often results in incomplete polyp removal, leading to a higher rate of recurrence. *Transantral ethmoidectomy* - This approach, also known as the **Caldwell-Luc procedure**, is primarily used for diseases of the **maxillary sinus** and is not the preferred method for isolated ethmoidal polyps. - It is a more invasive external approach with risks including facial swelling, pain, and damage to dental nerves. *Extranasal ethmoidectomy* - This is a more invasive **external approach** involving an incision on the face and is generally reserved for extensive or complicated cases, such as **tumors or severe trauma**, not for routine polyp removal. - It carries risks of visible scarring and longer recovery times, making it less favorable than endoscopic techniques.
Question 14: The artery which leads to bleeding in Woodruff's area is?
- A. Anterior ethmoidal artery
- B. Sphenopalatine artery (Correct Answer)
- C. Greater palatine artery
- D. Superior labial artery
Explanation: ***Sphenopalatine artery*** - **Woodruff's area** is located on the posterior lateral wall of the nasal cavity, specifically a plexus of veins and arteries inferior to the posterior end of the inferior turbinate. - Bleeding from this region, often associated with **posterior epistaxis**, typically involves branches of the **sphenopalatine artery**. *Anterior ethmoidal artery* - The **anterior ethmoidal artery** is primarily involved in **anterior epistaxis**, supplying Kiesselbach's plexus on the nasal septum. - It does not contribute significantly to bleeding from Woodruff's area on the posterior lateral wall. *Greater palatine artery* - The **greater palatine artery** supplies the hard and soft palate and a small portion of the nasal floor. - It is not a major contributor to bleeding in Woodruff's area, which is located more superiorly and posteriorly on the lateral nasal wall. *Superior labial artery* - The **superior labial artery** is a branch of the facial artery, primarily supplying the upper lip and philtrum. - While it contributes to the vascular supply of the anterior nasal septum, it is not involved in bleeding from Woodruff's area.
Question 15: Intrathecal fluorescein with endoscopic visualization is useful in diagnosis of?
- A. Rhinitis Medicamentosa
- B. Multiple ethmoidal polyps
- C. Diagnosis of CSF Rhinorrhoea (Correct Answer)
- D. Deviated nasal septum
Explanation: ***Diagnosis of CSF Rhinorrhoea*** - **Intrathecal fluorescein** is instilled into the cerebrospinal fluid, and its presence in the nasal cavity via endoscopy confirms a **CSF leak**. - This method provides direct visualization of the leak site, which is crucial for surgical planning. *Rhinitis Medicamentosa* - This condition is caused by overuse of **topical decongestants** and characterized by nasal congestion, not a CSF leak. - Diagnosis is typically based on patient history and clinical examination rather than specialized imaging or dye studies. *Multiple ethmoidal polyps* - **Ethmoidal polyps** are benign growths in the ethmoid sinuses, causing nasal obstruction and anosmia. - Diagnosis is made via nasal endoscopy and CT scan, and fluorescein staining is not indicated. *Deviated nasal septum* - A **deviated nasal septum** is a structural abnormality causing unilateral or bilateral nasal obstruction. - Diagnosis is clinical and confirmed by anterior rhinoscopy or nasal endoscopy, with no role for intrathecal fluorescein.
Question 16: All of the following are causes of perforation of the cartilaginous part of the nasal septum except?
- A. Tuberculosis
- B. Leprosy
- C. Trauma
- D. Syphilis (Correct Answer)
Explanation: ***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.
Question 17: Which of the following statements about malignant otitis externa is true?
- A. Not painful
- B. Common in diabetics and old age (Correct Answer)
- C. Caused by streptococcus
- D. Responds to topical antibiotics alone
Explanation: ***Common in diabetics and old age*** - **Malignant otitis externa** is an aggressive infection primarily affecting the external auditory canal and surrounding structures. - It most commonly occurs in **immunocompromised individuals**, especially **elderly diabetics**, due to impaired immune response and microvascular complications. *Not painful* - Malignant otitis externa is characterized by **severe, unrelenting otalgia (ear pain)** that often worsens at night and is disproportionate to the clinical findings. - The pain is due to the **inflammatory and destructive process** involving cartilage, bone, and nerves. *Caused by streptococcus* - The most common causative organism for malignant otitis externa is **Pseudomonas aeruginosa** (>90% of cases), not Streptococcus. - **Streptococcus species** are more commonly associated with acute otitis media or common skin infections. *Responds to topical antibiotics alone* - Malignant otitis externa requires **prolonged systemic antibiotic therapy** (typically 4-6 weeks of intravenous or oral fluoroquinolones like ciprofloxacin). - Topical antibiotics alone are **insufficient** due to the invasive nature of the infection, which extends beyond the external canal to involve bone and soft tissues.
Question 18: Which of the following is NOT a feature of a nasal foreign body?
- A. Deviated septum (Correct Answer)
- B. Epistaxis
- C. Nasal obstruction
- D. Vestibulitis
Explanation: ***Deviated septum*** - A **deviated septum** is an anatomical variation of the nasal septum which causes **nasal obstruction** but is not a symptom or complication resulting from a **nasal foreign body**. - It is a structural abnormality that is usually congenital or due to trauma, unrelated to the presence of an object. *Vestibulitis* - **Nasal vestibulitis** can develop as a secondary infection or inflammation around a foreign body due to irritation or bacterial growth. - The constant presence and irritation from the foreign object in the nasal cavity can lead to inflammation and infection of the nasal vestibule. *Epistaxis* - **Epistaxis** (nosebleed) is a common symptom of a nasal foreign body, especially if the object is sharp, causes trauma, or leads to significant irritation of the nasal mucosa. - The foreign body can directly traumatize the blood vessels in the nasal lining, leading to bleeding. *Nasal obstruction* - A **nasal foreign body** will physically block the nasal passage, leading to symptoms of **nasal obstruction**, often unilateral, depending on the size and location of the object. - This is one of the most direct and immediate symptoms caused by the presence of an object within the nasal cavity.
Question 19: All of the following are true about nasal myiasis except which of the following?
- A. Common in vasomotor rhinitis
- B. Nasal myiasis can cause intense nasal irritation.
- C. Meningitis may occur in severe nasal myiasis.
- D. Nasal myiasis is typically asymptomatic (Correct Answer)
Explanation: ***Nasal myiasis is typically asymptomatic*** - This statement is **INCORRECT** and is the correct answer to this "except" question. - **Nasal myiasis** is characterized by infestation of the nasal cavity with **fly larvae (maggots)**, which typically causes **significant symptoms** rather than being asymptomatic. - Patients usually experience **nasal obstruction**, **epistaxis (nosebleeds)**, **foul-smelling nasal discharge**, **intense irritation**, and a sensation of movement in the nose due to the feeding and movement of the larvae. - The condition is rarely asymptomatic and usually prompts patients to seek medical attention due to the distressing symptoms. *Common in vasomotor rhinitis* - This statement is **INCORRECT** as a factual claim about myiasis. Nasal myiasis is **NOT** commonly associated with vasomotor rhinitis. - Nasal myiasis is more commonly associated with **atrophic rhinitis**, **ozena**, neglected nasal wounds, poor hygiene, open mouth breathing during sleep, and immunosuppression. - **Vasomotor rhinitis** is a non-allergic condition characterized by fluctuating nasal congestion, rhinorrhea, and sneezing, without any direct association with parasitic infestations. - However, this option may cause confusion as it could also be considered false. The most clearly false statement is that myiasis is "typically asymptomatic." *Nasal myiasis can cause intense nasal irritation* - This statement is **TRUE**. The presence and movement of **maggots** within the nasal cavity leads to severe **irritation**, pain, and a foreign body sensation. - The feeding activity of the larvae causes **tissue destruction**, mucosal damage, and secondary bacterial infections, intensifying discomfort. - Patients often describe a crawling sensation and severe itching in the nasal cavity. *Meningitis may occur in severe nasal myiasis* - This statement is **TRUE**. In advanced or neglected cases, the **larvae** can erode through the nasal structures, sinuses, and skull base, potentially breaching the **meninges**. - This invasion can result in serious intracranial complications such as **meningitis**, **brain abscess**, **cavernous sinus thrombosis**, or other central nervous system infections. - These complications are life-threatening and require urgent surgical debridement and antimicrobial therapy.
Question 20: Which of the following is not typically associated with enlarged adenoids?
- A. Otitis media
- B. Nasal obstruction
- C. Failure to thrive of child
- D. Esophagitis (Correct Answer)
Explanation: ***Esophagitis*** - **Enlarged adenoids** are localized to the **nasopharynx** and do not directly impact the esophagus, making esophagitis an unlikely direct complication. - While chronic mouth breathing from enlarged adenoids can lead to **dry mouth**, it is not a direct cause of esophageal inflammation. *Otitis media* - Enlarged adenoids can obstruct the **eustachian tubes**, which connect the middle ear to the nasopharynx, predisposing to **recurrent acute otitis media** or **otitis media with effusion**. - This obstruction impairs middle ear ventilation and drainage, facilitating bacterial growth and inflammation. *Nasal obstruction* - Enlarged adenoids directly block the **nasopharyngeal airway**, leading to chronic **nasal obstruction** and obligate mouth breathing. - This can cause symptoms like snoring, sleep-disordered breathing, and a characteristic "adenoid facies." *Failure to thrive of child* - **Severe nasal obstruction** from enlarged adenoids can disrupt feeding, particularly in infants, as they must breathe through their mouths while attempting to feed. - This compromised feeding, along with **sleep apnea**, increases energy expenditure and can collectively contribute to **failure to thrive**.