Epistaxis — MCQs
Kiesselbach's area does not involve _______.
A 14-year-old child with a history of recurrent nasal bleeding has the endoscopic view provided. What is the investigation of choice?
Most common cause of epistaxis in a 3-year-old child is:
A patient with chronic nasal obstruction underwent a procedure 3 months ago and now presents with recurrent epistaxis, crusting, and the clinical image showing a septal perforation. What procedure was most likely carried out?
Which of the following is NOT typically associated with acute bacterial sinusitis?
Which of the following arteries does NOT contribute to Little's area?
Which of the following is NOT an indication for immediate referral to an ENT specialist in a case of epistaxis?
Most common presentation of adult rhinosporidiosis is?
A boy has developed epistaxis. What is the treatment of choice?
Atrophic dry nasal mucosa, extensive encrustations, and a woody hard external nose are most suggestive of:
Epistaxis Indian Medical PG Practice Questions and MCQs
Question 1: Kiesselbach's area does not involve _______.
- A. Anterior ethmoidal artery
- B. Posterior ethmoidal artery (Correct Answer)
- C. Sphenopalatine artery
- D. Greater palatine artery
Explanation: ***Posterior ethmoidal artery*** - The **posterior ethmoidal artery** typically supplies the posterior and superior aspects of the nasal septum and sinuses, but it does not directly contribute to the vascular network in **Kiesselbach's area**. - Its high-arising origin from the ophthalmic artery and posterior distribution anatomically excludes it from the anterior septal region. *Anterior ethmoidal artery* - The **anterior ethmoidal artery** is a major artery contributing to **Kiesselbach's plexus**, supplying the anterosuperior part of the nasal septum. - It anastomoses with branches from the sphenopalatine and labial arteries in this region. *Sphenopalatine artery* - The **sphenopalatine artery** is a terminal branch of the maxillary artery and its septal branch significantly contributes to the posteroinferior part of **Kiesselbach's plexus**. - It forms anastomoses with the anterior ethmoidal and greater palatine arteries in this vascular hotspot. *Greater palatine artery* - The **greater palatine artery**, a branch of the descending palatine artery, contributes to **Kiesselbach's plexus** by supplying the anteroinferior aspect of the nasal septum. - Its septal branch ascends to anastomose with other arterial branches in the region, forming part of this highly vascularized area.
Question 2: A 14-year-old child with a history of recurrent nasal bleeding has the endoscopic view provided. What is the investigation of choice?
- A. Biopsy
- B. X-ray
- C. FESS (Functional Endoscopic Sinus Surgery)
- D. CECT (Contrast-Enhanced CT) (Correct Answer)
Explanation: ***CECT (Contrast-Enhanced CT)*** - Given the history of recurrent nasal bleeding in an adolescent male suggestive of a **juvenile nasopharyngeal angiofibroma (JNA)**, CECT is the investigation of choice to delineate the tumor's extent, vascularity, and involvement of surrounding structures. - CECT provides crucial information for surgical planning and assessing intracranial extension due to the highly vascular nature of JNAs. *Biopsy* - Biopsy of a suspected angiofibroma is generally **contraindicated** due to the high risk of severe and uncontrolled hemorrhage because the tumor is highly vascular and lacks a true capsule. - The diagnosis of JNA is usually made based on clinical presentation and imaging findings. *X-ray* - **X-rays** (like plain radiographs of the sinuses) offer limited soft tissue detail and are **insufficient** to accurately visualize the extent or vascularity of a nasopharyngeal mass. - They may show some bony erosion but cannot provide the detailed information needed for diagnosis or surgical planning of a JNA. *FESS (Functional Endoscopic Sinus Surgery)* - **FESS** is a **surgical procedure** used for treating chronic sinusitis and other sinonasal conditions, not primarily an investigative tool for a suspected tumor like JNA. - While endoscopy is used for initial visualization, **surgery** is a treatment, and detailed imaging must precede it to understand tumor boundaries.
Question 3: Most common cause of epistaxis in a 3-year-old child is:
- A. Foreign body (Correct Answer)
- B. Nasal polyp
- C. Atrophic rhinitis
- D. Upper respiratory catarrh
Explanation: ***Foreign body*** - Young children, especially around 3 years old, are prone to inserting **foreign bodies** into their nostrils. - This is one of the most important causes of **epistaxis** in this age group, particularly when unilateral or recurrent. - Can mechanically irritate and traumatize the nasal mucosa leading to bleeding. *Upper respiratory catarrh* - **Upper respiratory infections** (common cold) are actually a very frequent cause of epistaxis in children. - However, the bleeding is usually mild and self-limiting, caused by **friable, inflamed nasal mucosa**. - Among the given options and considering clinically significant epistaxis requiring evaluation, foreign body is the more important diagnosis to consider. *Nasal polyp* - **Nasal polyps** are relatively uncommon in young children and are not a frequent cause of epistaxis in this age group. - When they do occur, they are often associated with conditions like **cystic fibrosis** or chronic sinusitis. *Atrophic rhinitis* - **Atrophic rhinitis** is a chronic inflammatory condition characterized by **atrophy of the nasal mucosa** and turbinates. - It is predominantly seen in adults, not typically in a 3-year-old child.
Question 4: A patient with chronic nasal obstruction underwent a procedure 3 months ago and now presents with recurrent epistaxis, crusting, and the clinical image showing a septal perforation. What procedure was most likely carried out?
- A. FESS (Functional Endoscopic Sinus Surgery)
- B. Caldwell-Luc's procedure
- C. Submucosal resection (SMR) (Correct Answer)
- D. Turbinate reduction surgery
Explanation: ***Submucosal resection (SMR)*** - **SMR** involves removing cartilage or bone from the nasal septum while preserving the septal mucosa. If both mucosal flaps are inadvertently damaged or devitalized during the procedure, it can lead to a **septal perforation** as a complication. - The symptoms of **recurrent epistaxis** and **crusting** are classic signs associated with compromised septal integrity and airflow changes due to a septal perforation, which commonly occurs weeks to months after such a procedure. *FESS (Functional Endoscopic Sinus Surgery)* - **FESS** is primarily used to treat chronic sinusitis by opening and ventilating the sinuses; it does not directly involve the nasal septum in a way that typically causes perforation. - While complications are possible, a septal perforation is not a common or direct consequence of FESS, which focuses on ethmoid, maxillary, frontal, or sphenoid sinus drainage pathways. *Caldwell-Luc's procedure* - The **Caldwell-Luc procedure** involves an incision above the canine fossa to access the maxillary sinus. - It is specifically aimed at the maxillary sinus and does not involve surgical manipulation of the nasal septum that would lead to a septal perforation. *Turbinate reduction surgery* - **Turbinate reduction** procedures target the inferior turbinates to improve nasal airflow by reducing their size. - These procedures do not involve the nasal septum itself, so a septal perforation would not be a direct or common complication.
Question 5: Which of the following is NOT typically associated with acute bacterial sinusitis?
- A. Purulent nasal discharge
- B. Epistaxis (Correct Answer)
- C. Facial pain
- D. Fever
Explanation: ***Epistaxis*** - While possible due to **mucosal inflammation** or irritation from forceful blowing, **epistaxis (nosebleeds)** is not considered a typical or primary symptom of acute bacterial sinusitis. - The main symptoms revolve around pressure, discharge, and systemic signs of infection. *Purulent nasal discharge* - This is a hallmark symptom of acute bacterial sinusitis, indicating the presence of **bacterial infection** and inflammation in the sinuses. - The discharge is often thick, colored (yellow, green), and can be accompanied by a **foul odor**. *Facial pain* - **Facial pain** or pressure, especially around the cheeks, forehead, or eyes, is a characteristic symptom stemming from inflammation and fluid accumulation within the **sinus cavities**. - This pain often worsens when bending forward. *Fever* - **Fever** is a systemic sign of infection and is commonly present in acute bacterial sinusitis, especially in more severe cases. - It indicates the body's immune response to the bacterial invasion.
Question 6: Which of the following arteries does NOT contribute to Little's area?
- A. Sphenopalatine artery
- B. Posterior Ethmoidal artery (Correct Answer)
- C. Greater palatine artery
- D. Anterior Ethmoidal artery
Explanation: Posterior Ethmoidal artery - The posterior ethmoidal artery primarily supplies the posterior ethmoidal cells and part of the sphenoid sinus, but it does not contribute to the vascular plexus in Little's area. - Little's area, also known as Kiesselbach's plexus, is formed by anastomoses of several arteries on the anterior nasal septum. Sphenopalatine artery - The sphenopalatine artery, a terminal branch of the maxillary artery, is a major contributor to Little's area through its septal branch. - It supplies a significant portion of the nasal septum and is frequently involved in posterior epistaxis. Greater palatine artery - The greater palatine artery, a branch of the descending palatine artery (from the maxillary artery), enters the nasal cavity through the incisive canal and contributes to Little's area on the nasal septum. - It primarily supplies the hard palate and then anastomoses with other vessels in the anterior nasal septum. Anterior Ethmoidal artery - The anterior ethmoidal artery, a branch of the ophthalmic artery, is a key contributor to Little's area. - It supplies the anterior and middle ethmoidal cells and also contributes to the blood supply of the dura mater.
Question 7: Which of the following is NOT an indication for immediate referral to an ENT specialist in a case of epistaxis?
- A. Uncontrolled bleeding
- B. Suspected nasal tumor
- C. Bleeding despite nasal packing
- D. Mild bleeding resolved with pressure (Correct Answer)
Explanation: ***Mild bleeding resolved with pressure*** - This scenario suggests a **self-limiting epistaxis** episode that responds to standard first-aid measures. - No indication for **ENT specialist intervention**, as the problem has already been successfully managed. *Uncontrolled bleeding* - **Persistent bleeding** despite initial management attempts (e.g., direct pressure, vasoconstrictive sprays) warrants immediate ENT referral. - This indicates a potentially **larger vessel involvement** or an underlying coagulopathy requiring specialized intervention. *Suspected nasal tumor* - **Recurrent or persistent epistaxis**, especially when unilateral or accompanied by other nasal symptoms (e.g., obstruction, pain, anosmia), raises suspicion for a **nasal or sinonasal malignancy**. - An ENT specialist is crucial for thorough evaluation, including **endoscopy and biopsy**, to rule out or diagnose a tumor. *Bleeding despite nasal packing* - If **bleeding persists** or recurs after appropriate nasal packing (anterior or posterior), it signifies a failure of initial specialized management. - This situation requires urgent **ENT assessment** to identify the source and consider more advanced interventions like **cautery or surgical ligation**.
Question 8: Most common presentation of adult rhinosporidiosis is?
- A. Halitosis
- B. Pain
- C. Anosmia
- D. Polypoidal mass (Correct Answer)
Explanation: ***Polypoidal mass*** - The most common presentation of adult rhinosporidiosis is a **friable, reddish, polypoidal or sessile mass** in the nasal cavity. - These masses are often described as having a **strawberry-like appearance** due to multiple white dots, which are sporangia. *Halitosis* - While rhinosporidiosis can cause symptoms like **nasal obstruction** and discharge, **fetid breath (halitosis)** is not typically the primary or most common presentation. - Halitosis is more commonly associated with other dental or systemic issues, or with severe secondary infections. *Pain* - **Pain is rare** in rhinosporidiosis unless there is significant secondary infection or involvement of adjacent structures. - The lesions are generally asymptomatic until they cause mechanical obstruction or bleeding. *Anosmia* - **Anosmia (loss of smell)** can occur due to mechanical obstruction of the nasal passages by the polypoidal mass. - However, it is a **secondary symptom** resulting from the mass effect, not the most common initial or direct presentation of the disease itself.
Question 9: A boy has developed epistaxis. What is the treatment of choice?
- A. Cauterization of vessels
- B. Surgical ligation
- C. Digital pressure (Correct Answer)
- D. Nasal packing
Explanation: ***Digital pressure*** - This is the **initial and most common first-line treatment** for acute epistaxis, especially in children, as most nosebleeds originate from Kiesselbach's plexus in the anterior septum. - Applying firm, continuous pressure to the soft part of the nose for 10-15 minutes can effectively compress the bleeding vessels and promote clot formation. *Cauterization of vessels* - This method is used when **digital pressure fails** to control the bleeding and the bleeding site can be identified, often in the anterior septum. - It involves using chemical (e.g., silver nitrate) or electrical methods to seal the bleeding vessel. *Surgical ligation* - **Surgical ligation** is reserved for severe, posterior epistaxis that is refractory to other methods like nasal packing or embolization. - It involves surgically tying off the major arteries supplying the nose (e.g., internal maxillary, external carotid) and carries greater risks. *Nasal packing* - **Nasal packing** is typically used when direct pressure has failed, and the bleeding site is not easily amenable to cauterization, or in cases of posterior epistaxis. - It involves inserting material into the nasal cavity to apply direct pressure to the bleeding vessel, but it is more invasive and uncomfortable than digital pressure.
Question 10: Atrophic dry nasal mucosa, extensive encrustations, and a woody hard external nose are most suggestive of:
- A. Bacteroides
- B. Staphylococcus aureus
- C. Peptostreptococcus
- D. Klebsiella pneumoniae (Correct Answer)
Explanation: ***Klebsiella pneumoniae*** - This constellation of symptoms—**atrophic dry nasal mucosa**, **extensive encrustations**, and a **woody hard external nose**—is characteristic of **primary atrophic rhinitis (ozena)** caused by *Klebsiella pneumoniae* subspecies *ozaenae*. - **Ozena** presents with the classic triad of **progressive nasal mucosal atrophy**, **foul-smelling greenish crusts**, and **anosmia** due to destruction of olfactory epithelium. - The **woody hard external nose** suggests either advanced ozena with fibrosis or **rhinoscleroma** (caused by *Klebsiella rhinoscleromatis*), both of which are Klebsiella-related chronic granulomatous conditions. - *K. pneumoniae* subspecies *ozaenae* is the **classic etiological agent** for this severe destructive form of atrophic rhinitis. *Staphylococcus aureus* - *S. aureus* causes **rhinitis sicca anterior** (anterior nasal vestibulitis), characterized by crusting and inflammation **limited to the anterior nasal vestibule**. - Unlike ozena, S. aureus infection does **not cause progressive atrophy** of the entire nasal mucosa or the extensive encrustations throughout the nasal cavity described here. - The **woody hard external nose** is not a feature of staphylococcal nasal infections, which remain superficial. *Peptostreptococcus* - **Peptostreptococcus** species are anaerobic bacteria typically involved in **polymicrobial infections** such as chronic sinusitis, dental abscesses, or deep neck space infections. - They are **not primary pathogens** in chronic atrophic rhinitis and do not cause the specific progressive nasal atrophy and external nasal changes described. *Bacteroides* - **Bacteroides** species are obligate anaerobes that are part of the normal gut flora and commonly cause **intra-abdominal infections** and abscesses. - They are **not associated** with chronic rhinitis, nasal mucosal atrophy, or the external nasal deformities characteristic of ozena or rhinoscleroma.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free