Diseases of the Nose and Paranasal Sinuses Practice Questions

Q: The nasal mucosa is supplied by which artery?

Mainly the external carotid artery. The blood supply to the nasal mucosa is derived from both the **Internal Carotid Artery (ICA)** and the **External Carotid Artery (ECA)** systems. However, the ECA provides the vast majority of the blood flow. ### Why Option C is Correct The nasal cavity receives a dual blood supply, but the **External Carotid Artery** is the primary contributor through its major branches: 1. **Sphenopalatine Artery:** A branch of the Maxillary artery (ECA). Known as the **"Artery of Epistaxis,"** it supplies most of the posterior part of the nasal septum and lateral wall. 2. **Greater Palatine Artery:** Also from the Maxillary artery (ECA). 3. **Superior Labial Artery:** A branch of the Facial artery (ECA). ### Why Other Options are Incorrect * **Options A & B:** These are incorrect because the supply is not exclusive. The ICA contributes via the **Ophthalmic artery**, which gives off the **Anterior and Posterior Ethmoidal arteries**. These supply the roof and upper part of the nasal cavity. * **Option D:** While the ICA supply is clinically significant (especially in ethmoidal surgeries), it is quantitatively much smaller than the extensive network provided by the ECA branches. ### High-Yield Clinical Pearls for NEET-PG * **Little’s Area (Kiesselbach’s Plexus):** Located on the anteroinferior part of the nasal septum, this is the most common site for epistaxis. It is an anastomosis of four arteries: **S**phenopalatine, **A**nterior Ethmoidal, **G**reater Palatine, and **S**uperior Labial (**Mnemonic: SAGS**). * **Woodruff’s Plexus:** Located posteriorly, below the posterior end of the inferior turbinate. Bleeding here is usually from the Sphenopalatine artery and is more common in elderly/hypertensive patients. * **Surgical Note:** In cases of severe, uncontrollable epistaxis, the **Maxillary artery** (ECA branch) or the **External Carotid Artery** itself may be ligated. Note that the ICA is never ligated for epistaxis.

Q: In a 60-year-old adult, which of the following diseases causes expansile maxillary lesions?

Paget's disease. **Explanation:** The correct answer is **Paget’s Disease (Osteitis Deformans)**. In Paget’s disease, there is a localized disorder of bone remodeling characterized by excessive bone resorption followed by disorganized and excessive bone formation. In the head and neck, it commonly affects the skull and the maxilla. In an **elderly patient (typically >50-60 years)**, Paget’s disease is a classic cause of progressive, painless, bilateral **expansile enlargement of the maxilla**. This often leads to a "lion-like" facial appearance (leontiasis ossea) and causes widening of the alveolar ridges, resulting in ill-fitting dentures—a classic clinical sign in NEET-PG questions. **Why other options are incorrect:** * **Acromegaly:** While it causes bony overgrowth due to excess Growth Hormone, it primarily affects the **mandible** (prognathism) and the frontal bone (frontal bossing), rather than causing isolated expansile maxillary lesions. * **Fibrous Dysplasia:** This also causes expansile bone lesions where normal bone is replaced by fibrous tissue. However, it is primarily a disease of the **young (children and adolescents)**. In a 60-year-old, Paget’s is statistically and clinically more probable. * **Rickets:** This is a disease of vitamin D deficiency in **children** leading to soft bones and skeletal deformities; it does not cause expansile maxillary masses in adults. **High-Yield Clinical Pearls for NEET-PG:** * **Paget’s Disease:** Look for "Cotton wool" appearance on X-ray, elevated Serum Alkaline Phosphatase (with normal Calcium/Phosphate), and a risk of malignant transformation to Osteosarcoma (1%). * **Fibrous Dysplasia:** Look for "Ground glass" appearance on CT and "Chinese letter" patterns on histology. * **Maxillary Expansion:** If unilateral and in a younger patient, consider an Antrochoanal polyp or Benign tumors; if bilateral and elderly, think Paget’s.

Q: A patient presents with a nasal polypoidal mass and subcutaneous nodules on the skin. What is the most likely diagnosis?

Rhinosporidiosis. **Explanation:** The correct diagnosis is **Rhinosporidiosis**, a chronic granulomatous infection caused by *Rhinosporidium seeberi*. While primarily known for causing friable, strawberry-like nasal polyps, it can spread hematogenously to involve the skin, presenting as **subcutaneous nodules** or verrucous lesions. This systemic dissemination is a high-yield clinical feature often tested in NEET-PG. **Why the other options are incorrect:** * **Zygomycosis (Mucormycosis):** This is an aggressive, angioinvasive fungal infection typically seen in uncontrolled diabetics. It presents with black eschar, rapid tissue necrosis, and orbital involvement, rather than chronic subcutaneous nodules. * **Sporotrichosis:** Known as "Rose gardener’s disease," it typically presents with a primary skin ulcer and linear lymphocutaneous nodules. While it involves the skin, it rarely presents as a primary nasal polypoidal mass. * **Aspergillosis:** In the nose, this usually presents as a non-invasive fungal ball (mycetoma) or allergic fungal rhinosinusitis (AFRS). It does not typically manifest with subcutaneous skin nodules. **Clinical Pearls for NEET-PG:** * **Causative Agent:** *Rhinosporidium seeberi* (now classified as a Mesomycetozoea, not a true fungus). * **Classic Appearance:** Leaf-like, vascular, "strawberry" polyp with white dots (sporangia) on the surface. * **Histology:** Large, thick-walled **sporangia** containing thousands of **endospores** (diagnostic). * **Epidemiology:** Common in South India (Tamil Nadu, Kerala) and Sri Lanka; associated with bathing in stagnant pond water. * **Treatment:** Wide surgical excision with cautery of the base; **Dapsone** is used to prevent recurrence.

Q: All of the following are true of septoplasty for deviated nasal septum (DNS) except?

Mucoperichondrium is stripped off. ### Explanation **Septoplasty** is a conservative surgical procedure aimed at correcting a deviated nasal septum (DNS) while preserving as much septal framework as possible. **Why Option B is the Correct Answer (The False Statement):** In Septoplasty, the mucoperichondrium/mucoperiosteum is **elevated on only one side** (unilateral flap). The flap on the opposite side is kept intact to maintain the blood supply to the septal cartilage. In contrast, **Submucous Resection (SMR)** involves stripping the mucoperichondrium from **both sides** (bilateral flaps), which increases the risk of septal perforation and "saddle nose" deformity. **Analysis of Other Options:** * **Option A:** DNS causing nasal obstruction, headache (Sluder’s neuralgia), or sinusitis is the primary indication for septoplasty. * **Option C:** It is preferably done after **17–18 years** of age (once mid-facial growth is complete). However, in modern practice, "conservative septoplasty" can be performed in children if the obstruction is severe, though the general rule for exams remains 16–18 years. * **Option D:** Septoplasty is indicated in epistaxis if a septal spur is causing localized drying/crusting or if the deviation prevents access to a bleeding vessel for cauterization. **High-Yield Clinical Pearls for NEET-PG:** * **Killian’s Incision:** Used in SMR (placed 5mm behind the caudal border). * **Freer’s Incision:** Used in Septoplasty (placed at the caudal border/hemitransfixion). * **Cottle’s Operation:** A sophisticated version of septoplasty addressing all four areas of the septum. * **Complication:** The most common complication of septal surgery is a **septal hematoma**, which, if untreated, leads to a septal abscess and subsequent saddle nose deformity.

Q: Which of the following is common about tumors of the Peripheral Nervous System (PNS) and Nasal Cavity?

Melanoma can occur.. ### Explanation **1. Why the Correct Answer is Right:** Mucosal Melanoma is a rare but aggressive malignancy that can arise from both the **nasal cavity** and the **paranasal sinuses (PNS)**. These tumors originate from melanocytes located in the respiratory mucosa of the sinonasal tract. While they represent only about 1% of all melanomas, they are a significant diagnostic consideration in these regions because they often present at an advanced stage with a poor prognosis. **2. Why the Other Options are Incorrect:** * **Option A (Squamous Cell Carcinoma - SCC):** While SCC is the most common malignancy of the **maxillary sinus**, it is not the most common tumor of the **nasal cavity** (where inverted papilloma is the most common benign tumor and SCC is common but not the "unifying" commonality in the context of this specific comparative question). * **Options B & D (Adenoid Cystic Carcinoma):** This is the most common **minor salivary gland tumor** of the sinonasal tract. While it occurs in both the PNS and nasal cavity, it is less frequent overall than SCC. It is characterized by perineural invasion and a "Swiss-cheese" pattern on histology, but it is not the defining commonality intended by this question. **3. Clinical Pearls for NEET-PG:** * **Most common site for Sinonasal SCC:** Maxillary Sinus (80%), followed by the Ethmoid Sinus. * **Occupational Risk:** Woodworkers (hardwood dust) have a significantly increased risk of **Adenocarcinoma** (specifically the ethmoid sinus). * **Inverted Papilloma:** Arises from the lateral wall of the nose; it is locally aggressive and has a 10% risk of malignant transformation into SCC. * **Esthesioneuroblastoma:** A neurogenic tumor arising from the olfactory epithelium in the roof of the nasal cavity (Kallmann’s area). * **Melanoma Presentation:** Often presents with epistaxis and nasal obstruction; look for "pigmented mass" on endoscopy, though 10-20% can be amelanotic.

Q: Pott's puffy tumor is related to which of the following conditions?

Pyogenic infection of frontal sinus. **Explanation:** **Pott’s Puffy Tumor** is a clinical entity characterized by a **subperiosteal abscess** of the frontal bone associated with underlying **osteomyelitis**. 1. **Why Option C is Correct:** The condition most commonly arises as a complication of an acute **pyogenic infection of the frontal sinus**. The infection spreads from the sinus to the frontal bone via direct extension or through the **valveless diploic veins** (Breschet’s veins). This leads to osteomyelitis and the formation of a fluctuant, "puffy" swelling on the forehead. Despite the name, it is not a neoplastic "tumor" but an inflammatory mass. 2. **Why Other Options are Incorrect:** * **Option A:** An infected cell in the middle turbinate is known as an infected **Concha Bullosa**, which typically causes nasal obstruction or localized pain but does not lead to frontal bone abscesses. * **Option B:** While Sir Percivall Pott (who first described the condition) is also associated with Pott’s disease (spinal TB), Pott’s Puffy Tumor is strictly a **pyogenic** (usually *Staphylococcus* or *Streptococcus*) complication, not tuberculous. * **Option C:** Cavernous sinus thrombosis is a dreaded intracranial complication of facial or sinus infections, but it involves the venous sinuses of the brain, not a subperiosteal forehead swelling. **Clinical Pearls for NEET-PG:** * **Etiology:** Most common in adolescents due to increased diploic vein vascularity. * **Diagnosis:** **Contrast-enhanced CT (CECT)** is the gold standard to visualize the bone erosion and abscess. * **Complications:** High risk of intracranial spread, leading to **epidural abscess** or meningitis. * **Management:** Requires urgent IV antibiotics and surgical drainage (often via Trephination or FESS).

Question 1

Extraction of a maxillary second molar has resulted in a perforation of the maxillary antrum 0.5 cm in diameter. What is an acceptable procedure?

Accepted Answer

Smoothening the bone margins of the socket and placement of sutures across the socket.

Answer

Caldwell-Luc procedure

Answer

Creation of a nasal antrostomy window for proper aeration and drainage.

Answer

Insertion of iodoform gauze packing into the socket to allow healing by second intention.

Question 2

The nasal mucosa is supplied by which artery?

Accepted Answer

Mainly the external carotid artery

Answer

Only the external carotid artery

Answer

Only the internal carotid artery

Answer

Mainly the internal carotid artery

Question 3

Which of the following statements are true regarding the disease depicted here?

Accepted Answer

The histopathology shows foamy macrophages with intracytoplasmic bacilli and plasma cells with Russell bodies; nasal obstruction is a common complaint; and streptomycin and tetracycline for 4-6 weeks are used in treatment.

Answer

The histopathology shows foamy macrophages with intracytoplasmic bacilli and plasma cells with Russell bodies; it is a case of granulomatosis with polyangiitis; and it is caused by a gram-positive bacillus.

Answer

The histopathology shows foamy macrophages with intracytoplasmic bacilli and plasma cells with Russell bodies; it is caused by a gram-positive bacillus; and streptomycin and tetracycline for 4-6 weeks are used in treatment.

Answer

Nasal obstruction is a common complaint; it is caused by a gram-positive bacillus; and streptomycin and tetracycline for 4-6 weeks are used in treatment.

Question 4

What is the most common cause of unilateral epistaxis in a 5-year-old child?

Accepted Answer

Foreign body

Answer

Polyp

Answer

Atrophic rhinitis

Answer

Maggot infestation

Question 5

In a 60-year-old adult, which of the following diseases causes expansile maxillary lesions?

Accepted Answer

Paget's disease

Answer

Acromegaly

Answer

Fibrous Dysplasia

Answer

Rickets

Question 6

A patient presents with a nasal polypoidal mass and subcutaneous nodules on the skin. What is the most likely diagnosis?

Accepted Answer

Rhinosporidiosis

Answer

Zygomycosis

Answer

Sporotrichosis

Answer

Aspergillosis

Question 7

All of the following are true of septoplasty for deviated nasal septum (DNS) except?

Accepted Answer

Mucoperichondrium is stripped off

Answer

Indicated in septal deviation

Answer

Preferably done after 16 years of age

Answer

May be indicated in some cases of epistaxis

Question 8

Which of the following is common about tumors of the Peripheral Nervous System (PNS) and Nasal Cavity?

Accepted Answer

Melanoma can occur.

Answer

Squamous cell carcinoma is the most common type.

Answer

Adenoid cystic carcinoma is the most common type.

Answer

Adenoid cystic carcinoma.

Question 9

Which of the following is used to treat nasal myiasis?

Accepted Answer

Chloroform water

Answer

Turpentine

Answer

Betadine

Answer

Chlorhexidine Gluconate

Question 10

Pott's puffy tumor is related to which of the following conditions?

Accepted Answer

Pyogenic infection of frontal sinus

Answer

Infected cell in middle turbinate

Answer

Tuberculous sinusitis

Answer

Cavernous sinus thrombosis

Diseases of the Nose and Paranasal Sinuses — MCQs

Diseases of the Nose and Paranasal Sinuses — MCQs

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