Diseases of the Nose and Paranasal Sinuses — MCQs
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Denker's operation may result in injury to which nerve?
Prolonged and repeated use of nasal decongestants leads to which condition?
Allergic salute is seen in which of the following conditions?
What is true about a foreign body in a child?
In Chevallet fracture of the nasal bone, what is the typical mechanism of trauma?
What is the management of maggots in a child's nose?
Which is the most common tumor of the nasal cavity?
What can a rhinolith cause?
The main vascular supply of Little's area is all, except?
Which of the following is NOT a function of the nose?
Diseases of the Nose and Paranasal Sinuses Indian Medical PG Practice Questions and MCQs
Question 91: Denker's operation may result in injury to which nerve?
- A. Posterior superior alveolar nerve
- B. Anterior superior alveolar nerve (Correct Answer)
- C. Greater palatine nerve
- D. Nasopalatine nerve
Explanation: **Explanation:** **Denker’s operation** is an extended version of the Caldwell-Luc procedure. While a standard Caldwell-Luc involves an opening through the canine fossa into the maxillary sinus, Denker’s operation involves the **removal of the bridge of bone between the piriform aperture and the antrum**, effectively merging the nasal cavity and the maxillary sinus into one large cavity. 1. **Why Option B is correct:** The **Anterior Superior Alveolar (ASA) nerve** descends in the anterior wall of the maxilla (within the *canalis sinuosus*) to supply the incisors and canine teeth. Because Denker’s operation involves extensive removal of the anterior and medial walls of the maxilla, this nerve is frequently transected or injured, leading to numbness of the upper front teeth and gums. 2. **Why other options are incorrect:** * **Posterior Superior Alveolar Nerve (A):** This nerve enters the maxilla through the posterior surface (infratemporal fossa). It is more likely to be injured during posterior maxillary resections or Le Fort fractures, rather than an anterior approach like Denker’s. * **Greater Palatine Nerve (C):** This nerve emerges from the greater palatine foramen on the hard palate. It is located too far posteriorly and inferiorly to be the primary risk in this anterior surgical approach. * **Nasopalatine Nerve (D):** This nerve passes through the incisive canal. While it is near the midline, it is generally medial to the site of the Denker’s bony resection. **High-Yield Clinical Pearls for NEET-PG:** * **Indication:** Denker’s is primarily used for accessing tumors in the anterior-lateral part of the maxillary sinus or for **Juvenile Nasopharyngeal Angiofibroma (JNA)** with significant lateral extension. * **Complication:** The most common side effect of both Caldwell-Luc and Denker’s is **cheek swelling** and **paresthesia** due to injury to the infraorbital nerve or its branches (ASA). * **Comparison:** Denker’s provides better access to the anterior-most part of the antrum compared to the standard Caldwell-Luc.
Question 92: Prolonged and repeated use of nasal decongestants leads to which condition?
- A. Rhinitis medicamentosa (Correct Answer)
- B. Bronchitis
- C. Both
- D. None
Explanation: **Explanation:** **1. Why Rhinitis Medicamentosa is Correct:** Rhinitis medicamentosa is a condition of non-allergic drug-induced rhinitis. It is caused by the prolonged and repeated use of **topical nasal decongestants** (sympathomimetics like Oxymetazoline or Xylometazoline) for more than 5–7 days. * **Mechanism:** These drugs cause vasoconstriction of the nasal mucosa. Overuse leads to a "rebound" phenomenon where the alpha-receptors become desensitized (tachyphylaxis), leading to compensatory vasodilation, interstitial edema, and severe nasal congestion. This creates a vicious cycle where the patient uses more medication to relieve the worsening obstruction. **2. Why Other Options are Incorrect:** * **B. Bronchitis:** This is an inflammation of the lining of the bronchial tubes. While systemic absorption of nasal drugs can occur, there is no direct causal link between topical nasal decongestants and the development of bronchitis. * **C & D:** Since Rhinitis medicamentosa is the specific clinical entity associated with this drug class, these options are incorrect. **3. Clinical Pearls for NEET-PG:** * **Treatment:** The first step is immediate **cessation** of the topical decongestant. To manage the withdrawal symptoms and rebound congestion, **topical steroid sprays** (e.g., Fluticasone) or a short course of oral steroids are prescribed. * **Histology:** Chronic use leads to loss of ciliary function, squamous metaplasia, and goblet cell hyperplasia. * **Key Symptom:** The hallmark is "rebound congestion" (nasal stuffiness without rhinorrhea or sneezing). * **Prevention:** Patients should be advised never to use topical decongestants for more than **5 consecutive days**.
Question 93: Allergic salute is seen in which of the following conditions?
- A. Allergic rhinitis (Correct Answer)
- B. Chronic sinusitis
- C. Nasal Myiasis
- D. Chronic conjunctivitis
Explanation: **Explanation:** **Allergic Rhinitis (Correct Answer):** The "Allergic Salute" is a characteristic clinical sign seen primarily in children with **Allergic Rhinitis**. It refers to the repetitive upward rubbing of the nose with the palm of the hand. This maneuver is performed to relieve nasal itching (pruritus) and to temporarily open the nasal airway. Over time, this chronic upward rubbing leads to the formation of a horizontal hypopigmented or hyperpigmented line across the lower third of the nasal bridge, known as the **Allergic Crease**. **Analysis of Incorrect Options:** * **Chronic Sinusitis:** While it involves nasal congestion and discharge, the primary symptom is facial pain or pressure rather than the intense pruritus that triggers the "salute" gesture. * **Nasal Myiasis:** This is an infestation of the nasal cavity by maggots. It presents with foul-smelling discharge, pain, and epistaxis, but not the chronic allergic rubbing pattern. * **Chronic Conjunctivitis:** While often comorbid with allergic rhinitis (as allergic rhinoconjunctivitis), the "salute" specifically refers to a nasal maneuver, not an ocular one. **High-Yield Clinical Pearls for NEET-PG:** * **Dennie-Morgan Lines:** Infraorbital folds/wrinkles caused by chronic edema of the lower eyelids in allergic patients. * **Allergic Shiners:** Dark circles under the eyes due to venous stasis from chronic nasal congestion. * **Treatment of Choice:** Intranasal corticosteroids are the most effective maintenance therapy for Allergic Rhinitis. * **Histology:** Nasal smear typically shows an abundance of **Eosinophils**.
Question 94: What is true about a foreign body in a child?
- A. Unilateral fetid discharge
- B. Presents with unilateral nasal obstruction (Correct Answer)
- C. Has torrential epistaxis
- D. Inanimate foreign bodies are more common than animate ones
Explanation: **Explanation:** Nasal foreign bodies (FBs) are a common pediatric emergency. The clinical presentation depends on the nature of the object and the duration it has been in the nasal cavity. **Why Option B is Correct:** **Unilateral nasal obstruction** is the most common presenting symptom of a nasal foreign body. Children often do not report the insertion, and the physical presence of the object, combined with subsequent mucosal edema and inflammatory reaction, leads to a blocked nasal passage on the affected side. **Analysis of Incorrect Options:** * **Option A:** While **unilateral fetid (foul-smelling) discharge** is a classic sign of a long-standing or neglected foreign body, it is not the *initial* presentation for all cases. If a child presents with unilateral purulent rhinorrhea, a foreign body must be ruled out, but obstruction remains the primary clinical feature. * **Option C:** Foreign bodies typically cause minor, blood-stained discharge rather than **torrential epistaxis**. Profuse bleeding is more characteristic of trauma, vascular tumors (like Juvenile Nasopharyngeal Angiofibroma), or systemic bleeding disorders. * **Option D:** This statement is actually **true** (inanimate objects like beads, seeds, and buttons are far more common than animate ones like maggots or leeches). However, in the context of standard ENT textbooks and NEET-PG patterns, Option B is prioritized as the hallmark clinical presentation. **High-Yield Clinical Pearls for NEET-PG:** 1. **Most common site:** Just anterior to the middle turbinate or below the inferior turbinate. 2. **Button Batteries:** These are **surgical emergencies** due to the risk of liquefactive necrosis and septal perforation within hours. Never use saline drops as they accelerate electrolysis. 3. **Management:** The "Parent’s Kiss" technique is a safe initial retrieval method. If using instruments, avoid forceps for smooth objects; use a **Jobson-Horne probe** or a small foley catheter. 4. **Rhinolith:** A neglected inanimate FB can act as a nidus for calcium and magnesium salt deposition, forming a "nasal stone."
Question 95: In Chevallet fracture of the nasal bone, what is the typical mechanism of trauma?
- A. Blow from the side (Correct Answer)
- B. Blow from below
- C. Blow directly from the front
- D. Any of the above
Explanation: **Explanation:** The **Chevallet fracture** is a specific type of nasal injury involving the **nasal septum**. It is characterized by a **vertical fracture** of the septal cartilage. 1. **Why Option A is Correct:** The mechanism of a Chevallet fracture is a **lateral blow (blow from the side)**. When a force is applied to the side of the nose, it causes a vertical fracture line in the cartilaginous septum. This often results in a significant deviation of the septum, leading to nasal obstruction and external deformity. 2. **Why Options B and C are Incorrect:** * **Blow from below:** This typically results in a **Jarjavay fracture**. This is a **horizontal fracture** of the septum, often involving the vomer and the maxillary crest, where the cartilage is dislocated from its bony groove. * **Blow from the front:** A direct frontal blow usually causes a "telescoping" injury, comminuted fractures of the nasal bones, or a "saddle nose" deformity due to the crushing of the septal support. 3. **Clinical Pearls for NEET-PG:** * **Chevallet = Vertical fracture** (Lateral force). * **Jarjavay = Horizontal fracture** (Basal force/Blow from below). * **Septal Hematoma:** Always rule this out in nasal trauma. If present, it requires urgent incision and drainage to prevent septal necrosis and a subsequent saddle nose deformity. * **Management:** Most nasal fractures are managed by closed reduction under local or general anesthesia within 7–14 days before the bones unite.
Question 96: What is the management of maggots in a child's nose?
- A. Manual removal by hand picking
- B. Surgical removal
- C. Conservative treatment with oil followed by removal (Correct Answer)
- D. Irrigation with warm saline solution
Explanation: **Explanation:** The management of nasal myiasis (maggots in the nose) focuses on the safe and complete extraction of larvae while preventing tissue trauma. **Why Option C is Correct:** The primary challenge in treating nasal myiasis is that maggots possess hooks that allow them to anchor firmly into the nasal mucosa, making forceful extraction painful and damaging. The standard protocol involves instilling **Turpentine oil** (or liquid paraffin/chloroform water) into the nasal cavity. This acts as an irritant and an asphyxiating agent, forcing the maggots to release their grip and crawl out or become sluggish. Once immobilized, they can be safely removed using forceps. **Why Other Options are Incorrect:** * **Option A (Manual removal by hand picking):** Attempting to pull live maggots without prior immobilization is difficult and traumatic. Their hooks can tear the delicate nasal mucosa, leading to severe bleeding and secondary infection. * **Option B (Surgical removal):** Surgery is rarely the first line of treatment. It is reserved only for cases where maggots have migrated into deep, inaccessible areas like the intracranial space or the orbit. * **Option D (Irrigation with warm saline):** Saline is ineffective at dislodging maggots and may push them deeper into the posterior choana or sinuses, increasing the risk of aspiration. **Clinical Pearls for NEET-PG:** * **Causative Agent:** Most commonly the larvae of the fly *Chrysomya bezziana*. * **Predisposing Factors:** Atrophic rhinitis (due to the foul smell attracting flies), leprosy, and poor hygiene. * **Complications:** Palatal perforation, septal destruction, and orbital cellulitis. * **Medical Management:** In severe cases, oral **Ivermectin** is considered an effective systemic treatment to kill the larvae.
Question 97: Which is the most common tumor of the nasal cavity?
- A. Adenoma
- B. Papilloma (Correct Answer)
- C. Myxoma
- D. Adamantinoma
Explanation: **Explanation:** The most common benign tumor of the nasal cavity is the **Schneiderian Papilloma**. These are true epithelial neoplasms arising from the Schneiderian membrane (the ectodermally derived schneiderian mucosa lining the nose and paranasal sinuses). Among the three types of Schneiderian papillomas—**Inverted**, **Fungiform (Exophytic)**, and **Oncocytic**—the Inverted Papilloma is the most clinically significant. It is characterized by its tendency to grow endophytically (into the underlying stroma), its high rate of recurrence, and its potential for malignant transformation into Squamous Cell Carcinoma (approx. 10%). **Analysis of Incorrect Options:** * **A. Adenoma:** These are rare glandular tumors. While Pleomorphic Adenoma is the most common benign salivary gland tumor, it rarely occurs in the nasal cavity (usually arising from the septum). * **C. Myxoma:** This is a rare mesenchymal tumor of the head and neck, more commonly found in the mandible or maxilla rather than the nasal cavity proper. * **D. Adamantinoma:** This is an old term for Ameloblastoma. It is an odontogenic tumor of the jaw (mandible > maxilla) and does not primarily arise from the nasal cavity. **High-Yield Clinical Pearls for NEET-PG:** * **Inverted Papilloma (Ringertz Tumor):** Most commonly arises from the **lateral wall** of the nose (middle meatus). * **Gold Standard Treatment:** Endoscopic Medial Maxillectomy. * **Radiology:** Look for "bony remodeling" or focal hyperostosis at the site of origin on CT scans. * **Etiology:** Strongly associated with **HPV types 6 and 11**.
Question 98: What can a rhinolith cause?
- A. Nasal obstruction
- B. Epistaxis
- C. Epiphora
- D. All the above (Correct Answer)
Explanation: **Explanation:** A **rhinolith** is a calcareous concretion formed by the gradual deposition of mineral salts (calcium and magnesium) around an endogenous or exogenous foreign body in the nasal cavity. Its clinical presentation is typically characterized by unilateral, foul-smelling nasal discharge. **Why "All the Above" is correct:** 1. **Nasal Obstruction (Option A):** As the rhinolith grows over time, it acts as a space-occupying lesion, physically blocking the nasal passage. This is the most common presenting symptom. 2. **Epistaxis (Option B):** The rough, irregular surface of the stone causes constant irritation and pressure necrosis of the surrounding nasal mucosa and septum, leading to ulceration and bleeding. 3. **Epiphora (Option C):** Large rhinoliths located in the inferior meatus can compress or obstruct the opening of the **nasolacrimal duct**, preventing tear drainage and resulting in a watery eye (epiphora). **Clinical Pearls for NEET-PG:** * **Composition:** Primarily Calcium phosphate, Calcium carbonate, and Magnesium phosphate. * **Common Site:** Usually found on the floor of the nose, between the inferior turbinate and the septum. * **Diagnosis:** While clinical examination (anterior rhinoscopy) is key, a **CT scan** is the investigation of choice to determine the extent and rule out bony destruction. On X-ray, it appears as a radio-opaque mass. * **Differential Diagnosis:** Must be differentiated from osteoma, calcified nasal polyp, or malignancy. * **Treatment:** Surgical removal, usually via an endonasal approach. Large stones may require lithotripsy (crushing) before removal.
Question 99: The main vascular supply of Little's area is all, except?
- A. Septal branch of superior labial artery
- B. Nasal branch of sphenopalatine artery
- C. Anterior ethmoidal artery
- D. Palatal branch of sphenopalatine artery (Correct Answer)
Explanation: **Explanation:** Little’s area (located in the anteroinferior part of the nasal septum) is the most common site for epistaxis. It contains **Kiesselbach’s Plexus**, an arterial anastomosis where branches from both the internal and external carotid systems meet. **Why Option D is correct:** The **Greater Palatine Artery** (a branch of the maxillary artery) contributes to the plexus by passing through the incisive canal. However, there is no "Palatal branch of the sphenopalatine artery" that supplies this area. The sphenopalatine artery itself terminates as posterior septal branches, not a specific "palatal branch" for Little's area. **Analysis of Incorrect Options:** * **A. Septal branch of superior labial artery:** A branch of the Facial artery (External Carotid system). It supplies the anteroinferior septum. * **B. Nasal branch of sphenopalatine artery:** Specifically the **Posterior Septal branch** of the Sphenopalatine artery (External Carotid system). It is often considered the "Artery of Epistaxis." * **C. Anterior ethmoidal artery:** A branch of the Ophthalmic artery (**Internal Carotid system**). It is the only internal carotid contribution to the plexus. **High-Yield Clinical Pearls for NEET-PG:** * **Woodruff’s Plexus:** Located over the posterior end of the middle turbinate (nasopharynx); the most common site for **posterior epistaxis**, primarily supplied by the Sphenopalatine artery. * **Trottter’s Triad:** Associated with Nasopharyngeal Carcinoma (Conductive hearing loss, Palatal palsy, Ipsilateral facial pain). * **Management:** Most anterior bleeds in Little's area can be managed by **Trotter’s Method** (pinching the nose and leaning forward) or chemical cautery (Silver Nitrate).
Question 100: Which of the following is NOT a function of the nose?
- A. Olfaction
- B. Air pressure control (Correct Answer)
- C. Humidification of air
- D. Temperature control of inspired air
Explanation: The nose serves as the primary portal for the respiratory system, performing several vital physiological functions. The correct answer is **Air pressure control**, as this is primarily a function of the **Eustachian tube** (which equilibrates pressure between the middle ear and the nasopharynx), not the nose itself. ### **Explanation of Options:** * **Olfaction (Option A):** The olfactory epithelium, located in the attic of the nasal cavity (superior turbinate and upper septum), contains bipolar sensory neurons responsible for the sense of smell. * **Humidification (Option C):** The nose acts as an "air conditioner." The rich vascularity and mucous glands add moisture to inspired air, bringing it to nearly **95% relative humidity** before it reaches the lungs. * **Temperature Control (Option D):** Through a vast network of venous sinusoids (especially in the turbinates), the nose warms or cools inspired air to near body temperature (**37°C**) via a heat-exchange mechanism. ### **NEET-PG High-Yield Pearls:** 1. **Filtration:** The nose filters particles. Large particles (>10 μm) are trapped by nasal vibrissae, while smaller ones are caught in the mucous blanket and moved by ciliary action toward the nasopharynx. 2. **Nasal Cycle:** This is the rhythmic alternating congestion and decongestion of the nasal mucosa, occurring every 2.5 to 4 hours. 3. **Protective Functions:** The nasal mucus contains **IgA antibodies, lysozymes, and interferon**, providing a first line of defense against pathogens. 4. **Resonance:** The nose and paranasal sinuses provide resonance to the voice, particularly for nasal consonants (M, N, NG).
Practice by Chapter
Rhinitis
Practice Questions
Acute Rhinosinusitis
Practice Questions
Chronic Rhinosinusitis
Practice Questions
Nasal Polyposis
Practice Questions
Allergic Fungal Sinusitis
Practice Questions
Deviated Nasal Septum
Practice Questions
Epistaxis
Practice Questions
Nasal Trauma
Practice Questions
Choanal Atresia
Practice Questions
CSF Rhinorrhea
Practice Questions
Tumors of the Nose and Paranasal Sinuses
Practice Questions
Complications of Sinusitis
Practice Questions
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