Diseases of the Nose and Paranasal Sinuses Practice Questions

Q: Killian's incision is used for?

Submucous resection of nasal septum. ### Explanation **Correct Answer: A. Submucous resection of nasal septum** **Why it is correct:** Killian’s incision is the classic incision used for **Submucous Resection (SMR)** of the nasal septum. It is a slanted, curvilinear incision made on the nasal septum, approximately **5 mm superior and posterior** to the caudal margin of the septal cartilage. It is specifically designed to bypass the columella and access the subperichondrial plane to remove the deflected bony and cartilaginous parts of the septum while preserving the mucosal flaps. **Analysis of Incorrect Options:** * **B. Intranasal antrostomy:** This procedure involves creating an opening in the inferior meatus to drain the maxillary sinus. It does not involve a septal incision. * **C. Caldwell-Luc operation:** This is a radical antrum operation where the maxillary sinus is accessed via a **sublabial incision** (in the gingivolabial sulcus) above the canine fossa. * **D. Myringoplasty:** This is an otological procedure used to repair a perforation of the tympanic membrane. Common incisions include the Wilde’s post-aural or Endaural (Lempert’s) incision. **High-Yield Clinical Pearls for NEET-PG:** * **Killian’s vs. Freer’s Incision:** While Killian’s is used for SMR, **Freer’s incision** (hemitransfixion incision) is made at the very **caudal border** of the septal cartilage and is the preferred incision for **Septoplasty**, especially when correcting caudal dislocations. * **SMR Contraindication:** SMR is generally avoided in children (usually below 17 years) as it can interfere with midfacial growth, leading to a saddle nose deformity. * **Complication:** The most common complication of SMR is a septal perforation, often occurring at the site of the incision if bilateral mucosal tears occur.

Q: Which of the following statements is NOT true about the frontal sinus?

It is present at birth.. **Explanation:** The correct answer is **D (It is present at birth)** because the frontal sinus is not anatomically present at birth. It is the last paranasal sinus to develop, typically appearing radiologically around the age of 5–7 years and reaching full adult size after puberty (around age 15–20). **Analysis of Options:** * **Option A (Osteomas are common):** This is a true statement. The frontal sinus is the most common site for paranasal sinus osteomas (benign bony tumors). They are often asymptomatic and discovered incidentally on imaging. * **Option B (Morning headaches):** This is a classic clinical feature of frontal sinusitis. It is often referred to as an **"Office Headache"**—the pain typically starts in the morning, peaks by midday as the sinus drains via gravity, and subsides by the evening. * **Option C (Opens into the middle meatus):** This is anatomically correct. The frontal sinus drains into the middle meatus via the frontonasal duct, which opens into the anterior part of the hiatus semilunaris or the ethmoid infundibulum. **NEET-PG High-Yield Pearls:** * **Developmental Sequence:** Ethmoid (present at birth) → Maxillary (present at birth, but rudimentary) → Sphenoid (appears age 3–5) → Frontal (appears age 5–7). * **Radiology:** The frontal sinus is the most common sinus to be **agenetic** (absent) in about 5-10% of the population. * **Complications:** Frontal sinusitis can lead to **Pott’s Puffy Tumor**, which is a subperiosteal abscess of the frontal bone presenting as a doughy swelling on the forehead.

Q: Which of the following is a complication of sinus disease?

Superior orbital fissure syndrome. **Explanation:** **Superior Orbital Fissure Syndrome (SOFS)** is a rare but serious complication of inflammatory or infectious sinus disease, particularly involving the **sphenoid sinus**. The sphenoid sinus is anatomically adjacent to the superior orbital fissure. When infection or inflammation spreads to this fissure, it compresses or affects the structures passing through it, leading to a characteristic clinical triad: 1. **Ophthalmoplegia:** Paralysis of Cranial Nerves III, IV, and VI (leading to a fixed, dilated pupil and loss of eye movement). 2. **Sensory Loss:** Anesthesia in the distribution of the Ophthalmic nerve (V1). 3. **Proptosis:** Due to venous congestion and muscle paralysis. **Why other options are incorrect:** * **Orbital Cellulitis & Cavernous Sinus Thrombosis (CST):** While these are indeed complications of sinusitis (ethmoid and sphenoid respectively), they are categorized as **orbital** and **intracranial** complications. In the context of specific "syndromes" arising from sinus disease extension, SOFS is a distinct clinical entity involving the bony fissure itself. * **Retrobulbar Neuritis:** This is an inflammation of the optic nerve (CN II). While it can rarely occur with sphenoiditis, the optic nerve passes through the **Optic Canal**, not the superior orbital fissure. If the optic nerve is involved along with SOFS, it is termed **Orbital Apex Syndrome**. **High-Yield NEET-PG Pearls:** * **Most common sinus causing orbital complications:** Ethmoid sinus (due to the thin *lamina papyracea*). * **Orbital Apex Syndrome:** SOFS + Optic nerve involvement (Vision loss/Blindness). * **Chandler’s Classification:** Used to grade orbital complications of sinusitis (Stage I: Preseptal cellulitis to Stage V: CST). * **Key differentiator:** In SOFS, vision is preserved; in Orbital Apex Syndrome, vision is lost.

Q: Posterior epistaxis is commonly seen in which of the following conditions?

Hypertension. **Explanation:** Epistaxis is classified into anterior and posterior based on the site of bleeding. **Posterior epistaxis** originates from the posterior part of the nasal cavity, most commonly from the **Woodruff’s plexus** (located over the posterior end of the middle turbinate). **Why Hypertension is Correct:** Hypertension is the most common systemic cause of posterior epistaxis, particularly in elderly patients. Chronic high blood pressure leads to **arteriosclerosis** of the sphenopalatine artery and its branches. These brittle vessels lose their ability to contract effectively when ruptured, leading to severe, spontaneous bleeding that often requires packing or surgical intervention. **Analysis of Incorrect Options:** * **A. Children with ethmoidal polyps:** Ethmoidal polyps typically present with nasal obstruction and anosmia; while they may cause blood-tinged discharge, they are not a classic cause of frank posterior epistaxis. * **B. Foreign bodies:** These usually cause unilateral, foul-smelling, purulent nasal discharge in children. While they can cause minor bleeding, it is typically anterior and localized. * **D. Nose picking:** This is the most common cause of **anterior epistaxis** in children and young adults, occurring at **Little’s area (Kiesselbach’s plexus)** on the anterior nasal septum. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site of Epistaxis:** Little’s area (Anterior). * **Most common site of Posterior Epistaxis:** Woodruff’s plexus. * **Artery of Epistaxis:** Sphenopalatine artery (a branch of the Maxillary artery). * **Management:** Anterior bleeding is usually managed by Trotter’s method or chemical cautery; posterior bleeding often requires **Post-nasal packing** or endoscopic ligation of the sphenopalatine artery.

Q: What is the presenting symptom of nasal myiasis?

Severe irritation with sneezing. **Explanation:** **Nasal Myiasis** (Peenash) is a condition caused by the infestation of nasal cavities by the larvae of flies, most commonly *Chrysomyia bezziana*. It is typically seen in patients with poor hygiene, atrophic rhinitis, or leprosy. 1. **Why Option A is correct:** The **earliest presenting symptom** of nasal myiasis is intense, severe irritation in the nose accompanied by persistent sneezing. This is a physiological reaction to the movement of the larvae and the toxins they secrete upon entering the nasal vestibule. This stage precedes the more visible signs of infestation. 2. **Why other options are incorrect:** * **Option B (Maggots):** While the presence of maggots is the hallmark of the disease, they are a **sign** (observed by the clinician or patient later) rather than the initial presenting symptom. * **Option C (Nasal pain):** Pain and headache occur later as the larvae invade the paranasal sinuses and cause tissue destruction/secondary infection. * **Option D (Impaired olfaction):** While destruction of the olfactory epithelium can occur in advanced stages, it is not the primary or presenting complaint. **High-Yield Clinical Pearls for NEET-PG:** * **Commonest Fly:** *Chrysomyia bezziana*. * **Predisposing factor:** Atrophic rhinitis (due to the wide nasal room and foul-smelling discharge attracting flies). * **Clinical Features:** Serosanguinous (blood-stained) discharge, foul "putrid" odor, and eventually palatal perforation or orbital complications. * **Management:** * **Initial:** Instillation of **Chloroform and Turpentine oil** (ratio 1:4) to stupefy the maggots. * **Definitive:** Manual removal of maggots using forceps. * **Medical:** Oral **Ivermectin** is highly effective.

Q: What is the commonest site of an ivory osteoma?

Frontal-ethmoidal region. **Explanation:** **Osteomas** are the most common benign tumors of the paranasal sinuses. They are slow-growing, encapsulated bony tumors composed of mature bone. **1. Why the Frontal-ethmoidal region is correct:** Statistically, the **frontal sinus** is the most common site for paranasal sinus osteomas (approx. 75-80%), followed by the **ethmoid air cells**. The "ivory" subtype refers to a dense, hard, and mature bone composition (as opposed to the "cancellous" type). These tumors typically arise near the fronto-ethmoidal suture line. While often asymptomatic, they can cause symptoms by obstructing the frontal sinus drainage pathway, leading to secondary sinusitis or a mucocele. **2. Why the other options are incorrect:** * **Mandible & Maxilla:** While osteomas can occur in the gnathic bones (often associated with **Gardner’s Syndrome**), they are significantly less common here than in the paranasal sinuses. * **Sphenoid:** The sphenoid sinus is the rarest site for a paranasal sinus osteoma. **Clinical Pearls for NEET-PG:** * **Radiology:** On a CT scan, an ivory osteoma appears as a very dense, homogeneous, "stone-like" radiopaque mass with well-defined margins. * **Gardner’s Syndrome:** If a patient presents with multiple osteomas (especially of the mandible), always look for **colonic polyposis** (premalignant), soft tissue tumors, and dental abnormalities. * **Management:** Small, asymptomatic osteomas are managed by observation. Surgical excision (Endoscopic or External/Lynch-Howarth) is indicated if the tumor is symptomatic, enlarging, or causing obstruction.

Q: Which of the following is NOT true about rhinocerebral mucormycosis?

Treatment with voriconazole. **Explanation:** Rhinocerebral Mucormycosis is a fulminant, life-threatening fungal infection caused by fungi of the order Mucorales (e.g., *Rhizopus*, *Mucor*). It primarily affects immunocompromised patients, particularly those with uncontrolled diabetes mellitus (ketoacidosis) or neutropenia. **Why Option B is the correct answer (False statement):** The drug of choice for Mucormycosis is **Liposomal Amphotericin B**. **Voriconazole**, while effective against *Aspergillus*, has **no activity** against Mucorales. Using voriconazole in a suspected case of mucormycosis is a common clinical pitfall and a high-yield exam point. Surgical debridement is also mandatory for survival. **Analysis of other options:** * **Option A (Also known as mucormycosis):** This is a true statement. Rhinocerebral is the most common clinical form of the disease. * **Option C (Angioinvasive):** This is a hallmark feature. The fungi invade blood vessel walls, leading to thrombosis, distal ischemia, and tissue infarction. * **Option D (Black necrotic turbinates):** Due to the angioinvasive nature and subsequent tissue necrosis, patients typically present with a characteristic **black eschar** on the nasal turbinates or the hard palate. **Clinical Pearls for NEET-PG:** * **Risk Factor:** Diabetic Ketoacidosis (acidosis allows the fungus to thrive by releasing iron from transferrin). * **Diagnosis:** Definitive diagnosis is made via biopsy showing **broad, ribbon-like, non-septate hyphae** branching at **right angles (90°)**. * **Management:** "Reverse the underlying cause + Aggressive surgical debridement + IV Amphotericin B." * **Second-line agents:** Posaconazole or Isavuconazole can be used as salvage therapy or step-down treatment.

Q: Caldwell-Luc operation is indicated for which condition?

Maxillary sinusitis. The **Caldwell-Luc operation** is a classic surgical procedure designed to provide direct access to the **maxillary sinus**. It involves creating an opening in the canine fossa (above the premolar teeth) to enter the sinus, followed by the creation of an intranasal antrostomy for drainage. ### Why Maxillary Sinusitis is Correct: The procedure is specifically indicated for chronic maxillary sinusitis that is unresponsive to conservative management or endoscopic approaches. It allows for the complete removal of irreversible diseased mucosa, polyps, or foreign bodies (like a displaced tooth root) from the maxillary antrum. It is also the approach used for biopsy of maxillary tumors and for the **Denker’s operation** (an extension for reaching the nasopharynx). ### Why Other Options are Incorrect: * **Frontal Sinusitis:** Managed via procedures like the Lynch-Howarth operation, Trephination, or more commonly, Functional Endoscopic Sinus Surgery (FESS). * **Ethmoid Sinusitis:** Addressed via internal or external ethmoidectomy (e.g., Patterson’s or Jansen-Horgan approach). * **Sphenoid Sinusitis:** Accessed via transnasal or transethmoidal routes, often using endoscopic techniques. ### High-Yield Clinical Pearls for NEET-PG: * **Key Indications:** Chronic maxillary sinusitis with irreversible changes, Oro-antral fistula closure, and removal of **Antrochoanal polyps** (to prevent recurrence by removing the base). * **Common Complication:** Numbness of the cheek or upper teeth due to injury to the **infraorbital nerve**. * **Current Status:** Largely replaced by **FESS** (Functional Endoscopic Sinus Surgery), which is more physiological and less invasive. * **Landmark:** The incision is made in the gingivolabial sulcus, lateral to the frenulum.

Q: Which of the following are features of congenital syphilis?

Perforation in the cartilaginous part of the nose. **Explanation:** Congenital syphilis is divided into early (manifesting before 2 years of age) and late (manifesting after 2 years) stages. **Why Option B is Correct:** Syphilis is characterized by an affinity for the **cartilaginous structures**. In congenital syphilis, the inflammatory process (gummatous destruction) specifically targets the **cartilaginous part of the nasal septum**. This leads to perforation and the subsequent collapse of the nasal bridge. **Analysis of Incorrect Options:** * **A. Snuffles:** This is a highly infectious nasal discharge (syphilitic rhinitis) and is an **early** manifestation, typically appearing within the first few weeks of life. * **C. Mulberry Molars:** These are permanent first molars with multiple poorly developed cusps. While seen in congenital syphilis, they are a **late** manifestation (appearing after age 2), and the question specifically highlights the cartilaginous involvement as a primary pathological feature. * **D. Saddle Nose Deformity:** While this is a classic sign of congenital syphilis, it results from the destruction of the **bony** part of the nasal bridge (the bridge itself), whereas the primary pathological perforation occurs in the **cartilaginous** septum. **High-Yield Clinical Pearls for NEET-PG:** * **Hutchinson’s Triad:** Interstitial keratitis, Hutchinson’s teeth (notched incisors), and 8th nerve deafness. * **Early Signs:** Snuffles, Condyloma lata, Pemphigus syphiliticus (bullous lesions on palms/soles), and Osteochondritis (Wimberger’s sign). * **Late Signs:** Clutton’s joints (painless knee swelling), Sabre shin (anterior bowing of tibia), and Rhagades (linear scars around the mouth). * **Screening:** VDRL/RPR are used for screening; TPHA/FTA-ABS are confirmatory. Treatment of choice is **Penicillin G**.

Q: What is the treatment of Rhinitis Medicamentosa?

Withdrawal of nasal drops with a short course of steroids. **Explanation:** **Rhinitis Medicamentosa** is a condition of rebound nasal congestion caused by the prolonged use (typically >5–7 days) of topical nasal decongestants (e.g., Oxymetazoline, Xylometazoline). These drugs cause vasoconstriction; however, chronic use leads to tachyphylaxis, interstitial edema, and secondary vasodilation, resulting in a "rebound" phenomenon where the patient feels more congested than before. **Why Option A is Correct:** The primary goal of treatment is to break the cycle of dependency. 1. **Withdrawal:** Immediate cessation of the offending topical decongestant is mandatory to allow the nasal mucosa to recover. 2. **Steroids:** Systemic or topical corticosteroids are used to reduce the underlying mucosal inflammation and edema, making the withdrawal process tolerable for the patient. **Why Other Options are Incorrect:** * **Option B (Antibiotics):** Rhinitis Medicamentosa is a drug-induced physiological change, not a bacterial infection. Antibiotics have no role unless there is a secondary bacterial sinusitis. * **Option C (Polypectomy):** This is a surgical procedure for nasal polyps. While chronic rhinitis can lead to mucosal hypertrophy, the initial management is medical withdrawal, not surgery. * **Option D (Increasing the dose):** This would exacerbate the condition, leading to further mucosal damage and worsening the rebound congestion. **High-Yield NEET-PG Pearls:** * **Pathophysiology:** Chronic use leads to the loss of vascular tone and permanent damage to the ciliary epithelium. * **Clinical Presentation:** The patient often describes a "red, beefy" nasal mucosa on examination. * **Management Tip:** To ease withdrawal, some clinicians suggest stopping the drops in one nostril at a time (the "one-nostril-at-a-time" method) while starting intranasal steroid sprays.

Question 1

Killian's incision is used for?

Accepted Answer

Submucous resection of nasal septum

Answer

Intranasal antrostomy

Answer

Caldwell-Luc operation

Answer

Myringoplasty

Question 2

Which of the following statements is NOT true about the frontal sinus?

Accepted Answer

It is present at birth.

Answer

Osteomas are common.

Answer

Sinusitis can lead to morning headaches.

Answer

It opens into the middle meatus.

Question 3

Which of the following is a complication of sinus disease?

Accepted Answer

Superior orbital fissure syndrome

Answer

Retrobulbar neuritis

Answer

Orbital cellulitis

Answer

Cavernous sinus thrombosis

Question 4

Posterior epistaxis is commonly seen in which of the following conditions?

Accepted Answer

Hypertension

Answer

Children with ethmoidal polyps

Answer

Foreign bodies of the nose

Answer

Nose picking

Question 5

What is the presenting symptom of nasal myiasis?

Accepted Answer

Severe irritation with sneezing

Answer

Maggots

Answer

Nasal pain

Answer

Impaired olfaction

Question 6

What is the commonest site of an ivory osteoma?

Accepted Answer

Frontal-ethmoidal region

Answer

Mandible

Answer

Maxilla

Answer

Sphenoid

Question 7

Which of the following is NOT true about rhinocerebral mucormycosis?

Accepted Answer

Treatment with voriconazole

Answer

Also known as mucormycosis

Answer

Angioinvasive

Answer

Black necrotic turbinates

Question 8

Caldwell-Luc operation is indicated for which condition?

Accepted Answer

Maxillary sinusitis

Answer

Frontal sinusitis

Answer

Ethmoid sinusitis

Answer

Sphenoid sinusitis

Question 9

Which of the following are features of congenital syphilis?

Accepted Answer

Perforation in the cartilaginous part of the nose

Answer

Snuffles is a late manifestation

Answer

Mulberry molars

Answer

Saddle nose deformity

Question 10

What is the treatment of Rhinitis Medicamentosa?

Accepted Answer

Withdrawal of nasal drops with a short course of steroids

Answer

Antibiotics

Answer

Polypectomy

Answer

Increasing the dose of the nasal drops

Diseases of the Nose and Paranasal Sinuses — MCQs

Diseases of the Nose and Paranasal Sinuses — MCQs

On this page

Practice by Chapter

Want unlimited practice?