Diseases of the Nose and Paranasal Sinuses Practice Questions

Q: What are the potential complications of acute sinusitis?

All of the above. Acute sinusitis can lead to serious complications due to the close anatomical proximity of the paranasal sinuses to the orbit and the cranial cavity. These complications are generally categorized into **Orbital, Intracranial, and Bony** types. ### **Explanation of Options:** * **Orbital Cellulitis (Option A):** This is the most common complication of acute sinusitis (especially ethmoiditis). Infection spreads via the thin lamina papyracea or through retrograde thrombophlebitis of the ophthalmic veins. It is part of the Chandler Classification of orbital infections. * **Pott’s Puffy Tumor (Option B):** This is a classic complication of **acute frontal sinusitis**. It represents osteomyelitis of the frontal bone, presenting as a localized, doughy, fluctuant swelling on the forehead. * **Conjunctival Chemosis (Option C):** This refers to edema of the conjunctiva. It is a clinical sign often seen in orbital complications (like orbital cellulitis) or as an early sign of **Cavernous Sinus Thrombosis**, where venous congestion leads to swelling. Since all three are recognized sequelae of sinus infections, **Option D (All of the above)** is correct. ### **High-Yield Clinical Pearls for NEET-PG:** * **Most common complication of sinusitis:** Orbital complications (specifically Preseptal/Orbital cellulitis). * **Most common sinus involved in orbital complications:** Ethmoid sinus (due to the thin lamina papyracea). * **Most common sinus involved in intracranial complications:** Frontal sinus. * **Chandler’s Classification:** Essential for exams. It stages orbital spread from Preseptal Cellulitis (Stage I) to Cavernous Sinus Thrombosis (Stage V). * **Red Flags:** Proptosis, ophthalmoplegia (restricted eye movement), and decreased visual acuity indicate a progression from preseptal to true orbital involvement, requiring urgent intervention.

Q: Mikulicz and Russell bodies are characteristic of which condition?

Rhinoscleroma. **Explanation:** **Rhinoscleroma** is a chronic granulomatous disease caused by the Gram-negative bacillus *Klebsiella pneumoniae subsp. rhinoscleromatis* (Frisch bacillus). It typically affects the nasal mucosa but can extend to the pharynx and larynx. The diagnosis is confirmed by its pathognomonic histopathological features: 1. **Mikulicz Cells:** These are large, foamy histiocytes (macrophages) with vacuolated cytoplasm containing the causative Frisch bacilli. 2. **Russell Bodies:** These are eosinophilic, hyaline inclusions found within plasma cells, representing accumulated immunoglobulin. **Why other options are incorrect:** * **Lethal Midline Granuloma:** Now largely classified as NK/T-cell lymphoma, it is characterized by extensive tissue necrosis and polymorphic cellular infiltrates, not Mikulicz cells. * **Plasma Cell Disorder:** While Russell bodies can be seen in various plasma cell reactive states or Multiple Myeloma, the specific combination with Mikulicz cells is unique to Rhinoscleroma. * **Rhinosporidiosis:** Caused by *Rhinosporidium seeberi*, it is characterized by large, thick-walled **sporangia** containing numerous endospores, typically presenting as leafy, friable nasal masses. **High-Yield Clinical Pearls for NEET-PG:** * **Stages of Rhinoscleroma:** Atrophic (resembles atrophic rhinitis) → Granulomatous/Proliferative (nodule formation) → Cicatricial (scarring and stenosis). * **Drug of Choice:** Streptomycin and Tetracycline are traditional; Ciprofloxacin is also highly effective. * **Biopsy:** Essential for diagnosis to visualize the characteristic cells. * **Hebra Nose:** The external deformity caused by the granulomatous stage, leading to a broadened, "woody" nose.

Q: What are the arteries supplying Little's area?

All of the above. **Explanation:** Little’s area (also known as Kiesselbach’s plexus) is a highly vascularized region located in the anteroinferior part of the nasal septum. It is the most common site for epistaxis (90% of cases). The correct answer is **"All of the above"** because Little’s area is formed by the anastomosis of four major arteries derived from both the internal and external carotid systems: 1. **Anterior Ethmoidal Artery** (Branch of the Ophthalmic artery – Internal Carotid system). 2. **Septal branch of Superior Labial Artery** (Branch of the Facial artery – External Carotid system). 3. **Greater Palatine Artery** (Branch of the Maxillary artery – External Carotid system). 4. **Sphenopalatine Artery** (Terminal branch of the Maxillary artery – External Carotid system). **Analysis of Options:** * **Options A, B, and C** are all individual components of this plexus. While each is a correct contributor, selecting only one would be incomplete, making "All of the above" the most accurate choice. Note that the *Posterior Ethmoidal Artery* does **not** contribute to Little's area (a common distractor in exams). **High-Yield Clinical Pearls for NEET-PG:** * **Woodruff’s Plexus:** Located over the posterior end of the middle turbinate; it is the most common site for **posterior epistaxis**, primarily involving the sphenopalatine artery. * **Trottter’s Triad:** Associated with Nasopharyngeal Carcinoma (Conductive deafness, Palatal palsy, and Temporofacial neuralgia). * **Management:** Initial management of epistaxis at Little’s area involves **Trotter’s Method** (pinching the soft part of the nose and leaning forward). If bleeding persists, chemical cautery (Silver Nitrate) or anterior nasal packing is indicated.

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

Arises from the fossa of Rosenmüller. **Explanation:** **1. Why Option A is the Correct Answer (False Statement):** Juvenile Nasopharyngeal Angiofibroma (JNA) does **not** arise from the fossa of Rosenmüller. Its site of origin is the **sphenopalatine foramen**, specifically at the junction where the sphenoid process of the palatine bone meets the pterygoid process of the sphenoid bone. The fossa of Rosenmüller is the most common site of origin for *Nasopharyngeal Carcinoma*, not angiofibroma. **2. Analysis of Other Options:** * **Option B:** JNA is a benign but locally aggressive, **sessile** tumor. Staging systems like **Sessions** and **Fisch** are common, but the **Radkowski** classification (a modification of Sessions) is widely used to assess the extent of spread, especially into the infratemporal fossa. * **Option C:** As the tumor grows, it can expand into the ethmoid sinuses and orbit, causing lateral displacement of the eyes and widening of the nasal bridge. This characteristic clinical appearance is known as **"Frog Face Deformity."** * **Option D:** JNA is a highly vascular tumor composed of thin-walled vessels lacking a muscular coat. **Biopsy is strictly contraindicated** in an office setting due to the risk of profuse, life-threatening hemorrhage. Diagnosis is primarily clinical and radiological. **Clinical Pearls for NEET-PG:** * **Demographics:** Almost exclusively seen in **adolescent males** (testosterone dependent). * **Classic Triad:** Adolescent male + Profuse recurrent epistaxis + Nasal obstruction. * **Radiology:** **Holman-Miller sign** (antral sign) is pathognomonic (anterior bowing of the posterior wall of the maxilla). * **Treatment of Choice:** Surgical excision (usually preceded by preoperative embolization to reduce blood loss).

Q: Which of the following is a true statement about Rhinosporidiosis?

It presents as a nasal polyp.. **Explanation:** **Rhinosporidiosis** is a chronic granulomatous infection caused by *Rhinosporidium seeberi*. While previously thought to be a fungus, it is now classified as an aquatic protist (Mesomycetozoea). 1. **Why Option C is Correct:** The hallmark clinical presentation is a **leafy, polypoid, friable mass** in the nasal cavity. It is typically vascular, bleeding easily on touch (epistaxis), and has a characteristic **"strawberry" appearance** due to the presence of mature sporangia visible as white dots on the surface. 2. **Why Options A, B, and D are Incorrect:** * **Option A:** *Klebsiella rhinoscleromatis* causes **Rhinoscleroma**, not Rhinosporidiosis. Rhinoscleroma is characterized by woody hard swelling and Mikulicz cells. * **Option B:** Rhinosporidiosis is typically seen in **immunocompetent** individuals. It is an endemic infection (common in South India and Sri Lanka) associated with bathing in stagnant water or ponds. * **Option D:** *Rhinosporidium seeberi* **cannot be cultured** in vitro (artificial media). Diagnosis relies on histopathology showing large, thick-walled **sporangia** containing thousands of endospores. **High-Yield NEET-PG Pearls:** * **Site:** Most common site is the **Nasal Septum** (followed by the nasopharynx). * **Histology:** Large sporangia (up to 350 μm) stained with H&E, GMS, or PAS. * **Treatment of Choice:** Wide surgical excision with **cauterization of the base** to prevent recurrence. Medical therapy (Dapsone) is sometimes used as an adjunct but is not definitive.

Question 1

What are the potential complications of acute sinusitis?

Accepted Answer

All of the above

Answer

Orbital cellulitis

Answer

Pott's puffy tumor

Answer

Conjunctival chemosis

Question 2

Mikulicz and Russell bodies are characteristic of which condition?

Accepted Answer

Rhinoscleroma

Answer

Lethal midline granuloma

Answer

Plasma cell disorder

Answer

Rhinosporidiosis

Question 3

What are the arteries supplying Little's area?

Accepted Answer

All of the above

Answer

Greater palatine artery

Answer

Septal branch of superior labial artery

Answer

Anterior ethmoidal artery

Question 4

What is the most common bacterial cause of rhinitis?

Accepted Answer

Haemophilus influenzae

Answer

Streptococcus haemolyticus

Answer

Pasteurella multocida

Answer

Corynebacterium diphtheriae

Question 5

Which of the following statements is NOT true about angiofibroma?

Accepted Answer

Arises from the fossa of Rosenmüller

Answer

Sessile and Radowski classification is used

Answer

Causes frog face deformity

Answer

Biopsy is contraindicated

Question 6

Which of the following is a true statement about Rhinosporidiosis?

Accepted Answer

It presents as a nasal polyp.

Answer

The most common organism causing it is Klebsiella rhinoscleromatis.

Answer

It is seen only in immunocompromised patients.

Answer

It can be diagnosed by isolation of the organism.

Question 7

Which type of polyp is most commonly associated with recurrence?

Accepted Answer

Ethmoidal polyp

Answer

Antrochoanal polyp

Answer

Nasal polyp

Answer

Hypertrophic turbinate

Question 8

Paroxysmal sneezing on getting up early in the morning from bed is associated with which of the following conditions?

Accepted Answer

Vasomotor rhinitis

Answer

Perineal rhinitis

Answer

Seasonal rhinitis

Answer

Allergic rhinitis

Question 9

What is true about septal hematoma?

Accepted Answer

Occurs due to trauma, can lead to saddle-nose deformity, and requires conservative treatment.

Answer

Occurs due to trauma, can lead to saddle-nose deformity, and may lead to abscess formation.

Answer

Occurs due to trauma, requires conservative treatment, and may lead to abscess formation.

Answer

Occurs due to trauma and can lead to saddle-nose deformity.

Question 10

A patient presents with an antrochoanal polyp arising from the medial wall of the maxilla. Which of the following is the best management for the patient?

Accepted Answer

FESS with polypectomy

Answer

Medial maxillectomy

Answer

Caldwell-Luc procedure

Answer

Intranasal polypectomy

Diseases of the Nose and Paranasal Sinuses — MCQs

Diseases of the Nose and Paranasal Sinuses — MCQs

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