Diseases of the Nose and Paranasal Sinuses — MCQs

Diseases of the Nose and Paranasal Sinuses Indian Medical PG Practice Questions and MCQs

Question 181: Woodruff's plexus is seen at which location?

A. Anterosuperior part of the superior turbinate
B. Middle turbinate
C. Posterosuperior part of the inferior turbinate (Correct Answer)
D. Anterosuperior part of the inferior turbinate

Explanation: **Explanation:** Woodruff’s plexus is a venous plexus located in the posterior part of the nasal cavity. Specifically, it lies on the lateral wall of the nose, **posterosuperior to the posterior end of the inferior turbinate**, in the area of the sphenopalatine foramen. It is the most common site for **posterior epistaxis**. **Why the correct answer is right:** * **Option C:** The plexus is situated just below the posterior end of the inferior turbinate on the lateral wall. It is formed by the anastomosis of the sphenopalatine artery (a branch of the maxillary artery), the ascending pharyngeal artery, and the posterior nasal branches of the maxillary nerve. **Why the other options are wrong:** * **Option A & B:** The superior and middle turbinates are located higher in the nasal vault. While these areas are vascular, they do not house the specific confluence of vessels known as Woodruff’s plexus. * **Option D:** The anterosuperior part of the nasal cavity is typically supplied by the ethmoidal arteries. The **anteroinferior** part of the nasal septum (not the turbinate) is the site of **Little’s area (Kiesselbach’s plexus)**, which is the most common site for anterior epistaxis. **Clinical Pearls for NEET-PG:** * **Posterior Epistaxis:** Unlike anterior bleeds, posterior bleeds from Woodruff’s plexus are often more severe, occur in older patients (associated with hypertension/atherosclerosis), and usually require **posterior nasal packing** or endoscopic ligation. * **Vessel involved:** The **Sphenopalatine artery** is the main arterial supply to this region and is often referred to as the "Artery of Epistaxis." * **Comparison:** Remember: **Little’s Area** = Anterior/Septum/Children; **Woodruff’s Plexus** = Posterior/Lateral wall/Elderly.

Question 182: While playing football, an 18-year-old boy sustained a blow to the nose, resulting in deviation of the nose. On examination, the nasal septum was not deviated. Which of the following statements is true about the patient?

A. He should be taken up for open reduction one week later.
B. He should be taken for closed reduction as soon as the overlying edema subsides. (Correct Answer)
C. Septoplasty should be done in the same sitting.
D. He is having a Jarjavay fracture.

Explanation: ### **Explanation** **1. Why Option B is Correct:** The patient has sustained a **nasal bone fracture** without septal involvement. In acute nasal trauma, the immediate management depends on the presence of edema. If the patient presents early (within hours), reduction can be done immediately. However, if significant swelling is present, it masks the underlying bony deformity, making accurate realignment difficult. The standard protocol is to wait **3–7 days** for the edema to subside and then perform **closed reduction** using instruments like the Walsham’s or Asch’s forceps. **2. Why Other Options are Incorrect:** * **Option A:** Open reduction is reserved for complex, comminuted fractures or cases where closed reduction has failed. It is not the first-line treatment for a simple deviation. * **Option C:** Septoplasty is indicated only if there is a significant septal deviation causing airway obstruction. Since the examination specifically states the **septum is not deviated**, septoplasty is unnecessary. * **Option D:** A **Jarjavay fracture** is a type of nasal *septal* fracture (vertical fracture from the anterior nasal spine upwards). Since the septum is normal here, this diagnosis is incorrect. (Note: A horizontal septal fracture is known as a Chevalier Jackson fracture). **3. Clinical Pearls for NEET-PG:** * **Golden Period for Reduction:** In children, reduction should be done within 7 days (due to rapid healing); in adults, within 14 days. Beyond this, the bones malunite, requiring rhinoplasty later. * **Must-Rule-Out:** Always check for a **Septal Hematoma** in nasal trauma. If present, it requires urgent incision and drainage to prevent septal necrosis and "Saddle Nose" deformity. * **Diagnosis:** Nasal bone fractures are primarily a **clinical diagnosis**. X-rays are often unreliable and not mandatory for management.

Question 183: What is an alternative for Septal Mucosal Resection (SMR)?

A. Tympanoplasty
B. Septoplasty (Correct Answer)
C. Caldwell Luc operation
D. Turboplasty

Explanation: ### Explanation The correct answer is **Septoplasty**. **Why Septoplasty is the correct alternative:** Both **Submucous Resection (SMR)** and **Septoplasty** are surgical procedures used to correct a deviated nasal septum (DNS). While SMR involves the radical removal of large portions of the septal cartilage and bone, Septoplasty is a more **conservative, reconstructive procedure**. In Septoplasty, the deviated parts are repositioned or minimally resected, preserving the structural integrity of the septum. It is currently the preferred alternative because it carries a lower risk of complications like septal perforation or "saddle nose" deformity. **Why the other options are incorrect:** * **Tympanoplasty:** This is a reconstructive surgery of the middle ear (specifically the tympanic membrane and ossicles) to treat chronic otitis media or hearing loss. * **Caldwell-Luc Operation:** This is a surgical approach to the **maxillary sinus** via the gingivobuccal sulcus. It is used for removing irreversible mucosal disease, foreign bodies, or tumors from the sinus, not for septal correction. * **Turboplasty:** This procedure involves reducing the size of the nasal turbinates (usually the inferior turbinate) to improve the airway. While often performed *alongside* septoplasty, it does not address the septum itself. **High-Yield Clinical Pearls for NEET-PG:** * **Age Factor:** SMR is generally avoided in patients below **17–18 years** to prevent interference with mid-facial growth. Septoplasty can be performed in children if the deviation is severe (using a conservative approach). * **Killian’s Incision:** The standard incision for SMR. * **Freer’s Incision:** Often used in Septoplasty (placed at the caudal border of the septal cartilage). * **Complication:** The most common complication of SMR is a **septal hematoma**, which, if untreated, can lead to a septal abscess and subsequent saddle nose deformity.

Question 184: Sphenoid sinusitis pain is most commonly referred to which region?

A. Occiput
B. Root of the nose (Correct Answer)
C. Frontal area
D. Temporal region

Explanation: **Explanation:** The sphenoid sinus is located deep within the skull, and its nerve supply is derived from the **posterior ethmoidal nerve** and the **sphenopalatine ganglion** (V1 and V2 branches of the Trigeminal nerve). **Why "Root of the Nose" is correct:** While sphenoid sinusitis is classically known for causing pain at the **vertex** (top of the head), the most characteristic referred pain site mentioned in standard ENT textbooks (like Dhingra) for acute sphenoiditis is the **root of the nose**. This is due to the sensory distribution of the ethmoidal nerves. Patients often describe a deep-seated, dull ache that can also be felt "behind the eyes." **Analysis of Incorrect Options:** * **A. Occiput:** While sphenoid pain can occasionally radiate to the occipital region, it is less common than the vertex or the root of the nose. Occipital pain is more frequently associated with tension headaches or cervical spine issues. * **C. Frontal area:** This is the classic site for **Frontal sinusitis** (often showing a "vacuum headache" periodicity) and Anterior Ethmoiditis. * **D. Temporal region:** Pain here is typically associated with **Maxillary sinusitis** or Temporomandibular joint (TMJ) disorders. **Clinical Pearls for NEET-PG:** * **Vertex Headache:** If "Vertex" is an option, it is often the most specific site for sphenoid pathology. However, in the absence of vertex, "Root of the nose" is the preferred answer. * **Isolated Sphenoid Sinusitis:** This is rare and should raise suspicion of fungal infections (Mucormycosis) or neoplasms. * **Relationship to Vital Structures:** Due to its location, sphenoiditis can lead to serious complications like **Cavernous Sinus Thrombosis** or optic neuritis.

Question 185: Thudichum's nasal speculum is used to visualize which part of the nasal anatomy?

A. Tonsils
B. Larynx
C. Anterior nasal cavity (Correct Answer)
D. Posterior nares

Explanation: ### Explanation **Correct Answer: C. Anterior nasal cavity** **1. Why it is correct:** Thudichum’s nasal speculum is the standard instrument used for **Anterior Rhinoscopy**. It is a self-retaining, spring-action speculum designed to dilate the nasal vestibule by retracting the ala nasi and the vibrissae (nasal hair). This allows the clinician to visualize the anterior part of the nasal cavity, including the nasal septum, the inferior turbinate, the middle turbinate, and the floor of the nose. **2. Why the other options are incorrect:** * **A. Tonsils:** These are visualized using a **Lack’s tongue depressor** during an oral cavity examination. * **B. Larynx:** The larynx is visualized via **Indirect Laryngoscopy (IDL)** using a laryngeal mirror or via Direct Laryngoscopy/Fiberoptic Bronchoscopy. * **D. Posterior nares:** The posterior part of the nose and nasopharynx are visualized using a **St. Clair Thompson posterior rhinoscopic mirror** (Posterior Rhinoscopy) or a rigid/flexible endoscope. **3. Clinical Pearls for NEET-PG:** * **Method of use:** It is held in the non-dominant hand. The spring is compressed between the index and middle fingers, while the thumb and ring finger provide stability. * **Killian’s Nasal Speculum:** Unlike Thudichum’s, Killian’s has longer blades and is primarily used for deep visualization during surgeries like Septoplasty or SMR (Submucous Resection). * **St. Clair Thompson Nasal Speculum:** Another variant used for anterior rhinoscopy, often preferred in some setups for its handle design. * **High-Yield Fact:** Always remember to withdraw the speculum in a **partially open** state to avoid pinching and pulling out the nasal vibrissae, which is painful for the patient.

Question 186: What is the commonest site of epistaxis in young individuals?

A. Bony septum
B. Little's area (Correct Answer)
C. Superior turbinate
D. Lateral wall of the nose

Explanation: **Explanation:** **Little’s Area** (also known as Kiesselbach’s plexus) is the correct answer because it is the most common site for anterior epistaxis, accounting for approximately 90% of all nosebleeds, particularly in children and young adults. **Why Little’s Area?** This area is located in the anteroinferior part of the nasal septum. It is a site of significant vascular anastomosis where four (or five) arteries meet: 1. **Anterior Ethmoidal** (from Internal Carotid) 2. **Sphenopalatine** (from External Carotid) 3. **Greater Palatine** (from External Carotid) 4. **Septal branch of Superior Labial** (from Facial/External Carotid) In young individuals, this area is highly susceptible to trauma (finger picking), mucosal drying, and environmental irritants because it is the first point where inspired air hits the nasal mucosa. **Analysis of Incorrect Options:** * **Bony Septum:** This is located posteriorly. While fractures here can cause bleeding, it is not a site of rich vascular plexuses like the membranous/cartilaginous junction. * **Superior Turbinate:** This area is supplied by the ethmoidal arteries. Bleeding from here is rare and usually associated with skull base trauma or ethmoidal sinus pathologies. * **Lateral Wall of the Nose:** While the lateral wall contains the **Woodruff’s Plexus** (located posteriorly under the posterior end of the inferior turbinate), this is a common site for *posterior* epistaxis, typically seen in elderly, hypertensive patients, not young individuals. **High-Yield Clinical Pearls for NEET-PG:** * **Woodruff’s Plexus:** The most common site for posterior epistaxis (Sphenopalatine artery is the main vessel). * **Trottter’s Method:** The first-line management for anterior epistaxis (pinching the soft part of the nose for 10–15 minutes). * **Most common artery of epistaxis:** Sphenopalatine artery. * **Most common cause of epistaxis (Overall):** Trauma (Finger picking/Digital trauma).

Question 187: A child has a retained disc battery in the nose. What is the most important consideration in its management?

A. The battery substance can leak and cause tissue damage. (Correct Answer)
B. It can lead to tetanus.
C. Refer the child to a specialist for removal of the battery.
D. Instill nasal drops.

Explanation: **Explanation:** A disc battery (button battery) in the nasal cavity is a **surgical emergency**. Unlike inert foreign bodies, disc batteries cause rapid and extensive tissue destruction through three primary mechanisms: 1. **Leakage of alkaline contents:** The caustic substance (usually potassium or sodium hydroxide) causes liquefactive necrosis. 2. **Electrical current:** The moist mucosa completes an electrical circuit, leading to electrolysis and the generation of hydroxide ions at the negative pole. 3. **Pressure necrosis:** Direct physical pressure on the delicate nasal mucosa and septum. **Analysis of Options:** * **Option A (Correct):** This is the most critical consideration because the chemical leakage and electrochemical reactions can lead to **septal perforation** and synechiae formation within hours. * **Option B:** While any foreign body carries a theoretical risk, tetanus is not the primary or most urgent concern in nasal battery impaction. * **Option C:** While specialist removal is necessary, it is a management step, not the "most important consideration" or the underlying pathological reason for the urgency. * **Option D:** **Contraindicated.** Instilling nasal drops or irrigation can liquefy the battery contents and accelerate the electrical conduction, worsening the chemical burn. **High-Yield Clinical Pearls for NEET-PG:** * **Imaging:** A lateral X-ray shows a **"Double Contour" or "Step-off" sign**, distinguishing a battery from a coin. * **Urgency:** Removal should ideally occur within **2–4 hours** to prevent permanent septal damage. * **Complications:** Septal perforation, saddle nose deformity, and orbital complications. * **Golden Rule:** Never irrigate the nose if a battery is suspected.

Question 188: Rhinitis medicamentosa is due to which of the following?

A. Nasal decongestants (Correct Answer)
B. Steroids
C. Antihistamines
D. Surgery

Explanation: **Explanation:** **Rhinitis Medicamentosa (RM)** is a condition of rebound nasal congestion brought on by the prolonged use of **topical nasal decongestants** (Option A). These drugs, typically sympathomimetic amines (e.g., Oxymetazoline, Xylometazoline), work by stimulating alpha-receptors to cause vasoconstriction. However, when used for more than 3–5 days, they lead to a "rebound" phenomenon. The underlying pathophysiology involves the downregulation of alpha-receptors and interstitial edema, resulting in severe compensatory vasodilation and nasal obstruction that is refractory to the original medication. **Analysis of Incorrect Options:** * **B. Steroids:** Topical nasal steroids (e.g., Fluticasone) are actually the **treatment of choice** for Rhinitis Medicamentosa. They do not cause rebound congestion and help reduce mucosal inflammation. * **C. Antihistamines:** These are used to treat allergic rhinitis by blocking H1 receptors. They do not affect the vasomotor tone of nasal mucosa in a way that leads to RM. * **D. Surgery:** While chronic mucosal hypertrophy (from long-term RM) might eventually require surgical reduction of turbinates, surgery itself is a treatment modality, not the cause of the condition. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Presentation:** A patient with a history of chronic cold/allergy who reports that their nasal spray "no longer works" or that they need to use it more frequently to breathe. * **Examination:** The nasal mucosa appears **beefy red**, swollen, and granular (unlike the pale/bluish mucosa seen in allergic rhinitis). * **Management:** Immediate cessation of the decongestant, initiation of topical/systemic steroids, and saline douches. * **Key Duration:** Advise patients never to use topical decongestants for more than **5 consecutive days**.

Question 189: Anterior bowing of the posterior maxillary wall is described as which sign?

A. Holman Miller sign (Correct Answer)
B. Hennebert sign
C. Holsky sign
D. Honeybell sign

Explanation: **Explanation:** The **Holman-Miller sign** (also known as the antral sign) is a classic radiological feature of **Juvenile Nasopharyngeal Angiofibroma (JNA)**. JNA is a benign but locally aggressive, highly vascular tumor that typically arises in the sphenopalatine foramen of adolescent males. As the tumor grows, it expands into the pterygopalatine fossa, creating pressure that pushes the posterior wall of the maxillary sinus forward. This characteristic **anterior bowing** is best visualized on a lateral skull X-ray or CT scan and is considered pathognomonic for JNA. **Analysis of Incorrect Options:** * **Hennebert sign:** This is a clinical sign seen in Otology. It refers to the occurrence of nystagmus or vertigo triggered by pressure changes in the external auditory canal (e.g., using a Siegel’s speculum). It is typically seen in Meniere’s disease or syphilis (due to a hypermobile stapes). * **Holsky sign / Honeybell sign:** These are distractors and do not represent recognized clinical or radiological signs in ENT. **High-Yield Clinical Pearls for JNA:** * **Demographics:** Almost exclusively seen in adolescent males (10–20 years). * **Triad:** Profuse recurrent epistaxis, nasal obstruction, and a mass in the nasopharynx. * **Diagnosis:** Diagnosis is primarily clinical and radiological. **Biopsy is contraindicated** due to the risk of life-threatening hemorrhage. * **Staging:** Often involves the Fisch or Radkowski classification systems. * **Treatment:** Surgical excision (e.g., Transpalatal or Endoscopic approach) preceded by preoperative embolization to reduce blood loss.

Question 190: Which paranasal sinuses are present at birth?

A. Frontal and maxillary
B. Ethmoid and maxillary (Correct Answer)
C. Frontal and ethmoid
D. Sphenoid and ethmoid

Explanation: **Explanation:** The development of paranasal sinuses is a high-yield topic for NEET-PG. At birth, only the **Ethmoid and Maxillary** sinuses are present and radiologically visible. 1. **Why Option B is Correct:** * **Ethmoid Sinus:** This is the most developed sinus at birth. It consists of small air cells that are present from the 5th fetal month. * **Maxillary Sinus:** This is the first sinus to begin development (around the 3rd fetal month). At birth, it is a small cavity (approx. 7x4x4 mm) located medial to the infraorbital nerve. 2. **Why Other Options are Incorrect:** * **Frontal Sinus (Options A & C):** This sinus is **absent at birth**. It starts developing from the anterior ethmoidal cells around age 2 and only becomes radiologically visible by age 6–7. It reaches adult size after puberty. * **Sphenoid Sinus (Option D):** While a rudimentary pouch exists at birth, it is clinically and radiologically **absent** as it has not yet pneumatized the sphenoid bone. Pneumatization typically begins at age 2–3 and is complete by age 10–12. **High-Yield Clinical Pearls for NEET-PG:** * **Order of Development:** Maxillary → Ethmoid → Sphenoid → Frontal. * **Order of Radiologic Appearance:** Ethmoid/Maxillary (Birth) → Sphenoid (4 years) → Frontal (6 years). * **First sinus to develop:** Maxillary. * **Most common sinus involved in childhood sinusitis:** Ethmoid (due to early development). * **Klaus’s Rule:** The maxillary sinus reaches the level of the nasal floor by age 8–9; before this, it is higher than the nasal floor.

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

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free