Diseases of the Nose and Paranasal Sinuses Practice Questions

Q: What is true about inverted papilloma?

It is also known as Schnedrian papilloma.. ### Explanation: Inverted Papilloma **1. Why Option A is Correct:** Inverted papilloma (IP) arises from the **Schneiderian membrane**, which is the ectodermally derived pseudostratified ciliated columnar epithelium lining the nasal cavity and paranasal sinuses. Hence, it is also known as a **Schneiderian papilloma**. It is a true neoplasm, not a simple inflammatory polyp. **2. Analysis of Incorrect Options:** * **Option B:** The term "inverted" refers to its **histological** appearance, not its anatomical or gross appearance. Microscopically, the surface epithelium proliferates and invaginates (grows inward) into the underlying stroma, rather than growing outward (exophytic). * **Option C:** While IP is locally aggressive and has a high recurrence rate, its primary malignant association is with **Squamous Cell Carcinoma (SCC)**, not basal cell carcinoma. Malignant transformation occurs in approximately 5–15% of cases. * **Option D:** Inverted papilloma typically affects **males** (M:F ratio of 3:1) in the **40–60 year** age group. It is rare in children and young girls. **3. High-Yield Clinical Pearls for NEET-PG:** * **Site of Origin:** Most commonly the **lateral wall of the nose** (middle meatus/ethmoid sinus). * **Clinical Presentation:** Unilateral nasal obstruction and epistaxis. * **Radiology:** CT scans show a unilateral soft tissue mass; a characteristic finding is **focal hyperostosis** (bony thickening) at the site of origin, which helps the surgeon identify the attachment point. * **Management:** The treatment of choice is **complete surgical excision** (usually via Endoscopic Sinus Surgery or Medial Maxillectomy) because of its high recurrence rate and malignant potential.

Q: Which of the following is NOT a symptom of sinusitis?

Diplopia. **Explanation:** Sinusitis is the inflammation of the mucosal lining of the paranasal sinuses. The diagnosis is primarily clinical, based on major and minor criteria. **Why Diplopia is the Correct Answer:** Diplopia (double vision) is **not** a standard symptom of uncomplicated sinusitis. While the sinuses are anatomically adjacent to the orbit, diplopia only occurs if the infection breaches the bony walls (causing orbital cellulitis or abscess) or involves the cavernous sinus. In NEET-PG, diplopia is considered a **"red flag" sign** indicating a serious complication or an alternative diagnosis like a sino-nasal malignancy or fungal invasion (Mucormycosis), rather than a symptom of the sinusitis itself. **Analysis of Other Options:** * **Nasal Blockage:** A cardinal symptom of sinusitis caused by mucosal edema and accumulated purulent secretions obstructing the nasal airway. * **Facial Edema:** Common in acute sinusitis, especially over the maxillary or frontal areas, due to localized inflammation and venous stasis in the overlying soft tissues. * **Blood-stained Rhinorrhea:** While typically purulent (yellow/green), the inflamed and fragile nasal mucosa can frequently bleed, leading to blood-tinged discharge. **Clinical Pearls for NEET-PG:** * **Major Criteria for Sinusitis:** Facial pain/pressure, nasal obstruction, purulent post-nasal drip, and hyposmia/anosmia. * **Most Common Sinus Involved:** Maxillary sinus (in adults); Ethmoid sinus (in children). * **Red Flags:** Diplopia, proptosis, reduced visual acuity, and forehead swelling (Pott’s Puffy Tumor) indicate intracranial or intraorbital complications.

Q: Which of the following is NOT a pneumatization pattern of the sphenoid sinus?

Concha bullosa. ### Explanation The sphenoid sinus undergoes a specific process of pneumatization (air-filling) as it develops from birth through adolescence. The classification of these patterns is based on the extent of air cell development in relation to the **Sella Turcica**. **Why "Concha bullosa" is the correct answer:** Concha bullosa is **not** a pattern of sphenoid pneumatization. Instead, it refers to the pneumatization of a **nasal turbinate** (most commonly the middle turbinate). It is a common anatomical variant of the lateral nasal wall and can lead to obstruction of the osteomeatal complex, potentially causing sinusitis. **Analysis of Sphenoid Pneumatization Patterns:** * **Conchal (Option D):** The most primitive type. The area anterior to the sella is filled with solid bone with no air cavity. It is usually seen in children under age 12. * **Pre-sellar (Option A):** Pneumatization extends up to, but not beyond, the anterior vertical plane of the sella turcica. * **Post-sellar (Option B):** The most common type in adults. Pneumatization extends posterior to the anterior wall of the sella, often involving the clivus. This provides the best surgical access for transsphenoidal pituitary surgery. **High-Yield Clinical Pearls for NEET-PG:** * **Surgical Significance:** The **Post-sellar** type is surgically preferred for transsphenoidal approaches because the thin bone allows easier access to the pituitary gland. * **Vital Relations:** The lateral wall of the sphenoid sinus is closely related to the **Internal Carotid Artery** and the **Optic Nerve**. In well-pneumatized (Post-sellar) sinuses, these structures may be dehiscent or bulge into the sinus. * **Onodi Cell:** A posterior ethmoid cell that migrates into the sphenoid bone, often lying superior to the sphenoid sinus, placing the optic nerve at risk during surgery.

Q: During extraction of a maxillary second molar, a 0.5mm perforation is created in the maxillary sinus. What is the appropriate initial management?

No treatment necessary. **Explanation:** The proximity of the maxillary molar roots to the floor of the maxillary sinus often leads to **Oroantral Communication (OAC)** during dental extractions. The management of OAC is strictly determined by the **size of the perforation** and the presence of pre-existing sinus infection. 1. **Why "No treatment necessary" is correct:** Perforations smaller than **2 mm** in diameter usually heal spontaneously. In such cases, the formation of a stable blood clot within the socket is sufficient to act as a biological barrier. The patient is simply advised on "sinus precautions" (avoiding nose blowing, sneezing with mouth open, and using straws) to prevent pressure changes that could dislodge the clot. 2. **Why other options are incorrect:** * **B (Smoothen bone and suture):** This is the management for medium-sized defects (**2–6 mm**). These require a figure-of-eight suture to stabilize the clot and ensure primary closure. * **C (Pack with gauze):** Packing the socket is contraindicated as it prevents natural healing and can lead to a chronic **Oroantral Fistula (OAF)** by epithelializing the tract. * **A (Caldwell-Luc):** This is an invasive surgical procedure reserved for retrieving a root displaced into the sinus or managing chronic refractory sinusitis; it is never an initial step for a minor perforation. **Clinical Pearls for NEET-PG:** * **Size-based Management:** * ** 6 mm:** Surgical flap (e.g., Buccal advancement flap or Palatal rotation flap). * **Diagnosis:** The **"Nose-blowing test"** (Valsalva) is used to confirm OAC by observing air bubbles or blood in the socket. * **Most common tooth involved:** Maxillary first molar, followed by the second molar.

Question 1

Frontal mucocele typically presents as:

Accepted Answer

Swelling above the medial canthus, below the floor of the frontal sinus

Answer

Swelling above the eyebrow, lateral to the glabella

Answer

External proptosis

Answer

Intranasal swelling

Question 2

Which of the following features is characteristic of a nasoalveolar cyst?

Accepted Answer

Erosion of the alveolar process superior to the lateral incisor and canine teeth.

Answer

An ovoid shaped radiolucency superior to the lateral incisor and canine teeth.

Answer

An inverted funnel shaped radiolucent lesion superior to the roots of the lateral incisor and canine teeth.

Answer

A pear shaped radiolucent lesion located between the roots of the lateral incisor and canine teeth.

Question 3

During extraction of a maxillary molar, a root tip is left in the maxillary sinus. What is the treatment of choice?

Accepted Answer

Perform Caldwell-Luc procedure to remove the tip

Answer

Perform hemi maxillectomy

Answer

Enlarge the opening in the socket area

Answer

No treatment indicated

Question 4

Which of the following is an indication for Functional Endoscopic Sinus Surgery (FESS)?

Accepted Answer

Inverted papilloma

Answer

Nasal allergic polyposis

Answer

Mucocele

Answer

Carcinoma of the maxilla

Question 5

What is true about inverted papilloma?

Accepted Answer

It is also known as Schnedrian papilloma.

Answer

Anatomically, it has an inverted appearance.

Answer

It may cause basal cell carcinoma.

Answer

It is commonly seen in young girls.

Question 6

Which of the following is NOT a symptom of sinusitis?

Accepted Answer

Diplopia

Answer

Blood-stained rhinorrhea

Answer

Facial edema

Answer

Nasal blockage

Question 7

What is the most common location for an osteoma?

Accepted Answer

Aryepiglottic folds

Answer

Frontal sinus

Answer

Ethmoid sinus

Answer

Maxillary sinus

Question 8

What is the cause of sudden death in a patient who recently underwent maxillary sinus irrigation?

Accepted Answer

Air embolism

Answer

Maxillary artery thrombosis

Answer

Septicemia

Answer

Meningitis

Question 9

Which of the following is NOT a pneumatization pattern of the sphenoid sinus?

Accepted Answer

Concha bullosa

Answer

Pre-sellar

Answer

Post-sellar

Answer

Conchal

Question 10

During extraction of a maxillary second molar, a 0.5mm perforation is created in the maxillary sinus. What is the appropriate initial management?

Accepted Answer

No treatment necessary

Answer

Perform Caldwell-Luc procedure

Answer

Smoothen the bone and place suture across the socket

Answer

Pack the opening with iodoform gauze and allow to heal by secondary intention

Diseases of the Nose and Paranasal Sinuses — MCQs

Diseases of the Nose and Paranasal Sinuses — MCQs

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