Diseases of the Nose and Paranasal Sinuses — MCQs

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

Question 331: Identify the instruments shown in the image:

A. A= Politzer bag, B= Hartmann catheter (Correct Answer)
B. A= Siegel speculum, B= Hartmann catheter
C. A= Politzer bag, B= Higginson catheter
D. A= Siegel speculum, B= Higginson catheter

Explanation: ***A= Politzer bag, B= Hartmann catheter*** - Image A depicts a **Politzer bag**, a rubber bulb device used to inflate air into the middle ear through the Eustachian tube via nasal route (Politzer's maneuver). - Image B shows a **Hartmann Eustachian catheter**, a curved metal catheter with an olive-shaped tip used in conjunction with the Politzer bag for middle ear inflation and Eustachian tube catheterization. *A= Siegel speculum, B= Hartmann catheter* - Image A is not a Siegel speculum, which is an otoscope attachment with a rubber bulb used for pneumatic otoscopy to assess tympanic membrane mobility and compliance. - Image B is correctly identified as Hartmann catheter, but this partial identification makes the option incorrect. *A= Politzer bag, B= Higginson catheter* - Image B is not a Higginson catheter (or Higginson's syringe), which is a double-bulb pump device used for irrigation and aspiration, typically for bowel procedures, not for Eustachian tube work. - Image A is correctly identified as Politzer bag, but this partial identification makes the option incorrect. *A= Siegel speculum, B= Higginson catheter* - Neither instrument is correctly identified in this option. - Image A shows a Politzer bag (not Siegel speculum) and image B shows a Hartmann catheter (not Higginson catheter).

Question 332: The instrument set shown below is used for performing which surgery?

A. Septal surgery
B. Adenotonsillectomy (Correct Answer)
C. Drainage of Quinsy
D. Tracheostomy

Explanation: ***Adenotonsillectomy*** - The image displays a **tonsil snare** (part of an adenotonsillectomy set) and a **Boyle-Davis mouth gag**, which are exclusively used for tonsil and adenoid removal. - Other instruments visible, such as varying sizes of **adenoid curettes** and **suction tubes**, are also characteristic of this procedure. *Septal surgery* - Septal surgery instruments typically include a **nasal speculum**, **septal scalpel**, **Freer elevator**, and **septal forceps**, which are not prominently featured as a complete set here. - While some general surgical tools might overlap, the distinctive instruments for adenotonsillectomy confirm it's not a septal surgery set. *Drainage of Quinsy* - Drainage of a peritonsillar abscess (Quinsy) primarily involves a **scalpel**, a **guarded blade**, and sometimes a **small bore suction catheter**. - The specialized cutting and grasping instruments shown in the image are not typical for a simple incision and drainage procedure. *Tracheostomy* - A tracheostomy set includes specific instruments like **tracheal retractors**, **tracheal hooks**, **dilators**, and various sizes of **tracheostomy tubes**. - None of these specialized instruments for incising and maintaining an airway are present in the provided image.

Question 333: Identify the surgical procedure being performed in the image shown below.

A. Inferior meatal antrostomy
B. Caldwell Luc operation (Correct Answer)
C. Proof puncture
D. Superior meatal antrostomy

Explanation: ***Caldwell Luc operation*** - The image shows an **incision in the gingivobuccal sulcus** above the upper incisor/canine teeth, reflecting the periosteum to access the anterior wall of the maxillary sinus, which is characteristic of the Caldwell-Luc operation. - This procedure involves creating an opening into the **maxillary antrum** to remove diseased tissue, often visualized through the anterior sinus wall as depicted in the right panel. *Inferior meatal antrostomy* - An inferior meatal antrostomy involves creating an opening in the **lateral nasal wall**, specifically beneath the inferior turbinate, to drain the maxillary sinus. - The approach in the image, through the oral cavity, is inconsistent with an inferior meatal antrostomy. *Proof puncture* - **Proof puncture** (also known as antral washout) is a diagnostic and therapeutic procedure where a needle is inserted into the maxillary sinus, typically through the inferior meatus, to aspirate contents and irrigate. - It does not involve a large surgical incision in the gingiva or removal of bone as shown in the image. *Superior meatal antrostomy* - The superior meatus is an anatomical space in the nasal cavity positioned **above the superior turbinate**. - A superior meatal antrostomy would access the posterior ethmoid cells or sphenoid sinus, not the maxillary sinus through an oral approach, and is not a standard procedure for maxillary sinus issues.

Question 334: All are contraindications to the procedure shown below except:

A. Acute maxillary sinusitis
B. Antral cyst (Correct Answer)
C. Fractured maxilla
D. Children less than 3 years

Explanation: The image displays a procedure known as **antral lavage** or **maxillary sinus washout**, which involves puncturing the maxillary sinus and irrigating it, typically through the inferior meatus using a Lichtwitz cannula. This procedure is performed to drain pus or fluid from the maxillary sinus and collect samples for diagnostic purposes. ***Antral cyst*** - An antral cyst is a benign, fluid-filled lesion within the maxillary sinus, and its presence does not contraindicate antral lavage. In fact, if the cyst causes symptoms or obstructs drainage, lavage might be performed to assess the sinus, though surgical removal might be ultimately indicated. - The procedure can sometimes help differentiate between a simple cyst and other conditions, or provide temporary relief if the cyst is causing pressure symptoms. *Acute maxillary sinusitis* - While antral lavage is often performed for **chronic sinusitis** or diagnostic purposes in suspected acute sinusitis that is not responding to medical treatment, it is generally **contraindicated in acute, uncomplicated maxillary sinusitis** due to the risk of spreading infection, increased pain, and potential for complications like orbital cellulitis if there is active inflammation and pus under pressure. - Initial management of acute sinusitis typically involves antibiotics, decongestants, and analgesics. *Fractured maxilla* - A **fractured maxilla** presents a significant contraindication because the structural integrity of the bone is compromised. Puncturing the sinus in such a situation could lead to further displacement of bone fragments, increased hemorrhage, direct injury to vital structures, or introduction of infection into surrounding tissues. - Any manipulation of the sinus floor or walls could worsen the fracture or impede healing. *Children less than 3 years* - Antral lavage is generally **contraindicated in children under the age of 3 years** due to the underdeveloped state of their paranasal sinuses, especially the maxillary sinuses. - The sinus walls are thin and fragile, increasing the risk of orbital or intracranial penetration, and children this young are often uncooperative, making the procedure difficult and dangerous.

Question 335: An 8-year-old boy presents with recurrent episodes of epistaxis. Histopathological specimen of the excised lesion is shown below. All are correct about this condition except:

A. Frog face deformity can occur in advanced cases
B. Emergency bleeding can be managed with adrenaline-soaked gauze
C. Radkowski stage IIIB involves cavernous sinus extension
D. Holman-Miller sign is always present in all cases (Correct Answer)

Explanation: ***Holman-Miller sign*** - The **Holman-Miller sign** (anterior bowing of the posterior wall of the maxillary antrum) is a helpful **radiological finding** in JNA but is **NOT always present** in all cases. - This sign is **supportive** when present but is not **pathognomonic** or universally found, making any claim of universal presence incorrect. *Frog face deformity* - **Frog face deformity** is indeed a characteristic physical finding in advanced **juvenile nasopharyngeal angiofibroma (JNA)** cases. - Results from significant **tumor extension** and **facial bone remodeling** due to mass effect, pushing facial structures forward and outward. *Management of emergency bleeding with adrenaline soaked gauze* - **Adrenaline-soaked gauze** is a valid emergency management approach for **epistaxis** in JNA due to its **vasoconstrictor** properties. - Provides temporary **hemostasis** while definitive treatment is planned, though systemic effects like **hypertension** must be monitored. *Radowski stage IIIB involves cavernous sinus extension* - The **Radkowski staging system** for JNA correctly classifies **Stage IIIB** as involving **cavernous sinus** extension. - This advanced staging is clinically significant for **surgical planning** and prognosis due to involvement of critical neurovascular structures.

Question 336: A 10-year-old child is brought with complaints of daily headache and nasal stuffiness. He also has paroxysms of sneezing daily. Nasal examination shows a lesion as shown in the image. All are true about the condition shown except?

A. Nasal polyp in right nostril
B. Antrochoanal polyp grows towards anterior choana (Correct Answer)
C. Stage IV polyp goes up to floor of nose
D. Krause nasal snare is used for removal of polyps

Explanation: ***Antrochoanal polyp grows towards anterior choana*** - An **antrochoanal polyp** originates from the maxillary sinus and typically grows towards the **posterior choana** and into the nasopharynx, not the anterior choana. - Polyps usually grow unilaterally and do not spread to the anterior choana. *Nasal polyp in right nostril* - The image clearly shows a **pinkish, edematous mass** protruding from the patient's right nostril, consistent with a nasal polyp. - The child's symptoms of **nasal stuffiness, headache, and sneezing** are also characteristic of nasal polyps. *Stage IV polyp goes up to floor of nose* - The **Lund-Mackay staging system** or similar classification systems for nasal polyps categorize Stage IV polyps as those that **obstruct the entire nasal cavity** or protrude outside the nostril, which matches the visual presentation in the image. - While not specifically mentioning the "floor of the nose" as a distinct stage element, a Stage IV polyp signifies extensive growth throughout the nasal cavity. *Krause nasal snare is used for removal of polyps* - A **Krause nasal snare** is a common surgical instrument used in polypectomy for the removal of larger nasal polyps. - It works by looping around the base of the polyp and excising it, often under local anesthesia.

Question 337: The image shows which of the following tests being performed? (Recent NEET Pattern 2016-17)

A. A= Indirect laryngoscopy, B= Spatula test (Correct Answer)
B. A= Posterior rhinoscopy, B= Spatula test
C. A= Direct laryngoscopy, B= Spatula test
D. A= Anterior rhinoscopy, B= Spatula test

Explanation: ***A= Indirect laryngoscopy, B= Spatula test*** - Image A depicts a mirror being used to visualize the larynx through the oral cavity, which is characteristic of **indirect laryngoscopy**. - Image B shows a spatula being used to apply pressure to the tongue or jaw while observing for a reflex action, which is consistent with the **spatula test** for tetanus. *A= Posterior rhinoscopy, B= Spatula test* - **Posterior rhinoscopy** involves visualizing the nasopharynx via a mirror placed behind the soft palate, which is not what is shown in Image A. - While Image B correctly shows a spatula test, Image A is clearly not a posterior rhinoscopy. *A= Direct laryngoscopy, B= Spatula test* - **Direct laryngoscopy** uses a laryngoscope to directly visualize the larynx without a mirror, often requiring sedation, which differs from the technique in Image A. - Image A shows the use of a mirror for visualization, thus ruling out direct laryngoscopy. *A= Anterior rhinoscopy, B= Spatula test* - **Anterior rhinoscopy** involves examining the anterior nasal cavity using a nasal speculum, which is not depicted in Image A. - Image A shows examination of the oral cavity and pharynx with a mirror, not the anterior nasal cavity.

Question 338: The volume of the balloons shown in epistaxis balloon is: (Recent NEET Pattern 2016-17)

A. 72. (d) (Correct Answer)
B. 73. (b)
C. 74. (b)
D. 75. (c)

Explanation: ***72. (d)*** - This option is indicated to be the correct answer, and without the full image context (which would include labels for the options a, b, c, d with specific volumes), we must assume this represents the correct volume combination for balloons A and B. For a typical epistaxis balloon, the **anterior balloon (A)** is designed to fill the anterior nasal cavity and the **posterior balloon (B)** is designed to seal the choana. - While exact volumes can vary by device, commonly, the anterior balloon (A) has a larger volume capacity than the posterior balloon (B) to effectively tamponade the larger anterior nasal space. *73. (b)* - Without specific volume values for options, it's impossible to confirm why this is incorrect. However, if this option provided volumes inconsistent with established medical device specifications for epistaxis balloons, it would be incorrect. - The volumes chosen must be suitable for effective tamponade without causing excessive pressure or tissue necrosis. *74. (b)* - Similar to the above, without the actual content of option 'b' (e.g., "A = 10ml, B = 20ml" from the provided image fragment text), it's difficult to specifically explain its incorrectness. However, if the implied volumes contradict the typical anatomical requirements and device design for epistaxis control, it is incorrect. - The relative sizes of the balloons (A larger than B, generally) are crucial for proper placement and function. *75. (c)* - Again, the lack of specific volume values for option 'c' (e.g., "A = 30ml, B = 10ml" from the provided image fragment text) prevents a direct explanation. Nevertheless, if the volumes listed do not correspond to the physiological requirements for anterior and posterior nasal packing, or if they are atypical for standard epistaxis devices, this option would be incorrect. - **Over-inflation** or **under-inflation** with incorrect volumes can lead to ineffective treatment or complications like pressure necrosis.

Question 339: The facial features shown in the image are characteristic of:

A. Frog face deformity
B. Adenoid facies (Correct Answer)
C. Ashen grey facies
D. Thyrotoxicosis

Explanation: ***Adenoid facies*** - The image displays characteristic features of adenoid facies, including a **long, open-mouthed face**, a **pinched nose**, and possibly a **high-arched palate** due to chronic mouth breathing from enlarged adenoids. - This chronic condition often leads to a dull expression, sometimes with **strabismus** (crossed eyes) as seen in the image, and a forward head posture. *Frog face deformity* - This deformity is characterized by **ocular hypertelorism** (widely spaced eyes), a **flat nasal bridge**, and a **short nose**, often associated with conditions like Apert syndrome. - While there is some facial dysmorphology, the specific combination of features does not align with a typical frog face. *Ashen grey facies* - This refers to a **pale, grayish complexion**, often indicative of severe cardiovascular compromise like **circulatory collapse** or **shock**. - The child in the image has a normal skin tone for their ethnicity and does not show signs of acute circulatory distress. *Thyrotoxicosis* - **Thyrotoxicosis** (hyperthyroidism) in children can cause symptoms like **exophthalmos** (bulging eyes), **tachycardia**, weight loss, and an enlarged thyroid gland. - While the child's eyes appear wide-set and sometimes strabismic, these are more consistent with the long-term effects of chronic mouth breathing on facial development rather than acute thyroid dysfunction.

Question 340: The following test is done for the evaluation of:

A. Cheek tenderness in maxillary sinusitis (Correct Answer)
B. Abnormality of nasal valve
C. Severity of proptosis
D. Skin pinch for dehydration

Explanation: ***Cheek tenderness in maxillary sinusitis*** - The image shows a person palpating the area over the **maxillary sinus** with their fingers. This examination technique is used to elicit tenderness, a common sign of **maxillary sinusitis**. - **Tenderness on palpation** over the maxillary sinus is a key clinical finding indicating inflammation or infection within the sinus cavity. *Abnormality of nasal valve* - Evaluation of the nasal valve typically involves external observation, internal examination with a speculum, or specialized maneuvers like the **Cottle test**, which involves pulling the cheek laterally to open the valve; it does not involve pressing on the cheek as depicted. - The nasal valve is an internal structure, and its palpation for abnormality would not be performed by pressing on the outer cheekbone as shown. *Severity of proptosis* - Proptosis (exophthalmos) refers to the **abnormal protrusion of the eyeball**. It is typically measured using an **exophthalmometer**. - The action shown in the image, pressing on the cheek, is not a method used to assess or quantify the severity of proptosis. *Skin pinch for dehydration* - The **skin pinch test** (turgor test) for dehydration is usually performed by pinching the skin on the back of the hand, lower arm, or abdomen, not the cheek. - Delayed return of the pinched skin to its normal state, known as **poor skin turgor**, indicates dehydration. The image does not show this technique.

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