Diseases of the Nose and Paranasal Sinuses Practice Questions

Q: Identify the instruments shown in the image:

A= Politzer bag, B= Hartmann catheter. ***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).

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

Adenotonsillectomy. ***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.

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

Caldwell Luc operation. ***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.

Q: 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:

Holman-Miller sign is always present in all cases. ***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.

Q: 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?

Antrochoanal polyp grows towards anterior choana. ***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.

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

A= Indirect laryngoscopy, B= Spatula test. ***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.

Q: The facial features shown in the image are characteristic of:

Adenoid facies. ***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.

Q: The following test is done for the evaluation of:

Abnormality of nasal valve. ***Abnormality of nasal valve*** - The image demonstrates the **Cottle test**, where fingers are placed on the cheek lateral to the nose and gently pulled laterally to open the **internal nasal valve**. - If breathing improves with this maneuver, it indicates **nasal valve dysfunction** or collapse, helping diagnose nasal obstruction. *Cheek tenderness in maxillary sinusitis* - Assessment of **maxillary sinusitis** involves direct palpation over the maxillary sinus area below the eye, not lateral traction on the cheek. - **Tenderness on palpation** would be elicited by pressing directly over the sinus, not by pulling the cheek laterally as shown. *Severity of proptosis* - **Proptosis** (exophthalmos) is measured using an **exophthalmometer** to quantify eyeball protrusion. - The lateral traction maneuver shown has no relevance to assessing **ocular protrusion** or orbital pathology. *Skin pinch for dehydration* - The **skin turgor test** for dehydration involves pinching skin on the back of the hand, forearm, or abdomen, not the cheek area. - **Poor skin turgor** is assessed by delayed return of pinched skin to normal position, which is not the technique demonstrated.

Question 1

Identify the instruments shown in the image:

Accepted Answer

A= Politzer bag, B= Hartmann catheter

Answer

A= Siegel speculum, B= Hartmann catheter

Answer

A= Politzer bag, B= Higginson catheter

Answer

A= Siegel speculum, B= Higginson catheter

Question 2

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

Accepted Answer

Adenotonsillectomy

Answer

Septal surgery

Answer

Drainage of Quinsy

Answer

Tracheostomy

Question 3

Identify the surgical procedure being performed in the image shown below.

Accepted Answer

Caldwell Luc operation

Answer

Inferior meatal antrostomy

Answer

Proof puncture

Answer

Superior meatal antrostomy

Question 4

All are contraindications to the procedure shown below except:

Accepted Answer

Antral cyst

Answer

Acute maxillary sinusitis

Answer

Fractured maxilla

Answer

Children less than 3 years

Question 5

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:

Accepted Answer

Holman-Miller sign is always present in all cases

Answer

Frog face deformity can occur in advanced cases

Answer

Emergency bleeding can be managed with adrenaline-soaked gauze

Answer

Radkowski stage IIIB involves cavernous sinus extension

Question 6

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?

Accepted Answer

Antrochoanal polyp grows towards anterior choana

Answer

Nasal polyp in right nostril

Answer

Stage IV polyp goes up to floor of nose

Answer

Krause nasal snare is used for removal of polyps

Question 7

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

Accepted Answer

A= Indirect laryngoscopy, B= Spatula test

Answer

A= Posterior rhinoscopy, B= Spatula test

Answer

A= Direct laryngoscopy, B= Spatula test

Answer

A= Anterior rhinoscopy, B= Spatula test

Question 8

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

Accepted Answer

72. (d)

Answer

73. (b)

Answer

74. (b)

Answer

75. (c)

Question 9

The facial features shown in the image are characteristic of:

Accepted Answer

Adenoid facies

Answer

Frog face deformity

Answer

Ashen grey facies

Answer

Thyrotoxicosis

Question 10

The following test is done for the evaluation of:

Accepted Answer

Abnormality of nasal valve

Answer

Cheek tenderness in maxillary sinusitis

Answer

Severity of proptosis

Answer

Skin pinch for dehydration

Diseases of the Nose and Paranasal Sinuses — MCQs

Diseases of the Nose and Paranasal Sinuses — MCQs

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