Diseases of the Nose and Paranasal Sinuses Practice Questions

Q: Young's operation is done for:

Atrophic rhinitis. ***Atrophic rhinitis*** - **Young's operation** is a surgical procedure specifically designed to treat **atrophic rhinitis**. - The goal of the surgery is to narrow the nasal passages by creating a **synechia** (adhesion) to reduce airflow and improve the humidification and temperature of inspired air. *Allergic rhinitis* - Allergic rhinitis is primarily managed with **medical therapy**, including antihistamines, nasal corticosteroids, and allergen avoidance. - Surgical intervention, if considered, typically involves procedures like turbinate reduction, not Young's operation, and is less common for this condition. *Vasomotor rhinitis* - Vasomotor rhinitis is a **non-allergic, non-infectious condition** characterized by fluctuating nasal congestion and rhinorrhea, often triggered by irritants or temperature changes. - Treatment usually involves **medical management** with anticholinergics or nasal corticosteroids, and sometimes turbinate reduction, but not Young's operation. *Antrochoanal polyp* - An antrochoanal polyp is a benign growth originating in the **maxillary sinus** and extending into the choana. - The primary treatment is **surgical removal**, typically via endoscopic sinus surgery, which is distinct from Young's operation.

Q: A young boy came to OPD with complaints of difficulty in breathing. On examination, bilateral polyps were found. On aspiration, bleeding was seen. What will be the initial management?

Topical corticosteroids. ***Topical corticosteroids*** - **Topical corticosteroids** are the **first-line medical management** for **nasal polyps**, helping to reduce inflammation and shrink polyp size. - They work by reducing local inflammation and edema, improving nasal airway patency and breathing. - **Important note**: The presence of **bleeding on aspiration** suggests a **vascular lesion** (such as juvenile nasopharyngeal angiofibroma in young males), which would require **imaging (CT/MRI) before any intervention** and **no biopsy** due to hemorrhage risk. However, if these are inflammatory polyps, topical steroids remain the initial medical management. *Antihistaminic* - **Antihistamines** are not first-line treatment for nasal polyps, as polyps are primarily an **eosinophilic inflammatory condition** rather than a simple IgE-mediated allergic reaction. - While antihistamines may help with associated allergic rhinitis symptoms, they do **not shrink polyps** or address the underlying inflammatory pathology. *Septoplasty* - **Septoplasty** is a surgical procedure to correct a **deviated nasal septum**, not for treating nasal polyps. - This would not address the bilateral polyps causing difficulty in breathing. *I and D* - **Incision and drainage (I&D)** is performed for abscesses or pus collections, which is not the presentation here. - Nasal polyps are benign inflammatory masses, not infectious collections requiring drainage.

Q: Failure of rupture of buccopharyngeal membrane leads to?

Choanal atresia. ***Choanal atresia*** - The **buccopharyngeal membrane** (also called the oronasal or choanal membrane) normally ruptures to establish communication between the nasal cavity and the pharynx. - Failure of this rupture results in a bony or membranous obstruction of the posterior nasal opening (choana). - This presents as **bilateral nasal obstruction in neonates**, which is life-threatening as neonates are obligate nasal breathers. *Epistaxis* - This refers to a **nosebleed**, which is typically caused by trauma, dryness, or underlying blood dyscrasias. - It is not related to the developmental failure of the buccopharyngeal membrane. *Rhinophyma* - This is a feature of advanced **rosacea**, characterized by an enlarged, red, and bulbous nose due to sebaceous gland hypertrophy. - It is a dermatological condition unrelated to embryonic development. *Crooked nose* - A crooked nose usually results from **trauma** or developmental abnormalities of the nasal cartilages and bones. - It is a structural deformity of the external nose and not the internal nasal passages.

Q: The incidence of malignant transformation in inverted papillomas of the upper respiratory tract is:

5%. ***5%*** - The **incidence of malignant transformation** to squamous cell carcinoma in inverted papillomas ranges from **5% to 15%**, with **5%** representing the lower end of this accepted range. - This transformation risk necessitates complete surgical excision and long-term follow-up for patients with inverted papillomas. - Some references cite the average closer to 10%, but 5% is a commonly reported figure in standard textbooks. *4%* - While 4% is close to the lower bound, it is generally considered slightly below the widely accepted minimum of the **5-15% range** for malignant transformation in inverted papillomas. - The typical range quoted in literature starts at 5%, emphasizing the importance of monitoring for this complication. *2%* - A 2% incidence is too low and does not accurately reflect the known risk of **malignant transformation** in inverted papillomas. - Relying on such a low figure might lead to underestimation of the severity and potential complications of this condition. *0.10%* - An incidence of 0.10% is significantly lower than the established **5-15% range** for malignant transformation of inverted papillomas. - This percentage would be representative of a rare event, whereas transformation to squamous cell carcinoma is a well-recognized and clinically significant risk.

Q: The incidence of the mucocele is lowest in

Sphenoid sinus. ***Sphenoid sinus*** - The **sphenoid sinus** has the **lowest incidence** of mucoceles among all paranasal sinuses, accounting for only **1-2%** of all cases. - Its deeper anatomical location, smaller size, and relatively protected position make obstruction less common. - The wide ostium and direct drainage into the sphenoethmoidal recess contribute to lower rates of obstruction. *Maxillary sinus* - The **maxillary sinus** accounts for approximately **5-10%** of mucoceles, making it the third most common site. - Despite being the largest paranasal sinus, mucoceles are relatively uncommon here due to the wide natural ostium and gravity-assisted drainage. *Ethmoid sinus* - The **ethmoid sinus** is the **second most common** site, accounting for **20-30%** of mucoceles. - Its complex anatomy with multiple small cells and narrow drainage pathways predisposes to obstruction. - Chronic inflammation and anatomical variations frequently lead to ostial blockage and mucus accumulation. *Frontal sinus* - The **frontal sinus** is the **most common** site for mucoceles, representing **60-65%** of all cases. - The long, narrow **frontonasal duct** is particularly prone to obstruction from inflammation, trauma, or previous surgery. - Its anatomical configuration makes it highly susceptible to drainage pathway blockage.

Q: Tumor arising from olfactory nasal mucosa is

Esthesioneuroblastoma. ***Esthesioneuroblastoma*** - **Esthesioneuroblastoma**, also known as olfactory neuroblastoma, is a rare malignant tumor that originates from the **neuroectodermal cells** of the olfactory epithelium in the nasal cavity. - It arises specifically from the **olfactory nasal mucosa**, which is responsible for the sense of smell. *Nasopharyngeal carcinoma* - This is a cancer that originates in the **nasopharynx**, the upper part of the pharynx behind the nose, not directly from the olfactory mucosa. - It is strongly associated with **Epstein-Barr virus (EBV) infection** and squamous cell histology. *Nasal glioma* - A nasal glioma is a **benign congenital lesion** consisting of mature glial tissue, typically not arising from the olfactory mucosa. - It is a **developmental rest** of brain tissue that has herniated outside the cranium, often presenting as a mass on the nose. *Adenoid cystic carcinoma* - This is a malignant tumor primarily affecting **glandular tissues**, such as salivary glands, but can occur in the nasal cavity as well. - It originates from the **minor salivary glands** or seromucinous glands within the nasal cavity, not specifically from the olfactory neuroepithelium.

Q: Treatment of choice for antrochoanal polyp in a 10-year-old child-

Intranasal polypectomy. ***Intranasal polypectomy*** - **Intranasal polypectomy**, particularly via **endoscopic sinus surgery**, is the preferred treatment for antrochoanal polyps in children due to its minimally invasive nature and ability to ensure complete removal of the polyp's antral component. - This approach allows for direct visualization and removal of the polyp, including its origin from the **maxillary sinus ostium**, which is crucial to prevent recurrence. *Caldwell luc's* - The Caldwell-Luc procedure is a more invasive technique that involves creating an antrostomy through the anterior wall of the maxillary sinus. - It is associated with higher morbidity, including potential for **facial swelling**, **nerve damage**, and **dental complications**, making it less favored, especially in children, for antrochoanal polyps. *Exploratory rhinotomy* - **Exploratory rhinotomy** is a highly invasive surgical approach typically reserved for extensive or malignant sinonasal tumors. - It is an overly aggressive and unnecessary procedure for a benign condition like an antrochoanal polyp. *Conservative treatment till 16 years* - Antrochoanal polyps cause symptoms like **nasal obstruction** and potential ostial blockage, leading to sinus infections. - Delaying treatment is not advisable as it can lead to chronic symptoms, impaired quality of life, and potential complications from untreated sinus disease.

Question 1

What is the most common cause of deafness in a patient with Nasopharyngeal Carcinoma:

Accepted Answer

Fluid accumulation in the middle ear due to eustachian tube obstruction

Answer

Middle ear Infection

Answer

Metastasis to Temporal Bone

Answer

Infiltration of Tumour into middle ear

Question 2

Young's operation is done for:

Accepted Answer

Atrophic rhinitis

Answer

Allergic rhinitis

Answer

Vasomotor rhinitis

Answer

Antrochoanal polyp

Question 3

A young boy came to OPD with complaints of difficulty in breathing. On examination, bilateral polyps were found. On aspiration, bleeding was seen. What will be the initial management?

Accepted Answer

Topical corticosteroids

Answer

Septoplasty

Answer

I and D

Answer

Antihistaminic

Question 4

Rhinoscleroma, true statement is:

Accepted Answer

Begins at the junction between the stratified squamous epithelium of the vestibule and the respiratory epithelium of the nose

Answer

Common in urban areas with high socioeconomic strata

Answer

Caused by Klebsiella ozonae

Answer

Histopathological picture with Mikulicz cell and the Russell body is not pathognomonic.

Question 5

Failure of rupture of buccopharyngeal membrane leads to?

Accepted Answer

Choanal atresia

Answer

Epistaxis

Answer

Rhinophyma

Answer

Crooked nose

Question 6

The incidence of malignant transformation in inverted papillomas of the upper respiratory tract is:

Accepted Answer

5%

Answer

4%

Answer

2%

Answer

0.10%

Question 7

The incidence of the mucocele is lowest in

Accepted Answer

Sphenoid sinus

Answer

Ethmoid sinus

Answer

Frontal sinus

Answer

Maxillary sinus

Question 8

Bernoulli's theorem explains -

Accepted Answer

Venturi effect in oxygen delivery systems

Answer

Airflow turbulence in stenotic airways

Answer

Vocal cord adduction during inspiration

Answer

Pressure changes in pleural space

Question 9

Tumor arising from olfactory nasal mucosa is

Accepted Answer

Esthesioneuroblastoma

Answer

Nasopharyngeal carcinoma

Answer

Nasal glioma

Answer

Adenoid cystic carcinoma

Question 10

Treatment of choice for antrochoanal polyp in a 10-year-old child-

Accepted Answer

Intranasal polypectomy

Answer

Caldwell luc's

Answer

Exploratory rhinotomy

Answer

Conservative treatment till 16 years

Diseases of the Nose and Paranasal Sinuses — MCQs

Diseases of the Nose and Paranasal Sinuses — MCQs

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