Diseases of the Nose and Paranasal Sinuses — MCQs

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

Question 351: What is the most common cause of deafness in a patient with Nasopharyngeal Carcinoma:

A. Fluid accumulation in the middle ear due to eustachian tube obstruction (Correct Answer)
B. Middle ear Infection
C. Metastasis to Temporal Bone
D. Infiltration of Tumour into middle ear

Explanation: ***Fluid accumulation in the middle ear due to eustachian tube obstruction*** - **Nasopharyngeal carcinoma** often grows in close proximity to the opening of the **eustachian tube**, leading to its obstruction. - Obstruction of the eustachian tube prevents proper ventilation of the middle ear, leading to a build-up of fluid (**serous otitis media**), which causes a **conductive hearing loss**. *Middle ear Infection* - While middle ear infections can cause deafness, they are not the most common cause of hearing loss directly attributable to **nasopharyngeal carcinoma**. - **Fluid accumulation due to Eustachian tube dysfunction** precedes infection and is the primary mechanism linked to the tumor. *Metastasis to Temporal Bone* - **Metastasis to the temporal bone** can occur in advanced stages of nasopharyngeal carcinoma, causing hearing loss. - However, direct **eustachian tube obstruction and serous otitis media** are significantly more common initial presentations of hearing impairment. *Infiltration of Tumour into middle ear* - While direct tumor infiltration into the middle ear can lead to deafness, it is less common than the effect of **eustachian tube obstruction**. - **Tumor infiltration** typically indicates more advanced local disease, whereas **eustachian tube dysfunction** can be an early symptom.

Question 352: Young's operation is done for:

A. Allergic rhinitis
B. Vasomotor rhinitis
C. Atrophic rhinitis (Correct Answer)
D. Antrochoanal polyp

Explanation: ***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.

Question 353: 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?

A. Septoplasty
B. I and D
C. Topical corticosteroids (Correct Answer)
D. Antihistaminic

Explanation: ***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.

Question 354: Rhinoscleroma, true statement is:

A. Common in urban areas with high socioeconomic strata
B. Begins at the junction between the stratified squamous epithelium of the vestibule and the respiratory epithelium of the nose (Correct Answer)
C. Caused by Klebsiella ozonae
D. Histopathological picture with Mikulicz cell and the Russell body is not pathognomonic.

Explanation: ***Begins at the junction between the stratified squamous epithelium of the vestibule and the respiratory epithelium of the nose*** - Rhinoscleroma characteristically starts at the **squamocolumnar junction** in the nose, which is a common site for chronic inflammation and infection due to its transitional nature. - This initial colonization and subsequent progression from the vestibule contribute to the typical presentation of the disease. *Common in urban areas with high socioeconomic strata* - Rhinoscleroma is typically found in **rural areas with poor hygiene** and lower socioeconomic conditions, which contribute to its spread. - It is an **endemic disease** in several developing countries, contrasting with urban, high-socioeconomic areas. *Caused by Klebsiella ozonae* - Rhinoscleroma is caused by **Klebsiella rhinoscleromatis**, a specific subspecies of Klebsiella pneumoniae. - **Klebsiella ozonae** is a different bacterial strain primarily associated with ozenic atrophic rhinitis. *Histopathological picture with Mikulicz cell and the Russell body is not pathognomonic.* - The presence of **Mikulicz cells** (large macrophages containing bacilli) and **Russell bodies** (eosinophilic inclusions of immunoglobulins) in biopsy samples is **highly characteristic and virtually diagnostic** for rhinoscleroma. - These features are essential for confirming the diagnosis histopathologically, making them pathognomonic.

Question 355: Failure of rupture of buccopharyngeal membrane leads to?

A. Epistaxis
B. Rhinophyma
C. Crooked nose
D. Choanal atresia (Correct Answer)

Explanation: ***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.

Question 356: The incidence of malignant transformation in inverted papillomas of the upper respiratory tract is:

A. 5% (Correct Answer)
B. 4%
C. 2%
D. 0.10%

Explanation: ***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.

Question 357: The incidence of the mucocele is lowest in

A. Ethmoid sinus
B. Frontal sinus
C. Sphenoid sinus (Correct Answer)
D. Maxillary sinus

Explanation: ***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.

Question 358: Bernoulli's theorem explains -

A. Airflow turbulence in stenotic airways
B. Vocal cord adduction during inspiration
C. Venturi effect in oxygen delivery systems (Correct Answer)
D. Pressure changes in pleural space

Explanation: ***Venturi effect in oxygen delivery systems*** - **Bernoulli's principle** states that in a streamlined (laminar) flow of fluid, an increase in velocity results in a decrease in pressure, and vice versa. - The **Venturi effect** is a direct application of Bernoulli's principle where oxygen flows through a narrow constriction (jet orifice), causing increased velocity and decreased pressure. - This low-pressure zone **entrains room air**, mixing it with the oxygen to deliver a precise FiO₂ (fraction of inspired oxygen). - Venturi masks are commonly used in clinical practice to deliver controlled oxygen concentrations (24%, 28%, 31%, 35%, 40%, 60%). *Airflow turbulence in stenotic airways* - Turbulence in stenotic airways is **not explained** by Bernoulli's principle. - Bernoulli's principle applies to **laminar (streamlined) flow**, not turbulent flow. - Turbulence occurs when the **Reynolds number** exceeds a critical threshold (~2000), which happens in narrowed airways due to increased velocity. - The turbulent airflow causes the **audible wheeze** and stridor heard in airway obstruction. *Vocal cord adduction during inspiration* - Vocal cord adduction and abduction are controlled by **intrinsic laryngeal muscles** (primarily the lateral cricoarytenoid and posterior cricoarytenoid muscles). - This is a **neuromuscular phenomenon** involving the vagus nerve (recurrent laryngeal nerve), not a fluid dynamics principle. - While airflow affects vocal cord vibration during phonation, the muscular control is independent of Bernoulli's principle. *Pressure changes in pleural space* - Pleural pressure changes are determined by **respiratory muscle action** (diaphragm, intercostals) and **elastic recoil** of lungs and chest wall. - These pressure gradients drive bulk airflow into and out of the lungs (according to **Boyle's law**: P₁V₁ = P₂V₂). - This is not explained by Bernoulli's principle, which describes pressure-velocity relationships within a flowing fluid.

Question 359: Tumor arising from olfactory nasal mucosa is

A. Esthesioneuroblastoma (Correct Answer)
B. Nasopharyngeal carcinoma
C. Nasal glioma
D. Adenoid cystic carcinoma

Explanation: ***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.

Question 360: Treatment of choice for antrochoanal polyp in a 10-year-old child-

A. Caldwell luc's
B. Exploratory rhinotomy
C. Conservative treatment till 16 years
D. Intranasal polypectomy (Correct Answer)

Explanation: ***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.

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

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