Diseases of the Nose and Paranasal Sinuses — MCQs

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

Question 361: Which of the following surgeries is not contraindicated below 12 years of age?

A. SMR
B. FESS (Correct Answer)
C. Rhinoplasty
D. Septoplasty

Explanation: ***FESS*** - **Functional Endoscopic Sinus Surgery (FESS)** is often indicated in children below 12 years with **chronic rhinosinusitis** or frequent **acute exacerbations** unresponsive to medical therapy. - Delaying FESS in appropriate cases can lead to recurrent infections, impacting quality of life and potentially growth. *SMR* - **Submucous Resection (SMR)** is generally avoided in children below 17-18 years of age due to the continued **growth of the nasal septum**. - Performing SMR too early can interfere with the **midfacial growth centers**, potentially leading to deformities. *Rhinoplasty* - **Rhinoplasty**, a cosmetic procedure to reshape the nose, is contraindicated in children due to the ongoing **development of facial bones and cartilage**. - Early rhinoplasty can disrupt growth and lead to unsatisfactory and potentially disfiguring results as the child matures. *Septoplasty* - **Septoplasty**, while sometimes necessary for severe septal deviation, is generally deferred until **nasal growth is complete** (typically after age 16-17). - Early septoplasty may disrupt the **septal growth plates**, leading to a saddle nose deformity or other nasal growth disturbances.

Question 362: Partial and full closure of nasal passages is characteristically seen in:

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

Explanation: ***Vasomotor rhinitis*** - This condition is characterized by **vascular dysregulation** in the nasal mucosa, leading to episodic **swelling** and **congestion** that can result in partial or full nasal closure without an identifiable allergic or infectious cause. - Symptoms are often triggered by **non-specific irritants** like temperature changes, strong odors, or emotional stress, causing the nasal blood vessels to dilate excessively. *Allergic rhinitis* - While it causes nasal congestion and obstruction, the primary mechanism is an **IgE-mediated inflammatory response** to specific allergens, leading to mucosal edema and increased mucus production. - The closure is typically accompanied by other allergic symptoms such as **sneezing**, **itching**, and **rhinorrhea**, which differentiates it from vasomotor rhinitis. *Atrophic rhinitis* - This condition involves **progressive atrophy** of the nasal mucosa, turbinates, and underlying bone, resulting in an abnormally wide nasal passage rather than obstruction. - Patients typically experience **paradoxical nasal obstruction** due to altered airflow dynamics and crusting, alongside a characteristic foul odor. *Occupational rhinitis* - This type of rhinitis is caused by **exposure to specific agents** in the workplace, leading to inflammation and nasal obstruction, often accompanied by sneezing and rhinorrhea. - Symptom onset is directly linked to **workplace exposure** and improves away from the occupational environment, which is not suggested by the general term "partial and full closure."

Question 363: True regarding rhinitis medicamentosa is/are?

A. Caused by beta-agonist sprays
B. Prolonged spray use can cause turbinate hypertrophy
C. Caused by adrenergic agonist decongestants (Correct Answer)
D. There is inferior turbinate hypertrophy

Explanation: ***Caused by adrenergic agonist decongestants*** - **Rhinitis medicamentosa** is a condition of nasal congestion caused by the overuse of topical **alpha-adrenergic agonist decongestant** nasal sprays like oxymetazoline or phenylephrine (NOT beta-agonists). - These decongestants cause **vasoconstriction**, and their prolonged use (typically >5-7 days) leads to a **rebound phenomenon** of vasodilation and worsening congestion. - This is the PRIMARY and DEFINING characteristic of rhinitis medicamentosa. *Caused by beta-agonist sprays* - Beta-agonist sprays are primarily used in the treatment of **asthma** and act on beta-adrenergic receptors in the bronchi. - They do **NOT** cause rhinitis medicamentosa, which is specifically linked to **alpha-adrenergic agonists** in the nasal mucosa. **Prolonged spray use can cause turbinate hypertrophy** - This statement is **ALSO MEDICALLY ACCURATE** - chronic use of topical decongestants leads to **mucosal edema, inflammation, and eventually structural turbinate hypertrophy**. - The pathophysiology involves chronic vasodilation, mucosal inflammation, and eventual fibrosis. - However, the PRIMARY defining feature remains the medication-induced rebound congestion from alpha-agonists. **There is inferior turbinate hypertrophy** - **Inferior turbinate hypertrophy** is indeed a **COMMON CLINICAL FINDING** in rhinitis medicamentosa on nasal endoscopy. - The chronic congestion and inflammation lead to bilateral inferior turbinate enlargement with pale, boggy mucosa. - However, this is a SECONDARY finding/complication rather than the PRIMARY defining characteristic. **NOTE:** Both turbinate hypertrophy statements are medically accurate features of rhinitis medicamentosa. The primary/most specific answer is the etiology (alpha-adrenergic agonist decongestants).

Question 364: FESS means:

A. Flexible endoscopic sinus surgery
B. Functional endoscopic sinus surgery (Correct Answer)
C. Fibroscopic endoscopic sinus surgery
D. Frontal endoscopic sinus surgery

Explanation: ***Functional endoscopic sinus surgery*** - **FESS** is a minimally invasive surgical technique used to treat **chronic sinusitis** and other sinus conditions. - The goal of FESS is to restore normal sinus function and ventilation by removing obstructions and diseased tissue. *Flexible endoscopic sinus surgery* - This term is incorrect; while FESS uses endoscopes, they are generally rigid, not flexible, for better visualization and instrumentation. - **Flexible endoscopes** are more commonly used for procedures like bronchoscopy or colonoscopy. *Fibroscopic endoscopic sinus surgery* - The term **fibroscopic** is typically associated with scopes employing fiber optics but is not the correct full form of the acronym FESS. - This option incorrectly modifies the standard medical terminology for this procedure. *Frontal endoscopic sinus surgery* - While FESS can be performed on the **frontal sinuses**, this option is too specific and does not represent the complete and correct expansion of the acronym. - FESS encompasses procedures on all paranasal sinuses, not just the frontal sinus.

Question 365: Young's surgery is done for the treatment of?

A. Atrophic rhinitis (Correct Answer)
B. Rhinoscleroma
C. Deviated nasal septum
D. Choanal atresia

Explanation: ***Atrophic rhinitis*** - **Young's surgery** is a procedure specifically designed to treat severe cases of **atrophic rhinitis**, aiming to narrow the nasal cavities and promote mucosal healing. - The surgery involves **closing the nostrils** partially or completely, often in two stages, to reduce airflow and dryness. *Rhinoscleroma* - This is a **chronic granulomatous infection** of the nose and upper respiratory tract caused by *Klebsiella rhinoscleromatis*. - Treatment primarily involves **antibiotics** like ciprofloxacin or tetracycline, and sometimes surgical debulking, not Young's surgery. *Deviated nasal septum* - A **deviated nasal septum** (DNS) is a structural abnormality where the wall between the nostrils is off-center. - The standard surgical correction for DNS is **septoplasty**, which reshapes or repositions the septum. *Choanal atresia* - **Choanal atresia** is a congenital malformation where the back of the nasal passage (choana) is blocked, usually by bone or soft tissue. - Surgical correction typically involves **transnasal endoscopic drilling** or other approaches to create an opening.

Question 366: Which of the following statements regarding nasolabial cyst is TRUE?

A. Presents submucosally in anterior nasal floor
B. Bilateral
C. Arises from odontogenic epithelium
D. Usually seen in adults (Correct Answer)

Explanation: ***Usually seen in adults*** - **Nasolabial cysts** most commonly manifest in **adulthood**, typically in the fourth to fifth decades of life. - This presentation is consistent across various demographic studies of these **rare developmental cysts**. *Presents submucosally in anterior nasal floor* - **Nasolabial cysts** typically present as a swelling in the **nasolabial fold region**, beneath the ala of the nose. - While they can extend internally, their primary presentation is not usually described as submucosal in the anterior nasal floor; rather they are more lateral and superior. *Bilateral* - **Nasolabial cysts** are almost exclusively **unilateral**, with bilateral presentation being exceedingly rare. - The vast majority of reported cases describe a single cyst on one side of the face. *Arises from odontogenic epithelium* - **Nasolabial cysts** are thought to arise from remnants of the **nasolacrimal duct**, or possibly from entrapped epithelium during facial development, specifically at the fusion of the maxillary, lateral nasal, and medial nasal processes. - They are not considered to be of **odontogenic origin**, which refers to cysts arising from tooth-forming tissues.

Question 367: Vidian neurectomy done in:

A. Vasomotor rhinitis (Correct Answer)
B. Atrophic rhinitis
C. Allergic rhinitis
D. Drug-induced rhinitis

Explanation: ***Vasomotor rhinitis*** - **Vidian neurectomy** involves sectioning the **vidian nerve**, which carries parasympathetic fibers to the nasal glands, effectively reducing troublesome rhinorrhea and congestion. - This procedure is primarily considered for severe cases of **vasomotor rhinitis** that are refractory to conventional medical management. *Atrophic rhinitis* - Characterized by **progressive atrophy** of the nasal mucosa, turbinates, and underlying bone, along with the formation of foul-smelling crusts. - Vidian neurectomy is **contraindicated** in atrophic rhinitis as it would further reduce nasal secretions, worsening symptoms. *Allergic rhinitis* - Primarily an **IgE-mediated hypersensitivity reaction** to airborne allergens, leading to inflammation of the nasal passages. - Management typically involves **antihistamines**, nasal corticosteroids, and allergen avoidance, with surgery being a last resort for specific complications. *Drug-induced rhinitis* - Occurs as a side effect of certain medications, such as **topical decongestants** (rhinitis medicamentosa) or some **systemic antihypertensives**. - Treatment involves **discontinuing the offending drug** and managing symptoms; vidian neurectomy is not an appropriate treatment.

Question 368: Assertion: Nasal polyps are commonly associated with aspirin-exacerbated respiratory disease (AERD). Reason: Aspirin directly causes nasal polyp formation in all patients with AERD.

A. Both Assertion and Reason are true, and Reason is the correct explanation for Assertion.
B. Both Assertion and Reason are false.
C. Assertion is true, but Reason is false. (Correct Answer)
D. Both Assertion and Reason are true, but Reason is not the correct explanation for Assertion.

Explanation: ***Assertion is true, but Reason is false.*** - The **assertion is correct** because nasal polyps are a hallmark feature of **aspirin-exacerbated respiratory disease (AERD)**, also known as **Samter's Triad** (asthma, aspirin sensitivity, chronic rhinosinusitis with nasal polyposis). - The **reason is false** because aspirin does not directly *cause* nasal polyp formation. Instead, aspirin triggers a severe inflammatory reaction in predisposed individuals through **COX-1 inhibition**, leading to an imbalance in **eicosanoid metabolism** with overproduction of **pro-inflammatory leukotrienes (LTC4, LTD4, LTE4)**. - Nasal polyps in AERD result from **chronic eosinophilic inflammation** and underlying mucosal disease, not direct causation by aspirin. *Both Assertion and Reason are true, and Reason is the correct explanation for Assertion.* - This is incorrect because the reason is fundamentally false. - Aspirin does not directly cause polyp formation; it exacerbates pre-existing inflammatory conditions in susceptible individuals. *Both Assertion and Reason are true, but Reason is not the correct explanation for Assertion.* - This is incorrect because the reason itself is false, not merely an incorrect explanation. - The pathophysiology involves aspirin triggering inflammation in predisposed patients, not causing the polyps directly. *Both Assertion and Reason are false.* - This is incorrect because the assertion is medically accurate. - Nasal polyps are indeed commonly associated with AERD and represent one component of the classic **Samter's Triad**.

Question 369: Which of the following statements about nasal polyps is the MOST accurate?

A. They are usually benign. (Correct Answer)
B. They are more common in adults than children.
C. They are commonly associated with aspirin sensitivity.
D. They are a complication of chronic sinusitis.

Explanation: ***They are usually benign.*** - The vast majority of **nasal polyps** are benign inflammatory lesions, originating from the nasal or sinus mucosa. - They are not considered neoplastic, differentiating them from malignant tumors that can occur in the nasal cavity. *They are more common in adults than children.* - While nasal polyps can occur in children, especially in association with **cystic fibrosis** or primary ciliary dyskinesia, they are still significantly more prevalent in adults. - The peak incidence is typically in individuals between 40 and 60 years old. *They are commonly associated with aspirin sensitivity.* - **Aspirin-exacerbated respiratory disease (AERD)**, also known as Samter's triad, is a specific syndrome characterized by asthma, recurrent nasal polyps, and aspirin sensitivity. - However, not all patients with nasal polyps have aspirin sensitivity; it's a specific subset of patients. *They are a complication of chronic sinusitis.* - While **chronic rhinosinusitis with nasal polyps (CRSwNP)** is a common presentation, and polyps often develop in the context of chronic inflammation, they are not strictly a "complication." - Rather, nasal polyp formation is a manifestation or an end-stage of a specific inflammatory process within chronic rhinosinusitis, not merely an incidental side effect.

Question 370: Which of the following is NOT typically associated with acute bacterial sinusitis?

A. Purulent nasal discharge
B. Epistaxis (Correct Answer)
C. Facial pain
D. Fever

Explanation: ***Epistaxis*** - While possible due to **mucosal inflammation** or irritation from forceful blowing, **epistaxis (nosebleeds)** is not considered a typical or primary symptom of acute bacterial sinusitis. - The main symptoms revolve around pressure, discharge, and systemic signs of infection. *Purulent nasal discharge* - This is a hallmark symptom of acute bacterial sinusitis, indicating the presence of **bacterial infection** and inflammation in the sinuses. - The discharge is often thick, colored (yellow, green), and can be accompanied by a **foul odor**. *Facial pain* - **Facial pain** or pressure, especially around the cheeks, forehead, or eyes, is a characteristic symptom stemming from inflammation and fluid accumulation within the **sinus cavities**. - This pain often worsens when bending forward. *Fever* - **Fever** is a systemic sign of infection and is commonly present in acute bacterial sinusitis, especially in more severe cases. - It indicates the body's immune response to the bacterial invasion.

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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