Diseases of the Nose and Paranasal Sinuses — MCQs

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

Question 381: A 40-year-old male presents with a 2-week history of nasal obstruction and facial pain. An X-ray in the Waters' view shows opacity in the maxillary sinus with an air-fluid level. What is the most likely diagnosis?

A. Acute maxillary sinusitis (Correct Answer)
B. Maxillary sinus polyp
C. Maxillary sinus carcinoma
D. Chronic maxillary sinusitis

Explanation: ***Acute maxillary sinusitis*** - An **air-fluid level** in the maxillary sinus on X-ray, along with a presentation of **nasal obstruction** and likely facial pain, is a classical finding in **acute sinusitis** due to fluid accumulation. - The symptoms are described as **chronic nasal obstruction** but the presence of an **acute inflammatory process** causing an air-fluid level points towards acute exacerbation or an acute episode. *Maxillary sinus polyp* - A maxillary sinus polyp typically presents as a **soft tissue density** filling the sinus, often causing remodeling of the sinus walls, but it does not usually cause an **air-fluid level**. - Polyps are growths of edematous mucosa, and while they can cause nasal obstruction, they don't involve the acute fluid accumulation seen with infection. *Maxillary sinus carcinoma* - Maxillary sinus carcinoma would typically show an **irregular, often destructive soft tissue mass** on imaging, with bone erosion, rather than a well-defined air-fluid level. - The clinical presentation often includes signs of malignancy such as epistaxis, facial swelling, or nerve involvement, which are not mentioned here. *Chronic maxillary sinusitis* - **Chronic sinusitis** usually presents with **mucosal thickening**, **sclerosis** of sinus walls, and sometimes **opacification** of the sinus on imaging due to persistent inflammation and edema. - While it causes chronic nasal obstruction, the specific finding of an **air-fluid level** is more indicative of an acute inflammatory process or fluid collection rather than the typical chronic features alone.

Question 382: A 17-year-old male presents with swelling in the cheek and recurrent epistaxis. What is the most likely diagnosis?

A. Nasopharyngeal carcinoma
B. Angiofibroma (Correct Answer)
C. Inverted papilloma
D. Sinonasal melanoma

Explanation: ***Angiofibroma (Juvenile Nasopharyngeal Angiofibroma)*** - **Juvenile nasopharyngeal angiofibroma (JNA)** is a benign but locally destructive vascular tumor that **exclusively** affects **adolescent males** (typically 10-25 years, peak at 14-18 years). - The classic triad includes: **adolescent male**, **recurrent severe epistaxis**, and **nasal mass with obstruction**. - **Cheek swelling** occurs due to tumor extension into the **pterygopalatine fossa**, **infratemporal fossa**, and **maxillary sinus**. - Despite being histologically benign, JNA is locally aggressive and can cause significant bony erosion. *Nasopharyngeal carcinoma* - While it can cause **epistaxis** and sometimes facial swelling, it is **uncommon** in adolescents and typically affects **older adults (40-60 years)**. - Usually presents with **cervical lymphadenopathy**, **otitis media** (due to eustachian tube obstruction), and **cranial nerve palsies** in advanced cases. - Strongly associated with **Epstein-Barr virus (EBV)** and has higher incidence in **Southeast Asian** populations. *Inverted papilloma* - **Inverted papillomas** are benign but locally aggressive sinonasal tumors with **5-15% risk of malignant transformation**. - Typically affects **middle-aged to older adults (50-70 years)**, with male predominance. - Presents with **unilateral nasal obstruction** and less commonly epistaxis, but **rarely** causes significant cheek swelling or severe recurrent epistaxis. - **Not characteristic** in a 17-year-old male. *Sinonasal melanoma* - **Sinonasal melanoma** is a rare and highly aggressive malignancy (1-2% of all melanomas) primarily affecting **older adults (60-70 years)**. - Presents with **epistaxis**, nasal obstruction, and facial pain, but is **extremely rare** in adolescents. - Has a **poor prognosis** with high rates of local recurrence and distant metastasis. - **Not the likely diagnosis** given the patient's age and clinical presentation.

Question 383: A patient with a history of asthma presents with nasal congestion and forehead pain. Nasal endoscopy reveals polyps. What is the most likely diagnosis?

A. Chronic rhinosinusitis with nasal polyps (Correct Answer)
B. Allergic rhinitis
C. Septal deviation
D. Adenoid hypertrophy

Explanation: ***Chronic rhinosinusitis with nasal polyps*** - The combination of **asthma**, **nasal congestion**, **forehead pain**, and the presence of **nasal polyps** on endoscopy is highly indicative of chronic rhinosinusitis with nasal polyps. - This condition is often associated with **aspirin-exacerbated respiratory disease (AERD)**, a co-morbidity syndrome frequently found in asthmatic patients with nasal polyps. *Allergic rhinitis* - While allergic rhinitis causes **nasal congestion** and can be associated with asthma, it typically does not lead to the formation of **nasal polyps**. - Symptoms are usually seasonal or triggered by specific allergens and do not commonly present with persistent **forehead pain** unless complicated by sinusitis. *Septal deviation* - **Septal deviation** can cause nasal obstruction and congestion, and sometimes facial pain, but it does **not** cause the formation of **nasal polyps**. - It is a structural abnormality of the nasal septum. *Adenoid hypertrophy* - **Adenoid hypertrophy** primarily affects children, causing nasal congestion, mouth breathing, and sleep-disordered breathing. - It is highly unlikely in an adult patient and does **not** involve the formation of **nasal polyps**.

Question 384: What is the most common cause of nasal obstruction in adults?

A. Nasal polyps
B. Adenoid hypertrophy
C. Deviated nasal septum (Correct Answer)
D. Allergic rhinitis

Explanation: ***Deviated nasal septum*** - **Deviated nasal septum (DNS)** is the most common cause of nasal obstruction in adults, with prevalence studies showing **70-80% of the population** having some degree of septal deviation. - It can cause **unilateral or bilateral obstruction** depending on the severity and type of deviation (C-shaped or S-shaped). - DNS may be **congenital or acquired** due to nasal trauma, and often becomes more symptomatic with age. - Many patients have **chronic, persistent symptoms** that don't respond to medical management, requiring surgical correction (septoplasty). *Allergic rhinitis* - **Allergic rhinitis** is the most common **inflammatory cause** of nasal obstruction, affecting 10-30% of adults. - It causes **intermittent or persistent congestion** with associated symptoms like sneezing, rhinorrhea, and nasal itching. - Unlike DNS, allergic rhinitis typically responds well to **medical management** with antihistamines, nasal steroids, and allergen avoidance. *Nasal polyps* - **Nasal polyps** are less common than DNS and allergic rhinitis in the general adult population. - They often coexist with **chronic rhinosinusitis**, allergic rhinitis, or **aspirin sensitivity** (Samter's triad). - Polyps cause progressive bilateral obstruction and are typically treated with steroids or surgical polypectomy. *Adenoid hypertrophy* - **Adenoid hypertrophy** is primarily a cause of nasal obstruction in **children**, not adults. - Adenoids typically **atrophy after puberty**, making this an uncommon cause in the adult population. - Persistent adenoid enlargement in adults should raise suspicion for **lymphoma or other pathology**.

Question 385: A 50-year-old male with a history of chronic sinusitis presents with a new onset of double vision. What is the most likely complication?

A. Cavernous sinus thrombosis
B. Nasal obstruction
C. Optic neuritis
D. Orbital abscess (Correct Answer)

Explanation: ***Orbital abscess*** - Chronic sinusitis, especially **ethmoid** or **frontal sinusitis**, can spread directly into the orbit due to the thin bony walls separating the sinuses from the orbital cavity, leading to an **orbital abscess**. - An orbital abscess can cause **proptosis**, **ophthalmoplegia**, and **diplopia (double vision)** due to compression or inflammation of extraocular muscles and nerves within the orbit. *Cavernous sinus thrombosis* - While a serious complication of sinusitis, **cavernous sinus thrombosis** typically presents with more widespread symptoms like severe headache, high fever, periorbital edema, and involvement of multiple cranial nerves (III, IV, V1, V2, VI), often leading to a more acute and severe clinical picture than just isolated double vision. - The double vision in cavernous sinus thrombosis would be due to multiple **oculomotor nerve palsies**, whereas in orbital abscess, it's more localized compression or inflammation. *Optic neuritis* - **Optic neuritis** is inflammation of the optic nerve, primarily causing **vision loss** (blurred vision, central scotoma), **pain with eye movement**, and sometimes **impairment of color vision**. - While sinusitis can sometimes cause optic neuropathy, optic neuritis primarily affects visual acuity rather than diplopia, which is related to motor function of the eyes. *Nasal obstruction* - **Nasal obstruction** is a common symptom of chronic sinusitis itself, but it is not a complication that would cause new onset of **double vision**. - Double vision implies involvement of the extraocular muscles or their innervation, which is not directly related to mechanical blockage of nasal passages.

Question 386: The antrochoanal polyp is usually:

A. Single and grows posteriorly (Correct Answer)
B. Multiple
C. Bleeding
D. Bilateral

Explanation: ***Single and grows posteriorly*** - Antrochoanal polyps (ACPs) are characteristically **solitary** and originate from the **maxillary sinus antrum**, extending through the osteum into the choana and often into the nasopharynx. - Their growth pattern is typically **posterior**, explaining symptoms such as nasal obstruction and sometimes dysphagia as they enlarge. *Multiple* - While other nasal polyps can be multiple (e.g., those associated with **chronic rhinosinusitis with nasal polyposis**), antrochoanal polyps are almost exclusively **single**. - A multiple presentation would suggest a different underlying pathology, such as **allergic fungal rhinosinusitis**. *Bleeding* - Significant bleeding is not a typical characteristic of antrochoanal polyps; they are generally **non-hemorrhagic**. - Recurrent epistaxis associated with a nasal mass might raise suspicion for more aggressive lesions like **angiofibroma** or malignancy. *Bilateral* - Antrochoanal polyps are overwhelmingly **unilateral** because they arise from a single maxillary sinus. - Bilateral nasal polyps are more commonly associated with widespread inflammatory conditions like **allergic rhinitis** or **cystic fibrosis**.

Question 387: A 30-year-old male presents with severe epistaxis following nasal trauma. Examination reveals a septal hematoma. What is the most appropriate management?

A. Nasal packing
B. Antibiotics
C. Incision and drainage (Correct Answer)
D. Observation

Explanation: ***Incision and drainage*** - A **septal hematoma** requires immediate **incision and drainage** to prevent complications like **septal necrosis** and **saddle nose deformity**. - Draining the hematoma relieves pressure and restores blood supply to the septal cartilage, which is essential for its viability. *Nasal packing* - While **nasal packing** can control epistaxis, it does not address the underlying **septal hematoma** and may even worsen pressure on the septum. - Packing alone would not relieve the pressure from the accumulated blood, leading to ongoing risk of complications. *Antibiotics* - **Antibiotics** might be administered as an adjunct to prevent infection after drainage, but they are not the primary treatment for the hematoma itself. - Giving antibiotics without draining the hematoma would not resolve the mechanical pressure or prevent cartilage necrosis. *Observation* - **Observation** is inappropriate for a **septal hematoma** due to the high risk of rapid complications such as **cartilage necrosis** and **abscess formation**. - Delaying intervention can lead to irreversible damage, including a permanent **saddle nose deformity**.

Question 388: In which condition is partial or full closure of the nasal passages considered as a treatment option?

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

Explanation: ***Atrophic rhinitis*** - **Partial or full closure of the nasal passages (e.g., Young's operation)** or increasing mucosal bulk is a surgical option aimed at reducing the size of the enlarged nasal cavity, which helps to improve crusting and dryness. Surgical interventions such as Young’s operation reduce the size of the nasal cavity, increase airflow resistance, and provide symptomatic relief by **decreasing fluid evaporation and crusting**. - The condition is characterized by **progressive atrophy of nasal mucosa and underlying bone**, leading to an abnormally wide nasal cavity, crusting, fetor, and paradoxical nasal obstruction. *Allergic rhinitis* - This condition is an **inflammatory response** to allergens, manifesting as sneezing, rhinorrhea, nasal itching, and congestion. - Treatment focuses on **avoidance of allergens**, antihistamines, intranasal corticosteroids, and immunotherapy, not surgical reduction of nasal passages. *Vasomotor rhinitis* - Vasomotor rhinitis is a **non-allergic, non-infectious condition** characterized by chronic rhinitis symptoms triggered by environmental factors like temperature changes or irritants. - Management primarily involves **avoidance of triggers** and symptomatic relief with nasal sprays (anticholinergics or corticosteroids) and does not involve nasal passage closure. *Occupational rhinitis* - This type of rhinitis is caused by **exposure to irritants or allergens in the workplace**, leading to symptoms such as sneezing, nasal congestion, and rhinorrhea. - The primary treatment involves **identifying and avoiding the offending agent** or using personal protective equipment, with medication for symptomatic relief, not surgical closure.

Question 389: What is a rhinolith?

A. A stone formed from mineral deposits in the nasal cavity
B. Deposition of calcium around a foreign body in the nasal cavity (Correct Answer)
C. An incorrect term for nasal stones
D. A foreign body lodged in the nasal cavity

Explanation: ***Deposition of calcium around a foreign body in the nasal cavity*** - A **rhinolith** is formed when **mineral salts**, primarily calcium and magnesium, are deposited around a **foreign body** or blood clot within the nasal cavity. - This process leads to the gradual enlargement and hardening of the mass over time. *A stone formed from mineral deposits in the nasal cavity* - While a rhinolith is a stone formed from mineral deposits in the nasal cavity, this option is less specific. - It does not highlight the crucial role of a **foreign body** or organic nidus in its formation. *An incorrect term for nasal stones* - This statement is incorrect; **rhinolith** is the correct medical term for a stone or calculus found in the nasal cavity. - It accurately describes a specific type of intraluminal nasal obstruction. *A foreign body lodged in the nasal cavity* - A **rhinolith** *develops around* a foreign body, but it is not simply the foreign body itself. - The distinct characteristic of a rhinolith is the **calcification** and mineral deposition that encases the foreign object or organic material.

Question 390: Which of the following statements regarding adenoids is true?

A. Enlarged adenoids can lead to failure to thrive.
B. A CT scan is the preferred method to assess the size of adenoids.
C. Both a and b are true.
D. Mouth breathing is a common symptom of enlarged adenoids. (Correct Answer)

Explanation: ***Mouth breathing is a common symptom of enlarged adenoids.*** - **Enlarged adenoids** obstruct the **nasopharyngeal airway**, forcing individuals, especially children, to breathe through their mouths. - This leads to characteristic facial features, known as **adenoid facies**, and can cause snoring, sleep disturbances, and altered speech. - Mouth breathing is one of the **cardinal symptoms** of adenoid hypertrophy. *Enlarged adenoids can lead to failure to thrive.* - While enlarged adenoids **can contribute** to failure to thrive through **poor feeding**, **sleep-disordered breathing**, and **increased work of breathing**, it is considered a **less common** direct consequence. - Failure to thrive from adenoid hypertrophy typically occurs in severe cases with significant obstructive symptoms. - This statement has some validity but is not as consistently true as mouth breathing being a common symptom. *A CT scan is the preferred method to assess the size of adenoids.* - **Lateral neck X-ray** or **nasal endoscopy** are generally the **preferred initial assessment methods** due to lower radiation exposure, cost-effectiveness, and adequate visualization. - A **CT scan** is typically reserved for cases with suspected complications, alternative diagnoses, or when detailed anatomical assessment of surrounding structures is required. - This statement is **false**. *Both a and b are true.* - This option refers to the first two options (enlarged adenoids causing failure to thrive, and CT scan being preferred). - Since the CT scan statement is clearly **false**, this combined option is **incorrect**. - While enlarged adenoids can sometimes contribute to failure to thrive, the CT scan statement is definitively wrong, making this option incorrect.

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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