Diseases of the Nose and Paranasal Sinuses — MCQs

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

Question 391: Most common benign tumor of the paranasal sinuses?

A. Papilloma
B. Osteoma (Correct Answer)
C. Antrochoanal polyp
D. Fibroma

Explanation: ***Osteoma*** - **Osteomas** are the **most common benign tumors** found in the paranasal sinuses, particularly the **frontal sinus**. - They are slow-growing **bone tumors** that are often asymptomatic but can cause symptoms like pain or obstruction if large. *Papilloma* - While **inverted papillomas** occur in the paranasal sinuses, they are less common than osteomas. - They have a significant risk of **malignant transformation** and tend to recur after excision. *Antrochoanal polyp* - **Antrochoanal polyps** are benign lesions arising from the **maxillary sinus** that extend through the ostium into the nasal cavity and nasopharynx. - They are relatively common but are **not true neoplasms**, rather inflammatory/edematous lesions, distinct from osteomas. *Fibroma* - **Fibromas** are benign tumors composed of **fibrous connective tissue** and are relatively rare in the paranasal sinuses compared to osteomas. - They can occur in various locations but are not the leading cause of benign sinus growths.

Question 392: What type of polyp is characterized by its extension from the maxillary sinus into the choana?

A. Antrochoanal polyp (Correct Answer)
B. Ethmoidal polyp
C. Frontal polyp
D. Maxillary polyp

Explanation: ***Antrochoanal polyp*** - An **antrochoanal polyp** classically originates in the **maxillary sinus** and extends through the **ostium** into the nasal cavity, eventually reaching the **choana** (the posterior opening of the nasal cavity). - This distinct growth pattern is a key diagnostic feature, differentiating it from other types of nasal polyps. *Ethmoidal polyp* - **Ethmoidal polyps** arise from the **ethmoid sinuses** and typically present as multiple, bilateral growths in the nasal cavity. - Unlike antrochoanal polyps, they do not originate specifically from the maxillary sinus and rarely extend into the choana in isolation. *Frontal polyp* - **Frontal polyps** originate from the **frontal sinuses** and are less common than ethmoidal or antrochoanal polyps. - Their growth pattern would involve extension into the nasal cavity from the frontal sinus, not from the maxillary sinus into the choana. *Maxillary polyp* - While an antrochoanal polyp originates from the maxillary sinus, the term **"maxillary polyp"** itself is too broad and does not specifically describe the characteristic extension into the choana. - A simple maxillary polyp might refer to any polyp located within the maxillary sinus that has not yet extended beyond its confines in this specific manner.

Question 393: Young's operation is done for?

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

Explanation: ***Correct: Atrophic rhinitis*** - **Young's operation** involves partially or completely closing the nostrils to create a warm, moist environment within the nasal cavity, which is beneficial for the regeneration of nasal mucosa in **atrophic rhinitis**. - This procedure aims to reduce the severity of symptoms like **crusting**, foul odor (ozena), and repeated infections associated with atrophic rhinitis. - The closure prevents excessive drying and promotes healing of the atrophied mucosa. *Incorrect: Allergic rhinitis* - Allergic rhinitis is an inflammatory condition triggered by **allergens**, typically managed with antihistamines, nasal corticosteroids, and allergen avoidance. - **Young's operation** is not indicated for allergic rhinitis, as it addresses structural and mucosal atrophy issues, not allergic responses. *Incorrect: Vasomotor rhinitis* - This condition involves **non-allergic triggers** causing nasal congestion, rhinorrhea, and sneezing due to dysregulation of the autonomic nervous system. - Treatment focuses on symptomatic relief with nasal sprays or anticholinergics; **surgical closure of nostrils** is inappropriate. *Incorrect: Idiopathic rhinitis* - **Idiopathic rhinitis** is a diagnosis of exclusion, meaning its cause is unknown, but it does not typically involve the severe mucosal atrophy seen in atrophic rhinitis. - Management is similar to vasomotor rhinitis, aiming for **symptomatic control**, making Young's operation unsuitable.

Question 394: Which of the following statements about vasomotor rhinitis is NOT true?

A. It is due to parasympathetic overactivity
B. Resistant cases may need cryotherapy
C. It may lead to hypertrophic rhinitis
D. It is caused by an allergic reaction (Correct Answer)

Explanation: ***It is caused by an allergic reaction.*** - Vasomotor rhinitis, also known as nonallergic rhinitis, is characterized by symptoms similar to allergic rhinitis but is **not mediated by an allergic reaction** or an IgE-mast cell response. - Its etiology is related to the **dysregulation of the autonomic nervous system**, specifically an imbalance in the vascular tone of nasal blood vessels, rather than an allergic trigger. *It is due to parasympathetic overactivity* - **Parasympathetic overactivity** is a recognized underlying mechanism in vasomotor rhinitis, leading to increased vascular permeability and glandular secretion. - This overactivity results in symptoms such as **nasal congestion**, rhinorrhea, and sneezing, mimicking allergic rhinitis without an identifiable allergen. *Resistant cases may need cryotherapy* - For severe and **medically refractory cases** of vasomotor rhinitis, **cryotherapy** (specifically cryoablation of the posterior nasal nerve) can be a treatment option. - This procedure targets the nerves responsible for parasympathetic outflow to the nasal mucosa, thereby reducing symptoms like rhinorrhea and congestion. *It may lead to hypertrophic rhinitis* - Chronic inflammation and vascular engorgement associated with long-standing vasomotor rhinitis can lead to **mucosal hypertrophy**, particularly of the inferior turbinates. - This condition, known as **hypertrophic rhinitis**, can exacerbate nasal obstruction and may require surgical intervention to improve airflow.

Question 395: Which of the following is NOT a feature of a nasal foreign body?

A. Deviated septum (Correct Answer)
B. Epistaxis
C. Nasal obstruction
D. Vestibulitis

Explanation: ***Deviated septum*** - A **deviated septum** is an anatomical variation of the nasal septum which causes **nasal obstruction** but is not a symptom or complication resulting from a **nasal foreign body**. - It is a structural abnormality that is usually congenital or due to trauma, unrelated to the presence of an object. *Vestibulitis* - **Nasal vestibulitis** can develop as a secondary infection or inflammation around a foreign body due to irritation or bacterial growth. - The constant presence and irritation from the foreign object in the nasal cavity can lead to inflammation and infection of the nasal vestibule. *Epistaxis* - **Epistaxis** (nosebleed) is a common symptom of a nasal foreign body, especially if the object is sharp, causes trauma, or leads to significant irritation of the nasal mucosa. - The foreign body can directly traumatize the blood vessels in the nasal lining, leading to bleeding. *Nasal obstruction* - A **nasal foreign body** will physically block the nasal passage, leading to symptoms of **nasal obstruction**, often unilateral, depending on the size and location of the object. - This is one of the most direct and immediate symptoms caused by the presence of an object within the nasal cavity.

Question 396: All of the following are causes of perforation of the cartilaginous part of the nasal septum except?

A. Tuberculosis
B. Leprosy
C. Trauma
D. Syphilis (Correct Answer)

Explanation: ***Syphilis*** - **Syphilis** typically causes perforation of the **bony part** of the nasal septum, particularly the vomer and perpendicular plate of the ethmoid bone, due to chronic granulomatous inflammation. - The cartilaginous septum is generally less affected by syphilis in terms of perforation, although early mucosal involvement can occur. *Trauma* - **Trauma** (e.g., nose picking, septal surgery, foreign body insertion) is a common cause of **perforation of the cartilaginous nasal septum**. - Such injuries can lead to localized necrosis and subsequent perforation due to disruption of the blood supply to the septal cartilage. *Tuberculosis* - **Tuberculosis** can cause **granulomatous inflammation** and necrosis, leading to perforation of the **cartilaginous nasal septum**. - This is part of extrapulmonary tuberculosis and can present with chronic nasal obstruction and discharge. *Leprosy* - **Leprosy** (Hansen's disease) is known to cause severe destruction of nasal structures due to chronic inflammation, including perforation of the **cartilaginous nasal septum**. - The specific bacteria cause granulomatous lesions that erode the cartilage over time.

Question 397: Which of the following statements about vasomotor rhinitis is false?

A. It is an infective condition (Correct Answer)
B. It primarily presents with nasal congestion and rhinorrhea
C. It involves autonomic dysfunction of nasal blood vessels
D. It is triggered by non-allergic stimuli like weather changes and strong odors

Explanation: ***It is an infective condition*** - **Vasomotor rhinitis** is a **non-allergic, non-infectious** condition of the nasal passages. - Its pathophysiology involves **autonomic nervous system dysfunction** affecting nasal blood vessels, not microbial infection. *It primarily presents with nasal congestion and rhinorrhea* - This statement is **true** because classic symptoms of vasomotor rhinitis include persistent or intermittent **nasal congestion** and **rhinorrhea** (runny nose). - These symptoms result from the dysregulation of the autonomic control over nasal vasculature and glands. *It involves autonomic dysfunction of nasal blood vessels* - This statement is **true** and describes the core mechanism of vasomotor rhinitis, where the **parasympathetic nervous system** is relatively overactive, leading to vasodilation and increased glandular secretions. - This dysfunction causes the characteristic symptoms without an allergic or infectious trigger. *It is triggered by non-allergic stimuli like weather changes and strong odors* - This statement is **true** as patients with vasomotor rhinitis often report symptoms triggered by **environmental irritants** such as strong perfumes, temperature changes, humidity fluctuations, or even emotional stress. - These triggers differentiate it clinically from allergic rhinitis.

Question 398: All of the following are true about nasal myiasis except which of the following?

A. Common in vasomotor rhinitis
B. Nasal myiasis can cause intense nasal irritation.
C. Meningitis may occur in severe nasal myiasis.
D. Nasal myiasis is typically asymptomatic (Correct Answer)

Explanation: ***Nasal myiasis is typically asymptomatic*** - This statement is **INCORRECT** and is the correct answer to this "except" question. - **Nasal myiasis** is characterized by infestation of the nasal cavity with **fly larvae (maggots)**, which typically causes **significant symptoms** rather than being asymptomatic. - Patients usually experience **nasal obstruction**, **epistaxis (nosebleeds)**, **foul-smelling nasal discharge**, **intense irritation**, and a sensation of movement in the nose due to the feeding and movement of the larvae. - The condition is rarely asymptomatic and usually prompts patients to seek medical attention due to the distressing symptoms. *Common in vasomotor rhinitis* - This statement is **INCORRECT** as a factual claim about myiasis. Nasal myiasis is **NOT** commonly associated with vasomotor rhinitis. - Nasal myiasis is more commonly associated with **atrophic rhinitis**, **ozena**, neglected nasal wounds, poor hygiene, open mouth breathing during sleep, and immunosuppression. - **Vasomotor rhinitis** is a non-allergic condition characterized by fluctuating nasal congestion, rhinorrhea, and sneezing, without any direct association with parasitic infestations. - However, this option may cause confusion as it could also be considered false. The most clearly false statement is that myiasis is "typically asymptomatic." *Nasal myiasis can cause intense nasal irritation* - This statement is **TRUE**. The presence and movement of **maggots** within the nasal cavity leads to severe **irritation**, pain, and a foreign body sensation. - The feeding activity of the larvae causes **tissue destruction**, mucosal damage, and secondary bacterial infections, intensifying discomfort. - Patients often describe a crawling sensation and severe itching in the nasal cavity. *Meningitis may occur in severe nasal myiasis* - This statement is **TRUE**. In advanced or neglected cases, the **larvae** can erode through the nasal structures, sinuses, and skull base, potentially breaching the **meninges**. - This invasion can result in serious intracranial complications such as **meningitis**, **brain abscess**, **cavernous sinus thrombosis**, or other central nervous system infections. - These complications are life-threatening and require urgent surgical debridement and antimicrobial therapy.

Question 399: Which of the following is not a feature of ethmoidal polyp?

A. Common in adults
B. Commonly bilateral
C. Associated with chronic rhinosinusitis
D. Commonly found as a single polyp (Correct Answer)

Explanation: ***Commonly found as a single polyp*** - **Ethmoidal polyps** are typically **multiple** and bilateral, originating from the ethmoid sinuses. - They rarely present as a single, isolated polyp, which is more characteristic of antrochoanal polyps. - This is the key distinguishing feature that makes this statement INCORRECT. *Common in adults* - **Ethmoidal polyps** are indeed **more prevalent in adults** than in children. - Peak incidence occurs between 30-50 years of age. - Their incidence tends to increase with age, often associated with chronic rhinosinusitis. *Commonly bilateral* - **Ethmoidal polyps** almost invariably present as **bilateral polyps**, involving both sides of the nasal cavity. - This bilateral nature is a key differentiating feature from antrochoanal polyps, which are typically unilateral. - Bilateral presentation is one of the hallmark characteristics of ethmoidal polyps. *Associated with chronic rhinosinusitis* - **Ethmoidal polyps** are strongly associated with **chronic rhinosinusitis with nasal polyposis (CRSwNP)**. - They arise from chronic mucosal inflammation of the ethmoid sinuses. - Often associated with conditions like aspirin-exacerbated respiratory disease (AERD/Samter's triad) and non-allergic eosinophilic inflammation.

Question 400: The artery which leads to bleeding in Woodruff's area is?

A. Anterior ethmoidal artery
B. Sphenopalatine artery (Correct Answer)
C. Greater palatine artery
D. Superior labial artery

Explanation: ***Sphenopalatine artery*** - **Woodruff's area** is located on the posterior lateral wall of the nasal cavity, specifically a plexus of veins and arteries inferior to the posterior end of the inferior turbinate. - Bleeding from this region, often associated with **posterior epistaxis**, typically involves branches of the **sphenopalatine artery**. *Anterior ethmoidal artery* - The **anterior ethmoidal artery** is primarily involved in **anterior epistaxis**, supplying Kiesselbach's plexus on the nasal septum. - It does not contribute significantly to bleeding from Woodruff's area on the posterior lateral wall. *Greater palatine artery* - The **greater palatine artery** supplies the hard and soft palate and a small portion of the nasal floor. - It is not a major contributor to bleeding in Woodruff's area, which is located more superiorly and posteriorly on the lateral nasal wall. *Superior labial artery* - The **superior labial artery** is a branch of the facial artery, primarily supplying the upper lip and philtrum. - While it contributes to the vascular supply of the anterior nasal septum, it is not involved in bleeding from Woodruff's area.

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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