Diseases of the Nose and Paranasal Sinuses Practice Questions

Q: All of the following are features of a nasal foreign body except:

Nasal polyps. ***Nasal polyps*** - While chronic inflammation can lead to nasal polyps, they are **not a direct or acute feature** of a nasal foreign body. - Nasal foreign bodies typically present with more immediate and obstructive symptoms rather than polyp formation. *Epistaxis* - A nasal foreign body can **irritate and traumatize the delicate nasal mucosa**, leading to bleeding. - This is a common symptom, especially if the foreign body is sharp or has been in place for some time. *Nasal obstruction* - The presence of any object in the nasal cavity will inevitably cause some degree of **physical blockage of airflow**. - This is one of the most common presenting symptoms, particularly in children. *Foul smelling discharge* - If a foreign body remains in the nasal cavity for an extended period, it can lead to **stasis of secretions and secondary bacterial infection**. - This infection often results in a **purulent, unilateral, and foul-smelling discharge**.

Q: Atrophic dry nasal mucosa, extensive encrustations, and a "woody" hard external nose are suggestive of?

Rhinoscleroma. ***Rhinoscleroma*** - This condition presents with **atrophic dry nasal mucosa**, extensive **encrustations**, and a characteristic "_woody_" hard external nose due to granulation tissue and fibrosis called **scleroma**. - It is a chronic granulomatous infection caused by **_Klebsiella rhinoscleromatis_**, leading to progressive tissue destruction and deformity. *Rhinosporidiosis* - Characterized by **polypoid lesions, friable masses**, and **strawberry-like appearance** in the nasal cavity, often associated with bleeding. - This is caused by **_Rhinosporidium seeberi_**, a pathogen found in stagnant water, and does not typically cause a woody hard external nose. *Atrophic rhinitis* - Involves progressive **atrophy of the nasal mucosa** and turbinates, leading to dryness, crusting, and a foul odor (**foetor**). - While it causes dry mucosa and encrustations, it does not typically lead to the **woody hardness** of the external nose described. *Carcinoma of the nose* - Can present with varied symptoms, including **nasal obstruction, discharge, epistaxis**, and sometimes **local invasion** leading to external deformity. - However, the combination of **atrophic mucosa, extensive crusting**, and specifically the "**woody**" hardness points more directly to Rhinoscleroma due to its characteristic fibrous tissue reaction.

Q: Strawberry appearance is seen in?

Rhinosporidiosis. ***Rhinosporidiosis*** - This is a chronic granulomatous disease caused by *Rhinosporidium seeberi* characterized by polypoid masses with a **strawberry-like (mulberry) appearance** due to numerous **sporangia** containing **spores** that are visible on the surface. - The appearance is described as \"strawberry\" or \"mulberry\" because of the granular, reddish, friable appearance of the lesions, typically seen in the nose or nasopharynx, which contain visible sporangia. - This characteristic appearance is pathognomonic and helps distinguish rhinosporidiosis from other nasal masses. *Lupus vulgaris* - This is a chronic, progressive, and destructive form of **cutaneous tuberculosis** that typically presents as reddish-brown plaques with an \"apple-jelly\" color on diascopy. - It does not present with a \"strawberry appearance\" but rather with **nodules** and **ulcerations** that can damage underlying tissue, leading to disfigurement. *Rhinoscleroma* - This is a chronic, specific **granulomatous infection** of the upper respiratory tract caused by **Klebsiella rhinoscleromatis**, presenting initially as hard, non-tender nodules or masses. - The lesions are typically firm and nodular, without the characteristic friable, red, and granular appearance of a \"strawberry.\" *Angiofibroma* - This is a **benign vascular tumor** that occurs almost exclusively in adolescent males, primarily in the nasopharynx. - It presents as a firm, lobulated mass that can cause epistaxis, but it does not have the \"strawberry appearance\" associated with fungal sporulation.

Q: Atrophy of the nasal mucosa, with extensive encrustations and a woody hard external nose, is seen in which of the following conditions?

Atrophic Rhinitis (Ozena). **Atrophic Rhinitis (Ozena)** - **Atrophy of nasal mucosa**, extensive **encrustations**, and a **woody hard external nose** are hallmark features of Ozena, a severe form of atrophic rhinitis. - This condition is characterized by chronic inflammation leading to mucosal degeneration, dilation of capillaries, and malodorous discharge. *Allergic rhinitis with nasal polyps* - **Allergic Rhinitis** primarily involves allergic inflammation, leading to sneezing, rhinorrhea, and nasal congestion, without significant mucosal atrophy or a woody external nose. - **Nasal polyps** are benign growths, commonly associated with chronic inflammation, but they do not cause the described atrophy or encrustations. *Chronic sinusitis with mucosal thickening* - **Chronic sinusitis** is characterized by persistent inflammation of the paranasal sinuses, often leading to mucosal thickening, but not atrophy or a woody hard external nose. - While it can cause nasal discharge and crusting, the extensive atrophy and the pathognomonic external nasal changes described are not typical. *Nasal septal perforation with crusting* - **Nasal septal perforation** is a hole in the nasal septum, which can cause crusting, bleeding, and whistling noises. - However, it does not typically lead to generalized mucosal atrophy of the entire nasal cavity or a "woody hard" external nose.

Q: A 30-year-old man presents with a 6-month history of nasal discharge, facial pain, and fever. On antibiotic therapy, the fever subsides. After 1 month, he again experiences symptoms of mucopurulent discharge from the middle meatus, and the mucosa of the meatus appears congested and oedematous. The next best investigation would be:

Non-Contrast CT of the nose and para-nasal sinuses. ***Non-Contrast CT of the nose and para-nasal sinuses*** - A **non-contrast CT scan** is the **gold standard** for diagnosing chronic rhinosinusitis due to its excellent anatomical detail of bony structures and paranasal sinuses. - It helps in identifying **mucosal thickening**, **obstruction**, and **bony remodelling** indicative of chronic inflammation, guiding further management and potential surgical planning. *MRI of the sinuses* - While MRI provides superior soft tissue resolution, it is **less effective than CT** in visualizing bony anatomy and subtle calcifications or bone thickness changes in the sinuses. - It is often reserved for suspected **intracranial extension**, **orbital complications**, or differentiating between inflammatory processes and tumors, which are not the primary concern here. *Plain x-ray of the para-nasal sinuses* - Plain X-rays have **limited sensitivity and specificity** for diagnosing chronic rhinosinusitis due to superimposed structures and poor resolution. - They can show gross opacification but **cannot adequately delineate** detailed sinus anatomy or the extent of mucosal disease. *Inferior meatus puncture* - Inferior meatus puncture is an **invasive procedure** primarily used for **sinus aspiration** or **lavage** in cases of acute purulent sinusitis for diagnostic culture and therapeutic drainage. - It is **not a primary diagnostic imaging tool** for evaluating chronic sinus disease or anatomical variations.

Q: All of the following are true about antrochoanal polyp except which of the following?

Premalignant. ***Premalignant*** - **Antrochoanal polyps are benign growths** and typically do not carry any **premalignant potential**. - They are **inflammatory or edematous mucosal outgrowths**, not neoplastic lesions. - This is the **FALSE statement**, making it the correct answer to this EXCEPT question. *Typically unilateral* - **Antrochoanal polyps** almost exclusively originate from the **maxillary antrum** on one side, making them characteristically **unilateral**. - While ethmoidal nasal polyps can be bilateral, antrochoanal polyps are **distinctly unilateral**. *Arises from the maxillary antrum* - The defining characteristic of an **antrochoanal polyp** is its origin from the **mucosa of the maxillary sinus** (antrum). - It then extends through the **maxillary ostium** into the nasal cavity and often prolapses into the **nasopharynx** or **oropharynx**. *Does not cause malignancy* - **Antrochoanal polyps** are benign lesions and are **not known to undergo malignant transformation**. - Their primary clinical concerns relate to **nasal obstruction**, **mouth breathing**, and **snoring** due to their mechanical effects.

Q: Most common presentation of adult rhinosporidiosis is?

Polypoidal mass. ***Polypoidal mass*** - The most common presentation of adult rhinosporidiosis is a **friable, reddish, polypoidal or sessile mass** in the nasal cavity. - These masses are often described as having a **strawberry-like appearance** due to multiple white dots, which are sporangia. *Halitosis* - While rhinosporidiosis can cause symptoms like **nasal obstruction** and discharge, **fetid breath (halitosis)** is not typically the primary or most common presentation. - Halitosis is more commonly associated with other dental or systemic issues, or with severe secondary infections. *Pain* - **Pain is rare** in rhinosporidiosis unless there is significant secondary infection or involvement of adjacent structures. - The lesions are generally asymptomatic until they cause mechanical obstruction or bleeding. *Anosmia* - **Anosmia (loss of smell)** can occur due to mechanical obstruction of the nasal passages by the polypoidal mass. - However, it is a **secondary symptom** resulting from the mass effect, not the most common initial or direct presentation of the disease itself.

Q: Atrophic dry nasal mucosa, extensive encrustations, and a woody hard external nose are suggestive of:

Atrophic rhinitis. ***Atrophic rhinitis*** - **Atrophic dry nasal mucosa**, extensive **encrustations**, and a **woody hard external nose** are classic presentations of atrophic rhinitis, especially the primary form (ozena). - This condition involves progressive atrophy of the nasal mucosa and turbinates. *Nasal obstruction due to foreign body* - A **foreign body** in the nose typically causes unilateral foul-smelling discharge, obstruction, and sometimes pain, not generalized dryness or extensive encrustations. - It does not lead to a "woody hard" external nose. *Chronic rhinosinusitis* - Characterized by **mucopurulent discharge**, facial pain/pressure, and nasal obstruction, usually without the extreme dryness or global mucosal atrophy seen in the question. - Encrustations can occur, but typically not to the extent or with the atrophic changes described. *Nasal polyps* - **Nasal polyps** cause nasal obstruction, anosmia (loss of smell), and often runny nose, but they do not typically cause atrophic mucosa or a woody hard external nose. - They are soft, movable growths, distinct from the features presented.

Q: Atrophic dry nasal mucosa, extensive encrustations, and foul-smelling nasal discharge are suggestive of which condition?

Atrophic Rhinitis. ***Atrophic Rhinitis*** - This condition is characterized by progressive atrophy of the **nasal mucosa and turbinates**, leading to dryness, extensive crusting, and a characteristic **foul odor (ozena)**. - The **wide nasal cavities** due to turbinate atrophy and the **paradoxical nasal obstruction** despite patent airways are classic features. - The **foul-smelling discharge with green-brown crusts** is pathognomonic for atrophic rhinitis. *Rhinoscleroma* - This is a chronic granulomatous disease caused by **Klebsiella rhinoscleromatis**, presenting in three stages: atrophic, granulomatous, and sclerotic. - The sclerotic stage produces a characteristic **woody hard induration** of the nose and upper airways. - While crusting can occur, the primary features are **nasal obstruction, granuloma formation**, and progressive fibrosis, not the extensive atrophy and foul odor seen in atrophic rhinitis. *Wegener's Granulomatosis* - This is a systemic vasculitis (now called Granulomatosis with Polyangiitis) that can affect the upper respiratory tract. - Features include **bloody crusting, epistaxis, and saddle nose deformity** due to cartilage destruction. - **Systemic symptoms** (kidney involvement, pulmonary nodules) and positive **c-ANCA** help differentiate it from isolated atrophic rhinitis. *Nasal Tuberculosis* - Nasal tuberculosis is rare and typically presents with **granulomatous ulcerative lesions**, nasal obstruction, and sometimes **septal perforation**. - The **generalized atrophy, extensive crusting, and characteristic foul odor** are not primary features of nasal TB. - Usually associated with **pulmonary tuberculosis** and responds to anti-tubercular therapy.

Q: Atrophic dry nasal mucosa, extensive encrustations, and a woody hard external nose are most suggestive of:

Klebsiella pneumoniae. ***Klebsiella pneumoniae*** - This constellation of symptoms—**atrophic dry nasal mucosa**, **extensive encrustations**, and a **woody hard external nose**—is characteristic of **primary atrophic rhinitis (ozena)** caused by *Klebsiella pneumoniae* subspecies *ozaenae*. - **Ozena** presents with the classic triad of **progressive nasal mucosal atrophy**, **foul-smelling greenish crusts**, and **anosmia** due to destruction of olfactory epithelium. - The **woody hard external nose** suggests either advanced ozena with fibrosis or **rhinoscleroma** (caused by *Klebsiella rhinoscleromatis*), both of which are Klebsiella-related chronic granulomatous conditions. - *K. pneumoniae* subspecies *ozaenae* is the **classic etiological agent** for this severe destructive form of atrophic rhinitis. *Staphylococcus aureus* - *S. aureus* causes **rhinitis sicca anterior** (anterior nasal vestibulitis), characterized by crusting and inflammation **limited to the anterior nasal vestibule**. - Unlike ozena, S. aureus infection does **not cause progressive atrophy** of the entire nasal mucosa or the extensive encrustations throughout the nasal cavity described here. - The **woody hard external nose** is not a feature of staphylococcal nasal infections, which remain superficial. *Peptostreptococcus* - **Peptostreptococcus** species are anaerobic bacteria typically involved in **polymicrobial infections** such as chronic sinusitis, dental abscesses, or deep neck space infections. - They are **not primary pathogens** in chronic atrophic rhinitis and do not cause the specific progressive nasal atrophy and external nasal changes described. *Bacteroides* - **Bacteroides** species are obligate anaerobes that are part of the normal gut flora and commonly cause **intra-abdominal infections** and abscesses. - They are **not associated** with chronic rhinitis, nasal mucosal atrophy, or the external nasal deformities characteristic of ozena or rhinoscleroma.

Question 1

All of the following are features of a nasal foreign body except:

Accepted Answer

Nasal polyps

Answer

Epistaxis

Answer

Nasal obstruction

Answer

Foul smelling discharge

Question 2

Atrophic dry nasal mucosa, extensive encrustations, and a "woody" hard external nose are suggestive of?

Accepted Answer

Rhinoscleroma

Answer

Rhinosporidiosis

Answer

Atrophic rhinitis

Answer

Carcinoma of the nose

Question 3

Strawberry appearance is seen in?

Accepted Answer

Rhinosporidiosis

Answer

Rhinoscleroma

Answer

Angiofibroma

Answer

Lupus vulgaris

Question 4

Atrophy of the nasal mucosa, with extensive encrustations and a woody hard external nose, is seen in which of the following conditions?

Accepted Answer

Atrophic Rhinitis (Ozena)

Answer

Chronic sinusitis with mucosal thickening

Answer

Allergic rhinitis with nasal polyps

Answer

Nasal septal perforation with crusting

Question 5

A 30-year-old man presents with a 6-month history of nasal discharge, facial pain, and fever. On antibiotic therapy, the fever subsides. After 1 month, he again experiences symptoms of mucopurulent discharge from the middle meatus, and the mucosa of the meatus appears congested and oedematous. The next best investigation would be:

Accepted Answer

Non-Contrast CT of the nose and para-nasal sinuses

Answer

MRI of the sinuses

Answer

Plain x-ray of the para-nasal sinuses

Answer

Inferior meatus puncture

Question 6

All of the following are true about antrochoanal polyp except which of the following?

Accepted Answer

Premalignant

Answer

Does not cause malignancy

Answer

Typically unilateral

Answer

Arises from the maxillary antrum

Question 7

Most common presentation of adult rhinosporidiosis is?

Accepted Answer

Polypoidal mass

Answer

Halitosis

Answer

Pain

Answer

Anosmia

Question 8

Atrophic dry nasal mucosa, extensive encrustations, and a woody hard external nose are suggestive of:

Accepted Answer

Atrophic rhinitis

Answer

Nasal obstruction due to foreign body

Answer

Chronic rhinosinusitis

Answer

Nasal polyps

Question 9

Atrophic dry nasal mucosa, extensive encrustations, and foul-smelling nasal discharge are suggestive of which condition?

Accepted Answer

Atrophic Rhinitis

Answer

Nasal Tuberculosis

Answer

Rhinoscleroma

Answer

Wegener's Granulomatosis

Question 10

Atrophic dry nasal mucosa, extensive encrustations, and a woody hard external nose are most suggestive of:

Accepted Answer

Klebsiella pneumoniae

Answer

Bacteroides

Answer

Staphylococcus aureus

Answer

Peptostreptococcus

Diseases of the Nose and Paranasal Sinuses — MCQs

Diseases of the Nose and Paranasal Sinuses — MCQs

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