Diseases of the Nose and Paranasal Sinuses — MCQs

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

Question 431: Halo sign and handkerchief test are positive in which condition?

A. Cerebrospinal Fluid Rhinorrhea (Correct Answer)
B. Nasal Septum Deviation
C. Nasal Myiasis Infection
D. Choanal Atresia Condition

Explanation: ***Cerebrospinal Fluid Rhinorrhea*** - The **halo sign** (or double ring sign) is a common diagnostic indicator for **CSF leakage**, appearing as a blood stain surrounded by a clear ring on filter paper. - The **handkerchief test** observes the spreading pattern of fluid, where CSF forms a distinct outer ring due to its capillary action, differentiating it from mucus or blood. *Nasal Septum Deviation* - This condition involves the displacement of the **nasal septum**, leading to symptoms like nasal obstruction and difficulty breathing. - It does not involve any fluid leakage and therefore would not present with a **halo sign** or be relevant to the **handkerchief test**. *Nasal Myiasis Infection* - **Nasal myiasis** is an infestation of the nasal cavity by fly larvae (maggots), causing pain, discharge, and obstruction. - The discharge associated with this condition is typically purulent and bloody, but it would not exhibit the characteristic **halo sign** or react uniquely to the **handkerchief test** like CSF. *Choanal Atresia Condition* - **Choanal atresia** is a congenital malformation where the back of the nasal passage (choana) is blocked, usually by bone or soft tissue. - Symptoms include difficulty breathing and feeding in neonates due to complete or partial nasal obstruction; there is no abnormal CSF leakage involved.

Question 432: Vidian neurectomy is used for the treatment of?

A. Chronic vasomotor rhinitis (Correct Answer)
B. Meniere's disease
C. Otosclerosis
D. Benign positional paroxysmal vertigo

Explanation: ***Chronic vasomotor rhinitis*** - **Vidian neurectomy** is a surgical procedure that targets the **vidian nerve** (also known as the **nerve of the pterygoid canal**), which carries parasympathetic fibers to the nasal mucosa. - By severing these fibers, the procedure aims to reduce the excessive nasal secretions and congestion characteristic of **vasomotor rhinitis**. *Benign positional paroxysmal vertigo* - This condition is primarily treated with **canalith repositioning maneuvers** (e.g., Epley maneuver), which aim to displace otoconia from the semicircular canals. - Surgical intervention is rarely required and, if so, would typically involve **posterior semicircular canal occlusion**, not vidian neurectomy. *Meniere's disease* - Management often involves dietary modifications, medications (e.g., diuretics, anti-emetics), and, in severe cases, procedures like **endolymphatic sac decompression** or **labyrinthectomy**. - **Vidian neurectomy** is not a treatment for the fluctuating hearing loss, vertigo, and tinnitus associated with Meniere's disease. *Otosclerosis* - The primary treatment for this condition, characterized by abnormal bone growth in the middle ear causing conductive hearing loss, is **stapedectomy** with prosthesis placement. - **Vidian neurectomy** has no role in addressing the bony pathology of otosclerosis.

Question 433: Deep head pain is most commonly associated with which of the following sinus conditions?

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

Explanation: ***Sphenoid sinusitis*** - **Sphenoid sinuses** are located deep within the skull, near the brainstem and pituitary gland - Due to their **deep and central location**, inflammation causes **deep, retro-orbital or vertex head pain** - The pain is often described as being "behind the eyes" or "in the center of the head" - This **deep headache** is characteristically **difficult to localize**, distinguishing it from other sinusitis patterns *Ethmoid sinusitis* - **Ethmoid sinuses** are located between the eyes and the bridge of the nose - Pain is typically experienced **between the eyes** or along the **bridge of the nose** - Headache is usually localized to the **nasal bridge or inner canthus**, not deep head pain *Maxillary sinusitis* - **Maxillary sinuses** are located in the cheekbones - Inflammation causes pain and pressure in the **cheeks**, under the eyes, or **referred pain to the upper teeth** - Most commonly associated with **facial pain**, not deep headache *Frontal sinusitis* - **Frontal sinuses** are located in the forehead - Pain is classic for being localized to the **forehead, above the eyebrows** - While it causes significant headache, it is typically in the **front of the head** - Pain is usually **exacerbated by leaning forward**

Question 434: What condition is characterized by atrophic dry nasal mucosa, extensive encrustations, and a woody hard external nose?

A. Chronic rhinosinusitis
B. Rhinitis sicca (Correct Answer)
C. Allergic rhinitis
D. Nasal polyps

Explanation: ***Rhinitis sicca*** - This condition is precisely described by **atrophic dry nasal mucosa** and the presence of **extensive encrustations**, alongside a **woody hard external nose**. - It involves a chronic inflammatory process leading to atrophy and dryness of the nasal lining, often with thick crust formation. *Allergic rhinitis* - Characterized by symptoms like **sneezing, rhinorrhea, nasal congestion**, and **itchy eyes/nose**, triggered by allergens. - It does not typically present with severe dryness, extensive encrustations, or a woody hard external nose. *Chronic rhinosinusitis* - Involves inflammation of the paranasal sinuses and nasal cavity for more than 12 weeks, leading to symptoms like **facial pain/pressure, nasal obstruction, and discharge**. - While it can involve crusting, the primary features of severe dryness and a woody hard external nose are not typical. *Nasal polyps* - These are **benign, grape-like growths** within the nasal passages or sinuses, often leading to nasal obstruction and reduced sense of smell. - They are a structural issue and do not primarily cause atrophic dry mucosa, extensive encrustations, or a woody hard external nose.

Question 435: In which condition is Young's operation performed?

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

Explanation: ***Atrophic rhinitis*** - **Young's operation** is a surgical procedure specifically designed to treat severe cases of **atrophic rhinitis**, aiming to narrow the nasal cavity and promote mucosal regeneration. - Involves **closing the nostrils temporarily** for several months to allow healing and reduce crusting and foul odor associated with the condition. *Allergic rhinitis* - This condition is managed primarily with **antihistamines**, **nasal corticosteroids**, and allergen avoidance, not surgical methods like Young's operation. - It is an **inflammatory response** to allergens, causing sneezing, itching, and rhinorrhea, which is distinct from the mucosal atrophy seen in atrophic rhinitis. *Vasomotor rhinitis* - Vasomotor rhinitis is characterized by **non-allergic triggers** like temperature changes or irritants, leading to nasal congestion and rhinorrhea. - Treatment typically involves **topical nasal sprays** (e.g., ipratropium bromide) or lifestyle modifications, not **Young's operation**. *Lupus vulgaris* - Lupus vulgaris is a form of **cutaneous tuberculosis** affecting the skin, primarily treated with **anti-tubercular drugs**, not a nasal surgical procedure. - It presents as chronic, progressive skin lesions and is unrelated to nasal cavity disorders.

Question 436: What condition is suggested by atrophic dry nasal mucosa, extensive encrustations, and a woody hard external nose?

A. Allergic rhinitis
B. Sarcoidosis
C. Rhinoscleroma (Correct Answer)
D. Wegener's granulomatosis

Explanation: ***Rhinoscleroma*** - **Rhinoscleroma** characteristically presents with **atrophic, dry nasal mucosa**, extensive **encrustations**, and the distinctive **"woody hard" external nose** due to granulomatous infiltration. - Caused by **Klebsiella rhinoscleromatis** (*Klebsiella pneumoniae* subspecies *rhinoscleromatis*). - Characterized by **Mikulicz cells** (foamy macrophages containing bacilli) on histopathology. - It progresses through stages (atrophic, granulomatous/nodular, and sclerotic), with the infiltrative stage leading to the hard, fixed lesions, and ultimately to nasal obstruction and deformity. *Sarcoidosis* - While sarcoidosis can affect the nasal mucosa, it typically presents with **granulomatous inflammation**, but less commonly with the severe encrustations and characteristic "woody hard" consistency seen in rhinoscleroma. - Nasal involvement in sarcoidosis often includes **papules, nodules**, or **ulceration**, rather than widespread atrophy and crusting. *Allergic rhinitis* - Allergic rhinitis is characterized by **nasal congestion, rhinorrhea, itching**, and sneezing, primarily due to **IgE-mediated inflammatory responses** to allergens. - It does not cause atrophic nasal mucosa, extensive encrustations, or the development of a "woody hard" external nose. *Wegener's granulomatosis* - **Wegener's granulomatosis** (now known as **Granulomatosis with Polyangiitis**) is a systemic vasculitis that can significantly impact the nose, causing **crusting, ulceration, saddle nose deformity**, and epistaxis. - However, it typically involves destructive inflammation and necrosis rather than the firm, "woody" induration and widespread atrophy described, and it is associated with **c-ANCA (PR3-ANCA) antibodies**.

Question 437: Where is a nasal antrostomy typically created following a Caldwell-Luc procedure?

A. Above the inferior turbinate
B. Beneath the superior turbinate
C. Above the superior turbinate
D. Beneath the inferior turbinate (Correct Answer)

Explanation: ***Beneath the inferior turbinate*** - The **Caldwell-Luc procedure** addresses chronic inflammatory disease of the **maxillary sinus**, and the creation of a nasal antrostomy beneath the inferior turbinate is a crucial step for **drainage and ventilation**. - This access point allows permanent communication between the maxillary sinus and the nasal cavity, facilitating healing and preventing recurrence of disease. *Above the inferior turbinate* - Creating an opening above the inferior turbinate would likely involve the **middle meatus** or other structures, which is not the standard location for a drainage antrostomy in a Caldwell-Luc procedure. - This area is usually reserved for procedures involving the **ethmoid or frontal sinuses**, not the maxillary sinus in this specific context. *Beneath the superior turbinate* - The superior turbinate is located much higher in the nasal cavity, and an opening beneath it would drain into the superior meatus. - This area is associated with the **sphenoid sinus** and posterior ethmoid cells, not the primary drainage of the maxillary sinus. *Above the superior turbinate* - There is no anatomical space or structure typically addressed directly above the superior turbinate for maxillary sinus drainage. - This would be an anatomically incorrect and surgically inaccessible approach for creating a permanent drainage pathway from the maxillary sinus.

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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