Pediatric Sinusitis — MCQs

10 questions

A 6-year-old boy presents with fever and chills, cough, rapid breathing, difficulty breathing, and chest pain. A culture from a respiratory sample shows Gram-positive bacteria. What is the most likely organism causing this infection?

4 year old male, recurrent URTI, has difficulty breathing, High arched palate, Failure to grow and impaired hearing, management is

Which drug is used as first-line treatment for acute bacterial sinusitis?

A 14-year-old child with a history of recurrent nasal bleeding has the endoscopic view provided. What is the investigation of choice?

A 13-year-old boy presents with right-sided nasal obstruction and recurrent epistaxis for the past 6 months. What is the most likely diagnosis?

All are major symptoms of sinusitis except?

A patient with a recent upper respiratory infection develops facial pain and tenderness over the maxillary sinuses. What is the most appropriate initial treatment?

One year old male child with cat's reflex and raised IOP. What is the most likely diagnosis?

Treatment of choice for antrochoanal polyp in a 10-year-old child-

Q10

The facial features shown in the image are characteristic of:

Pediatric Sinusitis Indian Medical PG Practice Questions and MCQs

Question 1: A 6-year-old boy presents with fever and chills, cough, rapid breathing, difficulty breathing, and chest pain. A culture from a respiratory sample shows Gram-positive bacteria. What is the most likely organism causing this infection?

A. Streptococcus pyogenes
B. Streptococcus pneumoniae (Correct Answer)
C. Staphylococcus aureus
D. Propionibacterium acnes

Explanation: ***Streptococcus pneumoniae*** - This clinical picture describes typical symptoms of **pneumonia** in a child, including fever, cough, rapid and difficult breathing, and chest pain. - **_Streptococcus pneumoniae_** is the most common bacterial cause of community-acquired pneumonia in children. The respiratory sample showing gram-positive bacteria further supports this. *Staphylococcus aureus* - While **_Staphylococcus aureus_** can cause pneumonia, it is less common than _Streptococcus pneumoniae_ in community-acquired cases in healthy children and often associated with more severe, necrotizing forms or post-viral infections. - While it is a **Gram-positive bacterium**, its clinical presentation would not be the most likely first choice for typical pneumonia symptoms in this age group. *Propionibacterium acnes* - **_Propionibacterium acnes_** (now *Cutibacterium acnes*) is primarily associated with **acne vulgaris** and, less commonly, opportunistic infections related to implanted devices or some rare soft tissue infections. - It is not a typical cause of primary respiratory infections like pneumonia. *Streptococcus pyogenes* - **_Streptococcus pyogenes_** (Group A Streptococcus) is known for causing **pharyngitis** (strep throat), skin infections (impetigo, cellulitis), and scarlet fever. - While it can rarely cause pneumonia, it is not a common cause, and the constellation of symptoms points more strongly to _Streptococcus pneumoniae_.

Question 2: 4 year old male, recurrent URTI, has difficulty breathing, High arched palate, Failure to grow and impaired hearing, management is

A. Airway management and feeding support
B. Genetic testing for syndromes
C. Speech and language therapy
D. Referral to ENT and geneticist (Correct Answer)
E. Prophylactic antibiotics and immunization

Explanation: ***Referral to ENT and geneticist*** - The constellation of **recurrent URTI**, **high-arched palate**, **failure to grow**, and **impaired hearing** in a 4-year-old child suggests a potential underlying craniofacial anomaly or genetic syndrome. - A **geneticist** can help diagnose underlying genetic conditions, while an **ENT specialist** can address the recurrent upper respiratory tract infections and impaired hearing, which could be related to conditions like **cleft palate** or **CHARGE syndrome**. - This is the **most appropriate initial step** for comprehensive evaluation and diagnosis. *Airway management and feeding support* - While important for immediate stabilization in some cases, these are *supportive measures* that might be necessary *after* a diagnosis is established or to manage acute crises. - They do not address the primary investigation and diagnosis of the complex symptoms presented. *Genetic testing for syndromes* - This is an integral part of the diagnostic process for many syndromes. - However, it's typically performed *after* an initial evaluation by a geneticist and often requires specific indications or panel choices based on clinical findings, rather than being the first and sole management step. *Speech and language therapy* - This is a crucial intervention if speech and language development is affected, which is likely given the impaired hearing and potential palate issues. - However, it addresses a symptom rather than the underlying cause and isn't the initial step for diagnosis or comprehensive management. *Prophylactic antibiotics and immunization* - While recurrent URTIs may warrant consideration of prophylactic measures, this approach treats symptoms without addressing the underlying cause. - Appropriate immunization should already be part of routine care, and prophylactic antibiotics don't address the structural and genetic issues causing the clinical presentation.

Question 3: Which drug is used as first-line treatment for acute bacterial sinusitis?

A. Ciprofloxacin
B. Azithromycin
C. Doxycycline
D. Amoxicillin-clavulanate (Correct Answer)

Explanation: ***Amoxicillin-clavulanate*** - This is generally recommended as the **first-line antibiotic** for acute bacterial sinusitis in adults and children due to its broad spectrum of activity against common respiratory pathogens like *Streptococcus pneumoniae* and *Haemophilus influenzae*, including beta-lactamase-producing strains. - The **clavulanate component** helps overcome bacterial resistance to amoxicillin by inhibiting beta-lactamase enzymes, making it effective against a wider range of bacteria. *Ciprofloxacin* - This is a **fluoroquinolone** antibiotic, typically reserved for **second-line treatment** of acute bacterial sinusitis, especially in cases of antibiotic failure or severe penicillin allergy. - Its use is generally avoided as a first-line choice due to concerns about increasing **antibiotic resistance** and potential side effects like tendinopathy and *Clostridioides difficile* infection. *Azithromycin* - This is a **macrolide antibiotic** that may be used in patients with **penicillin allergy**, but it's not considered first-line for acute bacterial sinusitis because of increasing rates of **macrolide resistance** among *Streptococcus pneumoniae*. - Its **narrower spectrum** against common sinusitis pathogens compared to amoxicillin-clavulanate makes it less ideal as initial therapy. *Doxycycline* - This is a **tetracycline antibiotic** that can be considered as an alternative for patients with **penicillin allergy** for acute bacterial sinusitis. - However, it is not typically preferred as a first-line agent over amoxicillin-clavulanate, given its potential side effects and the established efficacy and safety profile of beta-lactams.

Question 4: A 14-year-old child with a history of recurrent nasal bleeding has the endoscopic view provided. What is the investigation of choice?

A. Biopsy
B. X-ray
C. FESS (Functional Endoscopic Sinus Surgery)
D. CECT (Contrast-Enhanced CT) (Correct Answer)

Explanation: ***CECT (Contrast-Enhanced CT)*** - Given the history of recurrent nasal bleeding in an adolescent male suggestive of a **juvenile nasopharyngeal angiofibroma (JNA)**, CECT is the investigation of choice to delineate the tumor's extent, vascularity, and involvement of surrounding structures. - CECT provides crucial information for surgical planning and assessing intracranial extension due to the highly vascular nature of JNAs. *Biopsy* - Biopsy of a suspected angiofibroma is generally **contraindicated** due to the high risk of severe and uncontrolled hemorrhage because the tumor is highly vascular and lacks a true capsule. - The diagnosis of JNA is usually made based on clinical presentation and imaging findings. *X-ray* - **X-rays** (like plain radiographs of the sinuses) offer limited soft tissue detail and are **insufficient** to accurately visualize the extent or vascularity of a nasopharyngeal mass. - They may show some bony erosion but cannot provide the detailed information needed for diagnosis or surgical planning of a JNA. *FESS (Functional Endoscopic Sinus Surgery)* - **FESS** is a **surgical procedure** used for treating chronic sinusitis and other sinonasal conditions, not primarily an investigative tool for a suspected tumor like JNA. - While endoscopy is used for initial visualization, **surgery** is a treatment, and detailed imaging must precede it to understand tumor boundaries.

Question 5: A 13-year-old boy presents with right-sided nasal obstruction and recurrent epistaxis for the past 6 months. What is the most likely diagnosis?

A. JNA (Correct Answer)
B. Coagulation disorder
C. Antrochoanal polyp
D. Allergic rhinitis

Explanation: ***JNA (Juvenile Nasopharyngeal Angiofibroma)*** - **Classic presentation**: Adolescent male with **unilateral nasal obstruction** and **recurrent, often profuse epistaxis** - JNA is a **highly vascular benign tumor** that predominantly affects males aged 10-18 years - Though benign, it is **locally aggressive** and can extend into adjacent structures (orbit, skull base) - The combination of age, gender, unilateral symptoms, and recurrent epistaxis makes this the most likely diagnosis *Coagulation disorder* - Would cause **generalized bleeding tendencies**, not localized unilateral nasal obstruction - Epistaxis would typically be **bilateral** and associated with other bleeding manifestations (easy bruising, gum bleeding, prolonged bleeding from cuts) - No mass effect or persistent obstruction would be expected - Other systemic bleeding signs are absent in this presentation *Antrochoanal polyp* - **Benign inflammatory lesion** originating from maxillary sinus, extending through ostium into choana - Can cause nasal obstruction but epistaxis is **much less common and less severe** than in JNA - More commonly associated with **chronic sinusitis symptoms** (rhinorrhea, postnasal drip, facial pressure) - Less vascular than JNA, so recurrent profuse epistaxis would be unusual *Allergic rhinitis* - Characterized by **bilateral symptoms**: nasal obstruction, sneezing, rhinorrhea, and nasal itching - Often has **seasonal pattern** or clear allergen triggers - May cause minor epistaxis from mucosal irritation, but not the **severe recurrent epistaxis** seen here - **Unilateral** persistent obstruction would be atypical for allergic rhinitis

Question 6: All are major symptoms of sinusitis except?

A. Nasal blockage
B. Facial congestion
C. Halitosis (Correct Answer)
D. Anosmia

Explanation: ***Halitosis*** - While **halitosis** (bad breath) can be a symptom associated with sinusitis due to post-nasal drip and bacterial overgrowth, it is generally considered a **minor symptom** or a secondary effect rather than one of the primary, defining features. - Major symptoms focus on those directly caused by inflammation and obstruction of the sinuses. *Nasal blockage* - **Nasal blockage** or congestion is a cardinal symptom of sinusitis, resulting from inflammation and swelling of the nasal and sinus mucosa. - It often leads to difficulty breathing through the nose and contributes to a feeling of fullness. *Facial congestion* - **Facial congestion** or pressure is a key symptom of sinusitis, caused by the buildup of fluid and inflammation within the sinus cavities. - This symptom can manifest as pain or pressure around the eyes, cheeks, and forehead. *Anosmia* - **Anosmia**, or the loss of smell, is a significant symptom of sinusitis, particularly chronic sinusitis. - It occurs due to the inflammation and obstruction of the nasal passages, preventing odorants from reaching the olfactory receptors.

Question 7: A patient with a recent upper respiratory infection develops facial pain and tenderness over the maxillary sinuses. What is the most appropriate initial treatment?

A. Amoxicillin-clavulanate (Correct Answer)
B. Corticosteroid
C. Antihistamine
D. Topical decongestant

Explanation: ***Amoxicillin-clavulanate*** - This antibiotic combination is the **first-line empirical treatment** for **acute bacterial rhinosinusitis**, especially if symptoms persist or worsen after 7-10 days, or are severe at presentation. - It provides broad-spectrum coverage against common bacterial pathogens, including gram-positive and gram-negative bacteria, and addresses **beta-lactamase producing strains**. *Corticosteroid* - While **intranasal corticosteroids** can be used as an adjunct to reduce inflammation in acute rhinosinusitis, they are **rarely sufficient as initial monotherapy** in cases highly suggestive of bacterial infection. - Oral corticosteroids are generally reserved for more severe or refractory cases due to systemic side effects. *Antihistamine* - Antihistamines are primarily used for **allergic rhinitis** to block histamine release and reduce symptoms like sneezing and rhinorrhea. - They are **ineffective against bacterial infections** and can paradoxically dry out mucous membranes, potentially hindering mucociliary clearance in sinusitis. *Topical decongestant* - Topical decongestants provide temporary relief by reducing **nasal congestion** but do not treat the underlying bacterial infection. - Prolonged use (more than 3-5 days) can lead to **rhinitis medicamentosa**, a rebound congestion.

Question 8: One year old male child with cat's reflex and raised IOP. What is the most likely diagnosis?

A. Toxocara canis
B. Retinopathy of prematurity
C. Retinoblastoma (Correct Answer)
D. Toxoplasma gondii infection

Explanation: ***Retinoblastoma*** - A **cat's reflex (leukocoria)**, which is a white pupillary reflex, is the most common presenting sign of retinoblastoma in children. - **Raised intraocular pressure (IOP)** can occur in advanced retinoblastoma due to secondary glaucoma caused by tumor growth or neovascularization. *Toxocara canis* - Ocular **toxocariasis** can cause leukocoria and inflammation, but it's typically associated with **granuloma formation** and not usually primary elevated IOP. - This condition is caused by a **parasitic infection** from roundworms, often seen in children with exposure to contaminated soil or pets. *Retinopathy of prematurity* - Primarily affects **premature infants** exposed to high oxygen, leading to abnormal retinal vessel development. - While it can cause leukocoria in severe stages, it would be unusual for a **one-year-old** to present with this primary diagnosis especially with raised IOP. *Toxoplasma gondii infection* - Ocular **toxoplasmosis** typically presents with **chorioretinitis** and can cause inflammation, but **leukocoria** and **raised IOP** are not its primary or most characteristic features. - This is a parasitic infection, congenital or acquired, often presenting with **retinal scars**.

Question 9: Treatment of choice for antrochoanal polyp in a 10-year-old child-

A. Caldwell luc's
B. Exploratory rhinotomy
C. Conservative treatment till 16 years
D. Intranasal polypectomy (Correct Answer)

Explanation: ***Intranasal polypectomy*** - **Intranasal polypectomy**, particularly via **endoscopic sinus surgery**, is the preferred treatment for antrochoanal polyps in children due to its minimally invasive nature and ability to ensure complete removal of the polyp's antral component. - This approach allows for direct visualization and removal of the polyp, including its origin from the **maxillary sinus ostium**, which is crucial to prevent recurrence. *Caldwell luc's* - The Caldwell-Luc procedure is a more invasive technique that involves creating an antrostomy through the anterior wall of the maxillary sinus. - It is associated with higher morbidity, including potential for **facial swelling**, **nerve damage**, and **dental complications**, making it less favored, especially in children, for antrochoanal polyps. *Exploratory rhinotomy* - **Exploratory rhinotomy** is a highly invasive surgical approach typically reserved for extensive or malignant sinonasal tumors. - It is an overly aggressive and unnecessary procedure for a benign condition like an antrochoanal polyp. *Conservative treatment till 16 years* - Antrochoanal polyps cause symptoms like **nasal obstruction** and potential ostial blockage, leading to sinus infections. - Delaying treatment is not advisable as it can lead to chronic symptoms, impaired quality of life, and potential complications from untreated sinus disease.

Question 10: The facial features shown in the image are characteristic of:

A. Frog face deformity
B. Adenoid facies (Correct Answer)
C. Ashen grey facies
D. Thyrotoxicosis

Explanation: ***Adenoid facies*** - The image displays characteristic features of adenoid facies, including a **long, open-mouthed face**, a **pinched nose**, and possibly a **high-arched palate** due to chronic mouth breathing from enlarged adenoids. - This chronic condition often leads to a dull expression, sometimes with **strabismus** (crossed eyes) as seen in the image, and a forward head posture. *Frog face deformity* - This deformity is characterized by **ocular hypertelorism** (widely spaced eyes), a **flat nasal bridge**, and a **short nose**, often associated with conditions like Apert syndrome. - While there is some facial dysmorphology, the specific combination of features does not align with a typical frog face. *Ashen grey facies* - This refers to a **pale, grayish complexion**, often indicative of severe cardiovascular compromise like **circulatory collapse** or **shock**. - The child in the image has a normal skin tone for their ethnicity and does not show signs of acute circulatory distress. *Thyrotoxicosis* - **Thyrotoxicosis** (hyperthyroidism) in children can cause symptoms like **exophthalmos** (bulging eyes), **tachycardia**, weight loss, and an enlarged thyroid gland. - While the child's eyes appear wide-set and sometimes strabismic, these are more consistent with the long-term effects of chronic mouth breathing on facial development rather than acute thyroid dysfunction.

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free