Anatomy
3 questionsIn a patient with chronic sinusitis, which of the following structures is associated with the presence of ethmoidal bullae?
What is the type of epithelium of the adenoid?
Anterior tonsillar pillar is formed by?
NEET-PG 2015 - Anatomy NEET-PG Practice Questions and MCQs
Question 841: In a patient with chronic sinusitis, which of the following structures is associated with the presence of ethmoidal bullae?
- A. Posterior ethmoidal air cells
- B. Anterior ethmoidal air cells (Correct Answer)
- C. Superior ethmoidal air cells
- D. Inferior ethmoidal air cells
Explanation: ***Anterior ethmoidal air cells*** - The **ethmoidal bulla** is the largest and most constant **anterior ethmoidal air cell**, located in the lateral wall of the middle meatus. - It is a key component of the **ostiomeatal complex** and its inflammation or blockage can contribute to chronic sinusitis by obstructing drainage pathways. - The ethmoidal bulla drains into the **middle meatus** via the hiatus semilunaris and is positioned superior to the uncinate process. *Posterior ethmoidal air cells* - These are located more posteriorly and drain into the **superior meatus**, not the middle meatus where the ethmoidal bulla drains. - The posterior cells are separated from the anterior cells by the **basal lamella of the middle turbinate. - The **ethmoidal bulla** is an anterior structure, clearly distinguished from the posterior ethmoidal cell group. *Superior ethmoidal air cells* - This is **not a standard anatomical classification** for ethmoidal air cells. - The ethmoid labyrinth is divided into **anterior and posterior groups**, not superior/inferior or middle classifications. - The ethmoidal bulla belongs to the anterior ethmoid complex. *Inferior ethmoidal air cells* - This is **not a recognized anatomical classification** for ethmoidal air cells. - Standard classification divides ethmoidal cells into **anterior** (including the bulla) and **posterior** groups. - The ethmoidal bulla is specifically an anterior ethmoidal air cell, the largest of this group.
Question 842: What is the type of epithelium of the adenoid?
- A. Pseudostratified ciliated columnar epithelium (Correct Answer)
- B. Non-keratinized squamous epithelium
- C. Cuboidal epithelium
- D. Columnar epithelium with goblet cells
Explanation: ***Pseudostratified ciliated columnar epithelium*** - The adenoid (pharyngeal tonsil) is located in the nasopharynx, which is part of the upper respiratory tract and is lined with **pseudostratified ciliated columnar epithelium** with goblet cells [1]. - This type of epithelium is also known as **respiratory epithelium**, and its cilia and mucus-producing goblet cells help to trap and clear inhaled particles and pathogens [1]. *Non-keratinized squamous epithelium* - This type of epithelium is found in areas subject to friction and abrasion, such as the oral cavity, oro- and laryngopharynx, and esophagus, not typically in the nasopharynx. - It provides protection but lacks the ciliated and mucus-producing cells necessary for clearing respiratory passages. *Cuboidal epithelium* - This epithelium is typically found in glands and ducts, secretory and absorptive surfaces, such as renal tubules and thyroid follicles. - It does not have the specialized functions (cilia, mucus production) required for the respiratory system's protective lining. *Columnar epithelium with goblet cells* - While the adenoid epithelium does contain **goblet cells** for mucus production, specifically stating "columnar epithelium" is not as precise as "pseudostratified ciliated columnar epithelium." - The key feature of being **pseudostratified** and **ciliated** is crucial for its function in the nasopharynx [1].
Question 843: Anterior tonsillar pillar is formed by?
- A. Palatopharyngeal fold
- B. Palatoglossal fold (Correct Answer)
- C. Pterygopalatine arch
- D. Valleculae
Explanation: Palatoglossal fold - The palatoglossal fold (anterior faucial pillar) is formed by the mucous membrane covering the palatoglossus muscle. - It defines the anterior boundary of the tonsillar fossa, hence forming the anterior tonsillar pillar. - Clinical relevance: This landmark is important during tonsillectomy and for identifying peritonsillar abscess location. Palatopharyngeal fold - This fold is formed by the mucous membrane covering the palatopharyngeus muscle. - It forms the posterior boundary of the tonsillar fossa, thus being the posterior tonsillar pillar (posterior faucial pillar). Pterygopalatine arch - This is not a recognized anatomical structure related to the tonsillar region. - The term appears to conflate "pterygopalatine fossa" (a skull space) with the palatine arches (tonsillar pillars), making it an effective distractor. Valleculae - The valleculae are depressions located between the base of the tongue and the epiglottis. - They are part of the laryngopharynx involved in swallowing and are not associated with the tonsillar pillars.
ENT
6 questionsWhat is the treatment of choice for ethmoidal polyps?
The artery which leads to bleeding in Woodruff's area is?
Intrathecal fluorescein with endoscopic visualization is useful in diagnosis of?
Which of the following is NOT a feature of a nasal foreign body?
All of the following are true about nasal myiasis except which of the following?
Which of the following is not typically associated with enlarged adenoids?
NEET-PG 2015 - ENT NEET-PG Practice Questions and MCQs
Question 841: What is the treatment of choice for ethmoidal polyps?
- A. Functional Endoscopic sinus surgery with polypectomy (Correct Answer)
- B. Intranasal ethmoidectomy
- C. Transantral ethmoidectomy
- D. Extranasal ethmoidectomy
Explanation: ***Functional Endoscopic sinus surgery with polypectomy*** - This is the **gold standard treatment** for ethmoidal polyps, as it allows for **direct visualization** and complete removal of polyps while preserving healthy mucosa. - It also enables restoration of normal sinus ventilation and drainage, which helps prevent recurrence. *Intranasal ethmoidectomy* - This is an **older technique** that is performed blindly and carries a higher risk of complications, such as **orbital or intracranial injury**, compared to endoscopic approaches. - It often results in incomplete polyp removal, leading to a higher rate of recurrence. *Transantral ethmoidectomy* - This approach, also known as the **Caldwell-Luc procedure**, is primarily used for diseases of the **maxillary sinus** and is not the preferred method for isolated ethmoidal polyps. - It is a more invasive external approach with risks including facial swelling, pain, and damage to dental nerves. *Extranasal ethmoidectomy* - This is a more invasive **external approach** involving an incision on the face and is generally reserved for extensive or complicated cases, such as **tumors or severe trauma**, not for routine polyp removal. - It carries risks of visible scarring and longer recovery times, making it less favorable than endoscopic techniques.
Question 842: 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.
Question 843: Intrathecal fluorescein with endoscopic visualization is useful in diagnosis of?
- A. Rhinitis Medicamentosa
- B. Multiple ethmoidal polyps
- C. Diagnosis of CSF Rhinorrhoea (Correct Answer)
- D. Deviated nasal septum
Explanation: ***Diagnosis of CSF Rhinorrhoea*** - **Intrathecal fluorescein** is instilled into the cerebrospinal fluid, and its presence in the nasal cavity via endoscopy confirms a **CSF leak**. - This method provides direct visualization of the leak site, which is crucial for surgical planning. *Rhinitis Medicamentosa* - This condition is caused by overuse of **topical decongestants** and characterized by nasal congestion, not a CSF leak. - Diagnosis is typically based on patient history and clinical examination rather than specialized imaging or dye studies. *Multiple ethmoidal polyps* - **Ethmoidal polyps** are benign growths in the ethmoid sinuses, causing nasal obstruction and anosmia. - Diagnosis is made via nasal endoscopy and CT scan, and fluorescein staining is not indicated. *Deviated nasal septum* - A **deviated nasal septum** is a structural abnormality causing unilateral or bilateral nasal obstruction. - Diagnosis is clinical and confirmed by anterior rhinoscopy or nasal endoscopy, with no role for intrathecal fluorescein.
Question 844: 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 845: 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 846: Which of the following is not typically associated with enlarged adenoids?
- A. Otitis media
- B. Nasal obstruction
- C. Failure to thrive of child
- D. Esophagitis (Correct Answer)
Explanation: ***Esophagitis*** - **Enlarged adenoids** are localized to the **nasopharynx** and do not directly impact the esophagus, making esophagitis an unlikely direct complication. - While chronic mouth breathing from enlarged adenoids can lead to **dry mouth**, it is not a direct cause of esophageal inflammation. *Otitis media* - Enlarged adenoids can obstruct the **eustachian tubes**, which connect the middle ear to the nasopharynx, predisposing to **recurrent acute otitis media** or **otitis media with effusion**. - This obstruction impairs middle ear ventilation and drainage, facilitating bacterial growth and inflammation. *Nasal obstruction* - Enlarged adenoids directly block the **nasopharyngeal airway**, leading to chronic **nasal obstruction** and obligate mouth breathing. - This can cause symptoms like snoring, sleep-disordered breathing, and a characteristic "adenoid facies." *Failure to thrive of child* - **Severe nasal obstruction** from enlarged adenoids can disrupt feeding, particularly in infants, as they must breathe through their mouths while attempting to feed. - This compromised feeding, along with **sleep apnea**, increases energy expenditure and can collectively contribute to **failure to thrive**.
Surgery
1 questionsWhich of the following statements is MOST accurate regarding Zenker diverticulum?
NEET-PG 2015 - Surgery NEET-PG Practice Questions and MCQs
Question 841: Which of the following statements is MOST accurate regarding Zenker diverticulum?
- A. It is a pulsion diverticulum (Correct Answer)
- B. It is between superior and middle constrictor
- C. It projects posteriorly
- D. It is commonly seen in older adults
Explanation: ***It is a pulsion diverticulum*** - A **Zenker diverticulum** is formed by the herniation of the **pharyngeal mucosa** through a weak point in the posterior pharyngeal wall, driven by increased intraluminal pressure (**pulsion**). - This contrasts with **traction diverticula**, which are caused by external pulling forces on the esophageal wall. *It is between superior and middle constrictor* - **Zenker diverticulum** occurs in **Killian's triangle**, a weak area between the **cricopharyngeus muscle** (part of the inferior constrictor) and the **thyropharyngeus muscle** (also part of the inferior constrictor). - The superior and middle constrictor muscles are located more superiorly in the pharynx, and diverticula in this region are rare. *It projects posteriorly* - Although it originates from the **posterior pharyngeal wall**, the **Zenker diverticulum** typically projects **left laterally** or **inferiorly** into the neck as it enlarges. - Its initial herniation is posterior, but subsequent growth and gravitational forces lead to its characteristic downward and often left-sided displacement. *It is commonly seen in older adults* - While it most commonly affects **older adults**, this statement describes an **epidemiological characteristic** rather than a fundamental pathophysiological feature of the diverticulum's formation. - The question asks for the **most accurate statement** regarding its nature, and its classification as a pulsion diverticulum directly addresses its pathological mechanism.