NEET-PG 2013 - ENT Practice Questions

Q: All are major symptoms of sinusitis except?

Halitosis. ***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.

Q: In which condition is mulberry nasal mucosa typically observed?

Lupus vulgaris. ***Lupus vulgaris*** - **Mulberry nasal mucosa** is a **pathognomonic finding** in **lupus vulgaris**, a form of cutaneous tuberculosis affecting the nasal mucosa. - The mucosa shows characteristic **reddish-brown, soft nodules** that resemble mulberries, with a typical **apple-jelly appearance on diascopy**. - Lesions are **persistent, slowly progressive**, and may cause destruction of the nasal cartilage if untreated. *Vasomotor rhinitis* - **Vasomotor rhinitis** (non-allergic rhinitis) presents with **pale, bluish, or boggy nasal mucosa**, not the mulberry appearance. - Caused by **autonomic nervous system dysregulation**, leading to nasal congestion and rhinorrhea triggered by non-allergic stimuli. - The mucosal changes are **diffusely edematous** rather than nodular. *Atrophic rhinitis* - **Atrophic rhinitis** involves progressive atrophy of the nasal mucosa and underlying bone. - Mucosa appears **pale, dry, smooth, and shiny** with thick crusts (ozena in secondary form). - Wide nasal cavities with paradoxical nasal obstruction, **not mulberry-like nodular changes**. *Allergic rhinitis* - **Allergic rhinitis** typically shows **pale, edematous, bluish-gray mucosa** with watery discharge. - Caused by **IgE-mediated hypersensitivity** to environmental allergens. - Mucosa may appear **boggy but not nodular or mulberry-like**.

Q: Through which meatus is a nasal puncture typically performed?

Inferior meatus. ---Inferior meatus--- - A nasal puncture for **maxillary sinus irrigation** is typically performed through the **inferior meatus** because it provides direct access to the floor of the nasal cavity and the passage to the maxillary sinus. - The floor of the **inferior meatus** is the thinnest part of the lateral nasal wall, making it an ideal entry point for procedures into the maxillary sinus. *Superior meatus* - The **superior meatus** is associated with the drainage of the **posterior ethmoid cells** and the **sphenoid sinus**. - Puncturing here would not provide access for maxillary sinus irrigation and could risk damage to the **cribriform plate**. *Middle meatus* - The **middle meatus** is where the **maxillary**, **frontal**, and **anterior ethmoid sinuses** primarily drain. - While related to the maxillary sinus, it is not the preferred site for a puncture for irrigation, as it is more complex and less direct than the inferior meatus. *Sphenoethmoidal recess* - The **sphenoethmoidal recess** is located superior to the superior concha and is the drainage site for the **sphenoid sinus**. - This area is too high and posterior to be relevant for a puncture aimed at the **maxillary sinus**.

Q: All are seen in Samters triad except?

Bacterial infection. ***Bacterial infection*** - **Samter's triad**, also known as aspirin-exacerbated respiratory disease (AERD), consists of **asthma**, **nasal polyps**, and **aspirin sensitivity** (or NSAID sensitivity) [1]. - **Bacterial infection** is not a component of Samter's triad, although patients with nasal polyps may be more prone to secondary bacterial sinusitis. *Asthma* - **Asthma** is one of the three main components of Samter's triad, typically becoming more symptomatic after aspirin ingestion [1]. - Patients experience **bronchoconstriction** and worsening respiratory symptoms. *Nasal polyp* - **Nasal polyps** are a characteristic feature of Samter's triad, often extensive and recurrent [1]. - They contribute to nasal obstruction and chronic rhinosinusitis. *Aspirin sensitivity* - **Aspirin sensitivity** (or NSAID sensitivity) is the third key component, where ingestion of aspirin or other NSAIDs triggers severe respiratory reactions [1]. - This sensitivity is due to an abnormal arachidonic acid metabolism pathway involving **leukotrienes**.

Q: Posterior epistaxis occurs from:

Woodruff's plexus. ***Woodruff's plexus*** - **Woodruff's plexus** is a collection of large, often friable veins located on the **posterior aspect of the lateral wall of the nasal cavity**, making it the most common anatomical site for **posterior epistaxis**. - Bleeding from this plexus is typically more severe and difficult to control than anterior epistaxis due to the larger vessel size and posterior location. - Located in the **posterolateral nasal cavity** near the posterior end of the inferior turbinate. *Kiesselbach's plexus* - **Kiesselbach's plexus** (also known as Little's area) is located on the **anterior nasal septum** and is the most common site for **anterior epistaxis**. - This is an anastomotic network of vessels from multiple arterial sources in the anterior nasal cavity. - Bleeding from this plexus is usually less severe and often responds to local pressure or cauterization. *Sphenopalatine artery* - The **sphenopalatine artery** is the terminal branch of the maxillary artery and is the primary arterial supply to the posterior nasal cavity. - While it supplies the area where posterior epistaxis occurs, the venous **Woodruff's plexus** is the specific anatomical structure most commonly associated with posterior epistaxis. - The sphenopalatine artery may require ligation or embolization in severe posterior epistaxis cases. *Little's area* - **Little's area** is another name for **Kiesselbach's plexus** and is located on the **anterior nasal septum**, primarily responsible for anterior epistaxis. - This area is highly vascularized by anastomoses of the anterior ethmoidal, sphenopalatine, greater palatine, superior labial, and septal branches of arteries. - Prone to bleeding from minor trauma, digital manipulation, or mucosal dryness.

Q: In which condition do symptoms improve with crying?

Choanal atresia. ***Choanal atresia*** - In **bilateral choanal atresia**, a newborn is unable to breathe through the nose due to a bony or membranous obstruction. Symptoms like **cyanosis** worsen with feeding and improve with crying because crying involves **mouth breathing**, which bypasses the nasal obstruction. - This condition is a **medical emergency** as newborns are obligate nasal breathers, and immediate intervention (e.g., oral airway, surgical repair) is often required. *Tetralogy of Fallot* - This congenital heart defect can lead to **cyanotic spells** (hypercyanotic or "tet" spells), which are characterized by increased cyanosis, tachypnea, and irritability. These spells are often precipitated by activities that increase right-to-left shunting, and **crying can worsen them** rather than improve them due to increased systemic oxygen demand and vascular resistance. - Management often involves positioning (knee-chest) and medications to reduce pulmonary vascular resistance or increase systemic vascular resistance, to alleviate shunting. *Bronchial asthma* - **Crying is a common trigger for asthma attacks** in children, as it can induce bronchoconstriction due to hyperventilation and airway irritation. Symptoms typically worsen with crying, leading to **wheezing, coughing, and shortness of breath**. - Asthma is characterized by **reversible airway obstruction** and airway hyperresponsiveness, and its symptoms do not improve with crying. *None of the options* - This option is incorrect because **choanal atresia** is a condition where symptoms (specifically cyanosis) do improve with crying due to the switch from nasal to mouth breathing.

Q: What imaging study is typically required before endoscopic sinus surgery?

CT of PNS. ***CT of PNS*** - A **CT scan of the paranasal sinuses** is crucial prior to endoscopic sinus surgery for detailed anatomical mapping. - It helps identify **key anatomical landmarks**, variations, and the extent of disease, minimizing surgical risks. *MRI of paranasal sinus* - **MRI** is generally reserved for evaluating **soft tissue abnormalities**, such as tumors, fungal infections, or intracranial extension. - It provides less detail regarding **bony anatomy** and is not the primary imaging modality for surgical planning in routine cases. *Mucociliary clearing testing* - **Mucociliary clearing tests** assess the function of the **mucociliary escalator** in the nasal cavity and sinuses. - These tests are primarily diagnostic for conditions like **primary ciliary dyskinesia** and do not provide anatomical detail for surgical guidance. *Acoustic tests* - **Acoustic tests** are typically used to assess **hearing function** in the ear. - They have **no relevance** to the anatomical evaluation of the paranasal sinuses or planning for endoscopic sinus surgery.

Q: Which of the following statements about tubercular otitis media is false?

Causes painful ear discharge. ***Causes painful ear discharge*** - **Pain** is typically an **absent or minimal symptom** in tubercular otitis media, even with significant ear discharge. - The discharge is usually **thin, watery, and non-purulent**, reflecting the indolent nature of the infection. *Spreads through the eustachian tube* - Tubercular otitis media can spread via the **eustachian tube** from the nasopharynx, especially in cases of active pulmonary or pharyngeal tuberculosis. - This is a common route for infectious agents to reach the middle ear. *Usually affects only one ear* - Tubercular otitis media predominantly presents as a **unilateral infection**. - While bilateral involvement can occur, it is less common than unilateral presentation. *May cause multiple perforations* - Tubercular otitis media is notorious for causing **multiple, small perforations** in the tympanic membrane. - This feature, often described as a "sieve-like" drum, is a characteristic diagnostic clue for the condition.

Q: Weber-Ferguson approach is used for?

Maxillectomy. ***Maxillectomy*** - The **Weber-Ferguson approach**, also known as the **lateral rhinotomy approach**, is a standard surgical incision used to access the midface, particularly for procedures involving the maxilla. - It provides excellent exposure for **maxillectomy**, which is the surgical removal of part or all of the maxilla, often performed for tumors of the maxillary sinus or hard palate. *Mastoidectomy* - This procedure involves the surgical removal of diseased mastoid air cells, typically performed for chronic otitis media or cholesteatoma. - The surgical approaches for mastoidectomy usually involve incisions behind the ear (**postauricular** or **endaural**), not the Weber-Ferguson incision. *Myringoplasty* - Myringoplasty is a surgical repair of a perforated eardrum (tympanic membrane). - This procedure is typically performed through the ear canal (**transcanal approach**) or a small incision behind the ear, and does not require a large facial incision like the Weber-Ferguson. *Mandibulectomy* - Mandibulectomy involves the surgical removal of part or all of the mandible (jawbone), often for malignant tumors. - Approaches for mandibulectomy typically involve **transoral**, **submandibular**, or **lip-splitting incisions**, which are distinct from the Weber-Ferguson approach and designed for lower facial access.

Question 1

All are major symptoms of sinusitis except?

Accepted Answer

Halitosis

Answer

Nasal blockage

Answer

Facial congestion

Answer

Anosmia

Question 2

In which condition is mulberry nasal mucosa typically observed?

Accepted Answer

Lupus vulgaris

Answer

Vasomotor rhinitis

Answer

Atrophic rhinitis

Answer

Allergic rhinitis

Question 3

Through which meatus is a nasal puncture typically performed?

Accepted Answer

Inferior meatus

Answer

Superior meatus

Answer

Middle meatus

Answer

Sphenoethmoidal recess

Question 4

All are seen in Samters triad except?

Accepted Answer

Bacterial infection

Answer

Nasal polyp

Answer

Aspirin sensitivity

Answer

Asthma

Question 5

Posterior epistaxis occurs from:

Accepted Answer

Woodruff's plexus

Answer

Kiesselbach's plexus

Answer

Sphenopalatine artery

Answer

Little's area

Question 6

In which condition do symptoms improve with crying?

Accepted Answer

Choanal atresia

Answer

Tetralogy of Fallot

Answer

Bronchial asthma

Answer

None of the options

Question 7

What imaging study is typically required before endoscopic sinus surgery?

Accepted Answer

CT of PNS

Answer

MRI of paranasal sinus

Answer

Acoustic tests

Answer

Mucociliary clearing testing

Question 8

Which of the following statements about tubercular otitis media is false?

Accepted Answer

Causes painful ear discharge

Answer

Spreads through the eustachian tube

Answer

Usually affects only one ear

Answer

May cause multiple perforations

Question 9

Endolymphatic sac decompression is done in?

Accepted Answer

Definitive treatment for intractable vertigo in Meniere's disease

Answer

Management of endolymphatic hydrops in early-stage Meniere's disease

Answer

Prophylactic treatment in recurrent vertigo syndromes

Answer

Primary surgical approach for cochlear disorders

Question 10

Weber-Ferguson approach is used for?

Accepted Answer

Maxillectomy

Answer

Mastoidectomy

Answer

Myringoplasty

Answer

Mandibulectomy

NEET-PG 2013 — ENT