Nose and Paranasal Sinuses (Anatomy, Sinusitis, Polyps, Epistaxis) MCQs

ENT · 78 free questions with answers & explanations.

1. The ostiomeatal complex (OMC) is the final common drainage pathway for which sinuses?
2. A patient with allergic fungal sinusitis (AFS) undergoes FESS. Intraoperative findings include thick, inspissated, greenish-brown 'allergic mucin' filling the sinuses. The characteristic histological finding in this mucin is:
3. A 55-year-old diabetic male presents with progressive unilateral nasal obstruction, periorbital oedema, ptosis, and reduced vision. CT shows bony destruction of the medial orbital wall and roof of ethmoid. Biopsy shows aseptate hyphae with right-angle branching. The most critical prognostic determinant in this condition is:
4. The Caldwell-Luc operation involves access to the maxillary sinus through which route?
5. The Samter's triad consists of which combination of conditions, and aspirin sensitivity in this triad is mediated via which mechanism?
6. A 45-year-old patient with chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) fails 3 months of maximal medical therapy (topical steroid, nasal irrigation, systemic steroid course). Which biological agent is FDA-approved (and available in India) as add-on therapy for CRSwNP?
7. The Kiesselbach's plexus (Little's area) on the nasal septum is formed by anastomoses of which set of vessels?
8. On CT scan of the paranasal sinuses in a patient with left-sided chronic sinusitis, a 'halo sign' (central hyperdense material surrounded by a low-density rim) is noted in the left maxillary sinus. Which diagnosis should be considered?
9. In a case of posterior epistaxis not controlled by anterior nasal packing, endoscopic sphenopalatine artery ligation (ESPAL) is now the preferred next step. The sphenopalatine foramen is located in which nasal meatus?
10. Samter's triad (also called aspirin-exacerbated respiratory disease, AERD) consists of which three components, and what is the underlying eicosanoid mechanism?
11. In functional endoscopic sinus surgery (FESS), the 'osteomeatal complex' is the target of surgery. Which of the following structures is NOT part of the osteomeatal complex?
12. A patient with chronic rhinosinusitis with nasal polyps has failed maximal medical therapy (topical steroids, saline irrigation). According to current guidelines (EPOS 2020), the definition of 'difficult-to-treat' CRS includes patients who have undergone adequate FESS and still remain symptomatic. Which biological agent is currently approved for CRS with nasal polyposis?
13. The blood supply to Little's area (Kiesselbach's plexus) on the anterior nasal septum is a confluence of all EXCEPT:
14. Woakes' syndrome refers to a triad of nasal polyposis, ethmoidal mucosal hypertrophy, and broadening of the nasal bridge. This condition is most commonly seen in which underlying systemic disease?
15. Allergic fungal sinusitis (AFS) is characterised by all of the following EXCEPT:
16. In the ostiomeatal complex (OMC), the uncinate process plays a crucial role in sinus drainage. Medialization of the uncinate process on CT would be expected to obstruct drainage of which sinus first?
17. A 45-year-old asthmatic with nasal polyposis and aspirin sensitivity presents with recurrent nasal polyps after two prior polypectomies. This clinical triad is known as Samter's triad (aspirin-exacerbated respiratory disease). The pathomechanism primarily involves:
18. A 70-year-old hypertensive patient presents with severe posterior epistaxis uncontrolled by anterior nasal packing. After failed posterior packing, endoscopic sphenopalatine artery ligation (ESAL) is performed. Which foramen does the sphenopalatine artery traverse to enter the nasal cavity?
19. According to the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS 2020), the diagnosis of chronic rhinosinusitis without polyps (CRSwNP negative) requires symptoms for >12 weeks AND which objective criteria?
20. The ostiomeatal complex (OMC) is the key functional unit targeted in functional endoscopic sinus surgery (FESS). Which of the following structures is NOT part of the OMC?
21. A 35-year-old with chronic rhinosinusitis with nasal polyps (CRSwNP) unresponsive to intranasal corticosteroids and two courses of surgical FESS is being considered for biologic therapy. The current first-line approved biologic for CRSwNP targets which cytokine pathway?
22. A 25-year-old with recurrent profuse epistaxis has a CT scan showing a highly vascular lesion eroding the pterygoid plates arising from the posterior nasal cavity in a young male. Pre-operative embolization is planned. The most appropriate time interval between embolization and surgical excision (FESS/endoscopic) to reduce intraoperative blood loss while preventing revascularization is:
23. The Kiesselbach's plexus (Little's area) is the most common site for anterior epistaxis. Which of the following arteries does NOT contribute to the anastomosis in Kiesselbach's plexus?
24. ARIA (Allergic Rhinitis and its Impact on Asthma) guidelines classify allergic rhinitis severity and persistence. A patient with nasal symptoms for 4 days per week, lasting more than 4 consecutive weeks, with significant impact on work/school activities, is classified as:
25. In functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis, the key anatomical landmark that guides the surgery and whose recognition prevents orbital complications is:
26. A 40-year-old presents with asthma, aspirin sensitivity, and bilateral nasal polyps. This triad is BEST described as:
27. A patient with posterior epistaxis fails nasal packing. Endoscopic sphenopalatine artery ligation is planned. The sphenopalatine artery enters the nasal cavity through the sphenopalatine foramen at the level of:
28. Sinonasal inverted papilloma (Schneiderian papilloma) is associated with which clinically important characteristic that determines surgical approach?
29. In the ostiomeatal complex (OMC), which of the following components is MOST critical as the 'final common pathway' for maxillary, anterior ethmoidal, and frontal sinus drainage?
30. In the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP), the immunological endotype in Western populations predominantly involves which cytokine axis?
31. During FESS, uncinectomy is the critical first step. The uncinate process is a bony projection of the ethmoid bone. Its superior attachment determines the drainage pathway of the frontal sinus. If the uncinate attaches to the lamina papyracea, the frontal sinus drains:
32. The Kiesselbach plexus (Little's area) on the antero-inferior nasal septum is the site of 90% of anterior epistaxis. It is formed by anastomoses of which five vessels?
33. A 14-year-old boy presents with unilateral nasal obstruction, recurrent massive epistaxis, and cheek fullness. CT scan shows a hypervascular mass centred on the sphenopalatine foramen with extension into the pterygopalatine fossa. The MOST appropriate management sequence is:
34. The 'danger area' of the nose includes the nasal vestibule and adjacent mid-face because infections can spread to the cavernous sinus. The valveless venous pathway responsible for this is:
35. During functional endoscopic sinus surgery (FESS), the surgeon must identify the 'key landmark' of the middle turbinate basal lamella (ground lamella). Surgeons must not violate this structure because it separates:
36. A 45-year-old patient with refractory chronic rhinosinusitis with nasal polyps (CRSwNP) despite topical steroids and previous FESS is being considered for biologic therapy. Which biologic agent is approved for CRSwNP and primarily targets the IL-4 receptor alpha chain?
37. Woodruff's plexus, an important source of posterior epistaxis, is located in which region of the nasal cavity and receives its blood supply primarily from:
38. A patient with antrochoanal polyp (ACP) undergoes FESS. Unlike ethmoidal polyps, an ACP arises from which location, and what is the appropriate surgical approach?
39. A patient develops mucocele of the frontal sinus expanding into the orbit causing proptosis and diplopia. What is the pathophysiology of mucocele formation and the preferred treatment?
40. In massive posterior epistaxis that fails to respond to posterior nasal packing, endoscopic sphenopalatine artery ligation (ESPAL) is increasingly preferred over external carotid artery ligation. Which branch of the sphenopalatine artery is most commonly the source of posterior epistaxis?
41. Antrochoanal polyp (Killian's polyp) differs from bilateral ethmoidal nasal polyps in all of the following features EXCEPT:
42. Little's area (Kiesselbach's plexus) receives blood supply from all of the following EXCEPT:
43. The most common site of posterior epistaxis requiring arterial ligation or embolization is the territory of the:
44. Samter's triad (aspirin-exacerbated respiratory disease) consists of:
45. A patient with chronic rhinosinusitis with nasal polyps (CRSwNP) fails maximal medical therapy (topical steroids + saline irrigation for 12 weeks). Which biologic agent is FDA-approved as an add-on therapy specifically targeting the IL-4/IL-13 pathway in this condition?
46. During FESS, the landmark structure 'basal lamella' (ground lamella) separates which two ethmoidal areas?
47. A 25-year-old male presents with acute onset severe epistaxis following trauma. Bleeding persists despite anterior nasal packing. The most common artery responsible for posterior epistaxis in Woodruff's plexus is a branch of:
48. A 25-year-old patient presents with recurrent massive epistaxis requiring hospitalisation on three occasions. Examination shows multiple spider telangiectasias on the nasal mucosa and lips. His father had similar episodes. The underlying condition, inheritance pattern, and the vessel most commonly involved in epistaxis in this condition are:
49. A patient has persistent purulent nasal discharge and facial pain predominantly in the morning worsened by bending forward, following a recent dental procedure involving the upper left premolar. CT paranasal sinuses shows left maxillary sinus opacification with a periapical lucency in the adjacent second premolar. The most likely diagnosis and its aetio-pathogenesis are:
50. Epistaxis from Woodruff's plexus (posterior epistaxis) characteristically bleeds into the nasopharynx and is often not visible anteriorly. It is a venous plexus located in which region?
51. Antrochoanal polyp (Killian's polyp) differs from ethmoidal polyps in several ways. Which statement best characterises an antrochoanal polyp?
52. The ostiomeatal complex (OMC) is described as a functional unit that, when obstructed, leads to ipsilateral chronic rhinosinusitis. The key component of the OMC that acts as the final common drainage pathway for the maxillary, anterior ethmoid, and frontal sinuses is:
53. A 40-year-old male presents with posterior epistaxis not controlled by anterior nasal packing. Endoscopic examination under general anaesthesia identifies the bleeding point at the posterolateral nasal wall, posterior to the posterior end of the inferior turbinate. The vessel responsible is most likely:
54. A patient with antrochoanal polyp (Killian's polyp) undergoes FESS for definitive treatment. Unlike simple nasal polyps arising from the ethmoid, antrochoanal polyps arise from which specific location and have which characteristic feature on CT?
55. A patient with recurrent unilateral nasal obstruction, blood-tinged mucus, and facial pain is found to have a vascular mass in the posterior nasopharynx on endoscopy. Angiography shows supply from the internal maxillary artery. The patient is a 16-year-old male. What is the MOST appropriate pre-operative management before definitive surgery?
56. Little's area (Kiesselbach's plexus) of the nasal septum is the most common site of epistaxis (90%). Which arteries form this anastomotic plexus?
57. Nasal polyps in a 10-year-old child with recurrent pulmonary infections and steatorrhea should prompt testing for:
58. In the management of acute massive epistaxis unresponsive to anterior and posterior nasal packing, the next intervention in an elderly hypertensive patient is:
59. Agger nasi cells are important in endoscopic sinus surgery because they:
60. A 45-year-old patient presents with massive posterior epistaxis refractory to anterior and posterior nasal packing. Endoscopic surgery and arterial ligation is planned. Which artery, when ligated, most effectively controls posterior epistaxis from the sphenopalatine territory?
61. Antrochoanal polyp (Killian's polyp) differs from ethmoidal nasal polyps in that it:
62. Little's area (Kiesselbach's plexus) is the most common site of anterior epistaxis. Which of the following arteries does NOT contribute to this plexus?
63. A 35-year-old man presents with recurrent unilateral nasal polyps, anosmia, and CT showing opacification of multiple sinuses. Histopathology of the polyp shows eosinophilic infiltrate with Charcot-Leyden crystals. The most likely diagnosis is:
64. The most common site of epistaxis (anterior nosebleed) in adults is:
65. A patient with frontal sinusitis develops sudden onset severe headache, high fever, and a 'doughy' swelling over the forehead. CT shows destruction of the anterior table of the frontal sinus with a subperiosteal collection. The most likely complication is:
66. During endoscopic sinus surgery, the key landmark used to identify the sphenopalatine foramen is:
67. A 12-year-old boy presents with progressive unilateral nasal obstruction and episodic profuse nasal bleeding. Examination reveals a fleshy, pinkish-grey mass in the nasopharynx. CT shows extension into the pterygopalatine fossa with bone erosion. The most likely diagnosis and its primary blood supply respectively are:
68. A 60-year-old hypertensive male presents with profuse posterior epistaxis not controlled by anterior nasal packing. He is normotensive with resuscitation. The next step is:
69. A 14-year-old boy presents with unilateral nasal obstruction (right side) and progressive epistaxis. CT scan shows a lobulated, intensely enhancing mass centered at the sphenopalatine foramen. The most likely diagnosis and its treatment are:
70. Little's area (Kiesselbach's plexus) is the most common site of anterior epistaxis. Which vessels do NOT contribute to this anastomotic plexus?
71. Posterior epistaxis in elderly hypertensive patients is most commonly from which vessel?
72. A 28-year-old with nasal polyps, chronic purulent sinusitis, and bronchiectasis is most likely to have which underlying condition?
73. A 32-year-old atopic woman presents with bilateral nasal polyps, recurrent pansinusitis, and episodic severe bronchospasm triggered by aspirin use. Nasal smear shows numerous eosinophils. What is this syndrome called and which prostaglandin pathway is implicated?
74. A 9-year-old boy presents with recurrent epistaxis from the anterior nasal septum. On examination, a plexus of dilated vessels is seen on the anterior inferior part of the nasal septum. What is the name of this vascular plexus and what vessels contribute to it?
75. A 40-year-old man undergoes functional endoscopic sinus surgery. During the procedure, the surgeon removes the uncinate process. Which sinus ostium does this expose?
76. A patient with chronic rhinosinusitis undergoes imaging. The CT shows complete opacification of all sinuses on one side with expansion of the affected sinuses and thinning of the bony walls. Intraoperatively, the sinus contains thick, inspissated, dark green-brown material with a peanut butter consistency. What is the most likely diagnosis?
77. A 16-year-old male presents with recurrent unilateral nasal obstruction and profuse epistaxis. Examination shows a smooth pinkish-grey mass in the nasopharynx. CT shows a hypervascular mass centred at the sphenopalatine foramen with extension into the pterygopalatine fossa. Biopsy should NOT be attempted. What is the diagnosis?
78. A 50-year-old man with a history of prolonged woodworking presents with unilateral nasal obstruction, blood-stained nasal discharge, and a mass in the right nasal cavity. CT shows a heterogeneous soft tissue mass involving the right nasal cavity and ethmoid sinuses with medial wall orbital erosion. Biopsy reveals an intestinal-type adenocarcinoma. What occupational exposure is classically linked to this tumour?