Rhinology and Endoscopic Sinus Surgery (FESS, CRS Phenotypes, Invasive Fungal Sinusitis) MCQs

ENT · 48 free questions with answers & explanations.

1. During FESS for chronic rhinosinusitis, the surgeon identifies the uncinate process and plans to create an uncinectomy. Which landmark structure is immediately lateral to the uncinate process and at greatest risk of inadvertent entry?
2. A 55-year-old diabetic male presents with 2-week history of unilateral nasal blockage, orbital pain, and eschar formation in the nasal cavity. MRI shows T2 hypointense signal in the nasal cavity with perineural spread along V2. The most likely organism responsible is:
3. Chronic rhinosinusitis with nasal polyposis (CRSwNP) is classified as an endotype 2 disease. Which biological agent targeting the shared cytokine signaling pathway of IL-4 and IL-13 is now approved for severe CRSwNP?
4. The Draf III procedure (modified Lothrop procedure, endoscopic frontal drillout) is performed for which primary indication?
5. Keros classification of the olfactory fossa depth is important for surgical safety during ethmoidectomy. Which Keros type carries the highest risk of CSF leak during FESS?
6. A diabetic patient on immunosuppressants develops acute-onset unilateral facial pain, periorbital swelling, and a black eschar on the middle turbinate. CT shows bony erosion of the medial orbital wall. The most likely organism and the appropriate first-line treatment are:
7. Allergic fungal rhinosinusitis (AFRS) is characterized by which pathological finding on histology and mucin analysis?
8. The 'uncinate process' in the lateral nasal wall determines the drainage pathway of the maxillary sinus. The maxillary sinus natural ostium drains into which structure?
9. A 38-year-old asthmatic patient presents with nasal obstruction, anosmia, and bilateral nasal polyps. CT paranasal sinuses shows opacification of all sinuses with bilateral polyps. Tissue eosinophilia is >50 cells/HPF on biopsy. Which phenotype of chronic rhinosinusitis with nasal polyps (CRSwNP) best characterises this patient?
10. During FESS for chronic rhinosinusitis, uncinectomy is the initial step. The natural ostium of the maxillary sinus is located at the:
11. A 55-year-old diabetic patient on corticosteroids presents with rapid-onset facial swelling, orbital cellulitis, and black eschar over the hard palate and inferior turbinate. CT paranasal sinuses shows bony destruction of the medial orbital wall and anterior cranial fossa involvement. The most likely diagnosis and its causative organism are:
12. Dupilumab, an IL-4Rα antagonist blocking both IL-4 and IL-13 signalling, is approved for refractory CRSwNP. Which of the following represents the ideal candidate for biologic therapy in CRSwNP according to current guidelines?
13. A 45-year-old immunocompetent patient with chronic rhinosinusitis with nasal polyps (CRSwNP) has failed 3 months of topical corticosteroids and two courses of oral steroids. What biological agent is approved as add-on therapy for severe uncontrolled CRSwNP based on its mechanism of inhibiting IL-4 and IL-13 signaling?
14. During FESS for chronic maxillary sinusitis, the surgeon identifies the uncinate process. To open the natural maxillary ostium, the uncinate process should be displaced medially or excised. What important anatomical structure immediately lateral to the uncinate process determines which direction it drains?
15. A 55-year-old diabetic patient presents with a 1-week history of left-sided facial pain, periorbital swelling, proptosis, and blood-stained nasal discharge. CT PNS shows hyperdense material in the left maxillary and ethmoid sinuses with erosion of the medial orbital wall. Emergency nasal endoscopy shows black eschar on the left inferior turbinate. What is the most likely causative organism and the immediate management priority?
16. An immunocompetent 30-year-old presents with recurrent unilateral nasal obstruction, epistaxis, and a CT showing a heterogeneous expansile mass in the right maxillary sinus with central hyperdensity and peripheral rim enhancement. No bony erosion. The most likely diagnosis is:
17. A 52-year-old diabetic patient presents with left periorbital swelling, proptosis, ophthalmoplegia, and black necrotic turbinates following a week of poorly controlled hyperglycemia. CT scan shows destruction of the left medial orbital wall and ethmoid sinuses. KOH mount of nasal discharge reveals broad non-septate hyphae with right-angle branching. What is the NEXT most critical step in management?
18. Chronic rhinosinusitis with nasal polyps (CRSwNP) is increasingly understood as a type 2 inflammatory disease. Which biological agent targeting the IL-4/IL-13 pathway has received regulatory approval for CRSwNP management?
19. During FESS, the surgeon identifies the basal lamella of the middle turbinate. Which sinus is located posterior to this landmark, and what does its perforation risk?
20. A patient with allergic fungal sinusitis (AFS) is distinguished from chronic invasive fungal sinusitis by all of the following EXCEPT:
21. A 45-year-old immunocompetent patient with chronic rhinosinusitis with nasal polyps (CRSwNP) fails maximal medical therapy including systemic steroids and two FESS procedures. Biopsy confirms type 2 inflammatory pattern with eosinophilia. The most appropriate next biological therapy is:
22. A diabetic patient presents with a 5-day history of unilateral nasal obstruction, periorbital swelling, black eschar on the nasal mucosa, and proptosis. CT scan shows bone erosion of the medial orbital wall. The most critical immediate step in management is:
23. During FESS, the most important landmark for identifying the maxillary sinus ostium and avoiding injury to the orbit is the:
24. Samter's triad (aspirin-exacerbated respiratory disease — AERD) is characterized by which combination?
25. A 45-year-old diabetic patient presents with proptosis, complete ophthalmoplegia and cavernous sinus thrombosis 5 days after developing nasal pain. MRI shows soft tissue infiltration of the pterygopalatine fossa. The most likely diagnosis and causative organism are:
26. In FESS for chronic rhinosinusitis, the middle meatal antrostomy primarily targets drainage and ventilation of the:
27. Allergic fungal sinusitis (AFS) characteristically shows which finding on CT sinuses?
28. Regarding chronic rhinosinusitis (CRS) phenotypes, CRS with nasal polyps (CRSwNP) differs from CRS without nasal polyps (CRSsNP) in that it is predominantly characterized by:
29. The Onodi cell (sphenoethmoid cell) is surgically relevant because it:
30. During FESS for chronic rhinosinusitis, the surgical landmark identified first to guide all subsequent dissection is the:
31. A 35-year-old poorly controlled diabetic presents with nasal congestion, blood-tinged discharge, and periorbital swelling. Nasal endoscopy shows black necrotic tissue over the middle turbinate. CT reveals destruction of medial orbital wall. The organism most likely responsible is:
32. Allergic fungal rhinosinusitis (AFRS) is distinguished from chronic rhinosinusitis with polyps by the characteristic CT finding of:
33. The Draf III (modified Lothrop) procedure is performed to create a maximal drainage opening in which sinus?
34. A 35-year-old male with chronic rhinosinusitis with nasal polyps (CRSwNP) fails 3 months of topical steroids and saline irrigation. Which additional pharmacological agent has the strongest level of evidence for reducing polyp size and delaying recurrence?
35. During functional endoscopic sinus surgery (FESS), the most critical landmark used to identify the ethmoid roof and prevent intracranial entry is:
36. A 55-year-old uncontrolled diabetic presents with fever, unilateral facial pain, proptosis, and black necrotic eschar on the nasal turbinate. Emergency nasal endoscopy reveals black discolouration of the middle turbinate. The most appropriate immediate management is:
37. In allergic fungal rhinosinusitis (AFRS), which of the following histopathological findings on nasal polypectomy is pathognomonic?
38. A 45-year-old diabetic male presents with proptosis, periorbital ecchymosis, loss of vision, and fever for 5 days after a COVID-19 infection. CT sinuses show opacification of the left maxillary and ethmoid sinuses with erosion of the medial orbital wall. Nasal endoscopy reveals black eschar on the turbinate. The most urgent intervention is:
39. In functional endoscopic sinus surgery (FESS), the first structure routinely opened to access the maxillary sinus ostium via the infundibulum is the:
40. Chronic rhinosinusitis with nasal polyps (CRSwNP) — the Type 2 inflammatory endotype — is characterized by which cytokine profile?
41. A patient undergoing FESS for chronic sinusitis develops profuse clear fluid leak from the nose. The fluid is confirmed to be CSF by beta-2 transferrin testing. The most common site of inadvertent CSF leak during FESS is:
42. Antrochoanal polyp (Killian's polyp) differs from ethmoidal nasal polyps in which key feature?
43. In functional endoscopic sinus surgery (FESS), the 'key' structure that must be identified first to safely open the anterior ethmoid complex is:
44. Acute invasive fungal sinusitis (AIFRS) is most commonly caused by which organism, and what is the hallmark pathological feature?
45. Chronic rhinosinusitis with nasal polyps (CRSwNP) is predominantly driven by which cytokine endotype?
46. A diabetic patient with periorbital oedema, black eschar over the hard palate, and proptosis following a sinus infection requires emergency surgical debridement. Frozen section shows broad, non-septate hyphae with right-angle branching. The drug of choice is:
47. The Lund-Mackay scoring system is used to evaluate which condition on CT scan?
48. Dupilumab (anti-IL-4Rα monoclonal antibody) is approved as an add-on therapy for which CRS phenotype?