Category: Quiz

Bones of foot

BONES OF FOOT

Q. 1

Which of the following bones is not part of the medial arch of the foot?

 A

Cuneiform bones

 B

Navicular

 C

Calcaneus

 D

Cuboid

Q. 1

Which of the following bones is not part of the medial arch of the foot?

 A

Cuneiform bones

 B

Navicular

 C

Calcaneus

 D

Cuboid

Ans. D

Explanation:

The medial arch of the foot consists of the talus, calcaneus, cuneiforme, and the three medial metatarsal bones. The cuboid bone belongs to the lateral arch of the foot together with the calcaneus, and the two remaining metatarsal bones.


Q. 2

Tibialis posterior is inserted in all of the following bones distally, EXCEPT?

 A

Navicular bone

 B

Intermediate cuneiform

 C

Metatarsal 2

 D

Talus

Q. 2

Tibialis posterior is inserted in all of the following bones distally, EXCEPT?

 A

Navicular bone

 B

Intermediate cuneiform

 C

Metatarsal 2

 D

Talus

Ans. D

Explanation:

Tibialis posterior muscle attaches proximally to the interosseous membrane and the tibia and fibula; distally, it attaches to the navicular bone, all cuneiform bones, and metatarsals 2 to 4. The tibialis posterior muscle inverts and plantarflexes the foot, providing support to the medial arch of the foot during walking. The tibial nerve (L4 and L5) innervates this muscle.

Q. 3

The example of syndesmosis type of joint is ‑

 A

Sacroiliac

 B

Inferior tibiofibular

 C

Superior tibiofibular

 D

Mid tarsal

Q. 3

The example of syndesmosis type of joint is ‑

 A

Sacroiliac

 B

Inferior tibiofibular

 C

Superior tibiofibular

 D

Mid tarsal

Ans. B

Explanation:

B i.e. Inferior tibiofibular


Q. 4

True about cuboid bone :

 A

It develops by membranous ossification

 B

Proximally articulate with lunate bone

 C

Flexor retinaculum is attached

 D

Articulates with Calcaneum

Q. 4

True about cuboid bone :

 A

It develops by membranous ossification

 B

Proximally articulate with lunate bone

 C

Flexor retinaculum is attached

 D

Articulates with Calcaneum

Ans. D

Explanation:

D i.e. Articulates with Calcaneum


Q. 5

Length of tibia is:           

 A

10% of height

 B

20% of height

 C

30% of height

 D

40% of height

Q. 5

Length of tibia is:           

 A

10% of height

 B

20% of height

 C

30% of height

 D

40% of height

Ans. B

Explanation:

Ans. 20% of height



Adductor canal

ADDUCTOR CANAL

Q. 1

All of the following are contents of adductor canal, EXCEPT?

 A

Femoral artery

 B

Popliteal artery

 C

Nerve to Vastus medialis

 D

Saphenous nerve

Q. 1

All of the following are contents of adductor canal, EXCEPT?

 A

Femoral artery

 B

Popliteal artery

 C

Nerve to Vastus medialis

 D

Saphenous nerve

Ans. B

Explanation:

Femoral artery and vein, saphenous nerve and, in the upper part, the nerve to vastus medialis.

Adductor canal or subsartorial or Hunter‘s canal is a gutter-shaped tunnel in the middle third of the thigh. It extends from the apex of the femoral triangle to the adductor hiatus in the tendon of adductor magnus. 

Boundaries are given below:

  • Anterior and lateral wall: vastus medialis
  • Posterior wall – superior: adductor longus; inferior: adductor magnus
  • Medial wall: Sartorius, which overlies the groove between the above muscles, forming the roof of the canal.

Q. 2

Hunter’s canal is seen in‑

 A

Cubital fossa

 B

Popliteal fossa

 C

Thigh

 D

Calf

Q. 2

Hunter’s canal is seen in‑

 A

Cubital fossa

 B

Popliteal fossa

 C

Thigh

 D

Calf

Ans. C

Explanation:

Ans. is ‘c’ i.e., Thigh


Q. 3

Not a content of Hunter’s canal ‑

 A

Femoral artery

 B

Femoral vein

 C

Femoral nerve

 D

Sphenous nerve

Q. 3

Not a content of Hunter’s canal ‑

 A

Femoral artery

 B

Femoral vein

 C

Femoral nerve

 D

Sphenous nerve

Ans. C

Explanation:

Ans. is ‘c’ i.e., Femoral nerve

Contents of adductor canal are femoral artery, femoral vein, Saphenous nerve, nerve to vastus medialis, descending genicular artery, deep lymph vessels, and two terminal divisions of obturator nerve.



Hip joint

HIP JOINT

Q. 1

Which of the following muscle helps in the flexion of hip joint?

 A

Psoas

 B

Piriformis

 C

Pectoralis major

 D

External oblique abdominis

Q. 1

Which of the following muscle helps in the flexion of hip joint?

 A

Psoas

 B

Piriformis

 C

Pectoralis major

 D

External oblique abdominis

Ans. A

Explanation:

Flexors of hip: Psoas major and illiacus are the chief flexors of hip joint. Pectineus, rectus femoris, adductors and sartorius are the accessory muscles. Adductors mainly the adductor longus participate in the early stages of flexion.


Q. 2

Which of the ligaments limits extension at the hip joint?

 A

Iliofemoral

 B

Ligamentum capitis femoris

 C

Pubofemoral

 D

Zona orbicularis

Q. 2

Which of the ligaments limits extension at the hip joint?

 A

Iliofemoral

 B

Ligamentum capitis femoris

 C

Pubofemoral

 D

Zona orbicularis

Ans. A

Explanation:

The iliofemoral ligament is a Y-shaped ligament extending from the anterior inferior iliac spine to the anterior surface of the intertrochanteric line of the femur. It prevents hyperextension of the hip joint during standing by screwing the femoral head into the acetabulum. (The ischiofemoral ligament also helps to prevent hyperextension of the hip joint by screwing the femoral head into the acetabulum).

Ligamentum capitis femoris attaches the head of the femur to the acetabular fossa. The pubofemoral ligament connects the pubic portion of the rim of the bony acetabulum to the medial surface of the femoral neck. It prevents over abduction of the hip joint.

Zona orbicularis is a band of circularly oriented ligamentous fibers that reinforce the capsule of the hip joint. it helps keep the head of the femur in its socket.


Q. 3

Bigelow’s ligament is at

 A

Knee joint

 B

Shoulder joint

 C

Hip joint

 D

Ankle joint

Q. 3

Bigelow’s ligament is at

 A

Knee joint

 B

Shoulder joint

 C

Hip joint

 D

Ankle joint

Ans. C

Explanation:

C. i.e. Hip joint


Q. 4

True regarding the hip joint is :

 A

Medial rotation and Abduction is caused by Gluteus medius and Gluteus minimus

 B

Medial rotation and Adduction is caused by Gluteus medius and Gluteus minimus

 C

Lateral rotaters of thigh are supplied by femoral nerve

 D

Hyperextension of Hip is prevented by capsular thickening

Q. 4

True regarding the hip joint is :

 A

Medial rotation and Abduction is caused by Gluteus medius and Gluteus minimus

 B

Medial rotation and Adduction is caused by Gluteus medius and Gluteus minimus

 C

Lateral rotaters of thigh are supplied by femoral nerve

 D

Hyperextension of Hip is prevented by capsular thickening

Ans. A

Explanation:

A i.e. Medial rotation & abduction is caused by gluteus medius & minimus

Gluteus medius & minimus are powerful abductors of hip & also cause medial rotation (not lateral rotation). Gluteus maximus is extensor & lateral rotator of hip.

Sartorius is flexor, abductor & lateral rotator of hip & flexes knee joint. (i.e. palthi posture/ sitting crossed leg / position in which tailors sit).

Tensor fascia lata is flexor, abductor & medial rotator of hip; helps in knee extension.

Hyper extension is prevented by iliofemoral ligament (Ligament of Bigelow)  not by capsular thickening

Femoral nerve (L2L3L4) supplies flexor muscles of hip (anterior compartment of thigh) i.e. – Sartorius, Quadriceps femoris (rectus femoris + vastus laterlis, medialis & intermedius), articularis genu  not lateral rotators of thigh (eg. Gluteus maximus)


Q. 5

Ligament resisting hyperextension of hip are all except:        

 A

Ischiofemoral ligament

 B

Pubofemoral ligament

 C

Iliofemoral ligament

 D

Sacroiliac ligament

Q. 5

Ligament resisting hyperextension of hip are all except:        

 A

Ischiofemoral ligament

 B

Pubofemoral ligament

 C

Iliofemoral ligament

 D

Sacroiliac ligament

Ans. D

Explanation:

Ans. D: Sacroiliac ligament

When the knee is flexed, flexion is limited by the anterior surface of the thigh coming into contact with the anterior abdominal wall.

When the knee is extended, flexion is limited by the tension of the hamstring group of muscles.

Extension, which is the movement of the flexed thigh backward to the anatomic position, is limited by the tension of the iliofemoral, pubofemoral, and ischiofemoral ligaments.

Abduction is limited by the tension of the pubofemoral ligament, and adduction is limited by contact with the opposite limb and by the tension in the ligament of the head of the femur.

Lateral rotation is limited by the tension in the iliofemoral and pubofemoral ligaments, and medial rotation is limited by the ischiofemoral ligament.

The following movements take place:

  • Flexion is performed by the iliopsoas, rectus femoris, and sartorius and also by the adductor muscles.
  • Extension (a backward movement of the flexed thigh) is performed by the gluteus maximus and the hamstring muscles.
  • Abduction is performed by the gluteus medius and minimus, assisted by the sartorius, tensor fasciae latae and piriformis.

Adduction is performed by the adductor longus and brevis and the adductor fibers of the adductor magnus. These muscles are assisted by the pectineus and the gracilis.

Lateral rotation is performed by the piriformis, obturator internus and externus, superior and inferior gemelli, and quadratus femoris, assisted by the gluteus maximus.



Fess

FESS

Q. 1

In FESS surgery structure preserved is?

 A

Ethmoid sinus

 B

Sphenoid sinus

 C

Maxillary sinus

 D

None

Q. 1

In FESS surgery structure preserved is?

 A

Ethmoid sinus

 B

Sphenoid sinus

 C

Maxillary sinus

 D

None

Ans. C

Explanation:

 

TYPES OF FUNCTIONAL ENDOSCOPIC SINUS SURGERY:

Type 1

Nasal endoscopy and uncinectomy with or without agger nasi cell exenteration.

Type 2

Nasal endoscopy, uncinectomy, bulla ethmoidectomy, removal of sinus lateralis mucous

membrane and exposure of frontal recess/ frontal sinus

Type 3

Type 2 plus maxillary sinus antrostomy through the natural sinus ostium

Type 4

Type 3 plus complete posterior ethmoidectomy

Type 5

Type 4 plus sphenoidectomy & stripping of mucous membrane


Q. 2

Which of the following surgery is not contraindicated below 12 years of age?

 A

Rhinoplasty

 B

FESS

 C

SMR

 D

Septoplasty

Q. 2

Which of the following surgery is not contraindicated below 12 years of age?

 A

Rhinoplasty

 B

FESS

 C

SMR

 D

Septoplasty

Ans. B

Explanation:

 

FESS is the only surgery which can be perform before 17 years.

In rarest circumstances, septal surgery is performed in children,  septoplasty is also done and never SMR.


Q. 3

Treatment for recurrent atrochoanal polyp: 

 A

Caldwell Luc operation 

 B

FESS

 C

Simple polypectomy

 D

Both a and b

Q. 3

Treatment for recurrent atrochoanal polyp: 

 A

Caldwell Luc operation 

 B

FESS

 C

Simple polypectomy

 D

Both a and b

Ans. B

Explanation:

Q. 4

The current treatment of choice for a large antrochoanal polyp in a 10 year old is: 

 A

Intranasal polypectomy

 B

Caldwell Luc operation

 C

FESS

 D

Lateral rhinotomy and excision

Q. 4

The current treatment of choice for a large antrochoanal polyp in a 10 year old is: 

 A

Intranasal polypectomy

 B

Caldwell Luc operation

 C

FESS

 D

Lateral rhinotomy and excision

Ans. C

Explanation:

Q. 5

The current treatment of choice for a large antrochoanal polyp in a 30-year-old man is:

 A

Intranasal polypectomy

 B

Caldwell-Luc operation

 C

FESS (Functional Endoscopic Sinus Surgery)

 D

Lateral rhinotomy and excision

Q. 5

The current treatment of choice for a large antrochoanal polyp in a 30-year-old man is:

 A

Intranasal polypectomy

 B

Caldwell-Luc operation

 C

FESS (Functional Endoscopic Sinus Surgery)

 D

Lateral rhinotomy and excision

Ans. C

Explanation:

 

  • Current treatment of choice of antrochoanal polyp is endoscopic sinus surgery which has superceded other modes of polyp removal in all age groups.
  • In this procedure all polyps are removed under endoscopic control especially from the key area of the osteomeatal complex. This procedure helps to preserve the normal function of the sinuses. FESS can be done under local anesthesia although general anesthesia is preferred
  • Caldwell-Luc operation is avoided these days.

Q. 6

Orbital cellulitis is a complication of:

 A

Parasinusitis

 B

Faciomaxillary trauma

 C

Endoscopic sinus surgery

 D

All of these

Q. 6

Orbital cellulitis is a complication of:

 A

Parasinusitis

 B

Faciomaxillary trauma

 C

Endoscopic sinus surgery

 D

All of these

Ans. D

Explanation:

Q. 7

The best surgical treatment for chronic maxillary sinusitis is:

 A

Repeated antral washout

 B

Fibreoptic endoscopic sinus surgery

 C

Caldwell-Luc’s operation

 D

Horgan’s operation

Q. 7

The best surgical treatment for chronic maxillary sinusitis is:

 A

Repeated antral washout

 B

Fibreoptic endoscopic sinus surgery

 C

Caldwell-Luc’s operation

 D

Horgan’s operation

Ans. B

Explanation:

Q. 8

FESS means:

 A

Factual endoscopic sinus surgey

 B

Functionl endonasal sinus surgery

 C

Factual endonasal sinus surgery

 D

Functionl endoscopic sinus surgery

Q. 8

FESS means:

 A

Factual endoscopic sinus surgey

 B

Functionl endonasal sinus surgery

 C

Factual endonasal sinus surgery

 D

Functionl endoscopic sinus surgery

Ans. D

Explanation:

Q. 9

Endoscopic nasal surgery is indicated in:

 A

Chronic sinusitis

 B

Epistaxis

 C

Both

 D

None

Q. 9

Endoscopic nasal surgery is indicated in:

 A

Chronic sinusitis

 B

Epistaxis

 C

Both

 D

None

Ans. C

Explanation:

Ans. is c i.e. Both


Q. 10

indications of FESS:

 A

Inverted papilloma

 B

Orbital abscess

 C

Nasal polyposis

 D

All

Q. 10

indications of FESS:

 A

Inverted papilloma

 B

Orbital abscess

 C

Nasal polyposis

 D

All

Ans. D

Explanation:

Ans. is all

[indications of Function) endoscopic Endoscopic Surgery (FESS)

Nasal conditions:

Indian = Inflammation of sinus (sinusitis – chronic and fungal)

Prime = Polyp removal

Minister = Mucocelea of frontal and ethmoid sinus

Can = Choanal atresia repair Speak = Septoplasty

Fluent = Foreign body removal English = Epistaxis

Other conditions: Nose is separated from orbit by lamina papyracea, anterior cranal fossa by cribriform plate and pituitary by sphenoid.

Hence FESS can be used in:

  • Orbital conditions

–       Orbital decompression

–       Optic nerve decompression

–       Blow out of orbit

–       Drainage of periorbital abscess

–       Dacryocystorhinostomy

  • CSF leak
  • Pituitary surgery like trans sphenoid hypophysectomy

Q. 11

A patient presents with antrochoanal polyp arising from the medial wall of the maxilla. Which of the following would be the best management for the patient?

 A

FESS with polypectomy

 B

Medial maxillectomy (TEMM)

 C

Caldwell-Luc procedure

 D

Intranasal polypectomy

Q. 11

A patient presents with antrochoanal polyp arising from the medial wall of the maxilla. Which of the following would be the best management for the patient?

 A

FESS with polypectomy

 B

Medial maxillectomy (TEMM)

 C

Caldwell-Luc procedure

 D

Intranasal polypectomy

Ans. A

Explanation:

A patient presents with antrochoanal polyp arising from the medial wall of the maxilla. FESS with polypectomy would be the best management for the patient.

FESS (Functional Endoscopic Sinus Surgery):

  • Current treatment of choice of antrochoanal polyp is endoscopic sinus surgery, which has superseded other modes of polyp removal.
  • In this procedure, all polyps are removed under endoscopic control especially from the the key area of the osteomeatal complex. This procedure helps to preserve the normal function of the sinuses. FESS can be done under local anesthesia although general anesthesia is preferred.




Rhinosporidiosis

Rhinosporidiosis

Q. 1 Which of the following is true about rhinosporidiosis?
 A The most common organism is Klebsiella rhinoscleromatis
 B Seen only in immunocompromised patients
 C Presents as a nasal polyp
 D Can be diagnosed by isolation of the organism
 
Q. 1 Which of the following is true about rhinosporidiosis?
 A The most common organism is Klebsiella rhinoscleromatis
 B Seen only in immunocompromised patients
 C Presents as a nasal polyp
 D Can be diagnosed by isolation of the organism
 
Ans. C

Explanation:

Rhinosporidiosis – It is fungal granuloma caused by Rhinosporidium seeberi.

  • The disease mostly affects nose and nasopharynx
  • The disease is acquired through contaminated water of ponds and cow-pets
  • Presents as a leafy, polypoidal mass, pink to purple in colour and attached to nasal septum or lateral wall, sometimes it extends into the nasopharynx and may hang behind the soft palate

The mass is very vascular and bleeds easily on touch its surface is studded with white dots representing the sporangia of fungus Early stages complains of nasal discharge which is often blood-tinged or nasal stuffiness Sometimes frank epistaxis is the only presenting complaint

Diagnosis is made by biopsy, not possible to culture

Treatment – complete excision of the mass with diathermy knife and cauterization of its base, Dapsone has been tried with some success.


Q. 2

True statement about Rhinosporidiosis is:

 A

Most common organism is klebsiella rhinoscleromatis

 B

Seen only in immunocompromised patients

 C

Presents as a nasal polyp

 D

Can be diagnosed by isolation of organism

Q. 2

True statement about Rhinosporidiosis is:

 A

Most common organism is klebsiella rhinoscleromatis

 B

Seen only in immunocompromised patients

 C

Presents as a nasal polyp

 D

Can be diagnosed by isolation of organism

Ans. C

Explanation:

Q. 3

In rhinosporidiosis, the following is true:

 A

Caused by R.seeberi

 B

Grayish mass

 C

Surgery is the treatment 

 D

a and c

Q. 3

In rhinosporidiosis, the following is true:

 A

Caused by R.seeberi

 B

Grayish mass

 C

Surgery is the treatment 

 D

a and c

Ans. D

Explanation:

  • Rhinosporidiosis is a chronic granulomatous infection of the mucous membranes that usually manifests as vascular friable polyps that arise from the nasal mucosa.
  • The etiologic agent of rhinosporidiosis, R seeberi.
  • Rhinosporidium seeberi is an aquatic bacterium (not a fungus).
  • Rhinosporidiosis is treated with surgical excision.

Q. 4

Ideal treatment of Rhinosporidiosis is:

 A

Rifampicin

 B

Excision with cautery at base

 C

Dapsone

 D

Laser

Q. 4

Ideal treatment of Rhinosporidiosis is:

 A

Rifampicin

 B

Excision with cautery at base

 C

Dapsone

 D

Laser

Ans. B

Explanation:

Q. 5

Nasal polypoidal mass with subcutaneous nodules on skin are seen in:

 A

Zygomycosis

 B

Rhinosporidiosis

 C

Sporotrichosis

 D

Aspergillosis

Q. 5

Nasal polypoidal mass with subcutaneous nodules on skin are seen in:

 A

Zygomycosis

 B

Rhinosporidiosis

 C

Sporotrichosis

 D

Aspergillosis

Ans. B

Explanation:

 

In Rhinosporiodiosis, leafy, polypoidal mass of pink-purple color is seen attached to nasal septum or lateral wall. Subcutaneous nodules may be seen on skin.


Q. 6

Causative agent of rhinosporidiosis is ‑

 A

Bacteria

 B

Fungus

 C

Protozoa

 D

Virus

Q. 6

Causative agent of rhinosporidiosis is ‑

 A

Bacteria

 B

Fungus

 C

Protozoa

 D

Virus

Ans. A

Explanation:

Ans: is. ‘a’ i.e., Bacteria

“Molecular studies have shown that the organism is not a fungus, but a primitive aquatic bacterium”.

“By using molecular tools, recently it has been found that R. seeberi is not a fungus but an unusual protist that shares phylogenetic features with microbes that cause infection in fish” 

“The etiological agent, Rhinosporidium seeberi, has never been successfully propagated in vitro. Initially thought to be a parasite for more than 50 years, R seeberi had been considered a water mould. Molecular biological techniques have recently demonstrated that this organism is an aquatic protistan parasite. It is currently included in a new class, the mesomycetozoea, along with organisms that cause similar infections in amphibians and fish”.



Rhinosleroma

Rhinosleroma

Q. 1

Mikulicz cells and Russell bodies are seen in _________

 A

Rhinoscleroma

 B

Rhinosporidiosis

 C

Scleroderma

 D

Lupus vulgaris

Q. 1

Mikulicz cells and Russell bodies are seen in _________

 A

Rhinoscleroma

 B

Rhinosporidiosis

 C

Scleroderma

 D

Lupus vulgaris

Ans. A

Explanation:

Q. 2

A roomy nasal cavity with thick crust formation and woody hard external nose is seen in?

 A

Rhinoscleroma

 B

Rhinosporidiosis

 C

Atrophic rhinitis

 D

Vasomotor rhinitis

Q. 2

A roomy nasal cavity with thick crust formation and woody hard external nose is seen in?

 A

Rhinoscleroma

 B

Rhinosporidiosis

 C

Atrophic rhinitis

 D

Vasomotor rhinitis

Ans. A

Explanation:

Q. 3

Large nasal cavity with thick crust formation internally and ‘woody’ feel of external nose is TRUE about?

 A

Rhinoscleroma

 B

Rhinosporidiosis

 C

Atrophic rhinitis

 D

Vasomotor rhinitis

Q. 3

Large nasal cavity with thick crust formation internally and ‘woody’ feel of external nose is TRUE about?

 A

Rhinoscleroma

 B

Rhinosporidiosis

 C

Atrophic rhinitis

 D

Vasomotor rhinitis

Ans. A

Explanation:

  • Rhinoscleroma is caused by the gram-negative coccobacillus K rhinoscleromatis.

The disease begins in areas of epithelial transition such as the vestibule of the nose, the subglottic area of the larynx. It resembles atrophic rhinitis in atrophic stage. Subdermal infiltration of lower part of external nose and upper lip gives a ‘woody’ feel. 

  • Atrophic rhinitis is characterised by progressive atrophy of the nasal mucosa along with the underlying bones of turbinates.  There is also presence of foul smelling crusts. But woody external nose is not seen.

Q. 4

Histology of a specimen shows Mikulicz cells and Russell bodies. These are characteristic of:

 A

Rhinoscleroma

 B

Rhinosporidiosis

 C

Scleroderma

 D

Lupus vulgaris

Q. 4

Histology of a specimen shows Mikulicz cells and Russell bodies. These are characteristic of:

 A

Rhinoscleroma

 B

Rhinosporidiosis

 C

Scleroderma

 D

Lupus vulgaris

Ans. A

Explanation:

The classic biopsy findings compatible with rhinoscleroma include Mikulicz cells, macrophages containing large amounts of bacteria-filled vacuoles, and Russell bodies, spherical structures found in the cytoplasm of plasma cells. 

Mikulicz cells are large mononuclear histiocytes with vacuolated cytoplasm containing causative bacilli and Russell bodies are homogenous eosinophilic inclusion bodies found in the plasma cells.


Q. 5

ENT examination of an old man shows roomy nasal cavities, crust formation and woody hard external nose; which are seen in:

 A

Rhinoscleroma

 B

Rhinosporidiosis

 C

Atrophic rhinitis

 D

None of the above

Q. 5

ENT examination of an old man shows roomy nasal cavities, crust formation and woody hard external nose; which are seen in:

 A

Rhinoscleroma

 B

Rhinosporidiosis

 C

Atrophic rhinitis

 D

None of the above

Ans. A

Explanation:

Rhinoscleroma:
It is a rare, chronic progressive granulomatous disease of the upper respiratory tract caused by Klebsiella rhinoscleromatis.


Q. 6

True about rhinoscleroma are all, EXCEPT:

 A

Caused by Klebsiella pneumonia

 B

Slowly progressing granulomatous disease

 C

Most common in young adults 20–30 years old

 D

Poor nutrition contributes to its spread

Q. 6

True about rhinoscleroma are all, EXCEPT:

 A

Caused by Klebsiella pneumonia

 B

Slowly progressing granulomatous disease

 C

Most common in young adults 20–30 years old

 D

Poor nutrition contributes to its spread

Ans. A

Explanation:

Rhinoscleroma is a rare, slowly progressing granulomatous disease of the upper respiratory tract caused by Klebsiella rhinoscleromatis.

Nasal disease presents with three typical stages: (1) catarrhal (2) proliferative (3) cicatrical. 

Rhinoscleroma may be found in all age groups, but typically young adults 20–30 years old are most frequently affected.

Airborne transmission combined with poor hygiene, crowded living conditions, and poor nutrition contributes to its spread.

Q. 7

Drug of choice in rhinoscleromatosis is:

 A

Tetracycline

 B

Fluoroquinolone

 C

Aminoglycosides

 D

None of the above

Q. 7

Drug of choice in rhinoscleromatosis is:

 A

Tetracycline

 B

Fluoroquinolone

 C

Aminoglycosides

 D

None of the above

Ans. A

Explanation:

In rhinoscleromatosis, organism may be difficult to eradicate, despite aggressive therapy.

A combination of conservative surgical debridement and long-term antibiotic coverage is the mainstay of therapy for rhinoscleroma.

Tetracycline has been shown to be effective and inexpensive for patients unless contraindicated.

Fluoroquinolones may be used as an alternative, given their excellent gram-negative activity and convenient dosing regimen


Q. 8

Rhinoscleroma is caused by:

 A

Klebsiella

 B

Autoimmune

 C

Spirochetes

 D

Rhinosporidium

Q. 8

Rhinoscleroma is caused by:

 A

Klebsiella

 B

Autoimmune

 C

Spirochetes

 D

Rhinosporidium

Ans. A

Explanation:

Q. 9

Mikulicz cell and Russell bodies are characterisitic of: 

 A

Rhinoscleroma

 B

Rhinosporidiosis

 C

Plasma cell disorder

 D

Lethal midline granuloma

Q. 9

Mikulicz cell and Russell bodies are characterisitic of: 

 A

Rhinoscleroma

 B

Rhinosporidiosis

 C

Plasma cell disorder

 D

Lethal midline granuloma

Ans. A

Explanation:

Q. 10

Atrophic dry nasal mucosa, extensive encrustations with woody’ hard external nose is suggestive of

 A

Rhinosporidiosis

 B

Rhinoscleroma

 C

Atrophic rhinitis

 D

Carcinoma of nose

Q. 10

Atrophic dry nasal mucosa, extensive encrustations with woody’ hard external nose is suggestive of

 A

Rhinosporidiosis

 B

Rhinoscleroma

 C

Atrophic rhinitis

 D

Carcinoma of nose

Ans. B

Explanation:

Q. 11

Frish bacillus causes:

 A

Rhinoscleroma

 B

Rhinosporidiosis

 C

Rhinophyma

 D

Lupus vulgaris

Q. 11

Frish bacillus causes:

 A

Rhinoscleroma

 B

Rhinosporidiosis

 C

Rhinophyma

 D

Lupus vulgaris

Ans. A

Explanation:

 

Rhinoscleroma is a chronic granulomatous disease caused by Gram negative bacillus called Klebsiella rhinoscleromates or Frisch bacillus


Q. 12

Rhinoscleroma occurs due to ‑

 A

Autoimmune cause

 B

Inflammatory cause

 C

Klebsiella rhinoscleromatis infection

 D

Mycotic infection

Q. 12

Rhinoscleroma occurs due to ‑

 A

Autoimmune cause

 B

Inflammatory cause

 C

Klebsiella rhinoscleromatis infection

 D

Mycotic infection

Ans. C

Explanation:

Ans. is ‘c’ i.e., Klebsiellarhinoscleromatis infection

Rhinoscleroma

  • The causative organism is Klebsiellarhinosclerontatisor Frisch bacillus, which can be cultured from the biopsy material.
  • The disease is endemic in several parts of world.
  • In India, it is seen more often in northern than in the southern parts.
  • Biopsy shows infiltration of submucosa with plasma cells, lymphocytes, eosinophils, Mikulicz cells & Russell bodies.
  • The latter two are diagnostic features of the disease.
  • The disease starts in the nose & extends to nasopharynx, oropharynx, larynx, trachea & bronchi.
  • Mode of infection is unknown.
  • Both sexes of any age may be affected.


Femoral triangle

FEMORAL TRIANGLE

Q. 1

All are true about femoral triangle, EXCEPT?

 A

Lateral margin is formed by sartorius

 B

Floor is formed by adductor longus

 C

Contains the femoral vessels

 D

None of the above

Q. 1

All are true about femoral triangle, EXCEPT?

 A

Lateral margin is formed by sartorius

 B

Floor is formed by adductor longus

 C

Contains the femoral vessels

 D

None of the above

Ans. B

Explanation:

The femoral triangle is a depressed area of the thigh lying distal to the inguinal fold. Its apex is distal, its limits are the medial margin of sartorius laterally, the medial margin of adductor longus medially and the inguinal ligament proximally (the base). Its floor is provided laterally by iliacus and psoas major, medially by pectineus and adductor longus. The femoral vessels, passing from midbase to apex, are in the deepest part of the triangle. Lateral to the artery the femoral nerve divides. The triangle also contains fat and lymph nodes. 

 


Q. 2

What is medial most in femoral triangle?

 A

Vein

 B

Artery

 C

Nerve

 D

Lymphatics

Q. 2

What is medial most in femoral triangle?

 A

Vein

 B

Artery

 C

Nerve

 D

Lymphatics

Ans. D

Explanation:

The femoral triangle is an area in the inguinal region that is shaped like an upside-down triangle. The femoral triangle contains the femoral nerve, artery, and vein, and the lymphatics. The femoral triangle is an area in the inguinal region that is shaped like an upside-down triangle and is bordered by the sartorius muscle, adductor longus muscle and inguinal ligament.

Remember:
The femoral triangle contains the following structures from lateral to medial:

1. Femoral nerve: Originates as a branch of the lumbar plexus. The femoral nerve is not contained within the femoral sheath.

2. Femoral artery: Continuation of the external iliac artery. The femoral artery is located midway between the anterior superior iliac spine and the pubic symphysis.

3. Femoral vein: Continues as the external iliac vein.

4. Lymphatics.



Laryngocele

Laryngocele

Q. 1

Laryngocele arises from

 A

True cords

 B

Subglottis

 C

Saccule of the ventricle

 D

Anterior commissure

Q. 1

Laryngocele arises from

 A

True cords

 B

Subglottis

 C

Saccule of the ventricle

 D

Anterior commissure

Ans. C

Explanation:

 

 

The saccule is a diverticulum of MUCOUS membrane which starts from the anterior part of ventricular cavity and extends upwards between vestibular, .folds and lamina of thyroid cartilage. When its abnormally enlarged it forms the air containing sac – the laryngocele.

Laryngoceles can be classified into three types:

  • Internal – A laryngocele is defined as internal if the dilatation lies within the limits of the thyroid cartilage.
  • External – If the laryngocele extends beyond the thyroid cartilage and protrudes through the thyrohyoid membrane producing a lateral neck mass, it is considered external.
  • Combined – In which both internal and external components are seen.

Causes

Due to raised transglottic air pressure as in trumpet players, glass blowers or weight lifters.

Clinical symptoms.

External laryngocele presents as a reducible swelling in the neck which increases in size on coughing or performing valsalva

Patient may present with hoarseness, cough, dyspnea, dysphagia or a foreign body sensation.

Treatment

If symptomatic the management would consist of

.) For small lesion

Lamyngoscopic decompression.

2.) For larger lesions

Surgical excision through external approach.

Laser endoscopic excision.


Q. 2

External laryngocele is a herniation that arises from which of the following membrane?

 A

Thyrohyoid membrane

 B

Cricoepiglottic membrane

 C

Thyroid membrane

 D

Cricovocal membrane

Q. 2

External laryngocele is a herniation that arises from which of the following membrane?

 A

Thyrohyoid membrane

 B

Cricoepiglottic membrane

 C

Thyroid membrane

 D

Cricovocal membrane

Ans. A

Explanation:

A laryngocele is an air filled herniation of the saccule of the laryngeal ventricle.

It is caused by a prolonged increase in intraglottic pressure in patients with a predisposing long sacculus. Laryngoceles are of two types internal and external.

Internal laryngocele: are confined within the larynx and appear as cystic swellings of the aryepiglottic fold.

External laryngocele: extend through the thyrohyoid membrane and lie lateral to the thyroid cartilage.


Q. 3

An old man presented with hoarseness, cough, dysphagia, and foreign body sensation in the throat. Laryngocele was suspected. Laryngocele arises from herniation through:

 A

Cricothyroid membrane

 B

Thyrohyoid membrane

 C

Laryngeal fold

 D

None of the above

Q. 3

An old man presented with hoarseness, cough, dysphagia, and foreign body sensation in the throat. Laryngocele was suspected. Laryngocele arises from herniation through:

 A

Cricothyroid membrane

 B

Thyrohyoid membrane

 C

Laryngeal fold

 D

None of the above

Ans. B

Explanation:

A laryngocele is defined as an abnormal dilation or herniation of the saccule of the larynx.

Laryngoceles can be classified into three types: internal, external, and combined. 
A laryngocele is defined as internal if the dilation lies within the limits of the thyroid cartilage. 

If the laryngocele extends beyond the thyroid cartilage and protrudes through the thyrohyoid membrane producing a lateral neck mass, it is considered external.



Thyroplasty

Thyroplasty

Q. 1

Which of the following is the indication for Type I thyroplasty?

 A

Vocal cord medialization

 B

Vocal cord lateralization

 C

Vocal cord shortening

 D

Vocal cord lengthening

Q. 1

Which of the following is the indication for Type I thyroplasty?

 A

Vocal cord medialization

 B

Vocal cord lateralization

 C

Vocal cord shortening

 D

Vocal cord lengthening

Ans. A

Explanation:

Type I thyroplasty is a form of medialization laryngoplasty, in which an implant is placed between the thyroid cartilage and the vocalis muscle to medialize the membranous vocal fold.

 

Q. 2

Type I thyroplasty is for:

 A

Vocal cord medialization

 B

Vocal cord lateralization

 C

Vocal cord shortening

 D

Vocal cord lengthening

Q. 2

Type I thyroplasty is for:

 A

Vocal cord medialization

 B

Vocal cord lateralization

 C

Vocal cord shortening

 D

Vocal cord lengthening

Ans. A

Explanation:

Q. 3

In thyroplasty type 2, vocal cord is:

 A

Lateralized

 B

Medialized

 C

Shorterned

 D

Lengthened

Q. 3

In thyroplasty type 2, vocal cord is:

 A

Lateralized

 B

Medialized

 C

Shorterned

 D

Lengthened

Ans. A

Explanation:

 

Isshiki divided thyroplasty procedures into 4 categories to produce functional alteration of vocal cords:

  • Type 1 : Medial displacement of vocal cord (done by injection of gel foam/Teflon paste)
  • Type 2 : Lateral displacement of cord (done to improve the airway)
  • Type 3 : Shortening (relax) the cord, to lower the pitch (gender transformation from female to male)
  • Type 4 : Lengthening (tightening) the cord, to elevate the pitch (gender transformation from male to female)



Q. 4

Treatment of Puberphonia is ‑

 A

Thyroplasty type I

 B

Thyroplasty type II

 C

Thyroplasty type III

 D

Thyroplasty type IV

Q. 4

Treatment of Puberphonia is ‑

 A

Thyroplasty type I

 B

Thyroplasty type II

 C

Thyroplasty type III

 D

Thyroplasty type IV

Ans. C

Explanation:

Ans. is `c’ i.e., Thyroplasty type III

Puberphonia (Mutational falset to voice)

  • In males at the time of puberty, the voice normally drops by an octave and becomes low pitch. It occurs because vocal cords lengthen.
  • Failure of this change leads to persistence of childhood high pitched voice and is called as puberphonia.
  • It is seen in boys who are emotionally insecure and show excessive attachment to their mothers. Their physical and sexual development is normal.
  • So the surgical treatment of puberphonia is lengthening of vocal cord i. e. Thyroplasty type III

THYROPLASTY

  • Isshiki divided thyroplasty procedures into 4 categories to produce functional alteration of vocal cords : –
  1. Type 1: Medial displacement of vocal cord (done by injection of gel foam/Teflon paste)
  2. Type 2 : Lateral displacement of cord (done to improve the airway).
  3. Type 3 : Lengthening (relax) the cord, to lower the pitch (gender transformation from female to male).
  4. Type 4 : Shortening (tightening) the cord, to elevate the pitch (gender transformation from male to female), for example as a treatment of androphonia.


Antrochoanal Polyp

Antrochoanal Polyp

Q. 1

All are true about Antrochoanal polyp EXCEPT:

 A

Unilateral and single

 B

Grows backwards to the choana

 C

Avulsion is the treatment of choice

 D

Common in children

Q. 1

All are true about Antrochoanal polyp EXCEPT:

 A

Unilateral and single

 B

Grows backwards to the choana

 C

Avulsion is the treatment of choice

 D

Common in children

Ans. C

Explanation:

Avulsion is the treatment of choice 

TREATMENT OF ANTROCHOANAL POLYP:

An antrochoanal polyp is easily removed by avulsion (Avulsion Polypectomy) either through the nasal or oral route. Recurrence is uncommon after complete removal. In cases which do recur, Caldwell-Luc operation may be required to remove the polyp completely from the site of its origin and to deal with co-existent maxillary sinusitis. These days, endoscopic sinus surgery (treatment of choice) has superceded other modes of polyp removal. Caldwell-Luc operation is avoided.

DIFFERENCES BETWEEN ANTROCHOANAL AND ETHMOIDAL POLYP:

 

Antrochoanal polyp

Ethmoidal polyp

Age

Common in children

Common in adults

Aetiology

Infection

Allergy or multifactorial

Number

Solitary

Multiple

T.aterality

Unilateral

Bilateral

Origin

Max. sinus near the ostium

Ethmoidal sinuses, uncinate process, middle

turbinate and middle meatus

Growth

Grows backwards to the choana; may hang

down behind the soft palate

Mostly grow anteriorly and may present

at the nares

Size & shape

Trilobed with antral, nasal and choanal parts.

Choanal part may protrude through the choana

& fill the nasopharynx obstructing both sides

Usually small and grape-like masses

Recurrence

Uncommon, if removed completely

Common

Treatment

Polypectomy; endoscopic removal or Caldwell-

Luc operation if recurrent

Polypectomy: Endoscopic surgery or

ethmoidectomy (which may be intranasal,

extranasal or transantral)


Q. 2

The most appropriate management for Antrochoanal polyp in children is:

 A

Caldwell Luc operation

 B

Intranasal polypectomy

 C

Corticosteroids

 D

Wait and watch

Q. 2

The most appropriate management for Antrochoanal polyp in children is:

 A

Caldwell Luc operation

 B

Intranasal polypectomy

 C

Corticosteroids

 D

Wait and watch

Ans. B

Explanation:

Q. 3

Which of the following statement regarding Antrochoanal polyp is false?

 A

It often bleeds to touch

 B

Treatment is avulsion

 C

Arise from maxillary antrum

 D

It is commonly found in children

Q. 3

Which of the following statement regarding Antrochoanal polyp is false?

 A

It often bleeds to touch

 B

Treatment is avulsion

 C

Arise from maxillary antrum

 D

It is commonly found in children

Ans. A

Explanation:

Antrochoanal polyp is a benign polypoidal lesion arising from the maxillary antrum.

It is just an oedematous mucosa and does not bleed to touch.

It is commonly found in children and young adults.

FESS is the treatment of choice.


Q. 4

All are true about Antrochoanal polyp, EXCEPT:

 A

Unilateral and single

 B

Grows backwards to the choana

 C

Avulsion is the treatment of choice

 D

Common in children

Q. 4

All are true about Antrochoanal polyp, EXCEPT:

 A

Unilateral and single

 B

Grows backwards to the choana

 C

Avulsion is the treatment of choice

 D

Common in children

Ans. C

Explanation:

Antrochoanal polyp are benign lesions that are most commonly seen in children.

This isolated polyp has its origin from the mucosa of the maxillary sinus and extend into choana and nasopharynx.

The major problem is unilateral nasal obstruction. Treatment of choice is primary endoscopic removal with resection of the basis in the maxillary sinus.

Complete removal of the polyp’s base is mandatory to prevent a recurrence.


Q. 5

Which of the following is the MOST appropriate management for antrochoanal polyp in children?

 A

Caldwell Luc operation

 B

Intranasal polypectomy

 C

Corticosteroids

 D

Wait and watch

Q. 5

Which of the following is the MOST appropriate management for antrochoanal polyp in children?

 A

Caldwell Luc operation

 B

Intranasal polypectomy

 C

Corticosteroids

 D

Wait and watch

Ans. B

Explanation:

Endoscopic intranasal polyp resection is effective and and is the most popular procedure for the removal of antro choanal polyp even in paediatric patients. 
 
This procedure involves removal of antral portion of the polyp through the enlarged antrostomy with endoscopic visualization, and the nasopharyngeal portion of the polyp is removed transorally if large or transanally if size permits.
 
Caldwell Luc maxillary antrotomy with intranasal antrostomy approach may be useful for complete removal of antral portion of the polyp for minimizing recurrence.
 
 

 


Q. 6

Which of the following is the MOST appropriate management for antrochoanal polyp in children?

 A

Caldwell Luc operation

 B

Intranasal polypectomy

 C

Corticosteroids

 D

Wait and watch

Q. 6

Which of the following is the MOST appropriate management for antrochoanal polyp in children?

 A

Caldwell Luc operation

 B

Intranasal polypectomy

 C

Corticosteroids

 D

Wait and watch

Ans. B

Explanation:

Intranasal polypectomy is the treatment of choice for antrochoanal polyp in children.

In adults with recurrent antrochoanal polyps the operation of choice is Caldwell Luc operation accompanied by inferior meatus antrostomy.

But this surgery is contraindicated when children develop recurrent polyps as this procedure may hamper the growth of maxilla and present later on as facial deformity.  

Unilateral nasal polyps might represent a neoplastic lesion called antrochoanal polyp. 
 
 
 

Q. 7

Killian term is used for which of the following polyp

 A

Ethmoidal

 B

Antrochoanal

 C

Tonsillar cyst

 D

Tonsillolith

Q. 7

Killian term is used for which of the following polyp

 A

Ethmoidal

 B

Antrochoanal

 C

Tonsillar cyst

 D

Tonsillolith

Ans. B

Explanation:

Q. 8

All the following are true of antrochoanal polyp except: 

 A

Common in children

 B

Single and Unilateral

 C

Bleeds on touch

 D

Treatment involves Avulsion

Q. 8

All the following are true of antrochoanal polyp except: 

 A

Common in children

 B

Single and Unilateral

 C

Bleeds on touch

 D

Treatment involves Avulsion

Ans. C

Explanation:

Q. 9

All of the following are true about antrochonal polyp, except:

 A

Single

 B

Unilateral

 C

Premalignant

 D

Arises from maxillary antrum

Q. 9

All of the following are true about antrochonal polyp, except:

 A

Single

 B

Unilateral

 C

Premalignant

 D

Arises from maxillary antrum

Ans. C

Explanation:

Q. 10

Antrochoanal polyp is characterized by:

 A

Usually bilateral

 B

It is of allergic origin

 C

It arises from maxillary antrum

 D

All

Q. 10

Antrochoanal polyp is characterized by:

 A

Usually bilateral

 B

It is of allergic origin

 C

It arises from maxillary antrum

 D

All

Ans. C

Explanation:

 

Nasal polyps are non-neoplastic masses of edematous nasal or sinus mucosa. They do not bleed on touch and are insensitive to probing and never present with epistaxis or bleeding from nose.

Recurrence is uncommon in case of antrochoanal polyp.

Antrochoanal polyps arise from maxillary artrum and then grow into choana and nasal cavity.

 



Q. 11

The most appropriate management for antrochoanal polyp in children is:

 A

Caldwell-Luc operation

 B

Intranasal polypectomy

 C

Corticosteroids

 D

Wait and watch

Q. 11

The most appropriate management for antrochoanal polyp in children is:

 A

Caldwell-Luc operation

 B

Intranasal polypectomy

 C

Corticosteroids

 D

Wait and watch

Ans. B

Explanation:

Q. 12

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

 A

Caldwell-Luc operation

 B

Intranasal polypectomy

 C

Conservative treatment till 16 years

 D

Exploratory rhinotomy

Q. 12

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

 A

Caldwell-Luc operation

 B

Intranasal polypectomy

 C

Conservative treatment till 16 years

 D

Exploratory rhinotomy

Ans. B

Explanation:

 

Management Options for Antrochoanal Polyp 

  • The treatment of antrochoanal polyp is its complete removal along with the removal of the lining of the sinus (to avoid recurrence).
  • Sometimes it is possible to grasp the stalk and avulse the polyp, but most of the time it fails to remove the polyp and its lining completely
  • Therefore, it is not the treatment of choices



Q. 13

Treatment for recurrent atrochoanal polyp: 

 A

Caldwell Luc operation 

 B

FESS

 C

Simple polypectomy

 D

Both a and b

Q. 13

Treatment for recurrent atrochoanal polyp: 

 A

Caldwell Luc operation 

 B

FESS

 C

Simple polypectomy

 D

Both a and b

Ans. B

Explanation:

Q. 14

The current treatment of choice for a large antrochoanal polyp in a 10 year old is: 

 A

Intranasal polypectomy

 B

Caldwell Luc operation

 C

FESS

 D

Lateral rhinotomy and excision

Q. 14

The current treatment of choice for a large antrochoanal polyp in a 10 year old is: 

 A

Intranasal polypectomy

 B

Caldwell Luc operation

 C

FESS

 D

Lateral rhinotomy and excision

Ans. C

Explanation:

Q. 15

The current treatment of choice for a large antrochoanal polyp in a 30-year-old man is:

 A

Intranasal polypectomy

 B

Caldwell-Luc operation

 C

FESS (Functional Endoscopic Sinus Surgery)

 D

Lateral rhinotomy and excision

Q. 15

The current treatment of choice for a large antrochoanal polyp in a 30-year-old man is:

 A

Intranasal polypectomy

 B

Caldwell-Luc operation

 C

FESS (Functional Endoscopic Sinus Surgery)

 D

Lateral rhinotomy and excision

Ans. C

Explanation:

 

  • Current treatment of choice of antrochoanal polyp is endoscopic sinus surgery which has superceded other modes of polyp removal in all age groups.
  • In this procedure all polyps are removed under endoscopic control especially from the key area of the osteomeatal complex. This procedure helps to preserve the normal function of the sinuses. FESS can be done under local anesthesia although general anesthesia is preferred
  • Caldwell-Luc operation is avoided these days.

Q. 16

“Bernoulli’s theorem” explains:

 A

Nasal polyp

 B

Thyroglossal cyst

 C

Zenker’s diverticulum

 D

Laryngomalacia

Q. 16

“Bernoulli’s theorem” explains:

 A

Nasal polyp

 B

Thyroglossal cyst

 C

Zenker’s diverticulum

 D

Laryngomalacia

Ans. A

Explanation:

 

Bernoulli’s theorem states that if the speed of a fluid element increases as it travels along a horizontal streamline, the fresher of the fluid must decrease and conversely.                               —Fundamental of Physics, Halliday Resnic 6th/ed

Nasal polyps follow Bernoulli’s theorem as The increased speed of the air flowing through the nose decreases the pressure in the nasal cavity (Bernoulli’s theorem) which pulls down the polyp.



Q. 17

Topical steroids are not recommended post-surgery for:

 A

Allergic fungal sinusitis

 B

Chronic rhinosinusitis

 C

Antrochoanal polyp

 D

Ethmoidal polyps

Q. 17

Topical steroids are not recommended post-surgery for:

 A

Allergic fungal sinusitis

 B

Chronic rhinosinusitis

 C

Antrochoanal polyp

 D

Ethmoidal polyps

Ans. C

Explanation:

 

Topical steroids are not recommended in post surgery for antrochoanal polyps.

For antrochoanal polyps, cause is infection and not the allergy.

Antrochoanal polyps are single, unilateral and rarely recur.

Topical steroids are rarely recommended.


Q. 18

A patient presents with antrochoanal polyp arising from the medial wall of the maxilla. Which of the following would be the best management for the patient?

 A

FESS with polypectomy

 B

Medial maxillectomy (TEMM)

 C

Caldwell-Luc procedure

 D

Intranasal polypectomy

Q. 18

A patient presents with antrochoanal polyp arising from the medial wall of the maxilla. Which of the following would be the best management for the patient?

 A

FESS with polypectomy

 B

Medial maxillectomy (TEMM)

 C

Caldwell-Luc procedure

 D

Intranasal polypectomy

Ans. A

Explanation:

A patient presents with antrochoanal polyp arising from the medial wall of the maxilla. FESS with polypectomy would be the best management for the patient.

FESS (Functional Endoscopic Sinus Surgery):

  • Current treatment of choice of antrochoanal polyp is endoscopic sinus surgery, which has superseded other modes of polyp removal.
  • In this procedure, all polyps are removed under endoscopic control especially from the the key area of the osteomeatal complex. This procedure helps to preserve the normal function of the sinuses. FESS can be done under local anesthesia although general anesthesia is preferred.



Q. 19

Topical steroids are not recommended in:

 A

Post surgery for antrochoanal polyps

 B

Post surgery for ethmoidal polyps

 C

Post surgery for chronic rhinosinusitis

 D

Post surgery for allergic fungal sinusitis

Q. 19

Topical steroids are not recommended in:

 A

Post surgery for antrochoanal polyps

 B

Post surgery for ethmoidal polyps

 C

Post surgery for chronic rhinosinusitis

 D

Post surgery for allergic fungal sinusitis

Ans. A

Explanation:

 

Topical steroids are not recommended in post surgery for antrochoonol polyps.

For antrochoanal polyps, cause is infection and not the allergy. Antrochoanal polyps are single, unilateral and rarely recur. Topical steroids are rarely recommended.


Q. 20

Antrochoanal polyp is associated most commonly with ‑

 A

Superior meatus

 B

Inferior meatus

 C

Middle meatus

 D

Sphenoethmoidal recess

Q. 20

Antrochoanal polyp is associated most commonly with ‑

 A

Superior meatus

 B

Inferior meatus

 C

Middle meatus

 D

Sphenoethmoidal recess

Ans. C

Explanation:

 

ANTROCHOANAL POLYP

Antrochoanal polyp is non-cancerous growth arising from the mucous membrane of the maxillary sinus and reaches the opening of the sinus in the nasal cavity through the opening of maxillary sinus in the middle  meatus.

It is single and unilateral, i.e. it occurs in one of the maxillary sinus. It arises from maxillary sinus and grows backward in the nose towards the choana and may reach the nasopharynx.

Generally occurs in young age group (children and young adults) and is more common in male. Exact etiology is not known, However sinus infection has been incriminated (in contrast to ethmoidal polyp, which is considered as allergic).

Clinical features of antrochoanal polyp

  • Unilateral Nasal blockage (more on expiration than on inspiration)
  • Obstruction may become bilateral when polyp grows into nasopharynx and starts obstructing opposite choana.
  • Hyponasal voice
  • Mucoid nasal discharge
  • Conductive deafness due to eustachian tube dysfunction
  • On examination, polyp may not be visible on anterior rhinoscopy as it grows posteriorly
  • On posterior rhinoscopy – smooth, greyish white, spherical mass is seen in choana.

Treatment of antrochoanal polyp

  • There is no medical treatment for antrochoanal polyp. The treatment of choice is complete surgical removal of polyp along with removal of lining of maxillary sinus to prevent the recurrence. Surgeries for antrochoanal polyp include :‑

1) Avulsion of a polyp

  • The stalk of the polyp is grasped and gently moved around to tease out the antral lining.
  • Most of the time, avulsion fails to remove the polyp and antral lining completely.

2) Intranasal polypectomy

  • It was the treatment of choice for all age groups prior to the advent of endoscopic sinus surgery and is still the treatment of choice in those setups where endoscopic surgery is not practised.

3) Caldwell Luc operation

  • It is indicated if there is a recurrence and the age of the patient is more than 17 years.
  • Now a days with FESS available – Caldwell luc operation is avoided.

Q. 21

Xray showing air column between soft tissue mass and posterior wall of nasopharynx is suggestive of ‑

 A

Ethmoidal polyp

 B

Antrochoanal polyp

 C

Nasal myiasis

 D

None of the above

Q. 21

Xray showing air column between soft tissue mass and posterior wall of nasopharynx is suggestive of ‑

 A

Ethmoidal polyp

 B

Antrochoanal polyp

 C

Nasal myiasis

 D

None of the above

Ans. B

Explanation:

Ans. is b’ i.e., Antrochoanal polyp

On xray,antrochoanal polyp appears as a soft tissue density and shows a column of air between the soft tissue mass and posterior wall of nasopharynx.



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