Nasal Obstruction

Question 1

What are the 3 parts of the nasal septum

Answer 1

Septal cartilage
Perpendicular plate of ethmoid
Vomer

Question 2

Most common site of epistaxis in children

Answer 2

Little’s Area or Kiesselbach’s plexus

Question 3

The ophthalmic artery branches to what artery supplying the Little’s Area?

Answer 3

Anterior ethmoid artery

Question 4

The maxillary artery branches to what arteries supplying the Little’s Area?

Answer 4

Sphenopalatine artery
Greater Palatine Artery

Question 5

The little’s area is supplied by the septal branch of what artery?

Answer 5

Superior Labial Artery

Question 6

This nasal turbinate can cause obstruction

Answer 6

Inferior turbinate

Question 7

This nasal turbinate is where most of the drainage tracts from the surrounding paranasal sinuses drains into

Answer 7

Middle turbinate

Question 8

This nasal turbinate is where the ethmoid roof and cribiform plate are located

Answer 8

Superior turbinate

Question 8

Turbulent flow (speeds up/slows down) the flow velocity, (lessens/prolongs) contact of air with the mucosa

Answer 8

slows down
prolongs

Question 9

T/F: Turbinate hypertrophy periodically alternates between the 2 sides of the nose, causing periodic unilateral obstruction every 1 hour

Answer 9

F
every 3 hours

Question 10

Two methods to directly assess nasal obstruction

Answer 10

Routine anterior rhinoscopy
Nasal Endoscopy (rigid, flexible)

Question 11

Paranasal sinus Xray is indicated to confirm what disease?

What parts are visualized in Occipito-mental projection (Water’s)?

How about in Occipito-frontal projection (Caldwell’s)?

Answer 11

Acute Rhinosinusitis

Maxillary sinus, sphenoid sinus

Frontal sinus, ethmoid cells

Question 12

CT Scan is requested for patients who have ___________

Answer 12

nasal obstruction

Question 13

T/F: CT Scan is used to diagnose chronic sinusitis

Answer 13

T

Question 14

T/F: CT scan is not recommended for reconstructive surgery

Answer 14

F
It can be used in sagittal, coronal, and axial planes for 3D reconstruction of masses

Question 15

T/F: MRI is inferior when visualizing bones

Answer 15

T

Question 16

Preferred imaging modality for viewing paranasal sinuses

Answer 16

MRI

Question 17

What is the CHARGE syndrome in unilateral choanal atresia?

Answer 17

Coloboma
Heart Disease
Atresia of the chloanae
Retarded growth, devt, CNS abnormalities
Genital hypoplasia
Ear anomalies or deafness

Question 18

T/F: Unilateral chloanal atresia is life threatening

Answer 18

F - it’s bilateral that’s life threatening

Question 19

T/F: In bilateral chloanal atresia, perforation of the plate can be done in the first weeks or months of life, whereas surgery can be postponed on unilateral chloanal atresia until school age

Answer 19

T

Question 20

A 6-year-old patient has adenoid hypertrophy. He does not breathe through the mouth, no nasal discharge, does not snore, no anorexia, and normal voice. What treatment shall must be done?

Answer 20

NONE
- treated only if they are causing symptoms

Question 21

Adenoid hypertrophy can cause what complication which could lead to conductive hearing loss?

Answer 21

Otitis media with effusion Or chronic impairment of the eustachian tube ventilation

Question 22

T/F: Chronic mouth breathers can have maxillary deformity and dental malalignment (adenoid facies)

Answer 22

T

Question 22

T/F: Anterior rhinoscopy or endoscopy can be done to diagnose adenoid hypertrophy. Ear evaluation and sharing test should likewise be done

Answer 22

F
All are true except Anterior rhinoscopy. Must be POSTERIOR

Question 23

Tx of adenoid hypertrophy

Answer 23

Surgery Myringotomy with ventilation tube insertion if with otitis media with effusion

Question 23

This is the most common bilateral nasal mass T/F: This disease is rarely observed in children

Answer 23

Nasal polyposis T: except for those who have cystic fibrosis

Question 24

This treatment is done for any deviation of the septum causing subjective complaints and functional impairment

Answer 24

Septoplasty

Question 25

These cells/sinuses are usually involved in nasal polyps

Answer 25

Maxillary and Ethmoid

Question 26

T/F: Nasal polyps could cause rhinophonia clausa

Answer 26

T (it causes hyponasal speech)

Question 27

This is a mucocele that contains purulent material (superinfection)

Answer 27

Pyelocele

Question 28

These adhesions obstruct drainage from the paranasal sinuses system

Answer 28

Post-inflammatory Post-traumatic Post-operative

Question 29

T/F: Nasal polyps can cause mucocele formation

Answer 29

T Since it can cause obstruction

Question 30

Ranking of most common sinus involved in mucocele

Answer 30

Frontal > Ethmoid > Maxillary > Sphenoid

Question 31

What sinus is involved if the orbital contents move inferolaterally?

Answer 31

Frontal sinus (Frontal mucocele)

Question 32

What sinus is involved if the orbital contents move superiorly?

Answer 32

Maxillary sinus (Maxillary mucocele)

Question 33

What sinus is involved if the orbital contents move laterally?

Answer 33

Ethmoid Sinus (Ethmoid mucocele)

Question 34

T/F: Ethmoid mucocele causes headaches radiating to the vertex and occiput

Answer 34

F it's Sphenoid mucocele

Question 35

T/F: Endoscopy is not useful to detecting mucocele Best modality for mucocele detection Tx:

Answer 35

T CT Scan surgical removal

Question 36

Which of the following tumors of the nasal cavity and paranasal sinuses is benign? Adenocarcinoma Inverted papilloma Adenoid Cystic Carcinoma Squamous cell carcinoma

Answer 36

Inverted papilloma

Question 37

It is the most common cause of unilateral nasal mass What sinus is usually involved?

Answer 37

Inverted Papilloma Maxillary sinus

Question 38

Inverted papilloma can transform into what malignant disease?

Answer 38

Squamous cell carcinoma

Question 39

What pattern in MRI is checked to diagnose inverted papilloma? Imaging modality adequate for its diagnosis:

Answer 39

Cerebriform-columnar pattern CT Scan

Question 40

T/F: inverted papilloma can be endoscopically removed

Answer 40

T other option: maxillectomy (open approach)

Question 41

This is one of the most common causes of benign tumors in the adolescent/pediatric age group

Answer 41

Juvenile Angiofibroma

Question 42

What is juvenile angiofibroma?

Answer 42

It is a benign tumor in the nasopharynx that is common among males age 10-18 years old. It is a vascular malformation commonly located in the pterygopalatine fossa

Question 43

T/F: Juvenile angiofibroma can cause middle ear effusion and conductive hearing loss

Answer 43

T other sx: nasal obstruction, recurrent epistaxis, headache

Question 44

A 12yo male patient comes to the clinic with nasal obstruction. On endoscopy, a well-circumscribed vascular mass was found at the posterior nasopharynx. What is the diagnosis? Should biopsy be performed to confirm its malignancy? Can angiography be done? Tx:?

Answer 44

Juvenile Angiofibroma NO- biopsy should not be performed due to uncontrollable bleeding Yes- to identify feeding vessel; preferred for adolescent males Tx: Surgical removal or preoperative embolization of feeding vessels (usually the maxillary artery)

Question 45

Osteomas most frequently occur in what sinus?

Answer 45

Frontal (80%) > Ethmoid > Maxillary > Sphenoid

Question 46

This syndrome under osteoma has multiple colon polyp, osteoma of the skull, and multiple soft tissue tumore

Answer 46

Gardner's Syndrome

Question 47

T/F: osteomas are highly likely to transform into osteosarcoma

Answer 47

F it rarely transforms to a malignant tumor

Question 48

Main sites of malignant tumors

Answer 48

Nasal cavity and maxillary sinus Followed by ethmoid > frontal > sphenoid

Question 49

When CT is used to diagnose malignant tumors, it should include _________ T/F: Nasal endoscopy can be used to diagnose malignant tumors

Answer 49

the neck - to check for neck node involvement and metastasis T