ENT Rhinology and Sinonasal Disorders 2 β Questions and Answers
Question 1: During FESS, the landmark 'basal lamella' separates which two structures?
- Anterior and posterior ethmoid sinuses (Correct answer)
- Ethmoid sinuses and the orbit
- Maxillary sinus and the nasal cavity
- Sphenoid sinus and the posterior ethmoid
Correct answer: Anterior and posterior ethmoid sinuses
The basal lamella of the middle turbinate is the key surgical landmark dividing the anterior ethmoid (drained by OMC) from the posterior ethmoid sinuses.
Question 2: Which biologic agent targeting the IL-4/IL-13 receptor was FDA-approved for CRS with nasal polyps in adults?
- Omalizumab
- Mepolizumab
- Dupilumab (Correct answer)
- Benralizumab
Correct answer: Dupilumab
Dupilumab (anti-IL-4RΞ±) is FDA-approved for CRS with nasal polyps, blocking both IL-4 and IL-13 signaling to reduce type 2 inflammation.
Question 3: A patient with CSF rhinorrhea after endoscopic skull base surgery most likely requires repair of a defect in which anatomic region?
- Lamina papyracea
- Cribriform plate / fovea ethmoidalis (Correct answer)
- Sphenoid sinus lateral recess
- Posterior wall of the frontal sinus
Correct answer: Cribriform plate / fovea ethmoidalis
The cribriform plate and fovea ethmoidalis are the most common sites of iatrogenic CSF leaks during FESS due to their thin bony walls adjacent to the anterior skull base.
Question 4: Inverted papilloma of the sinonasal tract is clinically significant primarily because of its association with:
- High rate of spontaneous resolution
- Risk of malignant transformation to squamous cell carcinoma (Correct answer)
- Bilateral symmetric involvement
- Association with cystic fibrosis
Correct answer: Risk of malignant transformation to squamous cell carcinoma
Inverted papilloma carries a 5β15% risk of malignant transformation to squamous cell carcinoma and tends to recur after incomplete excision.
Question 5: Turbinate hypertrophy causing nasal obstruction is most commonly treated conservatively with which agent class before considering surgical intervention?
- Oral decongestants (pseudoephedrine)
- Intranasal corticosteroids (Correct answer)
- Antihistamines alone
- Leukotriene receptor antagonists
Correct answer: Intranasal corticosteroids
Intranasal corticosteroids are first-line therapy for turbinate hypertrophy related to allergic and non-allergic rhinitis, reducing mucosal edema and congestion.
Question 6: Granulomatosis with polyangiitis (GPA, formerly Wegener's) classically affects the sinonasal tract and produces which characteristic finding?
- Bilateral nasal polyposis with eosinophilia
- Saddle-nose deformity from septal perforation (Correct answer)
- Unilateral maxillary sinus opacification
- Septal hematoma
Correct answer: Saddle-nose deformity from septal perforation
GPA causes necrotizing granulomatous inflammation of the nasal septum, leading to septal perforation and the classic saddle-nose deformity.
Question 7: Which nerve is most at risk of injury during endoscopic posterior septectomy or sphenopalatine artery ligation?
- Vidian nerve (nerve of the pterygoid canal) (Correct answer)
- Greater palatine nerve
- Nasociliary nerve
- Anterior ethmoidal nerve
Correct answer: Vidian nerve (nerve of the pterygoid canal)
The Vidian nerve runs in the pterygoid canal adjacent to the sphenopalatine foramen; injury causes loss of lacrimation and altered nasal secretion.
ENT Rhinology and Sinonasal Disorders 2
During FESS, the landmark 'basal lamella' separates which two structures?