An 8-year-old boy has repeated small nosebleeds from the right nostril, often after picking his nose. Blood pressure and platelet count are normal. The bleeding most likely arises from:

Little's area on the anterior septum

Woodruff's plexus behind the turbinate

The anterior ethmoidal artery high up

A 9-year-old girl has a nosebleed from the right nostril that has not stopped after 15 minutes of her mother pinching the nose. In the ENT OPD, after a decongestant-soaked pack, a small bleeding vessel is seen on the anterior septum. What is the most appropriate next step?

Chemical cautery with silver nitrate

Endoscopic sphenopalatine ligation

Nose and paranasal sinuses, epistaxis

21 NEET-PG practice questions on Nose and paranasal sinuses, epistaxis, part of ENT. The first 21 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Easy
An 8-year-old boy has repeated small nosebleeds from the right nostril, often after picking his nose. Blood pressure and platelet count are normal. The bleeding most likely arises from:
1. AThe inferior turbinate mucosa
2. BLittle's area on the anterior septum
3. CWoodruff's plexus behind the turbinate
4. DThe anterior ethmoidal artery high up
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Answer: B · Little's area on the anterior septum
Little's area on the anteroinferior nasal septum is the commonest site of epistaxis, especially in children and young adults. Here four arteries meet in Kiesselbach plexus: the anterior ethmoidal, the septal branch of the sphenopalatine, the greater palatine and the septal branch of the superior labial. The area is exposed to drying and finger trauma. Most bleeds stop with firm pinching of the soft nose while sitting up and leaning forward; recurrent bleeds can be cauterised.
- A: The turbinate mucosa is not a common bleeding site in children.
- C: Woodruff's plexus gives posterior bleeds in older, often hypertensive, adults.
- D: Anterior ethmoidal bleeds come from high in the nose, usually after trauma.
Question 2 · Medium
A 36-year-old woman has had nasal blockage, facial pressure and reduced smell for over a year despite two courses of antibiotics. Nasal endoscopy shows mucopus in the middle meatus. Imaging is planned before considering surgery. Blockage of which region is central to her disease?
1. AOlfactory cleft
2. BOsteomeatal complex
3. CSphenoethmoidal recess
4. DInferior meatus
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Answer: B · Osteomeatal complex
Chronic rhinosinusitis, with symptoms for more than 12 weeks and mucopus on endoscopy, usually centres on the osteomeatal complex in the middle meatus, where the maxillary, frontal and anterior ethmoid sinuses drain. Mucosal swelling here blocks drainage and ventilation of these sinuses. Non-contrast CT of the paranasal sinuses with coronal sections shows the anatomy and disease and guides functional endoscopic sinus surgery, which aims to reopen this pathway. Maximal medical therapy, including saline and intranasal steroids, is tried first.
- A: The olfactory cleft affects smell but is not the key drainage pathway.
- C: The sphenoethmoidal recess drains the sphenoid and posterior ethmoid sinuses only.
- D: The inferior meatus receives the nasolacrimal duct, not the sinuses.
Question 3 · Medium
A 9-year-old girl has a nosebleed from the right nostril that has not stopped after 15 minutes of her mother pinching the nose. In the ENT OPD, after a decongestant-soaked pack, a small bleeding vessel is seen on the anterior septum. What is the most appropriate next step?
1. APosterior nasal packing
2. BIV tranexamic acid infusion
3. CEndoscopic sphenopalatine ligation
4. DChemical cautery with silver nitrate
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Answer: D · Chemical cautery with silver nitrate
Most childhood nosebleeds come from Little's area on the anterior septum, where several arteries meet. When a bleeding point is visible after first aid and topical decongestion, it is cauterised under local anaesthesia with a silver nitrate stick, working from the edges in. The opposite side of the septum is not cauterised at the same time because of the risk of septal perforation. If cautery fails, anterior nasal packing is the next step.
- A: Posterior packing is for posterior bleeds that anterior measures cannot control.
- B: Systemic tranexamic acid is not needed for a visible, treatable point.
- C: Arterial ligation is reserved for refractory posterior bleeding.
Question 4 · Hard
A 15-year-old boy is admitted with heavy recurrent epistaxis and a mass in the left nasal cavity. The ENT resident writes four statements about the likely tumour: 1. It is seen almost exclusively in adolescent males. 2. It is a benign but locally invasive vascular tumour. 3. An OPD punch biopsy should be done before imaging. 4. CT may show anterior bowing of the posterior wall of the maxillary sinus. Which statements are correct?
1. A1, 2, 3 and 4
2. B1, 2 and 3 only
3. C1 and 2 only
4. D1, 2 and 4 only
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Answer: D · 1, 2 and 4 only
Statements 1, 2 and 4 are correct for juvenile nasopharyngeal angiofibroma. It occurs almost only in adolescent boys and is histologically benign but spreads into the pterygopalatine fossa, infratemporal fossa, orbit and skull base. Forward bowing of the posterior maxillary wall on CT (Holman-Miller sign) shows spread into the pterygopalatine fossa. Statement 3 is wrong: biopsy is avoided because of torrential bleeding; diagnosis rests on the clinical picture and contrast imaging.
- A: Includes OPD biopsy, so not all four statements are correct.
- B: Includes OPD biopsy, which is dangerous in this vascular tumour.
- C: Omits the Holman-Miller sign, which is a correct statement.
Question 5 · Easy
A 17-year-old girl has had a blocked right nostril for a year and a nasal voice. Anterior rhinoscopy shows a smooth, pale grey mass in the right nasal cavity, and posterior rhinoscopy shows a large globular mass filling the choana. The left side is normal. From where does this polyp usually arise?
1. AMaxillary sinus
2. BSphenoid sinus
3. CEthmoid air cells
4. DFrontal sinus
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Answer: A · Maxillary sinus
A single, unilateral polyp that grows backwards to the choana in a child or young adult is an antrochoanal polyp. It arises from the mucosa of the maxillary antrum, emerges through the accessory ostium into the nose and enlarges towards the choana and nasopharynx. It is usually not allergic. Treatment is endoscopic removal including the antral part, which prevents recurrence.
- B: Sphenochoanal polyps are rare compared with the antral type.
- C: Ethmoidal polyps are multiple, bilateral and allergic, and grow forwards.
- D: The frontal sinus is not a source of choanal polyps.
Question 6 · Medium
A 42-year-old man has had repeated nosebleeds since his teens, now needing blood transfusions. He has small red spots on his lips, tongue and fingertips that blanch on pressure, and his mother had similar nosebleeds. His haemoglobin is 8.2 g/dL with microcytic indices. What is the most likely diagnosis?
1. AHereditary haemorrhagic telangiectasia
2. BScurvy
3. CImmune thrombocytopenia
4. DVon Willebrand disease
Answer and explanation in LearnFree account
Question 7 · Hard
A 9-year-old girl with acute ethmoid sinusitis has been on IV antibiotics for 48 hours. Her left eye is now pushed down and outwards, eye movements are painful and restricted, and her visual acuity has fallen from 6/6 to 6/18 with a red colour desaturation. Contrast CT shows a rim-enhancing collection along the medial orbital wall. What is the next best step?
1. AUrgent drainage of the abscess
2. BRepeat the CT scan in 48 hours
3. CAdd IV dexamethasone and observe
4. DContinue the same IV antibiotics
Answer and explanation in LearnFree account
Question 8 · Medium
A 14-year-old boy has a juvenile nasopharyngeal angiofibroma confined to the nasal cavity, nasopharynx and pterygopalatine fossa on CT and MRI. Surgery is planned. Which pre-operative step most reduces blood loss during excision?
1. ACourse of oral flutamide
2. BRadiotherapy to shrink the tumour
3. CLigation of the external carotid artery
4. DEmbolisation of the feeding vessels
Answer and explanation in LearnFree account
Question 9 · Medium
A 15-year-old boy had a frontal headache and nasal discharge for two weeks. He now has a soft, tender, doughy swelling over the forehead, fever and a CT showing erosion of the anterior wall of the frontal sinus with a collection under the periosteum. What is this condition called?
1. AFrontal lobe abscess
2. BFrontal sinus mucocele
3. COrbital subperiosteal abscess
4. DPott's puffy tumour
Answer and explanation in LearnFree account
Question 10 · Easy
A 22-year-old man from a village in Chhattisgarh who bathes regularly in a pond has a bleeding, strawberry-like polypoidal mass in his left nostril. A smear of the mass shows large spherical sporangia packed with spores. Which organism is responsible?
1. AKlebsiella rhinoscleromatis
2. BAspergillus flavus
3. CMucor species
4. DRhinosporidium seeberi
Answer and explanation in LearnFree account
Question 11 · Medium
A 16-year-old boy has recurrent profuse nosebleeds and right nasal obstruction. Endoscopy shows a firm, reddish, vascular-looking mass in the right posterior nasal cavity. What is the investigation of choice?
1. AContrast-enhanced CT of nose and sinuses
2. BFine-needle aspiration of the mass
3. CPlain X-ray of the paranasal sinuses
4. DPunch biopsy in the ENT OPD
Answer and explanation in LearnFree account
Question 12 · Medium
A 24-year-old man with allergic rhinitis and asthma has bilateral nasal polyps. CT shows expanded sinuses filled with material of mixed high density. At endoscopic sinus surgery, thick peanut-butter-like mucin is removed; it contains many eosinophils and Charcot-Leyden crystals, with scanty fungal hyphae that do not invade the mucosa. What is the most likely diagnosis?
1. AChronic granulomatous fungal sinusitis
2. BFungal ball (mycetoma)
3. CAllergic fungal rhinosinusitis
4. DAcute invasive fungal sinusitis
Answer and explanation in LearnFree account
Question 13 · Medium
A 7-year-old boy with acute ethmoid sinusitis is admitted with swelling and redness of the left upper and lower eyelids. Which finding would show that the infection has spread behind the orbital septum?
1. ALid oedema closing the eye
2. BTenderness over the cheek
3. CFever of 38.5 C
4. DPainful restricted eye movements
Answer and explanation in LearnFree account
Question 14 · Hard
A 45-year-old woman, who had nasal surgery for polyps 10 years ago, has slowly increasing swelling above the inner corner of her right eye for a year. The right eyeball is displaced forwards, downwards and laterally, and she has double vision on upward gaze. The swelling is painless and non-tender with an egg-shell crackling feel. CT shows a smooth, expanded, non-enhancing frontoethmoidal lesion with thinned bony walls. What is the most appropriate treatment?
1. ALong-term oral antibiotics
2. BRadiotherapy to the lesion
3. CEndoscopic marsupialisation of the lesion
4. DExcision with orbital exenteration
Answer and explanation in LearnFree account
Question 15 · Medium
A 30-year-old man from Andhra Pradesh has a recurrent bleeding polypoidal mass in his right nasal cavity. Histology of the earlier excised mass showed thick-walled sporangia with endospores. He asks how to stop it coming back. What is the most appropriate management?
1. AOral itraconazole for six months
2. BWide excision with cautery of the base
3. CRadiotherapy to the nasal cavity
4. DOral amoxicillin-clavulanate
Answer and explanation in LearnFree account
Question 16 · Medium
A 28-year-old man has had nasal blockage, thick yellow nasal discharge and right cheek pain for 12 days after a cold, with no improvement. He has fever of 38.5 C. There are no eye or neurological signs, and he has no drug allergies. What is the most appropriate first-line treatment?
1. AIV ceftriaxone
2. BOral amoxicillin-clavulanate
3. COral ciprofloxacin
4. DOral azithromycin
Answer and explanation in LearnFree account
Question 17 · Easy
A 38-year-old woman with bilateral nasal polyps and late-onset asthma developed severe wheeze after taking a painkiller for a toothache. Which drug should she be advised to avoid?
1. AMontelukast
2. BParacetamol
3. CIbuprofen
4. DFluticasone nasal spray
Answer and explanation in LearnFree account
Question 18 · Easy
A 15-year-old boy from Lucknow has had progressive left nasal blockage and repeated heavy, spontaneous nosebleeds for six months. Endoscopy shows a smooth, lobulated, reddish mass in the back of the left nasal cavity. Near which structure does this tumour arise?
1. AMaxillary sinus ostium
2. BSphenopalatine foramen
3. CCribriform plate
4. DFossa of Rosenmuller
Answer and explanation in LearnFree account
Question 19 · Medium
A 45-year-old man has bilateral nasal obstruction and loss of smell for two years. Endoscopy shows bilateral smooth, pale, grape-like polyps arising from the middle meatus. He has no asthma or aspirin sensitivity, and CT shows bilateral ethmoid disease. What is the most appropriate first-line treatment?
1. ALong-term oral antihistamines
2. BSix weeks of oral antibiotics
3. CIntranasal corticosteroid spray
4. DImmediate endoscopic sinus surgery
Answer and explanation in LearnFree account
Question 20 · Hard
A 66-year-old hypertensive man has been bleeding briskly from the nose for 3 hours. Blood runs down the back of his throat despite well-placed bilateral anterior nasal packs. After resuscitation, his BP is 150/90 mmHg, Hb 9.8 g/dL, and platelets and INR are normal. Endoscopy shows bleeding from behind the posterior end of the right inferior turbinate. What is the definitive step to stop the bleeding?
1. ALigation of the anterior ethmoidal artery
2. BEndoscopic sphenopalatine artery ligation
3. CLigation of the external carotid artery
4. DFurther anterior packing on both sides
Answer and explanation in LearnFree account
Question 21 · Hard
A 55-year-old man has had right-sided nasal obstruction and occasional blood-stained discharge for a year. Endoscopy shows a firm, irregular polypoidal mass arising from the right lateral nasal wall; the left side is normal. Biopsy shows epithelium growing inwards into the underlying stroma, with an intact basement membrane. What is the most appropriate treatment?
1. ASimple intranasal polypectomy
2. BIntranasal steroid spray for 3 months
3. CEndoscopic medial maxillectomy
4. DRadiotherapy alone
Answer and explanation in LearnFree account

Nose and paranasal sinuses, epistaxis

An 8-year-old boy has repeated small nosebleeds from the right nostril, often after picking his nose. Blood pressure and platelet count are normal. The bleeding most likely arises from:

A 36-year-old woman has had nasal blockage, facial pressure and reduced smell for over a year despite two courses of antibiotics. Nasal endoscopy shows mucopus in the middle meatus. Imaging is planned before considering surgery. Blockage of which region is central to her disease?

A 9-year-old girl has a nosebleed from the right nostril that has not stopped after 15 minutes of her mother pinching the nose. In the ENT OPD, after a decongestant-soaked pack, a small bleeding vessel is seen on the anterior septum. What is the most appropriate next step?

A 17-year-old girl has had a blocked right nostril for a year and a nasal voice. Anterior rhinoscopy shows a smooth, pale grey mass in the right nasal cavity, and posterior rhinoscopy shows a large globular mass filling the choana. The left side is normal. From where does this polyp usually arise?

A 14-year-old boy has a juvenile nasopharyngeal angiofibroma confined to the nasal cavity, nasopharynx and pterygopalatine fossa on CT and MRI. Surgery is planned. Which pre-operative step most reduces blood loss during excision?

A 15-year-old boy had a frontal headache and nasal discharge for two weeks. He now has a soft, tender, doughy swelling over the forehead, fever and a CT showing erosion of the anterior wall of the frontal sinus with a collection under the periosteum. What is this condition called?

A 22-year-old man from a village in Chhattisgarh who bathes regularly in a pond has a bleeding, strawberry-like polypoidal mass in his left nostril. A smear of the mass shows large spherical sporangia packed with spores. Which organism is responsible?

A 16-year-old boy has recurrent profuse nosebleeds and right nasal obstruction. Endoscopy shows a firm, reddish, vascular-looking mass in the right posterior nasal cavity. What is the investigation of choice?

A 7-year-old boy with acute ethmoid sinusitis is admitted with swelling and redness of the left upper and lower eyelids. Which finding would show that the infection has spread behind the orbital septum?

A 30-year-old man from Andhra Pradesh has a recurrent bleeding polypoidal mass in his right nasal cavity. Histology of the earlier excised mass showed thick-walled sporangia with endospores. He asks how to stop it coming back. What is the most appropriate management?

A 28-year-old man has had nasal blockage, thick yellow nasal discharge and right cheek pain for 12 days after a cold, with no improvement. He has fever of 38.5 C. There are no eye or neurological signs, and he has no drug allergies. What is the most appropriate first-line treatment?

A 38-year-old woman with bilateral nasal polyps and late-onset asthma developed severe wheeze after taking a painkiller for a toothache. Which drug should she be advised to avoid?

A 15-year-old boy from Lucknow has had progressive left nasal blockage and repeated heavy, spontaneous nosebleeds for six months. Endoscopy shows a smooth, lobulated, reddish mass in the back of the left nasal cavity. Near which structure does this tumour arise?