18.

The little’s area is supplied by : *

1/1
A. Superior labial, anterior ethmoidal, greater palatine and spheno-ethmoidal arteries.
B. Superior labial, posterior ethmoidal, greater palatine and spheno-ethmoidal arteries.
C. Superior labial, anterior ethmoidal, lesser palatine and spheno-ethmoidal arteries.
D. Inferior labial, anterior ethmoidal, greater palatine and spheno-ethmoidal arteries.
E. None of the above.
 
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Kiesselbach's plexus, which lies in Kiesselbach's area, Kiesselbach's triangle, or Little's area, is a
region in the anteroinferior part of the nasal septum where four arteries anastomose to form a
vascular plexus of that name. The arteries are:
1. Anterior ethmoidal artery (from the ophthalmic artery)
2. Sphenopalatine artery (terminal branch of the maxillary artery)
3. Greater palatine artery (from the maxillary artery)
4. Septal branch of the superior labial artery (from the facial artery)

 
5. Which of the following structure/s is/are not affected if there is a damage to
infraorbital artery? *
0/1
A. Extraocular muscles
B. Lateral side of the nose
 
C. Maxillary teeth
D. Upper eyelid
E. None of the above

Correct answer
D. Upper eyelid
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The infraorbital artery is a branch of the third part of the maxillary artery. It runs through the inferior
orbital fissure, orbit, infraorbital canal then the infraorbital foramen. Here it gives off the anterior
superior alveolar artery which supplies the anterior teeth and the anterior part of the maxillary sinus.

It emerges from the infraorbital foramen onto the midface, where it supplies the lateral aspect of the
nose, upper lip and the lower eyelid. It anastomoses with the transverse facial and buccal arteries
and branches of the ophthalmic and facial arteries.

 
30. All of the following are incorrect except one. *
1/1
A. The anterior ethmoid nerve, at least in part, supplies the sphenoid sinus.
B. The 2nd maxillary molar is an superior relation of the maxillary sinus.
C. The supraorbital nerve, at least in part, provides parasympathetic innervation to the frontal
sinus.
D. The ethmoid sinuses are supplied, at least in part, by the posterior lateral nasal branches
 
E. None of the above
Feedback
Nasal nerves:
These branches travel medially from the pterygopalatine ganglion and enter the nasal cavity through
the sphenopalatine foramen. They include medial and lateral posterior superior nasal nerves and
nasopalatine nerve. The lateral posterior superior nasal branches run anteriorly to supply the
mucosa of the lateral wall of the nasal cavity. While the medial posterior superior nasal branches
pass across the nasal roof to supply the medial wall. The nasopalatine nerve, which is the longest
among nasal branches, passes across the nasal roof and travels anteriorly down the nasal septum.
It emerges on the roof of the oral cavity through the incisive canal and innervates the mucosa,
gingiva, and glands adjacent to incisor teeth.[6] It also communicates with the greater palatine
nerve.

 
26. A 36-year-old woman presented with fever, swelling on the right side of his face,
purulent discharge from the nose and right-sided nasal blockage for 2 weeks. The
swelling was variable in consistency, tender on palpation with involvement of overlying
skin. Nasal examination revealed purulent discharge from right middle meatus. What
is the diagnosis? *
1/1
A. Anterior ethomoidal sinusitis
B. Frontal sinusitis
C. Maxillary sinusitis
 
D. Posterior ethmoidal sinusitis
E. None of the above
Feedback
Acute maxillary sinusitis is characterized by facial pain, localized to the cheek, but also in the frontal
area or the teeth, that is made worse by stooping down or straining. The pain can be unilateral or
bilateral, and tenderness may overlie the sinus. Acute frontoethmoidal sinusitis may cause pain
around the eye and in the frontal region, with overlying tenderness and erythema of the skin. There
is usually fever, and toxemia may occur. Differential diagnosis of facial pain is wide and includes
dental disease and the numerous causes of headache. Recently, all the accepted clinical signs and
symptoms noted here have been shown to be unreliable as diagnostic aids to acute sinusitis, with
the combination of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) giving the
best guide.

Chronic sinusitis is frequently pain free and presents with a sensation of congestion, poor
concentration, tiredness, and malaise. Other symptoms of chronic sinusitis include purulent nasal
discharge (often postnasal), sore throat, and a productive cough, especially in children in whom
misdiagnosis of asthma is not uncommon. Loss of smell and halitosis are additional features.

 
16. Examination of the nose and sinuses *
1/1
A. The best view of the eustachian tube orifices is obtained by a fibreoptic nasolaryngoscope
passed through the mouth.
B. Application of vasoconstrictor solutions is contraindicated in the examination of the nose.
C. Ultrasound scanning is the most accurate method of diagnosing maxillary sinusitis.
D. The inferior turbinate (concha) is easily seen in the child by turning up the tip of the nose with
the thumb.
 
E. Transillumination is a useful physical sign in the examination of the paranasal sinuses.
Feedback
Inferior and middle turbinates or nasal conchae are seen upon this examination, superior concha will
be difficult to inspect since it is more on the inner side.

 
29. Which of these following choices follows the correct sequence regarding the
sympathetic and parasympathetic innervation of the nasal cavity? *
1/1
A. parasympathetic preganglionic > facial nerve > deep petrosal nerve > vidian nerve >
pterygopalatine ganglion
B. sympathetic preganglionic > lateral horn > dorsal rami > superior cervical ganglion
C. parasympathetic postganglionic > pterygopalatine ganglion > CN 5 V1 and V3 > stimulates
mucus secretion
D. Sympathetic postganglionic > superior cervical ganglion > internal carotid > greater petrosal
nerve > inhibition of mucus secretion
E. None of the above
 
Feedback
The chief sympathetic (vasoconstrictor) and parasympathetic (vasodilator and secretory) innervation
of the nasal cavity follow nerve branches arising in the region of the pterygopalatine ganglion, but
some sympathetic fibers are carried along the walls of arteries. Parasympathetic preganglionic
nerve fibers to the nose leave the brain with the facial nerve and pass through the greater petrosal
nerve and the nerve of the pterygoid canal to reach the pterygopalatine ganglion, where they
synapse. Sympathetic preganglionic nerve fibers leave the upper thoracic spinal cord and traverse
white rami communicans in that region, ascend the cervical sympathetic chain and synapse in the
superior cervical sympathetic ganglion. The postganglionic nerve fibers follow the internal carotid
artery and then the nerve of the pterygoid canal to reach the pterygopalatine fossa. These nerve
fibers pass through the ganglion to join branches of the maxiallary nerve and artery to reach the
nasal mucosa.

NOTE: CN 5 V1 and V2
 
7. Which of the following concerning the branches of pterygopalatine ganglion in
pterygopalatine fossa is true? *
1/1
A. Lesser palatine nerve passes through lesser palatine foramen and supplies the hard palate
B. Damage will affect the motor innervation of palatal gingiva and mucosa from the region of the
central incisors to the canines
C. Damage will result to loss of sensation in oropharynx
D. Injury will result to loss of sensation to the palatal gingiva and mucosa from the area in the
premolar region to the anterior border of the hard palate to the midline
E. None of the above
 
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Option A - soft palate
Option B - sensory innervation
Option C - nasopharynx
Option D - posterior border

 
15. Nasal anatomy, except *
1/1
A. The cell bodies of olfactory neurons lie in the nasal mucosa.
B. The branches of greater palatine nerve supplies most of the inferior turbinate (concha) with
common sensation.
C. The posterior lateral nasal nerves are branches of the posterior ethmoidal nerve.
 
D. Lymph from the lower nasal cavity and both maxillary and mandibular alveolar ridges drains to
the submandibular nodes.
E. The posterior part of the nasal cavity drains to the retropharyngeal lymph nodes
Feedback
The nasociliary nerve gives off several smaller branches:

1. Communicating branch
This communicating branch passes to the ciliary ganglion (see Abducens Nerve).

2. Long ciliary nerves

These can exist either singly or two nerves and convey sympathetic fibers to the dilator pupillae and
afferent fibers from the uvea and cornea.

3. Infratrochlear nerve
The infratrochlear nerve passes to the eyelids, skin of the nose, and the lacrimal sac.

4. Posterior ethmoidal nerve

The posterior ethmoidal nerve is frequently absent. When present it provides sensory innervation to
the posterior ethmoidal and sphenoidal sinuses.
5. Anterior ethmoidal nerve
The anterior ethmoidal nerve is seen as the continuation of the nasociliary nerve. The anterior
ethmoidal nerve passes through the anterior ethmoidal foramen entering into the anterior cranial
fossa. It passes into the nasal cavity dividing into internal nasal branches. These branches supply
the walls of the nasal cavity. One of the branches passes to the skin of the nose as an external
nasal branch.

Lymph Node Drainage:

https://www.ncbi.nlm.nih.gov/books/NBK513317/

 
3. Which of the following is not correct regarding the spread of infection as bacteria
enters through mastoid air cells? *
1/1
A. The structure that is closely related to the spread is the nasopharyngeal tube
B. Eustachian tube is situated in the middle ear and allows for the spread of infection to that area
as well as the mastoid air cells
C.The nasal mucosa is continuous with the lining of the tympanic cavity and mastoid air cells
 
D. If eustachian tube dysfunction resolves, and the mucosa of the middle ear and mastoid
recovers
E. None of the above
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At birth, the mastoid consists of a single air cell, the antrum, which is connected to the middle ear by
a narrow channel, the aditus ad antrum. As the child grows, the mastoid bone becomes
pneumatized, resulting in a series of interconnected air cells that are lined by modified respiratory
epithelium.

When Acute Otitis Media (AOM) develops as a result of eustachian tube dysfunction, there is an
acute inflammatory response of the mucosa lining the middle ear and, in many cases, the mastoid.
Most episodes of AOM respond to antibiotic therapy. Eustachian tube dysfunction resolves, and the
mucosa of the middle ear and mastoid recovers.

NOTE: The pharyngeal mucosa is continuous with the lining of the tympanic cavity and mastoid air
cells

 
21. Regarding deviated nasal septum, which of the following is false? *
1/1
A. Deviated nasal septum (DNS) is a common physical disorder.
B. It is most frequently caused by impact trauma.
C. Deviated septum is associated with genetic connective tissue disorders such as Marfan
syndrome.
D. Septal haematoma and septal abscess are complications of its correction.
E. Mostly treated surgically.
 
Feedback
Small cases of septal deviation is treated surgically by:
1. Sub-mucosal resection.
2. Septoplasty.
3. Septorhinoplasty.

 
10. Which correctly shows the sympathetic nerve path to the Lacrimal Gland? *
1/1
A. Superior Cervical Ganglion > Internal Carotid Artery and Deep Petrosal Nerve > Vidian nerve >
Lacrimal gland (inhibited)
 
B. Superior Cervical Ganglion > External Carotid Artery and Deep Petrosal Nerve > Vidian nerve
> Lacrimal gland (stimulated)
C. Superior Cervical Ganglion > Internal Carotid Artery and Deep Petrosal Nerve > Vidian nerve
> Lacrimal gland (stimulated)
D. Superior Cervical Ganglion > External Carotid Artery and Deep Petrosal Nerve > Vidian nerve
> Lacrimal gland (inhibited)
Feedback
Sympathetic
- Fibres originate from the superior cervical ganglion, and are carried by the internal carotid plexus
and deep petrosal nerve.
- They join with the parasympathetic fibres in the nerve of pterygoid canal, and follow the same route
to supply the gland.
- Inhibits fluid secretion from the lacrimal gland

 
20. All about the vestibule of the nose are true except: *
1/1
A. It is the entrance to the nasal cavity.
B. It is lined with skin.
C. It contains sebaceous glands and hairs.
D. It is lined by mucus membrane of respiratory type.
 
E. Can be seen without nasal speculum.
Feedback
The nasal vestibule is the most anterior part of the nasal cavity. It is enclosed by the cartilages of
nose and lined by the same epithelium of the skin (stratified squamous, keratinized). The other part
of the nasal cavity, which is lined by the respiratory epithelium, is called nasal cavity proper. Inside
the vestibule are small hairs called vibrissae, which filter dust and other matter that are breathed in.
The vestibule can be seen by just elevation of the tip of the nose.

 
23. Which of the following is not a symptom of acute maxillary sinusitis? *
1/1
A. Pain in the cheek.
B. Tenderness over the cheek.
C. Edema over the cheek.
D. Discharge from the middle meatus.
E. Dullness on trans-illumination.
 
F. None of the above
Feedback
Dullness on trans-illumination is a sign (not a symptom) of acute maxillary sinusitis.

 
11. The walls of the maxillary sinus are sinus is related to: *
1/1
A. the floor of the orbit and the upper posterior teeth.
B. the floor of the orbit.
C. the floor of the orbit, the upper posterior teeth, the infratemporal fossa and the hard palate.
D. the floor of the orbit, the upper posterior teeth and the infratemporal fossa.
 
 
9. Which correctly shows the parasympathetic nerve path to the Lacrimal Gland? *
1/1
A. Facial nerve > Greater Petrosal Nerve > Pterygopalatine Ganglia > Zygomatic nerve >
Lacrimal Nerve > Lacrimal Gland (inhibited = increased tear production)
B. Facial nerve > Greater Petrosal Nerve > Pterygopalatine Ganglia > Ganglionic Branch of
Maxillary > Lacrimal Nerve > Lacrimal Gland (stimulated = increased production of tears)
C. Facial nerve > Greater Petrosal Nerve > Pterygopalatine Ganglia > Zygomatic nerve >
Lacrimal Nerve > Lacrimal Gland (stimulated = increased tear production)
 
D. Facial nerve > Greater Petrosal Nerve > Pterygopalatine Ganglia > Ganglionic Branch of
Maxillary > Lacrimal Nerve > Lacrimal Gland (inhibited = increased production of tears)
Feedback
Parasympathetic:
- Preganglionic fibres are carried in the greater petrosal nerve (branch of the facial nerve) and then
the nerve of pterygoid canal, before synapsing at the pterygopalatine ganglion.
- Postganglionic fibres travel with the maxillary nerve, and finally the zygomatic nerve.
- Stimulates fluid secretion from the lacrimal gland

 
6. Damage to he maxillary division of trigeminal nerve in pterygopalatine fossa will
result to the following, except: *
1/1
A. Loss of sensation to the buccal gingiva
B. Loss of sensation to the first maxillary mollar
 
C. Loss of sensation to maxillary sinus
D. Impaired autonomics of lacrimal gland
Feedback
Posterior superior alveolar
Passes through the pterygomaxillary fissure to enter the infratemporal fossa. In the infratemporal
fossa, it passes on the posterior surface of the maxilla along the region of the maxillary tuberosity.
Gives rise to a gingival branch that innervates the buccal gingiva alongside the maxillary molars.
Enters the posterior surface of the maxilla and supplies the maxillary sinus and the maxillary molars
with the possible exception of the mesiobuccal root of the 1st maxillary molar.

Zygomatic
Passes through the inferior orbital fissure to enter the orbit. Passes on the lateral wall of the orbit
and branches into the zygomaticotemporal and zygomaticofacial branches. A communicating branch
from it joins the lacrimal n. from the ophthalmic division of the trigeminal to carry autonomics to the
lacrimal gland

 
8. The greater petrosal nerve carries various function in sensation and autonomics
which provides innervation to the following structures, except: *
1/1
A. Glands and mucosa of nasopharynx
B. Hard palate
C. Tonsils
D. Uvula
E. oral mucus membranes
 
F. None of the above
Feedback
The greater petrosal nerve is a mixed nerve carrying parasympathetic, taste, and sensory fibers.
The parasympathetic fibers synapse at the pterygopalatine ganglion, as discussed in more detail
above. Parasympathetic fibers exit the pterygopalatine ganglion via:

1. The greater palatine nerve that innervates the bony hard palate of the mouth
2. The lesser palatine that innervates the uvula, tonsils and soft palate
3. The nasal palatine and posterior nasal branches that innervate the nasal mucous membranes
4. The pharyngeal branch that innervates the glands and mucosa of the nasopharynx

These fibers also carry postganglionic sympathetic fibers from the deep petrosal nerve. In addition
to the vidian nerve, the pterygopalatine ganglion receives two to three branches, the pterygoid
branches, from the maxillary division of the trigeminal nerve. This anatomical arrangement allows
CN VII, and the greater and deep petrosal nerves to utilize the trigeminal as an expressway for their
respective autonomic fibers. The post-ganglionic sympathetic and parasympathetic fibers that travel
with the zygomatic nerve of V2 provide innervation to the lacrimal glands. The greater petrosal
nerve, therefore, increases the secretomotor function of nasal-palatal glands and mucosa and
mediates reflexive tearing at the lacrimal glands.

The greater petrosal also carries taste afferents from the soft palate and sensory afferents from the
dura mater, internal carotid artery, and the pterygopalatine ganglion to the geniculate ganglion. The
greater petrosal has also been shown to communicate with the lesser petrosal nerve.

 
14. Blood supply of the nose, except *
1/1
A. Branches of both internal and external carotid arteries supply the nasal mucosa.
B. The maxillary artery provides the major blood supply to the nasal fossa.
C. Venous drainage occurs into the superior sagittal sinus via the foramen cecum.
D. Sympathetic motor fibres controlling the mucosal vessels run in the Vidian nerve.
E. Little's area is supplied by branches of the greater palatine, sphenopalatine, posterior
ethmoidal and spheno-ethmoidal arteries.
 
F. None of the above
Feedback
Epistaxis (nosebleed) is one of the most common ear, nose, and throat (ENT) emergencies that
present to the emergency department or the primary care clinic. There are two types of nosebleeds:
anterior (more common), and posterior (less common, but more likely to require medical attention).
The source of 90% of anterior nosebleeds is within Kiesselbach's plexus (also known as Little’s
area) on the anterior nasal septum. There are five named vessels whose terminal branches supply
the nasal cavity:

1) Anterior ethmoidal artery

2) Posterior ethmoidal artery

3) Sphenopalatine artery

4) Greater palatine artery

5) Superior labial artery

The watershed area of these five vessels is in the anterior nasal septum, comprising Kiesselbach's
plexus. This lies at the entrance to the nasal cavity and so is subject to extremes of heat and cold,
and of high and low moisture, and is easily traumatized. The mucosa over the septum in this area is
especially thin, making this the site of the majority of epistaxis. More rarely, vessels in the posterior
or superior nasal cavity will bleed, leading to the so-called "posterior" epistaxis. This is more
common in patients on anticoagulants, patients who are hypertensive, and patients with underlying
blood dyscrasia or vascular abnormalities. Management will depend on the severity of the bleeding
and the patient's concomitant medical problems

 
25. Not a cause of acute maxillary sinusitis: *
0/1
A. Acute infective rhinitis.
B. Swimming.
C. Common cold.
D. Fracture of maxillary sinus.
E. None of the above.
 
Correct answer
B. Swimming.
Feedback
Etiology of acute maxillary sinusitis: nasal origin 90% and dental origin10%.
1. Acute infective rhinitis.
2. Swimming and diving in contaminated water.
3. Fracture of maxillary sinus.
4. Barotrauma

The inflammation and swelling of the lining of the sinuses can be triggered by:

Viral infections, such as a common cold

Allergies
Air pollution and cigarette smoke
Dental infections
Narrowed nasal passages from nasal polyps

 
1. The zygomatic nerve is a branch of the maxillary division of trigeminal nerve that
passes through inferior orbital fissure to enter the cheek. The fissure is located in the
superior part of infratemporal fossa and is in between the fossa and the
pterygomaxillary fissure. *
1/1
A. Both statements are correct
B. Both statements are incorrect
 
C. First statement is correct, second statement is incorrect
D. First statement is incorrect, second statement is correct
Feedback
The zygomatic nerve originates in the pterygopalatine fossa, and it then passes into the orbit via the
inferior orbital fissure. It then runs on the outer wall of the orbit and terminates as two branches—the
zygomaticotemporal and the zygomaticofacial nerves.

The inferior orbital fissure is located at the superior part of the pterygopalatine fossa. Between the
pterygopalatine fossa and the orbit. Continues posteriorly with the superior part of the
pterygomaxillary fissure.

 
24. Regarding the management of sinusitis, which of the following is false? *
1/1
A. For sinusitis lasting more than 12 weeks a CT scan is not recommended.
 
B. Nasal endoscopy is generally a completely painless procedure which takes between five to ten
minutes to complete.
C. Imaging by either X-ray, CT or MRI is generally not recommended in acute sinusitis unless
complications develop.
D. Antibiotics are not recommended for most cases.
E. None of the above
Feedback
 The vast majority of cases of sinusitis are caused by viruses and will therefore resolve without
antibiotics.
 Nasal endoscopy involves inserting a flexible fiber-optic tube with a light and camera at its tip into
the nose to examine the nasal passages and sinuses. This is generally a completely painless
(although uncomfortable) procedure which takes between five to ten minutes to complete.
 CT scan is recommended for chronic sinusitis to delineated the extent of disease and the anatomy
of sinuses.
 Imaging by either X-ray, CT or MRI is generally not recommended in acute sinusitis unless
complications develop because most cases resolves with simple measures.
 Minor cases of acute sinusitis need surgery.

 
28. All of the following are correct except one: *
1/1
A. Causes include : trauma, sinus infections and rhinitis
B. Posterior epistaxis are more difficult to treat and may be accomplished with posterior nasal
packing or a balloon catheter
C. Epistaxis is often caused by a rupture of a vessel in Kiesselbach’s plexus.
D. Many nosebleeds are due to trauma to the septal branch of the superior labial artery from the
maxillary artery
 
E. With anterior epistaxis, another treatment, although somewhat drastic, is septal dermoplasty
Feedback
Anterior Epistaxis
- The most common form (in about 90% of cases)
- Usually found along the nasal septum and results from bleeding along Kiesselbach’s plexus
- Many nosebleeds are due to trauma to the septal branch of the superior labial artery from the facial
artery
- Typically managed with local pressure
- May be controlled with cautery via a silver nitrate stick or anterior nasal packing if bleeding is
persistent
- With anterior epistaxis, another treatment, although somewhat drastic, is septal dermoplasty

Posterior Epistaxis
- Usually found along the posterior part of the nasal cavity
- More difficult to treat and may be accomplished with posterior nasal packing or a balloon catheter
- Severe posterior epistaxis may require ligation of the maxillary artery

 
19. A ten year old girl presented with pain between the eyes, frontal headache,
discharge from the nose, post nasal drip and high fever; what is the provisional
diagnosis? *
0/1
A. Acute frontal sinusitis
 
B. Acute ethmoidal sinusitis
C. Acute sphenoidal sinusitis
D. Sphenoidal tumor
E. Chronic ethmoidal sinusitis

Correct answer
B. Acute ethmoidal sinusitis
Feedback
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1169095/

 
13. The maxillary sinus: *
1/1
A. is lined by stratified squamous epithelium.
B. drains into the superior meatus of the nasal cavities.
C. is innervated by branches of the maxillary division of the trigeminal nerve.
 
D. Receives its blood supply from the first part of the maxillary artery.
Feedback
In common with the rest of the respiratory tract, the air sinuses are lined with respiratory mucosa.
The maxillary sinus drains into the middle meatus and receives its blood supply from the third part of
the maxillary artery by the superior alveolar arteries. The superior alveolar nerves innervate the
sinus and the maxillary teeth, hence the referral of pain from one to the other structure during
toothache or sinusitis

 
22. All of the following are causes of bilateral nasal obstruction except: *
0/1
A. Adenoids
B. Allergic rhinitis
 
C. Antrochoanal polyp
D. Ethmoidal polyp
E. Atrophic rhinitis

Correct answer
C. Antrochoanal polyp
Feedback
Adenoids causing obstruction of both choana. Allergic rhinitis causing alternating bilateral nasal
obstruction. Ethmoidal polyps are multiple bilateral polyps arising from the ethmoidal sinuses.
Despite wide roomy nose in atrophic rhinitis it causes bilateral nasal obstruction because of
crustation and absence of the feeling of air current.

 
2. Sympathetic and parasympathetic fibers arises from the facial nerve forms a
synapse to the sphenopalatine ganglion. It synapses via the vidian nerve and greater
petrosal nerve. *
0/1
A. Both statements are correct
 
B. Both statements are incorrect
C. First statement is correct, second statement is incorrect
D. First statement is incorrect, second statement is correct

Correct answer
D. First statement is incorrect, second statement is correct
Feedback
The sphenopalatine (pterygopalatine) ganglion resides in the pterygopalatine fossa, located
posterior to the middle nasal concha and anterior to the pterygoid canal. It is adjacent to and inferior
to the maxillary nerve, a branch of the trigeminal nerve, and connects with it via the pterygopalatine
nerves. Only parasympathetic fibers arising in the facial nerve synapse in the ganglion via fibers of
the nerve of the pterygoid canal and the greater petrosal nerve.

 
17. The external nose shape is maintained by skeletal framework which is composed
of: *
0/1
A. Bone only
B. Cartilage only
C. Bone in upper 2/3 and cartilage in lower 1/3
 
D. Bone in upper 1/2 and cartilage in lower 1/2
E. Bone in upper 1/3 and cartilage in lower 2/3

Correct answer
E. Bone in upper 1/3 and cartilage in lower 2/3
Feedback
The external nose:- It is pyramidal in shape base cranially and tip caudally ,its shape is maintained
by skeletal framework which is composed of:- 1-bony constituent 2-cartilagenous constituents. The
bony constituents supports the upper 1\3 of the nose and mainly formed by the nasal bones. the
cartilaginous constituents support the lower 2\3 of the external nose and formed by:-1-upper lateral
cartilage 2-lower lateral cartilage 3-quadrilatewral cartilage of the nasal septum.

 
4. Le Fort I level fractures are essentially a separation of the hard palate from the
upper maxilla due to a transverse fracture running through the maxilla and pterygoid
plates at a level just above the floor of the nose. Which of the following structures is
not affected? *
0/1
A. Descending palatine artery
B. Maxillary artery
C. Posterior inferior alveolar artery
D. Descending palatine artery
E. Pterygoid plexus
F. None of the above
 
Correct answer
C. Posterior inferior alveolar artery
Feedback
The incidence of hemorrhage during or after a Le Fort I osteotomy is significantly higher when
compared to mandibular osteotomies.46,47 Major vessels at risk for injury during a Le Fort I
osteotomy are the descending palatine artery, sphenopalatine artery, maxillary artery, posterior
superior alveolar artery, and the pterygoid plexus.46,48-53 Hemorrhage from these vessels can be
minimized or avoided by using care and meticulous technique during the osteotomy and down
fracture of the maxilla.

 
27. The main functions of the nasal concha is to warm the air we breathe and humidify
this air as it passes through the nose. Concha bullosa of the middle turbinates widens
the space through which the sinuses drain. *
0/1
A. Both statementsa are correct
B. Both statements are incorrect
C. First statement is correct, second statement is incorrect
D. First statement is correct, second statement is incorrect
 
Correct answer
C. First statement is correct, second statement is incorrect
Feedback
The turbinates have three main functions. They warm the air we breathe, humidify this air as it
passes through the nose, and the mucous layer of the turbinates assist in filtering particles such as
dust and pollen.

The middle turbinates can be enlarged if an air-bubble develops inside the bone, a condition called
concha bullosa. Concha bullosa of the middle turbinates may narrow the space through which the
sinuses drain, the ostiomeatal complex, and hence can contribute to sinusitis.

 
12. Which of the following paranasal sinuses open into the middle meatus? *
1/1
A. The anterior ethmoidal, frontal and maxillary sinuses
 
B. The anterior ethmoidal and frontal sinuses
C. The anterior ethmoidal sinuses
D. The anterior ethmoidal, frontal, maxillary and sphenoidal sinuses
Feedback
All the paranasal air sinuses open into the middle meatus except the sphenoidal sinus which opens
into the sphenoethmoidal recess and the posterior ethmoidal air cells which open into the superior
meatus