Nose: localising a CSF leak: practice question

A ENT question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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ENT · Nose: localising a CSF leak

Sample item

After a skull base fracture, a patient has persistent clear rhinorrhoea that is positive for beta-2 transferrin, but CT and nasal endoscopy do not show the site. Which method best helps localise the leak before surgery?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Intrathecal fluorescein with nasal endoscopy, or MR cisternography

Beta-2 transferrin confirms CSF. When imaging is non-diagnostic, low-dose intrathecal fluorescein turns the leaking fluid green on endoscopy and MR cisternography shows the fluid track. Localisation guides endoscopic repair.

Option by option

  • A. Repeated nasal swabs

    Swabs do not identify the site.

  • B. Plain skull X-ray

    Plain films cannot show a small dural defect.

  • C. Intrathecal fluorescein with nasal endoscopy, or MR cisternography (correct)

    Correct. Both techniques localise the defect.

  • D. Nasal smear for eosinophils

    Eosinophils indicate allergy, not a leak.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this ENT question

What is the answer to this ENT question?

The best answer is C, Intrathecal fluorescein with nasal endoscopy, or MR cisternography. Beta-2 transferrin confirms CSF.

Why is "Repeated nasal swabs" not the answer?

Swabs do not identify the site.

Why is "Plain skull X-ray" not the answer?

Plain films cannot show a small dural defect.

Why is "Nasal smear for eosinophils" not the answer?

Eosinophils indicate allergy, not a leak.

What concept does this question test?

It tests Nose: localising a CSF leak in ENT. When imaging is non-diagnostic, low-dose intrathecal fluorescein turns the leaking fluid green on endoscopy and MR cisternography shows the fluid track. Localisation guides endoscopic repair.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Nose: localising a CSF leak?

Learn tuning fork results and audiogram patterns by sketching them. Then use the flashcards and the other ENT questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.