Nose and paranasal sinuses: spread of nasal vestibule infection: 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 and paranasal sinuses: spread of nasal vestibule infection

Sample item

A man squeezes a furuncle in the nasal vestibule. Two days later he has fever, periorbital oedema, chemosis and ophthalmoplegia, which then becomes bilateral. By which route did the infection most likely spread?

AFacial and angular veins to the ophthalmic veins and cavernous sinusBRetromandibular vein to the external jugular veinCLymphatics to the submandibular nodesDDirect bony erosion through the cribriform plate

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

The answer and the reasoning

A. Facial and angular veins to the ophthalmic veins and cavernous sinus

The facial vein has no valves and communicates through the angular vein with the ophthalmic veins, so infection from the danger area of the face can reach the cavernous sinus. Bilateral eye signs result from spread through the intercavernous sinuses. Furuncles should never be squeezed and need antibiotics.

Option by option

A. Facial and angular veins to the ophthalmic veins and cavernous sinus (correct)
Correct. Valveless veins link the face to the ophthalmic veins and the cavernous sinus.
B. Retromandibular vein to the external jugular vein
Drainage through the external jugular vein does not lead to the orbit or the cavernous sinus.
C. Lymphatics to the submandibular nodes
Lymphatic spread causes tender nodes and does not lead to ophthalmoplegia.
D. Direct bony erosion through the cribriform plate
Bony erosion of the cribriform plate is not the usual route for a skin infection.

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.

Questions about this ENT question

What is the answer to this ENT question?

The best answer is A, Facial and angular veins to the ophthalmic veins and cavernous sinus. The facial vein has no valves and communicates through the angular vein with the ophthalmic veins, so infection from the danger area of the face can reach the cavernous sinus.

Why is "Retromandibular vein to the external jugular vein" not the answer?

Drainage through the external jugular vein does not lead to the orbit or the cavernous sinus.

Why is "Lymphatics to the submandibular nodes" not the answer?

Lymphatic spread causes tender nodes and does not lead to ophthalmoplegia.

Why is "Direct bony erosion through the cribriform plate" not the answer?

Bony erosion of the cribriform plate is not the usual route for a skin infection.

What concept does this question test?

It tests Nose and paranasal sinuses: spread of nasal vestibule infection in ENT. Bilateral eye signs result from spread through the intercavernous sinuses. Furuncles should never be squeezed and need antibiotics.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 and paranasal sinuses: spread of nasal vestibule infection?

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.