Nose and paranasal sinuses: lupus pernio histology: 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: lupus pernio histology

Sample item

A 45-year-old woman has violaceous indurated plaques on the nose and cheeks, chronic nasal crusting and bilateral hilar lymphadenopathy. What would a biopsy of the skin most likely show?

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

The answer and the reasoning

D. Non-caseating epithelioid granulomas

Lupus pernio is a chronic cutaneous form of sarcoidosis, involving the nose, cheeks and ears, often with upper airway disease and hilar nodes. Biopsy shows non-caseating epithelioid granulomas. Lupus vulgaris of the nose is tuberculous and has caseating granulomas, a different diagnosis.

Option by option

  • A. Caseating granulomas with Langhans giant cells

    Caseating granulomas suggest tuberculosis, such as lupus vulgaris.

  • B. Foamy macrophages with Russell bodies

    Foamy macrophages with Russell bodies suggest rhinoscleroma.

  • C. Necrotising vasculitis with geographic necrosis

    Necrotising vasculitis with geographic necrosis suggests granulomatosis with polyangiitis.

  • D. Non-caseating epithelioid granulomas (correct)

    Correct. Sarcoid granulomas are compact and non-caseating.

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 D, Non-caseating epithelioid granulomas. Lupus pernio is a chronic cutaneous form of sarcoidosis, involving the nose, cheeks and ears, often with upper airway disease and hilar nodes.

Why is "Caseating granulomas with Langhans giant cells" not the answer?

Caseating granulomas suggest tuberculosis, such as lupus vulgaris.

Why is "Foamy macrophages with Russell bodies" not the answer?

Foamy macrophages with Russell bodies suggest rhinoscleroma.

Why is "Necrotising vasculitis with geographic necrosis" not the answer?

Necrotising vasculitis with geographic necrosis suggests granulomatosis with polyangiitis.

What concept does this question test?

It tests Nose and paranasal sinuses: lupus pernio histology in ENT. Biopsy shows non-caseating epithelioid granulomas. Lupus vulgaris of the nose is tuberculous and has caseating granulomas, a different diagnosis.

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 and paranasal sinuses: lupus pernio histology?

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.