Head and neck imaging: juvenile nasopharyngeal angiofibroma: practice question

A Radiology 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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Radiology · Head and neck imaging: juvenile nasopharyngeal angiofibroma

Sample item

An adolescent boy has recurrent profuse epistaxis. CT shows a mass at the sphenopalatine foramen with anterior bowing of the posterior wall of the maxillary sinus. What is the best step before surgical excision?

AFine needle aspiration under topical anaesthesiaBPre-operative embolisation of the internal maxillary artery feedersCRadiotherapy alone as definitive treatmentDIncisional biopsy in the clinic

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

The answer and the reasoning

B. Pre-operative embolisation of the internal maxillary artery feeders

The anterior bowing of the posterior maxillary wall, the Holman-Miller sign, with a sphenopalatine foramen mass in an adolescent male indicates juvenile nasopharyngeal angiofibroma, a highly vascular tumour. Embolisation of the internal maxillary feeders reduces blood loss at surgery. Biopsy risks torrential bleeding.

Option by option

A. Fine needle aspiration under topical anaesthesia
Needle aspiration also risks bleeding and is not diagnostic.
B. Pre-operative embolisation of the internal maxillary artery feeders (correct)
Correct. Embolising the feeding vessels reduces operative bleeding.
C. Radiotherapy alone as definitive treatment
Radiotherapy is reserved for unresectable or recurrent disease, not first-line treatment.
D. Incisional biopsy in the clinic
A blind biopsy of a vascular tumour can cause severe haemorrhage.

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 Radiology question

What is the answer to this Radiology question?

The best answer is B, Pre-operative embolisation of the internal maxillary artery feeders. The anterior bowing of the posterior maxillary wall, the Holman-Miller sign, with a sphenopalatine foramen mass in an adolescent male indicates juvenile nasopharyngeal angiofibroma, a highly vascular tumour.

Why is "Fine needle aspiration under topical anaesthesia" not the answer?

Needle aspiration also risks bleeding and is not diagnostic.

Why is "Radiotherapy alone as definitive treatment" not the answer?

Radiotherapy is reserved for unresectable or recurrent disease, not first-line treatment.

Why is "Incisional biopsy in the clinic" not the answer?

A blind biopsy of a vascular tumour can cause severe haemorrhage.

What concept does this question test?

It tests Head and neck imaging: juvenile nasopharyngeal angiofibroma in Radiology. Embolisation of the internal maxillary feeders reduces blood loss at surgery. Biopsy risks torrential bleeding.

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 Head and neck imaging: juvenile nasopharyngeal angiofibroma?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology 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.