Epistaxis

Question 1

What is the most common site of anterior epistaxis?

Answer 1

Kiesselbach’s plexus (Little’s area)

This area is highly vascular and prone to bleeding.

Question 2

Name four common causes of epistaxis.

Answer 2

• Local trauma (e.g., nose picking)
• Dry air / mucosal irritation
• URI / rhinitis
• Anticoagulants / antiplatelets

These factors can lead to bleeding from the nasal mucosa.

Question 3

Name three causes of posterior epistaxis.

Answer 3

• Hypertension
• Atherosclerosis (elderly)
• Coagulopathy

These conditions can lead to more severe bleeding from the posterior nasal cavity.

Question 4

Name three features that suggest posterior epistaxis.

Answer 4

• Bleeding from both nostrils
• Blood in posterior pharynx
• Difficult to visualize source / persistent bleeding

These signs indicate that the source of bleeding may be more serious.

Question 5

What is the first step in management of epistaxis?

Answer 5

Direct pressure to the soft part of the nose for 10–15 minutes

This is a simple and effective initial management technique.

Question 6

Name two adjuncts to initial compression.

Answer 6

• Topical vasoconstrictor (e.g., oxymetazoline)
• Lean forward (prevent aspiration)

These adjuncts can help reduce bleeding and prevent complications.

Question 7

Name two indications for cauterization.

Answer 7

• Visible anterior bleeding site
• Failure of compression + vasoconstrictor

Cauterization is used when initial measures are ineffective.

Question 8

Name two contraindications to bilateral nasal cautery.

Answer 8

• Risk of septal perforation
• Avoid cauterizing both sides simultaneously

These contraindications help prevent complications during treatment.

Question 9

Name two options if cautery fails.

Answer 9

• Anterior nasal packing
• Topical tranexamic acid

These options are considered when cauterization does not control the bleeding.

Question 10

Name two indications for posterior packing / ENT referral.

Answer 10

• Suspected posterior epistaxis
• Ongoing bleeding despite anterior measures

These indications suggest a more serious underlying issue requiring specialist intervention.

Question 11

Name two complications of nasal packing.

Answer 11

• Infection (e.g., sinusitis, rare TSS)
• Hypoxia / discomfort

These complications can arise from prolonged nasal packing.

Question 12

Name two discharge instructions for epistaxis.

Answer 12

• Avoid nose blowing / heavy lifting
• Use saline spray + humidification

These instructions help prevent recurrence of epistaxis after treatment.

Question 13

What artery is responsible for most posterior epistaxis?

Answer 13

• Sphenopalatine artery

The sphenopalatine artery is a branch of the maxillary artery and supplies the nasal cavity.

Question 14

Name ONE key instruction to reduce anxiety during epistaxis management.

Answer 14

• Reassure patient and family

Addressing anxiety can help improve cooperation and calmness during treatment.

Question 15

Name THREE key elements of history in epistaxis.

Answer 15

• Onset and duration
• Side of bleeding
• Previous episodes
• Trauma
• Medications (e.g., anticoagulants)
• Substance use (e.g., cocaine)

A thorough history can help identify potential causes and guide management.

Question 16

Name THREE systemic causes of epistaxis.

Answer 16

• Anticoagulation (OAC, ASA, NSAIDs)
• Thrombocytopenia
• Hemophilia
• Leukemia

Systemic causes can affect the blood’s ability to clot, leading to bleeding.

Question 17

If compression fails, what is the next step? Name ONE.

Answer 17

• Nasal packing
• OR topical decongestant with gauze

These methods can help control bleeding when initial measures are ineffective.

Question 18

Name ONE topical agent used before cautery in anterior epistaxis.

Answer 18

• Lidocaine + phenylephrine

This combination helps numb the area and constrict blood vessels.

Question 19

Name ONE method of cautery used for anterior epistaxis.

Answer 19

• Silver nitrate

Silver nitrate is a chemical cauterizing agent that can help seal bleeding vessels.

Question 20

Name ONE indication that suggests need for posterior packing.

Answer 20

• Failure of anterior measures

Posterior packing is often necessary when anterior treatments do not control bleeding.

Question 21

Name ONE definitive treatment if packing fails.

Answer 21

• Surgical arterial ligation
• Endovascular embolization

These interventions are considered when other methods do not resolve the bleeding.

Question 22

Name FOUR indications to order investigations in epistaxis.

Answer 22

• Hemodynamic instability
• Bleeding >10 minutes
• > 30 mL blood loss
• Frequent episodes (~25/year)
• Bilateral bleeding
• Age <2 years
• Family history of bleeding

These factors may indicate a more serious underlying condition.

Question 23

Name THREE labs to order when investigating epistaxis.

Answer 23

• CBC
• INR/PTT
• Group and screen
• Ferritin

These tests help assess blood counts and coagulation status.

Question 24

Name THREE measures to prevent recurrence of epistaxis.

Answer 24

• Nasal emollients (saline gel, Vaseline)
• Humidification
• Topical vasoconstrictors (oxymetazoline)
• Patient education on compression

Preventive measures can help reduce the frequency of bleeding episodes.