ENT

Question 1

Causes of epistaxis

Answer 1

Nearly always due to local trauma to little’s area (Kiessekbach’s plexus)

Pathological causes

• impaired coagulation (medications, liver failure, bone marrow failure)
• hypertension
• nasal neoplasm
• coccaine use
• rhinosinusitis

Question 2

Signs of nasopharyngeal tumour

Answer 2

Facial pain and epistaxis

Question 3

Management of epistaxis

Answer 3

A to E
-posterior bleeds can cause airway obstruction

Nose compression and Ice to the neck

ENT advice:

• Adrenaline-soaked gauze
• Nitrocautery if single bleeding point visualised
• Anterior packing with rapid rhino

If failed
-posterior packing with Foley catheter with bismuth parathion

All patients with packing require admission

Question 4

Reversing warfarin

Answer 4

Risk vs benefit assessment

IV vitamin K 10mg for three days

FFP IV

Recombinant factor VIIa

Prothrombin complex: Beriplex or Octiplex

Question 5

Little’s area

Answer 5

Also known as Kiesselbach’s plexus

LOCATED IN ANTERIOR WALL OF NASAL SEPTUM
5 arteries
1. anterior ethmoidal artery
2. posterior ethmoidal artery
3. sphenopalatine artery
4. greater palatine artery
5. septal branch of the superior labial artery