Epistaxis

Question 1

incidence of epistaxis

Answer 1

Incidence- peaks at <10 yrs & >45 yrs of age

Question 2

Functions of Nose

Answer 2

Humidification
Filtration
Olfaction
Vocal resonance
Aesthetic

Question 3

aetiology: local and systemic

Answer 3

Local:

• trauma
• mucosal irritation
• anatomic abnormalities,
• tumours
• local vascular congestion

Systemic:

• bleeding disorders
• medications
• neoplasms
• inflammatory disorders
• hypertension

Question 4

history

Answer 4

• Initial onset, frequency, duration, and triggers (such as weather).
• How are the nose bleeds controlled?
• Distinguish between anterior (blood running out of the nose, usually one nostril) and posterior (blood running into the throat or from both nostrils) bleeds.
• Trauma, including nose picking.
• Previous nasal surgery.
• Medical history, specifically checking for hypertension and clotting disorders in the patient or their family.
• Medication—check for aspirin, clopidogrel, warfarin, and any potential drug interactions that might have precipitated bleeding. - Also enquire about any homeopathic medicines.
• Facial pain or deep otalgia with epistaxis may be the first sign of a nasopharyngeal tumour.
• In a young male patients consider juvenile nasopharyngeal angiofibroma and ask about nasal obstruction, headache, rhinorrhea, and anosmia.

Question 5

juvenile nasopharyngeal angiofibroma

Answer 5

In a young male patients consider juvenile nasopharyngeal angiofibroma and ask about:

• nasal obstruction
• headache
• rhinorrhea
• anosmia

These are rare benign tumors that tend to bleed. They occur in the nasopharynx of prepubertal and adolescent males.

Question 6

management

Answer 6

Pressure
Cautery
Nasal pack to tamponade bleeding
Surgery

CORRECT ANY UNDERLYING CAUSE

Advice about further bleeding:

1) Pinch the soft part of the nose and lean forward
2) Avoid hot foods and drinks (preventing vasodilatation)
3) Place ice packs on the nose (to promote vasoconstriction).

Question 7

When to refer to ENT

Answer 7

Uncontrolled
Posterior
Recurrent
Anything other than simple

Question 8

What is the circulation blood volume of an adult male?

Answer 8

5l

Question 9

Which fluid are you going to prescribe?

Answer 9

0.9% Saline