I once had a friend who could make his nose bleed just by tapping it… very useful for getting out of PE! Enjoy this MCQ set on epistaxis and nasal conditions!
Reviewed by: awaiting review
Stem 1, question 1 of 4
You are a Fy1 in A&E and you've just started your shift. 20 minutes in at 8.25, a 26 year old female presents after waking up to a blood stained pillow. She has been driven in by her boyfriend. Her nose appears to still be bleeding from her right nostril.Which of the following would be your first concern?
Her pain level
Her blood pressure
Her risk of airway obstruction
Her current GCS
Stem 1, question 2 of 4
You remember that for anterior bleeds, Kiesselbach's plexus is the most common source of bleeding.Which of the following arteries does not contribute to Kiesselbach's plexus?
Greater palatine artery
Septal branch of the superior labial artery
Lesser palatine artery
Anterior ethmoidal artery
Stem 1, question 3 of 4
Effective first aid is able to stop ~90% of nose bleeds.Which of the following best describes how to manage simple nosebleeds?
Sit forwards so blood doesn't drip back into the stomach. Apply pressure by pinching the anterior aspect of the nose, avoiding the nasal bones. Do this for 15-20 minutes.
Sit forwards so blood doesn't drip back into the stomach. Apply pressure by pinching the anterior aspect of the nose, pinching specifically over the nasal bones. Do this for 5 minutes.
Sit backwards to limit blood dripping out of the nose, aiding clotting. Pinch the anterior aspect of the nose over the nasal bones. Do this for 15-20 minutes.
Sit backwards to limit blood dripping out of the nose, aiding clotting. Pinch the anterior aspect of the nose. Do this for 10 minutes, then sit forwards for 10 minutes.
Pinch the anterior aspect of the nose and place an ice pack to the nape of the neck, initiating vasoconstriction in the nasal mucosa.
Stem 1, question 4 of 4
Simple first aid measures are ineffective at stopping the bleeding in this patient. On examination, you think you can see the site of bleeding- it looks like a small red dot, but you can't quite tell how far it extends.What is your next step?
Nasal packing with a Folley catheter.
Nasal packing with a rapid rhino.
Further examination under anaesthesia.
Nasal cautery with silver nitrate, both nostrils.
Nasal cautery with silver nitrate, only the affected nostril.
Stem 2, question 1 of 5
A 86 year old female presents to A&E with a 12 hour history of epistaxis. She is breathless and very unhappy. She said that pinching her nose hasn't worked and she's subsequently swallowed lots of blood. She is on long term anticoagulation therapy but has not bothered attending her anti-coagulation appointments for the last few months as she feels well in herself. She is tachycardic with a pulse of 121bpm regular and blood pressure 82/64mmH.After fluid resuscitation, what investigations would you order?
An ECG, chest Xray and ABG. Then a coagulation screen.
Bloods for FBC, U&Es, clotting screen and crossmatch. An ECG and ABG.
An ECG, D dimer and ECG
Bloods for FBC, U&Es, clotting screen and crossmatch. A chest X ray
Troponin levels and an ECG
Stem 2, question 2 of 5
In your history taking, you find out the patient takes Warfarin. Her INR is 12.Based on this results, how would you further manage the patient?
Reduce the warfarin dose and check again in an hour.
Administer vitamin K and prothrombin complex.
Stop warfarin completely.
Reduce the warfarin dose and administer vitamin K.
Stop warfarin, administer vitamin K and prothrombin complex concentrate.
Stem 2, question 3 of 5You suspect that her epistaxis is due to over anti-coagulation. Which of the following aren't common causes of epistaxis?
Stem 2, question 4 of 5
After being stabilised, you talk to the patient about the importance of monitoring anticoagulation. She agrees this is with taking seriously. But she says she doesn't like being on warfarin because it has so many interactions.Which of the following doesn't interact with warfarin?
Stem 2, question 5 of 5What would be the best management for this patient as you discharge them?
Restart warfarin and continue with vitamin K.
Arrange anticoagulation follow up and continue with vitamin K.
Arrange anticoagulation follow up and re-start warfarin at a lower dose.
Arrange anticoagulation follow up and re-start warfarin at the same dose.
Arrange anticoagulation follow up and omit warfarin until her appointment.
Possibility of airway obstruction
Septal hematoma or abscess