Chapter 36 - Epistaxis
Bailey's Chapter 36
Questions and Answers
- 1.
Epistaxis presenting in a delayed fashion after maxillofacial trauma should raisesuspicion for
- A.
Undiagnosed nasal fracture
- B.
Arterial aneurysm
- C.
Continued traumatic insult to nasal mucosa
- D.
Altered nasal airflow
- E.
Bacterial infection
Correct Answer
B. Arterial aneurysmExplanation
Epistaxis presenting in a delayed fashion after maxillofacial trauma should raise suspicion for an arterial aneurysm. Delayed epistaxis suggests a vascular cause, and an arterial aneurysm can result from trauma to the blood vessels in the nose. This can lead to bleeding that may not be immediately apparent but becomes evident over time. Other options such as undiagnosed nasal fracture, continued traumatic insult to nasal mucosa, altered nasal airflow, and bacterial infection are less likely to cause delayed epistaxis compared to an arterial aneurysm.Rate this question:
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- 2.
The most common familial bleeding disorder to consider in frequent, difficult-to-manage epistaxis is
- A.
Hemophilia a
- B.
Hemophilia b
- C.
Von willebrand’s
- D.
Thrombocytopenia
- E.
Osler-weber-rendu
Correct Answer
C. Von willebrand’sExplanation
Von Willebrand's disease is the most common familial bleeding disorder that can cause frequent and difficult-to-manage epistaxis (nosebleeds). It is a genetic disorder that affects the blood's ability to clot properly due to a deficiency or dysfunction of von Willebrand factor, a protein involved in clotting. This can lead to prolonged bleeding and difficulty in stopping nosebleeds. Hemophilia A and B are also bleeding disorders, but they are less likely to present with frequent epistaxis compared to von Willebrand's disease. Thrombocytopenia refers to a low platelet count, which can cause bleeding, but it is not as common as von Willebrand's disease in causing recurrent nosebleeds. Osler-Weber-Rendu syndrome is a genetic disorder that can cause abnormal blood vessels, leading to nosebleeds, but it is less common than von Willebrand's disease.Rate this question:
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- 3.
In managing epistaxis, posterior nasal packing
- A.
Should be the 1st line therapy
- B.
Should be avoided
- C.
Should not be performed with anterior nasal packing
- D.
Requires the pt to be monitored for hypoxia, apnea and arrhythmias
- E.
May predispose to hypocarbia
Correct Answer
D. Requires the pt to be monitored for hypoxia, apnea and arrhythmiasExplanation
In managing epistaxis, posterior nasal packing requires the patient to be monitored for hypoxia, apnea, and arrhythmias. This is because posterior nasal packing can obstruct the airway and cause difficulty in breathing, leading to decreased oxygen levels and potential respiratory complications. Additionally, the pressure exerted by the packing on the nasal cavity can affect the heart rhythm, necessitating monitoring for arrhythmias. Therefore, close monitoring of the patient's respiratory status and cardiac function is crucial when using posterior nasal packing for epistaxis management.Rate this question:
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- 4.
Signs of fever, nausea/vomiting and diarrhea in the presence of nasal packing mayindicate
- A.
TSS
- B.
Strep infection
- C.
Viral infection
- D.
Contamination of the nasal packing
- E.
Anaphylactic reaction to nasal packing
Correct Answer
A. TSSExplanation
The presence of signs such as fever, nausea/vomiting, and diarrhea in the presence of nasal packing may indicate Toxic Shock Syndrome (TSS). TSS is a rare but serious condition caused by bacterial toxins. It can occur when bacteria enter the body through a wound or a medical device, such as nasal packing, and release toxins into the bloodstream. TSS can cause symptoms like high fever, nausea/vomiting, diarrhea, rash, and low blood pressure. Prompt medical attention is necessary if TSS is suspected, as it can be life-threatening.Rate this question:
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- 5.
The most effective laser for treatment of telangiectasias in O-W-R disease is
- A.
Nd:YAG
- B.
CO2
- C.
KTP
- D.
Argon
- E.
Pulse dye laser
Correct Answer
E. Pulse dye laserExplanation
The pulse dye laser is the most effective laser for treating telangiectasias in O-W-R disease. This laser emits a concentrated beam of light that specifically targets and destroys the dilated blood vessels in the skin, causing them to shrink and fade away. The pulse dye laser's wavelength and pulse duration are optimized for treating vascular lesions, making it an ideal choice for this condition. Nd:YAG, CO2, KTP, and Argon lasers are not as effective in treating telangiectasias in O-W-R disease.Rate this question:
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- 6.
The ICA supplies the nasal mucosa via the _______branches of the______artery
Correct Answer
ethmoidal, ophthalmicExplanation
The ethmoidal branches of the ophthalmic artery supply the nasal mucosa. The ophthalmic artery is a branch of the internal carotid artery (ICA).Rate this question:
- 7.
A patient on Coumadin presents with epistaxis. The site of bleeding is establishedand the patient is packed. INR is 4.5 What should be the next course ofmanagement?
- A.
Hold Coumadin and give Vit K
- B.
Hold Coumadin and give FFP
- C.
Hold Coumadin and give FFP and Vit K
- D.
Continue Coumadin
Correct Answer
B. Hold Coumadin and give FFPExplanation
In this scenario, the patient is on Coumadin (a blood thinner) and presents with epistaxis (nosebleed). The INR (a measure of blood clotting) is elevated at 4.5, indicating that the patient's blood is not clotting properly. The next course of management would be to hold Coumadin, as it is contributing to the bleeding, and give FFP (fresh frozen plasma). FFP contains clotting factors that can help restore normal clotting function. Giving vitamin K alone may not be sufficient in this case, as it takes time for the body to produce enough clotting factors. Therefore, the best option is to hold Coumadin and give FFP to quickly restore clotting function.Rate this question:
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- 8.
Elderly patient with recurrent and persistent epistaxis is taken to the OR forESPAL. Postoperatively, the patient continues to have epistaxis. The most likelyreason is
- A.
Underlying blood disorder
- B.
Anastomosis from the contralateral side
- C.
Anastomosis with the ipsilateral side
- D.
Not all branches were clipped/cauterized
Correct Answer
D. Not all branches were clipped/cauterizedExplanation
The most likely reason for the patient to continue experiencing epistaxis postoperatively is that not all branches were clipped or cauterized during the ESPAL procedure. This suggests that there may still be a source of bleeding that was not addressed during the surgery.Rate this question:
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- 9.
.During ESS, profuse and rapid bleeding is encountered while opening theanterior ethmoidals superiorly. What artery was most likely encountered?
- A.
Ophthalmic Artery
- B.
Anterior Ethmoid A
- C.
Posterior Ethmoid A
- D.
SPA
Correct Answer
B. Anterior Ethmoid AExplanation
During the ESS (endoscopic sinus surgery) procedure, if there is profuse and rapid bleeding encountered while opening the anterior ethmoidals superiorly, it is most likely that the anterior ethmoid artery has been encountered. The anterior ethmoid artery is a branch of the ophthalmic artery and is responsible for supplying blood to the anterior ethmoid sinus. Its injury can lead to significant bleeding in this region.Rate this question:
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