Epistaxis Overview and Management
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Questions and Answers

Which of the following are common culprits of rhinitis caused by medication? (Select all that apply)

  • Methylnaltrexone
  • Reserpine (correct)
  • NSAIDs (correct)
  • Methotrexate

    • What is the most likely cause of nasal congestion, a headache that intensifies when bending forward, and a fever?

  • Rhinitis medicamentosa
  • Chronic sinusitis
  • Acute sinusitis (correct)
  • Hypothyroidism

    • Which of the following is NOT a common local trigger for epistaxis?

  • Low humidity
  • Nasal trauma
  • Elevated blood pressure (correct)
  • Rhinitis

    • Which of these is a common presenting symptom of both acute and chronic sinusitis?

    <p>Nasal congestion (D)</p> Signup and view all the answers

    What is the typical presentation of an anterior nosebleed?

    <p>Unilateral bleeding with continuous moderate blood loss (D)</p> Signup and view all the answers

    What is the typical duration of symptoms with subacute sinusitis?

    <p>4 to 12 weeks (B)</p> Signup and view all the answers

    What is the primary treatment for posterior epistaxis?

    <p>Specialist consultation (C)</p> Signup and view all the answers

    What is the primary method used to diagnose rhinitis?

    <p>Physical examination (A)</p> Signup and view all the answers

    Which of the following is a common symptom of allergic rhinitis?

    <p>Nasal-ocular itching (B)</p> Signup and view all the answers

    Which of the following is a diagnostic tool for allergic rhinitis?

    <p>RAST testing (D)</p> Signup and view all the answers

    What is the typical appearance of the nasal membranes in a patient with allergic rhinitis?

    <p>Pale and boggy (C)</p> Signup and view all the answers

    Which of the following are potential causes of anosmia?

    <p>Aging (A), Head or facial trauma (D)</p> Signup and view all the answers

    Which diagnostic test is often used to evaluate a patient with suspected sinusitis?

    <p>CT scan (C)</p> Signup and view all the answers

    What is the primary cause of epistaxis in children under 10 years of age?

    <p>Idiopathic (unknown cause) (B)</p> Signup and view all the answers

    Which of the following is not a common symptom of sinusitis?

    <p>Sneezing (D)</p> Signup and view all the answers

    Which of the following is a common systemic condition that can lead to epistaxis?

    <p>Hematologic cancers (C)</p> Signup and view all the answers

    Which classification of medications is commonly used to treat sinusitis symptoms?

    <p>Antibiotics (D)</p> Signup and view all the answers

    A patient presents with nasal congestion, yellowish-green nasal discharge, and frontal sinus pain that worsens when leaning forward. Which condition is most likely?

    <p>Acute sinusitis (A)</p> Signup and view all the answers

    Which of the following conditions can cause a distorted sense of smell?

    <p>Parosmia (C)</p> Signup and view all the answers

    Which of the following is a recommended treatment for anterior epistaxis?

    <p>Leaning the patient forward to prevent blood swallowing (B)</p> Signup and view all the answers

    Which of the following diagnostic tests may be used to evaluate smell disturbances?

    <p>University of Pennsylvania Smell Identification Test (C)</p> Signup and view all the answers

    Which of the following is NOT a potential cause of taste disturbance?

    <p>Viral rhinosinusitis (D)</p> Signup and view all the answers

    Which of the following is a common treatment for smell and taste disturbances?

    <p>Intranasal glucocorticoid steroid treatment (A)</p> Signup and view all the answers

    Which of the following laboratory tests may be utilized to investigate the cause of anosmia or dysgeusia?

    <p>All of the above (D)</p> Signup and view all the answers

    Which of the following is the most common type of benign tumor in the nose?

    <p>Inverted papilloma (A)</p> Signup and view all the answers

    Which of the following is a common presentation of malignant tumors in the nose?

    <p>Unilateral nasal obstruction and discharge with pain (A)</p> Signup and view all the answers

    Which of the following is NOT a diagnostic tool used for tumors and polyps of the nose?

    <p>Electrocardiogram (ECG) (A)</p> Signup and view all the answers

    Which of the following medications is commonly used for treating nasal polyps?

    <p>Intranasal corticosteroids (C)</p> Signup and view all the answers

    What is the 'gold standard' diagnostic tool used for tumors and polyps of the nose?

    <p>Endoscopic evaluation and biopsy (C)</p> Signup and view all the answers

    Which of the following is a characteristic feature of posterior epistaxis?

    <p>Bleeding into the pharynx (D)</p> Signup and view all the answers

    Which of the following interventions is NOT recommended for managing anterior epistaxis?

    <p>Administering antibiotics (D)</p> Signup and view all the answers

    What is a defining characteristic of subacute sinusitis?

    <p>Symptom resolution within 4-12 weeks (D)</p> Signup and view all the answers

    Which of the following is NOT a common symptom of acute sinusitis?

    <p>Loss of smell (C)</p> Signup and view all the answers

    Which of the following medications is commonly associated with rhinitis?

    <p>Beta-blockers (B)</p> Signup and view all the answers

    Which of the following is NOT a potential cause of rhinitis medicamentosa?

    <p>Antibiotics (B)</p> Signup and view all the answers

    Which of these conditions is MOST likely if a patient presents with nasal congestion, yellowish-green nasal discharge, and frontal sinus pain that worsens when leaning forward?

    <p>Acute sinusitis (D)</p> Signup and view all the answers

    Which of the following is a diagnostic tool used to evaluate a patient with suspected allergic rhinitis?

    <p>Allergy referral (A)</p> Signup and view all the answers

    Which of the following is a common symptom of sinusitis that is more pronounced in the morning or when bending forward?

    <p>Facial pain (B)</p> Signup and view all the answers

    Which of the following is the 'gold standard' diagnostic tool used for tumors and polyps of the nose?

    <p>Nasal endoscopy (A)</p> Signup and view all the answers

    Which of the following is a defining characteristic of chronic sinusitis?

    <p>Symptoms persisting for 12 weeks or longer (D)</p> Signup and view all the answers

    Which of the following is a potential cause of sinusitis?

    <p>All of the above (D)</p> Signup and view all the answers

    Which of the following is NOT a typical symptom of chronic sinusitis?

    <p>High fever (C)</p> Signup and view all the answers

    What is the most likely cause of anosmia (loss of smell)?

    <p>Head injury (A)</p> Signup and view all the answers

    Which of the following medications is commonly used to treat sinusitis?

    <p>All of the above (D)</p> Signup and view all the answers

    Which of the following is a recommended treatment for smell and taste disturbances?

    <p>Intranasal corticosteroids (A)</p> Signup and view all the answers

    Which of the following is the most common type of malignant tumor found in the nose, nasopharynx, and paranasal sinuses?

    <p>Squamous cell carcinoma (B)</p> Signup and view all the answers

    What is the primary presenting symptom of an inverted papilloma, a common type of benign tumor in the nose?

    <p>All of the above (D)</p> Signup and view all the answers

    Which imaging study is considered the 'gold standard' for diagnosing tumors and polyps in the nose?

    <p>Endoscopic evaluation and biopsy (B)</p> Signup and view all the answers

    Which of the following is a common treatment option for nasal polyps?

    <p>All of the above (D)</p> Signup and view all the answers

    What is a common presenting symptom of malignant tumors in the nose?

    <p>All of the above (D)</p> Signup and view all the answers

    Which of the following is NOT a common benign tumor in the nose?

    <p>Malignant lymphoma (D)</p> Signup and view all the answers

    Which of the following is a potential treatment option for malignant tumors of the nose?

    <p>All of the above (D)</p> Signup and view all the answers

    Which of the following is a common symptom of both benign and malignant tumors in the nose?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the most likely reason for a patient to be referred to an Otorhinolaryngologist?

    <p>Suspected tumor or polyp in the nose (C)</p> Signup and view all the answers

    Study Notes

    Epistaxis (Nosebleeds)

    • Most nosebleeds are idiopathic, highest incidence in individuals under 10 and over 40.
    • Local triggers include nasal trauma, rhinitis, low humidity, nasal septal deviation, alcohol use, and chemical irritants (e.g., cocaine).
    • Systemic conditions that can cause nosebleeds include genetic or acquired coagulation disorders, hematologic cancers, and anticoagulation medication.

    Anterior Nosebleeds

    • Usually unilateral and involve moderate, continuous bleeding.
    • Small clots may be present, depending on the bleeding amount.
    • Bleeding may be spontaneous or follow nasal trauma.

    Posterior Nosebleeds

    • Can occur bilaterally and involve severe bleeding, often difficult to treat.
    • Bleeding into the pharynx is a sign of a posterior nosebleed.

    Epistaxis Management

    • Assess ABCs and CBC.
    • Apply direct pressure to the anterior portion of the nose for 15 minutes.
    • Have the patient sit upright and lean forward to reduce venous pressure and swallowing of blood.
    • May apply short-acting topical nasal decongestants (e.g., phenylephrine 0.125% to 1%).
    • Consider nasal packing.
    • Posterior nosebleeds require specialist consultation.

    Rhinitis

    • Rhinitis is a nasal sinus cavity inflammation triggered by exposures that prompt the body to remove foreign objects.
    • Allergic rhinitis causes a heterogeneous, inflammatory response affecting paranasal and sinus mucosa, characterized by sneezing, rhinorrhea, mucosal swelling, obstruction, conjunctivitis, and nasal-ocular and pharyngeal itching, in response to allergens.
    • Membranes typically have a pale, violaceous color and edematous appearance.
    • Other causes of rhinitis include infectious, anatomic, pharmacological, food/drink related, rhinitis medicamentosa, and other medical conditions such as pregnancy, hypothyroidism, cocaine use, and atrophic change.

    Rhinitis Diagnosis and Management

    • Diagnostics are based on clinical findings; cytologic studies (Wright Stain) and allergy referrals (RAST testing).
    • Management includes antihistamines, oral decongestants, intranasal steroids and environmental avoidance; thorough medication review is essential as many medications can trigger rhinitis.

    Sinusitis

    • Acute sinusitis resolves within 2-3 weeks of treatment; bacterial, viral, fungal, or allergic causes.
    • Abrupt onset, nasal congestion, purulent nasal discharge, headaches worsened by bending forward, fever, and fatigue are common.
    • A full HEENT and dermatologic exam are performed for diagnostics.
    • Nasal congestion, facial/dental pain, postnasal drip, headache, fever and yellow or green nasal discharge are common symptoms.
    • Sensations of pain in the teeth and forehead are often worse in the morning.
    • Frontal and maxillary sinus pain on palpation also are common symptoms and prodromal common cold, allergic or idiopathic rhinitis may be also present.

    Sinusitis - Subacute & Chronic

    • Subacute sinusitis resolves within 4 to 12 weeks, while chronic sinusitis lasts over 12 weeks.
    • Prolonged sinus infection (greater than 12 weeks), resisting treatment or with recurrent acute infections is characteristic.
    • Frequent exacerbations, often caused by gram-negative or anaerobic microorganisms are common in chronic cases.
    • Nasal congestion, discharge, a cough lasting more than 30 days, and dull headaches are frequently observed.
    • CT scans are used for recalcitrant cases. MRI with/without contrast, might be required for suspected masses.

    Sinusitis Management

    • Symptomatic treatment for rhinorrhea, sneezing, and coughing (viral rhinosinusitis).
    • Pharmacotherapy includes first-generation antihistamines, NSAIDs, decongestants or cough suppressant.
    • Antibiotics may be prescribed for symptomatic durations lasting over 10 days and/or purulent discharges. Antibiotic choices should be individualized based on community resistance.

    Smell and Taste Disturbances

    • Anosmia (loss of sense of smell), Parosmia (smell distortion) and Hyposmia (diminished sense of smell) can be caused by aging, tobacco, toxins, medications, malignant neoplasms, nasal inflammation, infection, malnutrition, head or facial trauma, Parkinson's disease, Alzheimer's disease, multiple sclerosis, diabetes, or inflammatory autoimmune disease.
    • Hypogeusia (diminished taste), ageusia (absent taste), and dysgeusia (persistent or unpleasant taste) can also result from similar underlying conditions, as well as endocrinologic dysfunction, anesthesia, malignant neoplasms, head or neck irradiation, and surgical procedures.

    Smell and Taste Disturbances - Diagnostics & Management

    • Exam and diagnostics include HEENT exam, cranial nerve exam, University of Pennsylvania Smell Identification Test, Sniffin' Sticks, CBC, electrolytes, BUN, creatinine, LFTs, TSH, ANA, ESR, SSA, LA/SSB, vitamin levels, metal concentrations, MRI, and CT scanning.
    • Treatment focuses on addressing underlying conditions like rhinitis, sinusitis, infections, gastroesophageal reflux disease, or anemia.
    • Medications triggering the problem may be discontinued. Intranasal glucocorticoids often are effective.
    • Additional treatments include antihistamines, leukotriene inhibitors, proton pump inhibitors (for GERD-related throat pain), and tricyclic antidepressants. Referral to a specialist might be necessary for ineffective interventions.

    Tumors and Polyps of the Nose

    • Malignant tumors (e.g., carcinomas, lymphomas, sarcomas, melanomas, squamous cell carcinoma) can develop in the nose, nasopharynx, and paranasal sinuses.
    • Benign tumors, like Juvenile angiofibroma and inverted papilloma, are common types.
    • Symptoms vary but may include nasal obstruction, discharge, facial swelling, bleeding (epistaxis), headache and/or visual/olfactory changes. Early symptoms often remain asymptomatic.
    • Diagnostics for tumors usually include a full HEENT and nasopharynx exam, sinus X-rays, CT scans, MRI, and potentially endoscopic evaluations/biopsies.
    • Management for malignant tumors often involves chemotherapy or radiotherapy. For nasal polyps, nasal topical steroids, intranasal capsaicin, surgical excision, or referral to otorhinolaryngology may be needed .

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    Description

    This quiz covers the essential information regarding epistaxis, commonly known as nosebleeds. It addresses the types of nosebleeds, their triggers, and effective management strategies. Learn how to assess and treat this common condition with appropriate techniques and considerations.

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