Epistaxis MCQs

The mostly likely diagnosis in this case is Wegeners granulamotosis. Sinusitis is the commonest ENT manifestation of this auto immune disorder. Septal perforation (bony and cartilaginous), saddle nose deformity with epistaxis is commonly seen. The multi-system involvement leads to pulmonary symptoms. The biopsy from the nose reveals necrotising vasculitis in this case. ANCA(Anti-neutrophil cytoplasmic antibodies) testing is further helpful for the diagnosis. Reference: Scott Brown's Otolaryngology, Head and Neck Surgery, 8th edition - Volume 1 - Page - 133

Internal carotid artery is a very important source of blood supply to the brain. It is never ligated for control of epistaxis due to the risk of serious cerebral complications and mortality. The following arteries are ligated for control of epistaxis. Transnasal Endoscopic Sphenopalatine Artery Ligation (TESPAL) is done first. If uncontrolled, ligation of maxillary artery is done. Then ligation of external carotid artery above the origin of superior thyroid artery should be done. If still uncontrolled, ligation of ethmoidal arteries is done. Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, pg. no - 210 Gray's Anatomy- The Anatomical Basis of Clinical Practice - 41 st edition - Page - 280

Above middle turbinate , the area is supplied by Internal Carotid Artery through the Ethmoidal arteries . Below middle turbinate , the External Carotid Artery supplies the area through its branches- greater palatine, sphenopalatine and superior labial. Option A – Hypertension and arteriosclerosis lead to posterior epistaxis . Option C - Posterior nasal pack has 3 threads. Two threads are tied at nostril . 3 rd hangs in throat . It helps in removal of pack. Option D - Woodruff is venous plexus in posterior part of lateral wall of nose. It is a site of posterior epistaxis. Reference – Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra ,8 th Edition, pg. no – 205, 207, 208

Endoscopic sphenopalatine artery ligation (ESPAL) is an effective intervention for severe or refractory epistaxis when conservative management fails. It involves the ligation of the sphenopalatine artery, which is the main source of blood supply to the anterior nasal septum. Other options: B. Maxillary artery: While the maxillary artery is the source of blood supply to the sphenopalatine artery, ligating the maxillary artery is an extensive and invasive procedure not typically performed for epistaxis. C. ICA (Internal Carotid Artery): The internal carotid artery is a major blood vessel supplying the brain. D. ECA (External Carotid Artery): This artery supplies blood to the face and scalp. It is not as likely to be the source of epistaxis.

Disc batteries contain alkali - sodium hydroxide, potassium hydroxide and mercury which leaks through them to cause injury. It is observed that a disc battery causes damage to mucosa in 1 hour. Hence disc battery should be urgently removed from the nose. Xylometazoline nasal drops decongest the nose and are used in management of rhinosinusitis. Anterior nasal packing is used in management of epistaxis. Next day removal of foreign body is not suggestive for disc batteries. Reference – Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra ,8 th Edition, pg. no - 409

In rhinitis sicca, the ciliated columnar epithelium undergoes squamous metaplasia with atrophy of seromucinous glands. Rhinitis sicca - Crust-forming disease seen in those who work in hot, dry and dusty surroundings, like bakers, iron- and goldsmiths . Anterior 1/3 rd of nose affected since it is most exposed to the dry air. The ciliated columnar epithelium undergoes squamous metaplasia with atrophy of seromucinous glands. Crust removal → ulceration and epistaxis, and may lead to septal perforation . Treatment - Antibiotic and steroid ointment to the affected part. Reference – Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra ,8 th Edition, pg. no 180

Strawberry appearance of nasal mucosa is seen in Sarcoidosis . Granulomatous disease It is a systemic disorder - involvement of lungs, lymph nodes, eyes or skin. In the nose , it presents with submucosal nodules involving septum or the inferior turbinate with nasal obstruction, nasal pain and sometimes epistaxis X-ray chest shows diffuse pulmonary infiltrate with hilar adenopathy . Serum and urinary calcium levels are raised . Serum ACE (Angiotensin converting enzyme) levels raised in active disease. Biopsy of the lesions helps to establish the diagnosis. Treatment is with systemic steroids. For nasal symptoms, steroids can be used locally as nasal spray. Reference – Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra ,8 th Edition, pg. no 187

Nasal polypi form due to allergy or chronic inflammation. DNS cannot lead to polyp formation. The clinical features of DNS (Deviated Nasal Septum) include- Nasal obstruction Headache – due to a spur pressing the lateral wall of nose or sinusitis Sinusitis - By obstructing the opening of sinus ostia Epistaxis - drying effects of air currents on deviated septum leads to crust formation, which when removed cause bleeding. Anosmia/ Hyposmia – due to failure of the inspired air to reach the olfactory region External Deformity Middle Ear Infection Inferior turbinate hypertrophy on roomier side. Reference – Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra ,8 th Edition, pg. no 172, 173, 200