Epistaxis — Causes and Management

A 52-year-old woman on warfarin for atrial fibrillation (INR 8.5) presents with recurrent posterior epistaxis that has occurred three times in the past 2 weeks. She underwent anterior nasal packing 5 days ago for a previous episode, which was removed after 48 hours without rebleeding. Today, she has active bleeding from the posterior nasal cavity. Vital signs: BP 138/82, HR 92, RR 18. Hemoglobin 9.2 g/dL (baseline 13 g/dL). What is the most appropriate immediate next step in management?

A 42-year-old man with a 10-year history of epistaxis undergoes nasal endoscopy. Bleeding is noted from the posterolateral nasal wall and nasopharynx. A 55-year-old woman presents with acute anterior epistaxis after a fall; examination shows a bleeding point on the nasal septum. Which finding best distinguishes posterior epistaxis from anterior epistaxis?

A 68-year-old woman on warfarin for atrial fibrillation presents with severe epistaxis. Anterior rhinoscopy shows bleeding from the anteroinferior part of the nasal septum. After initial hemostasis, which investigation is most appropriate to identify the underlying vascular source before definitive management?

A 52-year-old man with a history of hypertension presents to the ENT clinic with recurrent epistaxis over the past 3 months. Anterior rhinoscopy reveals a pulsatile mass in the posterolateral wall of the nasopharynx. Which investigation is most appropriate to confirm the diagnosis?

A 35-year-old man with uncontrolled hypertension presents with recurrent epistaxis. On examination, bleeding originates from the anteroinferior part of the nasal septum. Another patient, a 28-year-old with hereditary hemorrhagic telangiectasia (HHT), presents with epistaxis from multiple sites in the nasal cavity. Which feature best distinguishes bleeding from Kiesselbach's plexus versus HHT-related epistaxis?