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  1. Omar Mulla, specialty registrar1,
  2. Simon Prowse, specialist registrar1,
  3. Tim Sanders, academic general practitioner2,
  4. Paul Nix, consultant ear, nose, and throat surgeon1
  1. 1Ear, Nose, and Throat Department, Leeds General Infirmary, Leeds LS1 3EX, UK
  2. 2The Shap Medical Practice, Penrith CA10 3LW, UK
  1. Correspondence to: O Mulla omarmulla{at}doctors.org.uk
  • Accepted 7 December 2011

A 52 year old man presents with recurrent epistaxis. It usually settles after 10 minutes.

What you should cover

Ask about

  • Initial onset, frequency, duration, and triggers (such as weather)

  • How are the nose bleeds controlled?

  • Distinguish between anterior (blood running out of the nose, usually one nostril) and posterior (blood running into the throat or from both nostrils) bleeds

  • Trauma, including nose picking

  • Previous nasal surgery

  • Medical history, specifically checking for hypertension and clotting disorders in the patient or their family

  • Medication—check for aspirin, clopidogrel, warfarin, and any potential drug interactions that might have precipitated bleeding. If appropriate, test blood clotting. Also inquire about any homeopathic medicines

  • Assess for symptoms and signs of anaemia if bleeding has been heavy or prolonged. If appropriate, carry out a full blood count

  • Facial pain or deep otalgia with epistaxis may be the first sign of a nasopharyngeal tumour

  • In young male patients consider juvenile nasopharyngeal angiofibroma and ask about …

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