Epistaxis

Clinical Summary & Active Recall

FreeMedSite USMLE STEP 1 REVIEW

Interactive Study:

Definition

Bleeding from the nasal cavity, ranging from minor and self-limiting to life-threatening hemorrhage.

Classification

Type	Key Features
Anterior	MC Site: Kiesselbach plexus. Usually mild.
Posterior	MC Site: Sphenopalatine artery. Can be life-threatening.

Kiesselbach Mnemonic

"Kiesselbach drives his Lexus with his LEGS"

Labial (Sup) Ethmoidal (Ant/Post) Greater Palatine Sphenopalatine

Etiology

Local & Inflammatory

• • Trauma (e.g., nose picking)
• • Foreign bodies
• • Allergic Rhinitis

Systemic & Tumors

• • Hypertension
• • Coagulopathies / Anticoagulants
• • Juvenile Nasopharyngeal Angiofibroma

Clinical Pearls

Exam Alert: Adolescent Males
Recurrent, severe epistaxis in an adolescent male is Juvenile Nasopharyngeal Angiofibroma until proven otherwise.

Management
Anterior bleeds: Compression + Vasoconstrictors. Posterior bleeds: Posterior packing or arterial ligation.

High Yield Rapid Fire

Tap the blurred text to reveal the high-yield answer.

1. Most common site for anterior epistaxis?

Answer: Kiesselbach plexus (Little’s area).

2. Most common site for posterior epistaxis?

Answer: Sphenopalatine artery (branch of Maxillary).

3. What does "LEGS" stand for in the Kiesselbach mnemonic?

Answer: Labial (Sup), Ethmoidal, Greater Palatine, Sphenopalatine.

4. Suspected diagnosis in adolescent male with recurrent severe nosebleeds?

Answer: Juvenile Nasopharyngeal Angiofibroma.

5. Why are posterior bleeds considered more dangerous?

Answer: High pressure (arterial) and risk of aspiration.