Nose and Epistaxis Practice Questions

30 multiple-choice questions on Nose and epistaxis for paramedic and EMT students, from Chapter 20 (Diseases of the Eyes, Ears, Nose, and Throat). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

30 practice questions

1. Where do most nosebleeds originate?

   1. A. Superior turbinate
   2. B. Maxillary sinus
   3. C. Posterior nasopharynx
   4. D. Anterior septum
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   Answer: D. Anterior septum

   About 90% of nosebleeds are anterior, arising from Kiesselbach's plexus on the anterior septum. They are usually easy to control with pressure.

2. The area of the anterior nasal septum with a rich network of vessels is called:

   1. A. Kiesselbach's plexus
   2. B. Woodruff's plexus
   3. C. Sphenopalatine ganglion
   4. D. Pterygoid plexus
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   Answer: A. Kiesselbach's plexus

   Kiesselbach's plexus (Little's area) is where several arteries meet on the anterior septum and is the most common site of anterior epistaxis. Woodruff's plexus lies at the back of the nasal cavity and is linked to posterior bleeds, the pterygoid plexus is a network of veins deep in the face, and the sphenopalatine ganglion is a nerve cluster rather than a vascular network.

3. Which type of nosebleed is more likely to cause significant blood loss and airway compromise?

   1. A. Septal hematoma
   2. B. Posterior epistaxis
   3. C. Nasal vestibulitis
   4. D. Anterior epistaxis
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   Answer: B. Posterior epistaxis

   Posterior bleeds are less common but often more severe, harder to control, and can drain down the throat, risking aspiration, vomiting, and hypovolemia.

4. A 64-year-old has a nosebleed controlled with pressure. His BP is 224/132 mm Hg, and he has a severe headache, new confusion and chest pain. How should you interpret the high BP?

   1. A. A normal stress response to bleeding
   2. B. A sign of a bleeding disorder
   3. C. Signs of a hypertensive emergency
   4. D. A reason to release the pressure
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   Answer: C. Signs of a hypertensive emergency

   A high BP during a nosebleed is often from anxiety and is not lowered aggressively in the field, but confusion, severe headache and chest pain are signs of organ damage, which makes this a hypertensive emergency needing rapid transport and evaluation of the brain and heart. Calling it a normal stress response ignores the organ signs, high BP is not a sign of a bleeding disorder, and nothing about the BP is a reason to release the pressure.

5. What is the correct position for a conscious patient with an uncomplicated nosebleed?

   1. A. Supine with head tilted back
   2. B. Sitting up and leaning forward
   3. C. Trendelenburg position
   4. D. Sitting and leaning backward
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   Answer: B. Sitting up and leaning forward

   Leaning forward keeps blood from flowing into the airway and stomach. Tilting the head back can cause swallowing of blood, nausea, vomiting, and aspiration.

6. Why should a patient with epistaxis avoid tilting the head back?

   1. A. It slows clot formation
   2. B. It compresses the neck vessels
   3. C. It raises blood pressure
   4. D. Blood may be aspirated
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   Answer: D. Blood may be aspirated

   Blood running down the throat can be aspirated or swallowed, and swallowed blood is a gastric irritant that commonly causes vomiting. Head position does not slow clotting at the bleeding site or compress the neck vessels, and tilting back does not raise blood pressure; the danger is where the blood goes.

7. Where should pressure be applied to control an anterior nosebleed?

   1. A. Pinch the soft fleshy nostrils together
   2. B. Press under the upper lip only
   3. C. Apply ice to the back of the neck
   4. D. Press on the bony bridge of the nose
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   Answer: A. Pinch the soft fleshy nostrils together

   Firmly pinching the soft, fleshy part of the nose compresses the anterior septum and Kiesselbach's plexus. Pressing the bony bridge does not compress the bleeding site.

8. How long should continuous pressure be held for an anterior nosebleed before checking?

   1. A. 30 to 60 seconds
   2. B. 45 to 60 minutes
   3. C. 2 to 3 minutes
   4. D. 10 to 15 minutes
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   Answer: D. 10 to 15 minutes

   Continuous pressure for roughly 10 to 15 minutes without releasing to peek allows a clot to form. Releasing early often restarts bleeding.

9. Which condition is a common risk factor for epistaxis?

   1. A. Anticoagulant use
   2. B. Beta-blocker use
   3. C. Daily iron supplements
   4. D. Hypothyroidism
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   Answer: A. Anticoagulant use

   Anticoagulants and antiplatelet agents increase bleeding risk. Other risk factors include dry air, nose picking, trauma, hypertension, cocaine use, and coagulopathies.

10. A 40-year-old has frequent nosebleeds and a perforated nasal septum. Which history would best explain this?

    1. A. Intranasal cocaine use
    2. B. Seasonal allergies treated with pills
    3. C. Daily aspirin for 1 week
    4. D. Chronic constipation
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    Answer: A. Intranasal cocaine use

    Chronic intranasal cocaine use causes vasoconstriction, ischemia, and septal necrosis and perforation, which predispose to bleeding.

11. A patient with a nosebleed is pale and dizzy, with a heart rate of 128 and BP of 92/60. What is the priority in addition to bleeding control?

    1. A. Delay transport until bleeding stops
    2. B. Pack the nose with tampons
    3. C. Have him lie flat and tilt head back
    4. D. Treat for shock and establish IV access
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    Answer: D. Treat for shock and establish IV access

    Signs of hypovolemia require shock management, including IV access and fluids per protocol. Positioning should still protect the airway.

12. What is the most appropriate airway step for an obtunded patient with heavy posterior epistaxis?

    1. A. Position on side and suction
    2. B. Pinch the nostrils only
    3. C. Insert a nasopharyngeal airway
    4. D. Lay supine and give oral fluids
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    Answer: A. Position on side and suction

    Protect the airway from aspiration with lateral positioning and aggressive suctioning; advanced airway management may be needed. NPAs are avoided in active nasal bleeding and possible facial fractures.

13. Which medication, per many protocols, can be sprayed into the nose to help control anterior epistaxis?

    1. A. Ipratropium
    2. B. Albuterol
    3. C. Intranasal naloxone
    4. D. Oxymetazoline
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    Answer: D. Oxymetazoline

    Oxymetazoline is a topical vasoconstrictor used in some EMS protocols to help control anterior nosebleeds along with direct pressure. It is not used in all systems.

14. Which statement about hypertension and nosebleeds is most accurate?

    1. A. High BP may prolong bleeding
    2. B. BP should be lowered rapidly in the field
    3. C. It is the main cause of most nosebleeds
    4. D. It means the nose cannot form a clot
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    Answer: A. High BP may prolong bleeding

    Elevated BP can make bleeding harder to control, but most nosebleeds come from dry or picked mucosa, and anxiety commonly raises BP. Rapid BP lowering in the field is not indicated, high BP is not the main cause of most nosebleeds, and the nose can still form a clot with firm pressure.

15. A child has a foul-smelling discharge from one nostril only. What is most likely?

    1. A. Allergic rhinitis
    2. B. Bilateral sinusitis
    3. C. Common cold
    4. D. Nasal foreign body
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    Answer: D. Nasal foreign body

    Unilateral foul or bloody nasal discharge in a child strongly suggests a retained foreign body. Bilateral discharge is more typical of infection or allergy.

16. A 3-year-old pushed a button battery into his nostril. Why is this an urgent situation?

    1. A. It blocks breathing through the nose
    2. B. It leaks toxic heavy metals
    3. C. It is a risk mainly if it cracks
    4. D. It can cause rapid tissue necrosis
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    Answer: D. It can cause rapid tissue necrosis

    Button batteries in the nose can cause liquefactive necrosis and septal perforation within hours, so they need prompt removal in the ED. The injury comes from electrical current that produces alkali where the battery touches tissue, so an intact battery is dangerous, and heavy metal leakage is not the main problem. A child can breathe through the mouth, so nasal blockage is not what makes it urgent.

17. A 7-year-old put two small round magnets in her nose, one in each nostril. They are now stuck together through the septum. Why is this urgent?

    1. A. They may block nasal breathing
    2. B. The pinch can kill septal tissue
    3. C. The magnets will fall out on their own
    4. D. Magnets disrupt the heart rhythm
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    Answer: B. The pinch can kill septal tissue

    Two magnets attracting each other across the nasal septum squeeze the tissue between them, which can cut off its blood supply and cause necrosis or a hole in the septum within hours, so she needs prompt removal in the ED. She can still breathe through her mouth, small magnets do not affect the heart rhythm, and they will not fall out while held together.

18. Which finding after nasal trauma is an urgent concern that requires drainage?

    1. A. A displaced nasal fracture
    2. B. Septal hematoma
    3. C. Mild swelling of the nose
    4. D. A laceration of the nasal bridge
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    Answer: B. Septal hematoma

    A septal hematoma is a bluish, boggy swelling on the septum. If not drained, it can lead to cartilage necrosis, abscess, and a saddle nose deformity. A displaced nasal fracture is reduced later rather than drained, a laceration is cleaned and closed, and mild swelling settles with cold packs.

19. A patient struck in the nose has deformity, swelling, and bleeding. Which action is appropriate?

    1. A. Insert an NPA to keep it open
    2. B. Realign the nose in the field
    3. C. Pack the nose tightly with gauze
    4. D. Bleeding control and cold packs
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    Answer: D. Bleeding control and cold packs

    Control bleeding, apply cold packs to reduce swelling, and assess for other facial, head, and cervical injuries. Do not attempt reduction in the field.

20. A 34-year-old who snorts cocaine regularly has crusting inside his nose, frequent small nosebleeds and a whistling sound when he breathes through his nose. What is the most likely cause?

    1. A. Allergic rhinitis from dust
    2. B. A hole in the nasal septum
    3. C. A foreign body in one nostril
    4. D. A deviated septum from birth
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    Answer: B. A hole in the nasal septum

    Cocaine tightly constricts the small vessels of the septum, and repeated use can kill the cartilage and leave a septal perforation, which causes crusting, nosebleeds and a whistling sound with nasal breathing. Ask about use without judgment and report it to the hospital. Allergic rhinitis from dust causes sneezing and clear discharge without whistling, a foreign body in one nostril causes one-sided foul discharge, usually in a child, and a deviated septum from birth blocks one side rather than causing crusting and whistling.

21. How can you quickly check whether nasal drainage after head trauma may contain CSF?

    1. A. Check for a foul odor
    2. B. Check for a halo sign
    3. C. Test for a bitter taste
    4. D. Look for a green color
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    Answer: B. Check for a halo sign

    Blood containing CSF may form a halo or target pattern on gauze, with a clear ring around a central blood spot. The finding is suggestive, not definitive.

22. A patient has a nosebleed, bruising over both arms, and bleeding gums. What should you consider?

    1. A. Simple dry-air nosebleed
    2. B. A bleeding disorder
    3. C. Allergic rhinitis
    4. D. Acute sinus infection
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    Answer: B. A bleeding disorder

    Multiple bleeding sites suggest coagulopathy from anticoagulants, liver disease, thrombocytopenia, leukemia, or inherited disorders.

23. Which inherited condition causes recurrent nosebleeds from abnormal blood vessels in the nasal mucosa?

    1. A. Osler-Weber-Rendu disease
    2. B. Von Hippel-Lindau disease
    3. C. Ehlers-Danlos syndrome
    4. D. Sturge-Weber syndrome
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    Answer: A. Osler-Weber-Rendu disease

    Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu) produces fragile telangiectasias in the nose, skin, and organs, causing recurrent epistaxis.

24. A patient with a posterior nasal pack in place is being transferred. What complication should you watch for?

    1. A. A rise in intracranial pressure
    2. B. Facial nerve palsy
    3. C. Sudden hearing loss
    4. D. Airway obstruction
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    Answer: D. Airway obstruction

    Posterior packs can slip and obstruct the airway, and they can also trigger reflex bradycardia and hypoventilation. Monitor SpO2 and airway closely. A nasal pack does not raise intracranial pressure or injure the facial nerve, and sudden hearing loss is not an expected problem.

25. Which environmental factor commonly causes nosebleeds, especially in winter?

    1. A. Dry indoor air
    2. B. Bright sunlight
    3. C. High humidity
    4. D. Cold water exposure
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    Answer: A. Dry indoor air

    Dry air dries and cracks the nasal mucosa, making vessels fragile. Humidifiers and saline sprays help prevent recurrence.

26. Inflammation of the paranasal sinuses with facial pain and purulent nasal discharge is called:

    1. A. Epiglottitis
    2. B. Pharyngitis
    3. C. Sinusitis
    4. D. Rhinitis
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    Answer: C. Sinusitis

    Sinusitis causes facial pressure or pain, nasal congestion, and discharge. Rarely, it spreads to the orbit or brain.

27. A patient with sinusitis develops a severe headache, fever, stiff neck, and confusion. What complication do you suspect?

    1. A. Intracranial infection
    2. B. Simple viral rhinitis
    3. C. Severe allergic reaction
    4. D. Tension headache only
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    Answer: A. Intracranial infection

    Sinus infections can spread to the meninges or brain (meningitis, abscess) or to the cavernous sinus. Altered mental status and meningismus are red flags.

28. A 78-year-old on 4 L/min of oxygen by nasal cannula at home has had several small nosebleeds this week. The air in her home is very dry. What is the most likely cause?

    1. A. A tumor of the nasal septum
    2. B. Dry nasal lining from oxygen
    3. C. A bleeding disorder from oxygen
    4. D. A blood pressure that is too low
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    Answer: B. Dry nasal lining from oxygen

    Continuous oxygen through a nasal cannula dries the nasal lining, especially in dry indoor air, which makes the small vessels crack and bleed. Humidifying the oxygen and using a water-based nasal gel help, and a face mask can be used while it bleeds. A tumor of the septum is far less likely, oxygen does not cause a bleeding disorder, and a blood pressure that is too low does not cause nosebleeds.

29. A patient took a blow to the nose and is now holding a towel. Bleeding has stopped. What should you advise about preventing rebleeding?

    1. A. Sneeze with mouth closed
    2. B. Lie flat for 24 hours
    3. C. Blow the nose to clear clots
    4. D. Avoid blowing the nose
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    Answer: D. Avoid blowing the nose

    Blowing the nose, picking it, or straining can dislodge the clot. Sneezing with the mouth open reduces pressure.

30. You are managing epistaxis in a patient who is also vomiting dark material. What is a likely explanation?

    1. A. Bile from an empty stomach
    2. B. Coffee or cola drunk earlier
    3. C. Swallowed blood
    4. D. Food poisoning from a meal
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    Answer: C. Swallowed blood

    Swallowed blood irritates the stomach and causes vomiting, and digested blood can look dark. Consider true GI bleeding as well if history suggests it. Bile is green-yellow rather than dark, and recent drinks or a foodborne illness do not explain dark vomit in a patient who has been swallowing blood from a nosebleed.