ENT & Ophthalmology — UKMLA MCQ
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Correct answer: A — Silver nitrate cautery of the bleeding point
After simple compression fails, the recommended next step is to inspect the nose and treat an identified anterior bleeding point. A visible bleeding point should be cauterized locally, commonly with silver nitrate, after appropriate topical anaesthesia/vasoconstriction and with cautery restricted to the bleeding site. Anterior nasal packing is used when the bleeding point cannot be identified or cautery fails. Surgical sphenopalatine artery ligation is reserved for persistent or recurrent bleeding not controlled by packing or cautery. No intervention is inappropriate, and oral tranexamic acid is not the guideline-recommended next step here.
Reference: American Academy of Otolaryngology–Head and Neck Surgery Foundation. Clinical Practice Guideline: Nosebleed (Epistaxis). Otolaryngology–Head and Neck Surgery. 2020;162(1_suppl):S1-S38. https://journals.sagepub.com/doi/10.1177/0194599819890327