Epistaxis in children — formative SAQs

SAQ 1 — The seven-year-old with recurrent nosebleeds and bruising (10 marks, 15 minutes)

A seven-year-old girl is referred by her general practitioner for recurrent nosebleeds over four months, two to three times a week, each lasting up to ten minutes and usually from the left nostril. Her mother mentions she bruises easily and has "always had heavy periods," and an uncle had bleeding after a dental extraction. On examination there are a few small bruises on the shins and a faint petechial rash over the knees; the nose shows a prominent vessel on the anteroinferior septum. ^[2]

a) What is the most likely underlying diagnosis to consider, and which two historical features support it? (2 marks) ^[2]

b) State the first-line laboratory panel you would send, and the specific additional tests if the panel is abnormal, naming the commonest inherited cause. (3 marks) ^[2]

c) Explain why you would defer silver-nitrate cautery until after investigation, and state the one-side-of-the-septum rule and the complication it prevents. (3 marks) ^{[6] [5]}

d) Give the definitive management of the recurrent anterior bleeds, including one evidence-based topical measure and its duration, and the safety-net advice. (2 marks) ^[11]