A 7-Year-Old Girl Is Brought to the Office for a Routine

question 1088

Multiple Choice

A 7-year-old girl is brought to the office for a routine health maintenance examination.  While in the waiting room, she develops a nosebleed.  An assistant pinches the patient's nasal alae against the nasal septum for 10 minutes while the girl is seated and leaning forward.  This slows, but does not stop, the flow of blood.  Prior to the appointment, the patient was at a summer camp playing outside in hot, dry weather.  She has had no recent facial trauma, unusual bruising, or gingival bleeding.  Blood pressure is 100/70 mm Hg and pulse is 94/min.  On examination, the patient is sitting in a chair, awake, alert, and in no distress.  A continuous trickle of blood from her left naris obscures the mucosa.  She has no oropharyngeal lesions.  Which of the following is the best next step in management of this patient's condition?

• A)Apply a topical nasal corticosteroid to the left nostril
• B)Apply topical lidocaine and cauterize with silver nitrate
• C)Insert a bacitracin-covered sponge to tamponade the bleeding
• D)Insert a posterior nasal pack with a catheter
• E)Place a cotton pledget with a topical vasoconstrictor

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Definitions:

Serum Protein

Proteins present in blood serum, involved in various functions such as clotting, immune responses, and transporting substances.

Urine

A liquid by-product of metabolism in humans and many animals, expelled through the urethra during urination, serving as a key method for the excretion of waste products from the body.

Milky Appearance

Describes a visual characteristic often associated with fluids that are opaque and white, resembling milk.

Urine Sample

A sample of urine collected for medical testing to diagnose or monitor conditions affecting the urinary tract and beyond.