Anterior/Posterior Nasal Packing MCQ Quiz | Procedures – Minor

1. The most common source of anterior epistaxis is:

• Kiesselbach’s plexus
• Woodruff’s plexus
• The ethmoidal arteries
• The sphenopalatine artery

2. Before performing anterior nasal packing for epistaxis, what is the recommended first-line management step?

• Administer systemic antibiotics
• Apply direct pressure and a topical vasoconstrictor
• Immediately insert a posterior pack
• Perform silver nitrate cautery without anesthesia

3. Which of the following is a potential life-threatening complication specifically associated with posterior nasal packing?

• Septal perforation
• Acute sinusitis
• Airway obstruction and hypoxia
• Nasal alar necrosis

4. A patient with nasal packing develops a high fever, diffuse erythematous rash, and hypotension. What is the most likely diagnosis?

• Sepsis from sinusitis
• Toxic Shock Syndrome (TSS)
• Anaphylactic reaction to packing material
• Meningitis

5. When using a Foley catheter for posterior epistaxis control, the balloon should be inflated with:

• Air, for easy removal
• Lidocaine solution for analgesia
• Sterile water or saline
• Contrast medium for radiographic confirmation

6. What is the standard duration for leaving a non-absorbable anterior nasal pack in place?

• 6-12 hours
• 24-48 hours
• 5-7 days
• Until the bleeding stops completely

7. The nasopulmonary reflex, a potential complication of posterior packing, can lead to:

• Hypertension and tachycardia
• Bradycardia and bronchoconstriction
• Hyperventilation and anxiety
• Pulmonary embolism

8. Which of the following is an example of an absorbable hemostatic nasal packing material?

• Bismuth Iodoform Paraffin Paste (BIPP) gauze
• Merocel (PVA sponge)
• Surgicel (Oxidized regenerated cellulose)
• Rapid Rhino (CMC-coated balloon)

9. Woodruff’s plexus, a common site for posterior epistaxis, is located in the:

• Anterior nasal septum
• Roof of the nasal cavity near the cribriform plate
• Posterior-inferior aspect of the lateral nasal wall
• Floor of the nasal cavity

10. Prophylactic systemic antibiotics are often prescribed with nasal packing to primarily prevent:

• Re-bleeding upon pack removal
• Sinusitis and Toxic Shock Syndrome
• Pain and discomfort
• Anosmia

11. A Bellocq’s cannula is a historical instrument used specifically for which procedure?

• Inserting an expandable sponge pack
• Chemical cauterization with silver nitrate
• Placing a traditional posterior gauze pack
• Sphenopalatine artery ligation

12. Which of the following is NOT a component artery of Kiesselbach’s plexus?

• Anterior Ethmoidal Artery
• Sphenopalatine Artery
• Greater Palatine Artery
• Basilar Artery

13. The primary advantage of balloon catheters (e.g., Epistat, Brighton) over traditional posterior gauze packs is:

• Lower cost
• Less patient discomfort
• Ease and speed of insertion
• No need for an anterior pack component

14. When removing an anterior nasal pack, what step should be taken to minimize the risk of re-bleeding?

• Remove the pack as quickly as possible
• Ask the patient to blow their nose immediately after removal
• Thoroughly moisten the pack with saline before removal
• Apply a cold compress to the nose during removal

15. If epistaxis persists despite a well-placed anterior pack, the next most appropriate step is to:

• Insert a second anterior pack on top of the first one
• Administer intravenous tranexamic acid
• Remove the anterior pack and place a larger one
• Suspect a posterior bleed and consider posterior packing

16. Pressure necrosis of the nasal ala is a complication most directly caused by:

• The pack being too large for the nasal cavity
• An allergic reaction to the packing material
• Excessive tension on the device securing a posterior pack
• A co-existing bacterial infection

17. A ‘Rapid Rhino’ device controls epistaxis primarily through:

• A chemical reaction that cauterizes the vessel
• An inflatable balloon providing direct pressure and a CMC fabric promoting platelet aggregation
• Absorbing a large volume of blood to form a clot
• Delivering a hemostatic agent like thrombin

18. In a patient with a suspected cribriform plate fracture, nasal packing should be performed with extreme caution due to the risk of:

• Intracranial placement of the packing material
• Exacerbating the fracture
• Causing severe, uncontrollable pain
• Inducing a seizure

19. The sphenopalatine artery, a major source of posterior epistaxis, is a terminal branch of the:

• Internal Carotid Artery
• Facial Artery
• Maxillary Artery
• Ophthalmic Artery

20. Patients with posterior nasal packs must be admitted to the hospital for monitoring primarily due to the risk of:

• Pain and anxiety
• Hypoxia, dysrhythmias, and airway compromise
• Dehydration from inability to drink
• Development of a sinus infection

21. What is the main purpose of coating ribbon gauze with petroleum jelly or antibiotic ointment before anterior packing?

• To act as a hemostatic agent
• To provide lubrication and prevent mucosal adhesion
• To dissolve the packing material over time
• To make the pack radiopaque

22. Which patient comorbidity is a significant relative contraindication for using cocaine as a topical vasoconstrictor?

• Diabetes Mellitus
• Asthma
• Severe coronary artery disease
• Chronic kidney disease

23. When inserting a layered ribbon gauze anterior pack, the correct technique is to layer it:

• From superior to inferior
• From anterior to posterior, then back again, in an accordion-like fashion
• Loosely in the center of the nasal cavity
• Only in the posterior part of the cavity

24. A patient with a bleeding disorder (e.g., hemophilia) presents with epistaxis. Which management strategy is often preferred over traditional packing?

• Vigorous chemical cautery
• Use of absorbable hemostatic agents (e.g., Gelfoam, Floseal) and factor replacement
• Immediate surgical ligation of arteries
• Application of a very tight, non-absorbable pack

25. After successful placement of a posterior pack using a Foley catheter, what is the mandatory next step?

• Discharge the patient with follow-up in 24 hours
• Place an anterior pack in the same nostril
• Check the oral cavity for proper placement and to ensure no part of the balloon is visible
• Advise the patient to lie flat