Questions directed towards specific causes of epistaxis can help you identify the diagnosis.  Your patient says he has no history of previous epistaxis.  He does have a history of hypertension and arthritis.  He is currently taking aspirin for pain control of his arthritis.  He admits that he sometimes "scratches the inside of his nose."  He has no history or family history of clotting disorders or any other systemic diseases.  He denies any illicit drug use.  He denies any recent infections.

History FYI

As an efficient physician, you complete your history just as 10 minutes is complete.  The patient then releases the pressure on his nose and now the bleeding has stopped. 

What’s next? 

• Send the patient home
• Give yourself a pat on the back
• Arrange an ENT referral
• Perform a physical exam