Question: A 41 year old woman is referred to you for recurrent epistaxis. She notes that she will experience brisk arterial epistaxis several times per week. It is not unilateral. Usually, pressure and nasal decongestant sprays are effective. She notes that multiple family members have the same problem. Examination reveals multiple telangiectasias bilaterally on the turbinates and septum. Which of the following is the next best step in management?

a) Advise her to present to the ED for nasal packing during episodes

b) Laser ablation of telangiectasias

c) Rule out pulmonary and cerebral AVMs

d) Nasal steroid spray

[Answer will be posted with next week's new question]

Answer to last week's question, “Lip Service” (June 14, 2021)

D - A trial of topiramate or verapamil may reduce the frequency and severity of episodes