Nose and paranasal sinuses: bleeding disorder in epistaxis: practice question

A ENT question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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ENT · Nose and paranasal sinuses: bleeding disorder in epistaxis

Sample item

A 14-year-old girl has recurrent spontaneous nosebleeds, heavy menstrual bleeding and prolonged bleeding after a tooth extraction. Platelet count and prothrombin time are normal, and the APTT is mildly prolonged. What is the most likely diagnosis?

AHereditary haemorrhagic telangiectasiaBHaemophilia ACVon Willebrand diseaseDVitamin K deficiency

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Von Willebrand disease

Mucosal bleeding with menorrhagia in a girl, a normal platelet count and prothrombin time, and a mildly raised APTT from low factor VIII indicate von Willebrand disease, the commonest inherited bleeding disorder. Recurrent epistaxis in a young patient warrants a coagulation screen.

Option by option

A. Hereditary haemorrhagic telangiectasia
Hereditary haemorrhagic telangiectasia has normal clotting tests with visible mucocutaneous telangiectasia.
B. Haemophilia A
Haemophilia A is X-linked, mostly affects boys and bleeds into joints and muscles.
C. Von Willebrand disease (correct)
Correct. Mucocutaneous bleeding with a prolonged APTT and normal platelets and PT suggests von Willebrand disease.
D. Vitamin K deficiency
Vitamin K deficiency prolongs the prothrombin time first.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this ENT question

What is the answer to this ENT question?

The best answer is C, Von Willebrand disease. Mucosal bleeding with menorrhagia in a girl, a normal platelet count and prothrombin time, and a mildly raised APTT from low factor VIII indicate von Willebrand disease, the commonest inherited bleeding disorder.

Why is "Hereditary haemorrhagic telangiectasia" not the answer?

Hereditary haemorrhagic telangiectasia has normal clotting tests with visible mucocutaneous telangiectasia.

Why is "Haemophilia A" not the answer?

Haemophilia A is X-linked, mostly affects boys and bleeds into joints and muscles.

Why is "Vitamin K deficiency" not the answer?

Vitamin K deficiency prolongs the prothrombin time first.

What concept does this question test?

It tests Nose and paranasal sinuses: bleeding disorder in epistaxis in ENT. Recurrent epistaxis in a young patient warrants a coagulation screen.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Nose and paranasal sinuses: bleeding disorder in epistaxis?

Learn tuning fork results and audiogram patterns by sketching them. Then use the flashcards and the other ENT questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.