Review Question - QID 215142

A 55-year-old man presents to the emergency department with profuse bleeding from his nose. He states that it started 30 minutes ago while at a family picnic, and he has been unable to control the bleeding with external pressure and ice. The patient has a history of deep vein thrombosis and is currently taking apixaban. His temperature is 97.9°F (36.6°C), blood pressure is 128/82 mmHg, pulse is 86/min, respirations are 12/min, and oxygen saturation is 98% on room air. Physical exam reveals blood leaking from the left nare; however, the volume makes it difficult to localize the source of bleeding. Packing soaked in tranexamic acid is placed in the anterior nare and the patient is observed. Roughly 30 minutes later, the packing is removed, and there is no more bleeding. Which of the following is the most likely cause of this patient’s initial symptoms?