Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 68M Recurrent right sided nosebleeds resistant to treatment followed by respiratory infectionMy dad is a 68 year old Mexican (mestizo) male. At the time of his first nosebleed, he was diagnosed with diabetes, high cholesterol, and prehypertension. He's 5'6" and weights 180 pounds. He rarely drinks and doesn't smoke or use recreational drugs. He's prescribed metformin, insulin, aspirin, and lovastatin but refuses to use the last two. He also has arthritis in his elbows, for which his doctor tells him to use ibuprofen as needed. I don't know his cholesterol levels or A1C.About two weeks ago now, had a nosebleed (limited to the right nostril) for the first time in over 30 years while he was cleaning the garage. We asked him if he accidentally hit himself, scratched his nose, or sneezed but he insisted that it just started out of nowhere. Initially he was able to stop the bleeding but later that same day the bleeding resumed while he was moving some boxes (15-35lbs). We were unable to stop the bleeding and he went to the emergency room where they tried to stop the bleeding with Tranexamic acid and, after that failed, cocaine hydrochloride before ultimately applying an anterior nasal packing. His blood pressure was checked and it was high 143/83 but the doctor said it could be due to the stress of the situation and didn't warrant immediate treatment (side info, he had a heart rate of 85, low 60s seems to be normal for him). He was told to go back in two days to remove it and cauterize the affected area. He was also prescribed cephalexin (I'm assuming to prevent opportunistic infections). Apart from the nosebleed, he seemed fine. He was a little shook from the experience but was feeling good. No other symptoms.Two days later he went to get the nasal packing removed and the doctor determined nothing needed to be cauterized. My dad was told to be careful for a few days and to schedule an appointment with his PCP, which he did. He has that appointment later today. Two days after getting the nasal packing removed, he woke up with a bloody nose that he was unable to stop. He went to the ER again where they ended up cauterizing his nose. He had some minor discomfort from the procedure but was fine otherwise. He was also referred to an ENT doctor and was able to schedule an appointment, but it's a month from now.Since then, he's experienced 1 more severe nosebleeding episode. He went to the ER and got it treated with lidocaine and since his blood pressure was higher 153/89, he was prescribed blood pressure medication (something starting with an an L -- I don't have the documents on hand). He was also given a nose clip and finally had some lab work done (cbc, complete metabolic panel, and prothrombin time test -- those results will probably be discussed today). He's since experienced two minor nosebleeding episodes that have been effectively treated at home. In addition, starting the day his nasal pack was removed he started experiencing symptoms of what appears to be a respiratory infection. This will be explained in the next paragraph.The day my dad got his nasal pack removed, he complained of discomfort in the nose and sinuses. Some discomfort was to be expected but the day after he started developing a sore throat which eventually progressed to a dry cough, headache, coughing fits and nocturnal fever (no thermometer available to record temperature). He went to urgent care which prescribed him prednisone and azithromycin. It's been two days since and there's been no change on his condition on that front. The illness appears to be communicable since my mom started displaying symptoms about 4 days after my dad. It's possible that he caught the bug during Easter since we had a small gathering (<8 people) though no one else was displaying symptoms at the time or has displayed symptoms since. My dad has been tested for both covid and the flu, for which he has tested negative. It's also possible he caught it while seeking treatment for his nosebleed due to the area of treatment but I'm wondering if the two could be interrelated.It's concerning that after having no nosebleed or symptomatic medical issues for so long (other than the diabetes), one would present so abruptly and severely without any physical trauma or changes in medicine or lifestyle habits. My questions would be what would be some of the most likely causes of nosebleeds in someone with his medical history (hypertension seems to be a big one)? His visit with the PCP is today. What would be some good things to bring up or ask about in his upcoming visit that his doctor might overlook but could be important?. ### Response: Hypertension does not cause nosebleeds, not does it prolong them. Except very rarely and dramatically they are not from an artery.The most common cause is actually nosepicking, so grill him more about this. Dry air, a cold, allergies and exposure to dust in his garage are other likely causes. Once you start getting them they tend to persist for a while. He is not on a blood thinner.While waiting for ENT he can use saline nasal spray to keep it moist, use a humidifier at night, and learn how to apply effective pressure to stop the bleeding..