TCRN Neurological Trauma 1 — Questions and Answers
Question 1: A patient's GCS is calculated as: eyes open to voice (3), confused verbal response (4), localizes to pain (5). What is the total GCS score?
- 10
- 11
- 12 (Correct answer)
- 13
Correct answer: 12
GCS = E3 + V4 + M5 = 12, indicating moderate brain injury.
Question 2: Which clinical finding is the earliest sign of increasing intracranial pressure (ICP)?
- Cushing's triad
- Altered level of consciousness or restlessness (Correct answer)
- Decerebrate posturing
- Fixed and dilated pupils
Correct answer: Altered level of consciousness or restlessness
Altered level of consciousness, including subtle confusion or restlessness, is the earliest and most sensitive indicator of rising ICP.
Question 3: Cushing's triad, the late sign of increased ICP, includes which three findings?
- Tachycardia, hypotension, and bradypnea
- Bradycardia, hypertension, and irregular respirations (Correct answer)
- Tachycardia, hypertension, and tachypnea
- Bradycardia, hypotension, and apnea
Correct answer: Bradycardia, hypertension, and irregular respirations
Cushing's triad—bradycardia, hypertension, and irregular respirations—is a late, ominous sign of brainstem herniation.
Question 4: A patient with a basilar skull fracture may exhibit which classic finding?
- Lhermitte's sign
- Battle's sign or raccoon eyes with possible CSF rhinorrhea or otorrhea (Correct answer)
- Babinski reflex bilaterally
- Absent corneal reflexes only
Correct answer: Battle's sign or raccoon eyes with possible CSF rhinorrhea or otorrhea
Basilar skull fractures classically produce periorbital or mastoid ecchymosis (raccoon eyes/Battle's sign) and possible CSF leaks.
Question 5: Which type of intracranial hematoma is associated with a lucid interval followed by rapid deterioration?
- Subdural hematoma
- Epidural hematoma (Correct answer)
- Diffuse axonal injury
- Intracerebral hemorrhage
Correct answer: Epidural hematoma
Epidural hematoma, classically from middle meningeal artery rupture, produces a lucid interval before rapid neurological decline.
Question 6: What is the target systolic blood pressure for a hypotensive patient with a traumatic brain injury (TBI) per ATLS guidelines?
- ≥70 mmHg
- ≥90 mmHg (Correct answer)
- ≥110 mmHg
- ≥130 mmHg
Correct answer: ≥90 mmHg
Maintaining SBP ≥90 mmHg is critical in TBI to ensure adequate cerebral perfusion pressure and prevent secondary brain injury.
TCRN Neurological Trauma 1
A patient's GCS is calculated as: eyes open to voice (3), confused verbal response (4), localizes to pain (5).
What is the total GCS score?