TCRN TCRN Head and Neck Trauma 2 — Questions and Answers
Question 1: A patient arrives after a motorcycle crash with a GCS of 9, unequal pupils, and posturing. Which herniation pattern is most consistent with a unilateral fixed and dilated pupil?
- Central herniation
- Uncal herniation (Correct answer)
- Tonsillar herniation
- Upward herniation
Correct answer: Uncal herniation
Uncal herniation causes ipsilateral CN III compression, resulting in a fixed, dilated pupil on the same side as the expanding lesion.
Question 2: During assessment of a neck trauma patient, you note tracheal deviation, absent breath sounds on the left, and distended neck veins. What is the priority intervention?
- Immediate intubation
- Needle decompression of the left chest (Correct answer)
- Pericardiocentesis
- Chest X-ray confirmation
Correct answer: Needle decompression of the left chest
Tension pneumothorax presents with tracheal deviation away from the affected side, absent breath sounds, and JVD, requiring immediate needle decompression.
Question 3: A patient with a basilar skull fracture most likely exhibits which sign indicating cerebrospinal fluid leak from the ear?
- Raccoon eyes
- Otorrhea with a halo sign (Correct answer)
- Rhinorrhea
- Battle's sign
Correct answer: Otorrhea with a halo sign
Otorrhea with a positive halo (ring) sign on filter paper indicates CSF leaking from the ear, consistent with a basilar skull fracture.
Question 4: What is the recommended target PaCO2 range when managing a severe TBI patient without signs of imminent herniation?
- 25–30 mmHg
- 30–35 mmHg
- 35–45 mmHg (Correct answer)
- 45–50 mmHg
Correct answer: 35–45 mmHg
Normocapnia (35–45 mmHg) is the target for severe TBI; hyperventilation is reserved only for acute herniation as a bridge measure.
Question 5: A restrained driver involved in a high-speed MVC complains of severe neck pain and bilateral upper extremity weakness. Which spinal cord injury syndrome is most likely?
- Brown-Séquard syndrome
- Central cord syndrome (Correct answer)
- Anterior cord syndrome
- Posterior cord syndrome
Correct answer: Central cord syndrome
Central cord syndrome causes greater weakness in the upper extremities than lower extremities and is the most common incomplete spinal cord injury, often from hyperextension.
Question 6: When preparing a patient with suspected cervical spine injury for intubation, which technique is most appropriate in the emergency setting?
- Nasotracheal intubation only
- Rapid sequence intubation with manual in-line stabilization (Correct answer)
- Blind nasal intubation
- Surgical cricothyrotomy without RSI attempt
Correct answer: Rapid sequence intubation with manual in-line stabilization
Rapid sequence intubation with manual in-line stabilization (MILS) is the standard approach for airway management with suspected cervical spine injury.
Question 7: A patient with a penetrating neck injury to Zone II is hemodynamically unstable. What is the immediate management priority?
- CT angiography of the neck
- Mandatory surgical exploration (Correct answer)
- Bronchoscopy and esophagoscopy
- Observation and serial exams
Correct answer: Mandatory surgical exploration
Hemodynamic instability with a Zone II penetrating neck injury mandates immediate surgical exploration without delay for imaging.
TCRN TCRN Head and Neck Trauma 2
A patient arrives after a motorcycle crash with a GCS of 9, unequal pupils, and posturing.
Which herniation pattern is most consistent with a unilateral fixed and dilated pupil?