TCRN TCRN Head and Neck Trauma 2

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?

Accepted Answer

Uncal herniation

Answer

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?

Accepted Answer

Needle decompression of the left chest

Answer

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?

Accepted Answer

Otorrhea with a halo sign

Answer

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?

Accepted Answer

35–45 mmHg

Answer

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?

Accepted Answer

Central cord syndrome

Answer

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.

TCRN Exam Practice Test

TCRN Exam Practice Test

TCRN TCRN Head and Neck Trauma 2