TCRN TCRN Head and Neck Trauma 3 — Questions and Answers
Question 1: Which of the following is a Class I indication for ICP monitoring according to Brain Trauma Foundation guidelines?
- GCS 13–15 with normal CT
- Severe TBI (GCS 3–8) with abnormal CT scan (Correct answer)
- Moderate TBI with intact pupils
- Mild TBI with brief loss of consciousness
Correct answer: Severe TBI (GCS 3–8) with abnormal CT scan
ICP monitoring is indicated in patients with severe TBI (GCS 3–8) and an abnormal CT scan showing hematoma, contusion, or compressed cisterns.
Question 2: A patient develops Cushing's triad after TBI. Which set of vital signs best represents this response?
- Hypotension, tachycardia, irregular respirations
- Hypertension, bradycardia, irregular respirations (Correct answer)
- Hypertension, tachycardia, normal respirations
- Hypotension, bradycardia, tachypnea
Correct answer: Hypertension, bradycardia, irregular respirations
Cushing's triad is hypertension, bradycardia, and irregular respirations, representing a late sign of severely elevated ICP and impending herniation.
Question 3: A patient with facial trauma and suspected Le Fort III fracture is at greatest risk for which airway complication?
- Laryngeal fracture
- Complete craniofacial separation with airway loss (Correct answer)
- Tracheal tear
- Bilateral vocal cord paralysis
Correct answer: Complete craniofacial separation with airway loss
Le Fort III fractures involve craniofacial disjunction, placing the patient at risk for total airway obstruction due to posterior displacement of the midfacial skeleton.
Question 4: Which medication is considered first-line for reducing cerebral edema and ICP in patients with TBI when osmotic therapy is indicated?
- Furosemide 40 mg IV
- Mannitol 0.25–1 g/kg IV (Correct answer)
- Dexamethasone 10 mg IV
- Normal saline 1 L bolus
Correct answer: Mannitol 0.25–1 g/kg IV
Mannitol is the first-line osmotic agent for ICP reduction, drawing fluid from brain parenchyma into the vascular space.
Question 5: A patient post-TBI develops sudden agitation, diaphoresis, hyperthermia, tachycardia, and hypertension three days after injury. What syndrome is most likely?
- Serotonin syndrome
- Sympathetic storming (paroxysmal sympathetic hyperactivity) (Correct answer)
- Neuroleptic malignant syndrome
- Alcohol withdrawal
Correct answer: Sympathetic storming (paroxysmal sympathetic hyperactivity)
Paroxysmal sympathetic hyperactivity (sympathetic storming) occurs after severe TBI due to loss of inhibitory control, causing episodic autonomic surges.
Question 6: Which cervical vertebra is most commonly fractured in an elderly patient after a ground-level fall?
- C1 (atlas)
- C2 (axis) odontoid process (Correct answer)
- C5
- C7
Correct answer: C2 (axis) odontoid process
Odontoid (dens) fractures of C2 are the most common cervical fractures in elderly patients, typically from low-energy falls.
Question 7: A patient arrives with blunt anterior neck trauma and a hoarse voice, subcutaneous emphysema, and stridor. Which injury is most suspected?
- Carotid artery dissection
- Laryngeal fracture (Correct answer)
- Esophageal perforation
- Thyroid gland hematoma
Correct answer: Laryngeal fracture
Hoarseness, subcutaneous emphysema, and stridor after blunt anterior neck trauma are classic signs of laryngeal fracture requiring urgent airway management.
TCRN TCRN Head and Neck Trauma 3
Which of the following is a Class I indication for ICP monitoring according to Brain Trauma Foundation guidelines?