TCRN TCRN Head and Neck Trauma 4 — Questions and Answers
Question 1: A patient with a subdural hematoma has a lucid interval followed by rapid neurological deterioration. This presentation is more classic for which type of hematoma?
- Chronic subdural hematoma
- Epidural hematoma (Correct answer)
- Acute subdural hematoma
- Subarachnoid hemorrhage
Correct answer: Epidural hematoma
Epidural hematomas classically present with a lucid interval followed by rapid deterioration due to arterial bleeding (typically middle meningeal artery) expanding between the dura and skull.
Question 2: The cerebral perfusion pressure (CPP) is calculated as:
- MAP – CVP
- MAP – ICP (Correct answer)
- SBP – ICP
- MAP + ICP
Correct answer: MAP – ICP
CPP = MAP – ICP; maintaining CPP between 60–70 mmHg is the target in severe TBI management to prevent secondary ischemic injury.
Question 3: Which type of facial fracture involves the orbital floor and can cause entrapment of the inferior rectus muscle?
- Zygomatic arch fracture
- Orbital blowout fracture (Correct answer)
- Nasal bone fracture
- Mandibular condyle fracture
Correct answer: Orbital blowout fracture
Orbital blowout fractures fracture the orbital floor, potentially trapping the inferior rectus muscle and causing diplopia and restricted upward gaze.
Question 4: When assessing a trauma patient using the AVPU scale, a patient who responds only to painful stimuli is classified as:
- Alert
- Voice
- Pain (Correct answer)
- Unresponsive
Correct answer: Pain
On the AVPU scale, 'P' (Pain) indicates the patient responds only to painful stimulation, roughly correlating with a GCS of 8 or below.
Question 5: A trauma patient with a scalp laceration is found to have a depressed skull fracture on CT. Which finding would most clearly indicate the need for urgent surgical intervention?
- Fracture depth equal to skull thickness
- Fracture depression greater than the thickness of the skull with dural tear (Correct answer)
- Isolated linear fracture with overlying hematoma
- Fracture overlying the parietal bone only
Correct answer: Fracture depression greater than the thickness of the skull with dural tear
A depressed skull fracture with depression greater than skull thickness and an associated dural tear typically warrants surgical elevation to prevent infection and neurological deficit.
Question 6: A patient with anterior cord syndrome after a cervical spine injury would be expected to have loss of which functions below the level of injury?
- Proprioception and vibration only
- Motor function and pain/temperature sensation with preserved proprioception (Correct answer)
- Motor function only with all sensation intact
- All sensory modalities with intact motor function
Correct answer: Motor function and pain/temperature sensation with preserved proprioception
Anterior cord syndrome causes bilateral motor loss and loss of pain and temperature sensation, while proprioception and vibration (carried by the posterior columns) are preserved.
Question 7: Which imaging modality is the gold standard for evaluating suspected vascular injury in penetrating Zone I neck trauma?
- Plain radiography
- CT angiography (Correct answer)
- Duplex ultrasound
- MRI
Correct answer: CT angiography
CT angiography is the gold standard for evaluating vascular injury in neck trauma, providing rapid, non-invasive assessment of the carotid and vertebral arteries.
TCRN TCRN Head and Neck Trauma 4
A patient with a subdural hematoma has a lucid interval followed by rapid neurological deterioration.
This presentation is more classic for which type of hematoma?