TCRN TCRN Head and Neck Trauma 5

Question 1

A patient with severe TBI has an ICP of 28 mmHg despite initial interventions. Which second-tier intervention is most appropriate?

Accepted Answer

Decompressive craniectomy or barbiturate coma

Answer

Second-tier interventions for refractory ICP elevation include decompressive craniectomy or barbiturate (pentobarbital) coma when first-tier measures have failed.

Question 2

Which of the following is a contraindication to nasotracheal intubation in a head trauma patient?

Accepted Answer

Suspected basilar skull fracture

Answer

Suspected basilar skull fracture is a contraindication to nasotracheal intubation due to the risk of passing the tube through the fractured skull base into the cranial vault.

Question 3

A patient with traumatic brain injury becomes hyponatremic with elevated urine sodium and urine osmolality. Which syndrome best explains this?

Accepted Answer

Cerebral salt wasting

Answer

Cerebral salt wasting after TBI causes hyponatremia with high urine sodium and high urine osmolality, but is distinguished from SIADH by volume depletion rather than euvolemia.

Question 4

Which zone of the neck contains the aortic arch, innominate artery, and proximal common carotid arteries?

Accepted Answer

Zone I

Answer

Zone I of the neck extends from the clavicles/sternal notch to the cricoid cartilage and contains major thoracic outlet vessels including the aortic arch and innominate artery.

Question 5

A trauma patient is noted to have bilaterally fixed and dilated pupils after a fall from height. Which intervention should still be performed immediately?

Accepted Answer

Ensure adequate oxygenation, BP support, and neurosurgical consult

Answer

Bilaterally fixed dilated pupils suggest severe herniation but do not confirm brain death; immediate resuscitation and neurosurgical evaluation should not be withheld.

TCRN Exam Practice Test

TCRN Exam Practice Test

TCRN TCRN Head and Neck Trauma 5