TNCC Neurological Assessment 2 — Questions and Answers
Question 1: A trauma patient has a GCS score of 8. Which component breakdown best fits this score?
- Eye 2, Verbal 2, Motor 4
- Eye 3, Verbal 2, Motor 3 (Correct answer)
- Eye 1, Verbal 3, Motor 4
- Eye 2, Verbal 3, Motor 3
Correct answer: Eye 3, Verbal 2, Motor 3
E3+V2+M3=8 is one valid combination; multiple breakdowns can sum to 8, but E3V2M3 represents a common clinical presentation.
Question 2: Which finding during pupillary assessment most strongly suggests uncal herniation?
- Bilateral miosis with sluggish response
- Unilateral fixed and dilated pupil ipsilateral to injury (Correct answer)
- Bilateral fixed and dilated pupils
- Anisocoria with both pupils reactive
Correct answer: Unilateral fixed and dilated pupil ipsilateral to injury
Uncal herniation compresses CN III on the same side as the expanding lesion, causing an ipsilateral fixed dilated pupil.
Question 3: A patient with a brain injury begins posturing with arms flexed and legs extended. This is classified as:
- Decorticate posturing
- Decerebrate posturing (Correct answer)
- Opisthotonus
- Spastic paraplegia
Correct answer: Decerebrate posturing
Decerebrate (extensor) posturing involves extension of all extremities and indicates brainstem dysfunction at the midbrain-pons level.
Question 4: The Cushing's triad is a late sign of increased ICP. Which combination correctly identifies all three components?
- Hypotension, tachycardia, irregular respirations
- Hypertension, bradycardia, irregular respirations (Correct answer)
- Hypertension, tachycardia, apnea
- Hypotension, bradycardia, Cheyne-Stokes breathing
Correct answer: Hypertension, bradycardia, irregular respirations
Cushing's triad consists of hypertension with widened pulse pressure, bradycardia, and irregular respirations, indicating imminent brainstem herniation.
Question 5: When assessing a trauma patient's best motor response on the GCS, nail bed pressure is applied and the patient withdraws. This scores as:
- 3
- 4 (Correct answer)
- 5
- 2
Correct answer: 4
Withdrawal from pain scores a 4 on the motor component of the GCS scale.
Question 6: Which cervical spine injury pattern is most associated with a diving accident mechanism?
- Hyperextension injury at C6-C7
- Axial compression (burst) fracture at C4-C5 (Correct answer)
- Flexion-rotation injury at C1-C2
- Lateral bending injury at C3-C4
Correct answer: Axial compression (burst) fracture at C4-C5
Diving into shallow water causes axial loading and burst fractures most commonly at C4-C5 due to the alignment of the cervical spine during impact.
Question 7: A patient presents with loss of pain and temperature sensation below T6 on one side, and loss of motor function and proprioception on the opposite side below T6. This pattern describes:
- Central cord syndrome
- Anterior cord syndrome
- Brown-Séquard syndrome (Correct answer)
- Posterior cord syndrome
Correct answer: Brown-Séquard syndrome
Brown-Séquard syndrome results from hemisection of the spinal cord, causing ipsilateral motor/proprioception loss and contralateral pain/temperature loss.
TNCC Neurological Assessment 2
A trauma patient has a GCS score of 8.
Which component breakdown best fits this score?