TNCC Neurological Assessment 3 — Questions and Answers
Question 1: Which neurological finding in a trauma patient warrants immediate neurosurgical consultation for possible epidural hematoma?
- Progressive confusion with no loss of consciousness
- Brief loss of consciousness followed by a lucid interval then rapid deterioration (Correct answer)
- Gradual onset headache over 24 hours with vomiting
- Persistent anterograde amnesia with stable vitals
Correct answer: Brief loss of consciousness followed by a lucid interval then rapid deterioration
The classic lucid interval followed by rapid neurological deterioration is the hallmark presentation of an epidural hematoma from middle meningeal artery rupture.
Question 2: When performing the AVPU scale, a patient who opens eyes and groans when you call their name is classified as:
- A - Alert
- V - Responds to Voice (Correct answer)
- P - Responds to Pain
- U - Unresponsive
Correct answer: V - Responds to Voice
The AVPU scale classifies V as any response—eye opening, vocalization, or movement—elicited by verbal stimulation.
Question 3: A spinal cord injury patient has diaphragmatic breathing but absent intercostal muscle function. The injury level is most likely:
- C2
- C4 (Correct answer)
- T1
- T6
Correct answer: C4
The phrenic nerve (C3-C5) controls the diaphragm, so C4 injury preserves diaphragmatic breathing while T1 intercostal innervation is lost.
Question 4: Which assessment finding best differentiates neurogenic shock from hypovolemic shock in a spinal cord injury patient?
- MAP less than 65 mmHg in both conditions
- Bradycardia with warm, dry skin in neurogenic shock (Correct answer)
- Tachycardia with cool, clammy skin in neurogenic shock
- Decreased urine output in hypovolemic shock only
Correct answer: Bradycardia with warm, dry skin in neurogenic shock
Neurogenic shock causes paradoxical bradycardia with vasodilation (warm, dry skin) due to loss of sympathetic tone, unlike the tachycardia and vasoconstriction of hypovolemic shock.
Question 5: The recommended MAP target for maintaining spinal cord perfusion in an acute spinal cord injury during the first 7 days is:
- 55-65 mmHg
- 85-90 mmHg (Correct answer)
- 70-75 mmHg
- 60-70 mmHg
Correct answer: 85-90 mmHg
Current guidelines recommend maintaining MAP at 85-90 mmHg for the first 7 days after acute SCI to optimize spinal cord perfusion pressure.
Question 6: A patient with a head injury has a PaCO2 of 55 mmHg. What is the most likely effect on cerebral blood flow?
- Decreased CBF due to vasoconstriction
- Increased CBF due to vasodilation (Correct answer)
- No change in CBF
- Decreased CBF due to decreased metabolic demand
Correct answer: Increased CBF due to vasodilation
Hypercapnia (elevated PaCO2) causes cerebral vasodilation, increasing cerebral blood flow and potentially worsening intracranial hypertension.
Question 7: Which intervention is the first priority when a trauma patient shows signs of transtentorial herniation?
- Administer 20% mannitol IV
- Ensure airway, optimize oxygenation, and elevate HOB 30° (Correct answer)
- Immediately perform a burr hole
- Administer hypertonic saline and furosemide
Correct answer: Ensure airway, optimize oxygenation, and elevate HOB 30°
Airway management with oxygenation and head-of-bed elevation are the immediate priorities to reduce ICP before pharmacologic or surgical interventions.
TNCC Neurological Assessment 3
Which neurological finding in a trauma patient warrants immediate neurosurgical consultation for possible epidural hematoma?