Head Trauma — MCQs

10 questions

Signs of increased intracranial tension are all except:

Which of the following is false regarding cranial trauma?

What will be the Glasgow Coma Scale (GCS) score for a head injury patient who opens eyes to painful stimulus, uses inappropriate words, and localizes pain?

A young man is brought to the emergency department with head injury following a motor vehicle accident. The patient is unconscious. BEST prognostic factor for head injury is:

Which of the following is not a common complication of tubercular meningitis?

Which of the following is not done in the primary survey of trauma?

Best prognostic factor for head injury?

A 20-year-old male presents to the emergency department with a head injury. Examination reveals normal consciousness, no neurological deficits, and blood in the tympanic membrane. What is the most likely cause?

A lady comes to OPD after fall from scooty. Her vitals are stable. She is having continuous, clear watery discharge from nose after 2 days. This is most likely a feature of?

Q10

In an accident case, after the arrival of medical team, all should be done in early management except;

Head Trauma Indian Medical PG Practice Questions and MCQs

Question 1: Signs of increased intracranial tension are all except:

A. Headache
B. Seizures
C. Papilledema
D. Tachycardia (Correct Answer)

Explanation: ***Tachycardia*** - **Tachycardia** is generally *not* a sign of increased intracranial pressure (ICP); rather, **bradycardia** (Cushing's reflex) is a classic finding. - While other systemic responses may occur, a direct, consistent increase in heart rate due to elevated ICP is uncommon. *Papilledema* - **Papilledema** is a swelling of the **optic disc** due to increased ICP, a critical diagnostic sign [1]. - The increased pressure impedes venous return from the retina, causing the optic nerve head to bulge. *Headache* - **Headache** is a common and often early symptom of increased ICP due to the stretching of pain-sensitive meningeal and vascular structures [1]. - It is typically described as a dull, throbbing pain, often worse in the morning or with straining. *Seizures* - **Seizures** can result from increased ICP as the pressure on brain tissue can lead to electrical instability and abnormal neuronal discharge [2]. - This symptom indicates significant cortical irritation or dysfunction caused by the elevated pressure.

Question 2: Which of the following is false regarding cranial trauma?

A. Depressed skull is associated with brain injury at the immediate area of impact
B. Raccoon eyes seen in subgaleal hemorrhage (Correct Answer)
C. Carotid-cavernous fistula occur in base skull
D. Post traumatic epilepsy seen in 15%

Explanation: ***Raccoon eyes seen in subgaleal hemorrhage*** - **Raccoon eyes** (periorbital ecchymosis) are typically seen with **anterior cranial fossa fractures**, not subgaleal hemorrhage. - Subgaleal hemorrhage is a collection of blood between the galea aponeurotica and the periosteum, usually causing diffuse **scalp swelling**. *Depressed skull is associated with brain injury at the immediate area of impact* - A depressed skull fracture means a portion of the skull is pushed inward, directly impacting the underlying **brain tissue**. - This can lead to localized **contusions**, **lacerations**, or **hematomas** at the site of impact. *Carotid-cavernous fistula occur in base skull* - **Carotid-cavernous fistulas** (CCF) commonly result from **traumatic rupture** of the internal carotid artery within the **cavernous sinus**. - This type of injury is often associated with **severe skull base fractures**, particularly those involving the sphenoid bone. *Post traumatic epilepsy seen in 15%* - The incidence of **post-traumatic epilepsy** (PTE) after severe head injury ranges from 5% to 15%, making 15% a plausible, though upper-end, estimate. - Risk factors for PTE include **depressed skull fractures**, **intracranial hematomas**, and **early seizures**.

Question 3: What will be the Glasgow Coma Scale (GCS) score for a head injury patient who opens eyes to painful stimulus, uses inappropriate words, and localizes pain?

A. 10 (Correct Answer)
B. 14
C. 8
D. 12

Explanation: ***10*** - The patient opens eyes to **painful stimulus (E2)**, uses **inappropriate words (V3)**, and **localizes pain (M5)**. - Summing these scores: **E2 + V3 + M5 = 10**. - This represents a **moderate head injury** (GCS 9-12). *14* - This score would require higher functioning in multiple domains. - Would need responses such as opening eyes to **speech (E3)**, **confused conversation (V4)**, and **localizing or obeying commands (M5-M6)**. - The described patient's responses do not reach this level of function. *8* - A GCS of **8 or less** indicates **severe head injury** requiring immediate **airway protection and intubation**. - The patient's ability to **localize pain (M5)** and use **inappropriate words (V3)** indicates a consciousness level above severe injury threshold. - This patient does not meet criteria for severe head injury. *12* - This score would require better responses in at least two categories. - Could include: opening eyes to **speech (E3)**, **confused conversation (V4)**, or **obeying commands (M6)**. - The patient's specified responses (E2 + V3 + M5) sum to only 10, not 12.

Question 4: A young man is brought to the emergency department with head injury following a motor vehicle accident. The patient is unconscious. BEST prognostic factor for head injury is:

A. Age
B. CT findings
C. Glasgow coma scale (Correct Answer)
D. Mode of injury

Explanation: ***Glasgow coma scale*** - The **Glasgow Coma Scale (GCS)** is a standardized neurological assessment tool used to objectively quantify the level of consciousness in a patient with a head injury. - It is a powerful **prognostic indicator** because it directly reflects the severity of brain dysfunction and can track changes in neurological status over time. *Age* - **Age** is an important prognostic factor in head injury, with younger patients generally having better outcomes. - However, while significant, it is a static demographic factor and does not directly measure the real-time neurological impact or severity of the injury as the GCS does. *CT findings* - **CT scan findings** are crucial for identifying the type and extent of intracranial lesions (e.g., hematomas, edema). - While essential for guiding management, CT findings alone may not fully capture the functional neurological impairment, especially in cases of diffuse axonal injury where initial CT can be normal. *Mode of injury* - The **mode of injury** (e.g., motor vehicle accident, fall) can provide clues about the potential energy transfer and severity. - However, it does not directly reflect the physiological impact on the brain or the patient's neurological status, making it less direct as a prognostic factor compared to GCS.

Question 5: Which of the following is not a common complication of tubercular meningitis?

A. Hydrocephalus
B. Infarction
C. Obliterative endarteritis
D. Sinovenous thrombosis (Correct Answer)

Explanation: ***Sinovenous thrombosis*** - While possible in severe inflammatory states, **sinovenous thrombosis** is not considered a common or characteristic complication of tubercular meningitis, unlike the other mentioned complications. - The inflammatory exudates in TB meningitis primarily affect the base of the brain, leading to complications related to CSF flow and arterial compromise rather than venous sinus obstruction [1]. *Hydrocephalus* - **Hydrocephalus** is a very common complication of tubercular meningitis, resulting from obstruction of CSF flow by thick inflammatory exudates, particularly at the base of the brain [1], [2]. - The blockage can occur at various points, leading to accumulation of cerebrospinal fluid and increased intracranial pressure [2]. *Infarction* - **Infarction** (stroke) is a frequent and serious complication, caused by **vasculitis** and narrowing or occlusion of intracranial blood vessels, particularly the basal arteries [1]. - This is secondary to the extensive inflammatory exudate that surrounds and infiltrates the vessels, leading to **ischemia** and tissue death. *Obliterative endarteritis* - **Obliterative endarteritis** is the underlying pathological process leading to infarction in tubercular meningitis, involving inflammation and fibrosis of the arterial walls. - This inflammation of the small and medium-sized arteries, especially at the base of the brain, causes luminal narrowing and eventual occlusion.

Question 6: Which of the following is not done in the primary survey of trauma?

A. Intubation
B. NCCT head (Correct Answer)
C. ICD drainage
D. CXR

Explanation: ***NCCT head*** - A **Non-Contrast CT (NCCT) head** is typically performed during the **secondary survey** once the patient is hemodynamically stable and life-threatening conditions have been addressed. - The primary survey focuses on immediate **life-saving interventions** for airway, breathing, circulation, disability, and exposure. *Intubation* - **Intubation** is a critical intervention during the primary survey, specifically under the **'A' (Airway)** component, to establish and secure a patent airway in a compromised patient. - Failure to establish an airway can rapidly lead to **hypoxia** and death. *ICD drainage* - **Intercostal drain (ICD) drainage** is an urgent intervention in the primary survey, falling under **'B' (Breathing)**, to manage conditions like **tension pneumothorax** or massive hemothorax. - These conditions can severely compromise ventilation and circulation, requiring immediate relief. *CXR* - A **Chest X-ray (CXR)** is a rapid and essential diagnostic tool in the primary survey, also under **'B' (Breathing)**, to identify life-threatening thoracic injuries such as pneumothorax, hemothorax, or mediastinal shift. - It provides quick information crucial for immediate management decisions.

Question 7: Best prognostic factor for head injury?

A. Age of patient
B. Glasgow coma scale (Correct Answer)
C. Mode of injury
D. Presence of facial trauma

Explanation: ***Glasgow coma scale*** - The **Glasgow Coma Scale (GCS)** is the single most important and consistently reliable **prognostic factor** for patients with head injuries. - It assesses the patient's neurological status by evaluating **eye opening**, **verbal response**, and **motor response**, providing a quantitative measure of consciousness that strongly correlates with outcome. *Age of patient* - While **older age** generally correlates with a worse prognosis after head injury, it is not as strong or immediately indicative as the GCS score. - Younger patients often have a better capacity for neurological recovery, but this is a general trend rather than a precise predictor. *Mode of injury* - The **mode of injury** (e.g., fall, motor vehicle accident) can indicate the potential severity of impact but does not directly reflect the extent of brain damage or predict recovery as precisely as the GCS. - Different mechanisms can cause similar types and severity of brain injury. *Presence of facial trauma* - **Facial trauma** may indicate the force of impact and can be associated with head injury, but it does not directly predict neurological outcomes. - Extensive facial injuries do not necessarily correlate with severe brain damage, and vice-versa.

Question 8: A 20-year-old male presents to the emergency department with a head injury. Examination reveals normal consciousness, no neurological deficits, and blood in the tympanic membrane. What is the most likely cause?

A. Subdural haemorrhage
B. Basilar skull fracture (Correct Answer)
C. Intraventricular haemorrhage
D. Extradural haemorrhage

Explanation: ***Basilar skull fracture*** - **Blood in the tympanic membrane** (hemotympanum) is a classic sign of a **basilar skull fracture**, indicating a fracture extending into the petrous part of the temporal bone. - Despite the potential severity of a basilar fracture, patients can initially present with **normal consciousness** and **no focal neurological deficits**. - Other signs of basilar skull fracture include Battle's sign (postauricular ecchymosis), raccoon eyes (periorbital ecchymosis), and CSF rhinorrhea/otorrhea. *Subdural haemorrhage* - A subdural hemorrhage is a collection of blood between the **dura mater and arachnoid mater**, typically resulting in neurological deficits due to brain compression. - While head injury is the cause, it does not directly explain **blood in the tympanic membrane** as a primary finding. *Extradural haemorrhage* - An extradural (epidural) hemorrhage is often characterized by a **lucid interval** followed by rapid neurological deterioration due to arterial bleeding. - It does not typically manifest with **blood in the tympanic membrane** unless there's a co-occurring basilar fracture, which would be the more direct cause of the tympanic finding. *Intraventricular haemorrhage* - An intraventricular hemorrhage involves bleeding into the **brain's ventricular system** and is usually associated with significant neurological impairment and altered consciousness. - It does not cause **blood in the tympanic membrane**.

Question 9: A lady comes to OPD after fall from scooty. Her vitals are stable. She is having continuous, clear watery discharge from nose after 2 days. This is most likely a feature of?

A. CSF rhinorrhoea (Correct Answer)
B. Acute respiratory infection
C. Rhinitis
D. Middle cranial fossa fracture

Explanation: ***CSF rhinorrhoea*** - **Clear watery discharge** appearing **two days after head trauma** (fall from scooty) is highly suggestive of **cerebrospinal fluid (CSF) rhinorrhoea**. - This occurs due to a breach in the **skull base**, allowing CSF to leak from the subarachnoid space into the nasal cavity. *Acute respiratory infection* - An acute respiratory infection typically presents with symptoms like **fever, cough**, and **nasal discharge** that is often thicker and discolored, not clear and watery. - The onset of discharge two days after trauma without other signs of infection also makes this less likely. *Rhinitis* - Rhinitis involves inflammation of the nasal mucosa, leading to watery discharge, sneezing, and congestion. - However, the traumatic etiology and the specific timing of the discharge make **CSF leak** a more pertinent diagnosis than simple rhinitis. *Middle cranial fossa fracture* - While a **middle cranial fossa fracture** can cause CSF leakage, the discharge from the nose (rhinorrhoea) typically originates from an **anterior cranial fossa fracture**. - A middle cranial fossa fracture is more commonly associated with **otorrhoea** (CSF leakage from the ear) if the temporal bone is involved.

Question 10: In an accident case, after the arrival of medical team, all should be done in early management except;

A. Glasgow coma scale
B. Check BP (Correct Answer)
C. Stabilization of cervical vertebrae
D. Check Respiration

Explanation: ***Check BP*** - In the **immediate/early management** of trauma (primary survey), while circulation assessment is crucial, the **initial assessment of circulation** focuses on: - **Pulse rate and quality** (radial, carotid) - **Capillary refill time** - **Skin color and temperature** - **Active hemorrhage control** - **Formal blood pressure measurement** with a cuff, while important, is typically recorded during or after these rapid initial assessments, as it takes more time to obtain an accurate reading. - In the context of this question, among the four options listed, BP measurement is relatively less immediate compared to the other life-saving priorities (airway protection, breathing assessment, C-spine stabilization, and GCS). - **Note:** This is a nuanced distinction - BP is assessed during primary survey, but the other three options have more immediate life-threatening implications if not addressed. *Glasgow coma scale* - **GCS assessment** is part of the **"D" (Disability)** step in the ATLS primary survey. - It is performed early to assess neurological status and level of consciousness. - GCS <8 indicates need for **definitive airway protection** (intubation). - This is a critical early assessment that guides immediate management decisions. *Stabilization of cervical vertebrae* - **C-spine immobilization** is part of the **"A" (Airway)** step - "Airway with cervical spine protection." - It is performed **simultaneously** with airway assessment using a **rigid cervical collar**. - This is the **first priority** in trauma management to prevent secondary spinal cord injury. - All trauma patients should be assumed to have C-spine injury until proven otherwise. *Check Respiration* - **Respiratory assessment** is part of the **"B" (Breathing)** step in the ATLS primary survey. - This involves checking: - **Respiratory rate and pattern** - **Chest wall movement** - **Air entry bilaterally** - **Signs of tension pneumothorax or flail chest** - This is an immediate life-saving priority and must be assessed early.

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