A 30 year old man is brought to emergency with history of accident. Which of the following sign indicates skull fracture

Appeared in: NHM UP Staff Nurse-2021 Shift-1st

Explanation

This option correctly identifies two hallmark signs of a basilar skull fracture.
Fluid draining from the ear (CSF otorrhea) or nose (CSF rhinorrhea) indicates a tear in the dura mater, the protective covering of the brain.
Periorbital ecchymosis, also known as 'Raccoon eyes,' is caused by blood from the fracture site pooling in the soft tissues around the eyes.
The presence of both these signs together is highly suggestive of a fracture at the base of the skull.

Option B: These signs are non-specific. Bleeding from the nose (epistaxis) or a forehead laceration can occur with many types of facial trauma and do not specifically indicate a skull fracture.
Option C: This option is only partially correct. While Battle's sign (bruising behind the ear) is a classic sign of a basilar skull fracture, Kernig's sign is not. Kernig's sign is a test for meningeal irritation (meningitis), where flexing the hip and knee and then attempting to extend the knee causes pain and resistance.
Option D: This option is incorrect because Option A provides two valid and classic signs of a basilar skull fracture.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical signs of basilar skull fracture as background academic context rather than a clinical decision trigger.
Recognizing the signs of a basilar skull fracture is critical for nurses as it indicates a high-risk injury with potential for severe complications like meningitis and brain injury.
A key nursing safety priority is to avoid inserting a nasogastric (NG) tube in patients with suspected basilar skull fractures, as the tube could inadvertently enter the brain through the fracture site.
The 'halo sign' is a bedside test where fluid leaking from the nose or ear is dripped onto gauze. A positive sign is a central spot of blood surrounded by a yellowish ring of CSF, confirming a dural tear.

How to Approach the Question

First, identify the core of the question: it asks for specific signs of a skull fracture in a trauma patient.
Analyze each option to determine if the signs are specific to a skull fracture or are more general signs of trauma.
Evaluate Option A: CSF leak and raccoon eyes are both classic, specific signs of a basilar skull fracture.
Evaluate Option B: Bleeding from the nose and forehead are non-specific and can occur without a fracture.
Evaluate Option C: Battle's sign is correct, but Kernig's sign is for meningeal irritation, making the combination incorrect.
Conclude that the option listing two specific, classic signs is the best answer.

Concept Tested & Keywords

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E6 Nursing Brunner Adult Health 3SA Vol 2 Part 2 p. 83-85

E6 Medicine Harrison 22e Part 2 p. 1476-1478

Practise the full NHM UP Staff Nurse-2021 Shift-1st

Attempt every question from this paper in a timed mock, then review the full solution for each one.