NORCET 5 Prelims - Sept 2023 (Shift-1)
Medical & Surgical Nursing
Easy
Haemato-tympanum and otorrhoea are associated with which of the following head injuries?
Appeared in: NORCET 5 Prelims - Sept 2023 (Shift-1)
Explanation
- A basilar skull fracture is a break in the bones at the base of the skull, such as the temporal bone, occipital bone, sphenoid bone, or ethmoid bone.
- Fractures of the temporal bone can disrupt the middle and inner ear structures, leading to haemato-tympanum (blood in the middle ear) and potentially tearing the dura, causing CSF otorrhoea (leakage of cerebrospinal fluid from the ear).
- Other classic signs, like Battle's sign (mastoid ecchymosis) and raccoon eyes (periorbital ecchymosis), are also caused by blood from the fracture tracking along tissue planes to these locations.
Why Other Options Were Wrong
- Option B: A subdural hematoma is a collection of blood under the dura mater. Its primary signs are related to increased intracranial pressure, such as headache, altered level of consciousness, and focal neurological deficits. It does not typically cause haemato-tympanum or CSF otorrhoea.
- Option C: An epidural hematoma is bleeding between the dura mater and the skull, often from an arterial tear. The classic presentation is a brief loss of consciousness followed by a 'lucid interval' and then rapid neurological decline. It does not directly cause the specific ear and eye signs of a basilar fracture.
- Option D: A frontal lobe fracture involves the frontal bone of the skull. While it can be serious and cause CSF rhinorrhoea (leakage from the nose) if the sinuses are involved, it is not typically associated with haemato-tympanum or otorrhoea, which are related to temporal bone involvement.
Related Visual
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.
- A primary nursing responsibility is to monitor for CSF leakage from the nose (rhinorrhoea) or ears (otorrhoea). The fluid can be tested for glucose (a positive result indicates CSF) or observed for a 'halo' sign on gauze (a yellowish ring forms around a central blood spot).
- Never insert a nasogastric (NG) tube or perform nasotracheal suctioning in a patient with a suspected basilar skull fracture. The tube could inadvertently pass through the fracture into the brain, causing severe trauma and infection.
- What if? If a patient with a basilar skull fracture develops a fever, headache, and nuchal rigidity (stiff neck), the nurse must immediately suspect meningitis. This is a medical emergency requiring prompt antibiotic therapy, and the healthcare provider must be notified at once.
How to Approach the Question
- First, identify the key clinical signs presented in the question: 'haemato-tympanum' (blood behind the eardrum) and 'otorrhoea' (ear discharge).
- Consider the anatomy. These signs directly involve the ear structures. A head injury causing these symptoms must involve the part of the skull that houses the ear—the temporal bone, which is part of the skull base.
- Evaluate the options. A 'Basilar skull fracture' specifically refers to a fracture at the base of the skull, which often involves the temporal bone.
- Eliminate the other options. Subdural and epidural hematomas are bleeds within the cranium that cause pressure symptoms, not typically these specific signs. A frontal lobe fracture affects a different part of the skull.
- Conclude that the combination of haemato-tympanum and otorrhoea is the classic presentation for a basilar skull fracture.
Concept Tested & Keywords
- Concept Tested: Clinical signs of basilar skull fracture
- Stem keywords: Haemato-tympanum, otorrhoea, head injuries
- Lead-in keywords: associated with
- Clinical cues: The combination of blood behind the eardrum and ear discharge points to a fracture at the base of the skull affecting the ear structures.
Question ID
Qfynq18MKMyK_UzA-xyT7c
Reference Book
E6 Medicine Harrison 22e Part 2 p. 1476-1478
E6 Nursing Brunner Adult Health 3SA Vol 2 Part 2 p. 83-85
Practise the full NORCET 5 Prelims - Sept 2023 (Shift-1)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
More Neurologic Function Questions
- Which of the following is a differentiating test between mucus and cerebrospinal fluid (CSF) from a nasal discharge?
- The nurse is posted in ED and patient comes with seizure. The priority management of seizure patient is:
- In the following picture, little finger under jaw is used because for:
- Parkinson's disease is characterized by deficiency of neurotransmitter.
- All of the following are complications of spinal cord injury (SCI); EXCEPT:
- A Patient with Parkinson's syndrome receives continuous levodopa to prevent what complication?
- During RTA, a person has a stroke, then his pupils are?
- A 28 year old patient was admitted to the hospital for a suspected brain tumor. While assessing the patient, the nurse would keep in mind that the mo…
- A patient develops an acute confusion (delirium) state. What would be the priority nursing Intervention?
- Pain at lower back and legs when flexed of knee flexes is known as?
More NORCET 5 Prelims - Sept 2023 (Shift-1) Questions
- Which of the following electrocardiogram finding would be seen in a client with Hyperkalemia?
- Identify the following ECG finding in the depicted image?
- Which of the following is not used in management of orthostatic hypotension?
- Which of the following clinical features is not seen in shock?
- Which position is best to identify left pleural effusion?
- A male patient comes in casualty who has a lacerated untidy wound after 4 hours. What would be the priority nursing action?
- A client who underwent abdominal surgery earlier in the day has a small amount of bright red blood on the surgical dressing. How should the nurse doc…
- A nurse entered a nursery unit and observed that a newborn shows jerky movement of the lower limbs. Which of the following is the priority nursing ac…
- The nurse should be concerned for which while a child is on chemotherapy?
- Following a head injury, a person comes into the emergency department with personality changes and loss of voluntary control. Which lobe of the brain…