NORCET 5 Prelims - Sept 2023 (Shift-2)
Medical & Surgical Nursing
Easy
Hematotympanum and otorrhea are associated with which of the following head injuries?
Appeared in: NORCET 5 Prelims - Sept 2023 (Shift-2)
Explanation
- Hematotympanum (blood behind the eardrum) and otorrhea (fluid from the ear) are hallmark signs of a basilar skull fracture.
- This injury involves a fracture at the base of the skull, often traversing the temporal bone which houses the middle and inner ear structures.
- The fracture tears the dura mater (the membrane surrounding the brain), allowing cerebrospinal fluid (CSF) to leak out through the ear (otorrhea).
- Damage to blood vessels within the temporal bone or middle ear space causes bleeding, which collects behind the tympanic membrane (hematotympanum).
Why Other Options Were Wrong
- Option B: A subdural hematoma is a collection of venous blood between the dura and arachnoid layers. Its symptoms, such as headache, confusion, and gradual neurologic decline, are caused by increased intracranial pressure, not by a direct fracture into the ear structures.
- Option C: An epidural hematoma is an arterial bleed between the skull and the dura mater. It classically presents with a brief loss of consciousness followed by a lucid interval and then rapid deterioration. It does not cause otorrhea or hematotympanum.
- Option D: A frontal lobe fracture involves the frontal bone of the skull. While it can cause a CSF leak, the drainage would be from the nose (rhinorrhea) if the fracture extends into the sinuses, not from the ear (otorrhea).
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Assessment of Traumatic Brain Injury as background academic context rather than a clinical decision trigger.
- The presence of CSF otorrhea signifies a dural tear, which creates a direct pathway for bacteria to enter the central nervous system, placing the patient at high risk for meningitis.
- A key nursing safety measure is to NEVER pack the nose or ear of a patient with a suspected basilar skull fracture. Packing can obstruct CSF flow, increase intracranial pressure, and introduce pathogens.
- A simple bedside test for CSF is the 'halo' or 'ring' sign, where a drop of the fluid on gauze will form a central blood spot surrounded by a yellowish ring of CSF. A glucose test strip can also be used, as CSF is positive for glucose.
How to Approach the Question
- First, identify the key clinical signs presented in the question: 'hematotympanum' (blood behind the eardrum) and 'otorrhea' (discharge from the ear).
- Recognize that these are highly specific signs related to the ear and the base of the skull.
- Consider the anatomy associated with each answer choice. A basilar skull fracture involves the base of the skull, which includes the temporal bone where the ear structures are located.
- Evaluate the other options. Subdural and epidural hematomas are intracranial bleeds that cause symptoms of increased pressure on the brain, not direct communication with the ear canal.
- A frontal lobe fracture affects the front of the skull and would be associated with nasal signs (rhinorrhea), not ear signs.
- Conclude that the basilar skull fracture is the only option that anatomically explains both bleeding and fluid leakage from the ear.
Concept Tested & Keywords
- Concept Tested: Assessment of Traumatic Brain Injury
- Stem keywords: Hematotympanum, otorrhea, head injuries
- Lead-in keywords: associated with
Question ID
QZmkqtwXpc294whzm0BNrP
Reference Book
E6 Medicine Harrison 22e Part 2 p. 1476-1478
E6 Nursing Brunner Adult Health 3SA Vol 2 Part 2 p. 83-85
E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1830-1832
Practise the full NORCET 5 Prelims - Sept 2023 (Shift-2)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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