NORCET 3 - 2022 (Shift-1)
Medical & Surgical Nursing
Easy
Which of the following injury would be suspected in a patient who have otorrhea?
Appeared in: NORCET 3 - 2022 (Shift-1)
Explanation
- Otorrhea, particularly the leakage of clear cerebrospinal fluid (CSF), is a hallmark sign of a basilar skull fracture.
- This occurs because a fracture at the base of the skull can tear the dura mater (meninges), creating a pathway for CSF to leak out through the middle ear and external auditory canal.
- Other classic signs associated with this injury include Battle's sign (bruising over the mastoid process) and raccoon eyes (periorbital ecchymosis).
Why Other Options Were Wrong
- Option A: An epidural hematoma is an arterial bleed between the skull and the dura mater. Its classic presentation includes a brief loss of consciousness followed by a 'lucid interval' and then rapid neurological decline. It does not cause CSF leakage.
- Option B: A subdural hematoma is typically a venous bleed beneath the dura mater. Symptoms develop more slowly than in an epidural hematoma and are related to increased intracranial pressure. It is not associated with otorrhea.
- Option C: While a ruptured eardrum can cause discharge from the ear, it is usually blood or pus (in case of infection). It does not involve a fracture of the skull base or a tear in the dura, so it does not cause CSF leakage.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Assessment of Traumatic Brain Injury to guide bedside assessment, documentation, and the next nursing action.
- A nurse must immediately recognize clear or watery drainage from the ear or nose after head trauma as a potential CSF leak, which is a medical emergency due to the high risk of meningitis.
- A simple bedside test is the 'halo sign' or 'ring sign': when the fluid is dripped onto a gauze pad, the CSF will form a clear or yellowish ring around a central spot of blood.
- Key nursing priorities include maintaining spinal precautions, elevating the head of the bed, and avoiding any packing or suctioning of the affected orifice to prevent introducing infection.
How to Approach the Question
- First, identify the key clinical sign presented in the question, which is 'otorrhea' (discharge from the ear).
- Consider the context: the patient has sustained an 'injury'. In trauma, ear discharge can be blood, pus, or cerebrospinal fluid (CSF).
- Evaluate each option's potential to cause otorrhea after an injury.
- Recall that epidural and subdural hematomas are intracranial bleeds that do not typically cause external fluid leakage.
- Differentiate between a simple ruptured eardrum, which is a localized injury, and otorrhea as a sign of a more severe, underlying injury.
- Recognize that CSF otorrhea is a classic and specific sign of a fracture at the base of the skull (basilar skull fracture) that has torn the meninges.
Concept Tested & Keywords
- Concept Tested: Assessment of Traumatic Brain Injury
- Stem keywords: otorrhea, injury, suspected
- Lead-in keywords: Which
- Clinical cues: The presence of otorrhea is the key clinical finding pointing to the diagnosis.
Question ID
Q49Eg9WShfzxw5rRL1cX44
Reference Book
E6 Medicine Harrison 22e Part 2 p. 1476-1478
E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1830-1832
E6 Nursing Brunner Adult Health 3SA Vol 2 Part 1 p. 66-68
Practise the full NORCET 3 - 2022 (Shift-1)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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