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Common acute head trauma exam questions for medical finals, OSCEs and MRCP PACES


Question 1. Aetiology

List three causes of head trauma

  • Falls
  • Assaults
  • RTCs


Question 2. Meninges

List three meninges from superficial to deep

  • Dura mater
  • Arachnoid mater
  • Pia mater


Question 3. Potential Spaces

List three potential spaces from superficial to deep

  • Extradural space
  • Subdural space
  • Subarachnoid space


Question 5. Cerebral perfusion pressure (CPP)

Summarize the Monroe-Kellie doctrine

  • CPP = MAP – ICP

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  • CPP is autoregulated at MAP = 50-150 mmHg


Question 6. Cushing’s triad

List the three features of Cushing’s triad and explain its mechanism

  • Hypertension
  • Bradycardia
  • Irregular respirations
  • As ICP rises, MAP rises to maintain CPP; excessive MAP may cause a reflex bradycardia


Question 7. GCS

A 79 year old lady presents with a reduced level of consciousness after sustaining a head injury during a fall; she does not open her eyes but moans and flexes her limbs when given a jaw thrust; give a breakdown of her GCS including the total score

  • GCS = E1 V2 M3 = 6

On opening her eyes, you see that one of her pupils is fixed and dilated; what is the likely mechanism of this?

  • Third nerve palsy from uncal herniation secondary to an expanding intracranial haematoma


Question 8. NICE indications for CT head

Give six of the NICE indications for CT head.

  • Any six of
    • GCS <13 initially
    • GCS <15 at 2 hours post-injury
    • Suspected open or depressed skull fracture
    • Signs of basal skull fracture
      • Periorbital ecchymoses (panda eyes)
      • Postauricular ecchymoses (Battle’s sign)
      • CSF otorhinorrhoea
      • Haemotympanum
    • Post-traumatic seizure
    • >1 episode of vomiting
    • Focal neurological deficit
    • Loss of consciousness/amnesia + one of the following
      • Age >65
      • Dangerous mechanism (pedestrian or cyclist struck by a motor vehicle; occupant ejected from motor vehicle; fall from >1 m or five stairs)
      • >30 min retrograde amnesia


Question 9. Primary and secondary brain injury

Explain the difference between primary and secondary brain injury

  • Primary brain injury occurs during the initial trauma; secondary brain injury occurs after the initial insult and is potentially preventable or treatable