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OVER 98% PASS RATE FOR THE NCS, OCS, AND PCS EXAMS forums NCS Advantage Practice Test 1- Q 80 answer seems off

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    • #479575
      Julie Schwertfeger

      Hello. This is a query regarding Q80 of practice test 1. Here it is for reference:

      Which type of hematoma requires the most immediate medical attn?

      The answer choice the test states is correct is Epidural.

      The alternate distractors include Aural, Intracerebral, and Subdural.

      The correct answer should be subdural based on the following:
      a. Epidural hemorrhage occurs between calvarium and outermost layer of epidural meninge, and is often self contained or slowed by the toughness of the dura nd the strength of adhesion to calvarium. In older patients they often monitor and do not evacuate the hemorrhage.
      b. Subdural hemorrhage occurs below dura and above parenchyma, which allows free space to fill rapidly with blood without resistance, and create pressure on brain across regions.
      c. intracerebral occurs within neural tissue, and spreads like a fan across white matter tracts.
      d. Aural is bleeding in ear cavity.

      Please share your insights on this line of thinking and question. I look forward to learning from the discussion.

    • #479678
      Alyssa Urtula

      Hello Julie,
      I believe the answer of an epidural hematoma is correct because of the following:
      a. They are usually arterial bleeds vs usually venous bleeds (subdural)
      b. Because they are in the space between the outermost layer and the skull, there is no place for the blood to go which can cause a rapid increase in ICP
      c. Although subdural hematomas have a higher mortality rate than epidural hematomas, I think that because there are also minor subdural hematomas that can occur without issue, the rapid increase in ICP that occurs in epidural hematomas raise a more emergent issue. (But of course both need immediate medical attention, one is just more emergent than the other)

      Please let me know if this has been helpful. I wish you luck in your studies!

    • #479699
      Julie Schwertfeger

      Thank you Alyssa,
      Yes, this is helpful and I appreciate you responding to my question on this. It is interesting to explore areas within my expertise and still get stumped! This is a good thing and makes this journey very worthwhile. To add to your good insights, the famous Natasha Richardson case of epidural hemorrhage is a nice review of the symptomology. Here is a link in case you do not already have this one: https://www.webmd.com/brain/news/20090319/natasha-richardson-dies-of-epidural-hematoma
      Happy New Year and happy studying!

    • #479702
      Julie Schwertfeger

      Hi Alyssa,
      One more insight regarding age in the practice test Q 80 is that EDH in younger age and adolescent is more of an emergency than in older people (which is where my experience if focused). The dura is not tightly adhered to the calvarium in youth and adolescence, making all of your good points Alyssa, the most emergent hematoma case of the question choices. In effect, youth TBI that causes EDH have the rapid rise in ICP as you have stated. In older aged persons, the arterial bleed is often stopped or self-limited by the tightly adhered dura and the shrunken brain diameter further lessen the emergency hierarchy level rank of this type of hematoma across the four answer choices provided. It is a nice reflection on Kleim and Jones as well – “Age Matters!”. https://medlineplus.gov/ency/article/001412.htm

    • #479715
      Alyssa Urtula

      Hi Julie,
      Thank you for those resources you listed there! Good luck in your studies.

    • #479779
      Julie Schwertfeger

      Thanks. You too Alyssa!

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