# A 25-year-old construction worker presents to the emergency department after a piece of metal debris struck his left ear during work. Which assessment finding would be most concerning and require immediate intervention?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=541718  
> language: ko  
> subject: Adult Health

## 문제

A 25-year-old construction worker presents to the emergency department after a piece of metal debris struck his left ear during work. Which assessment finding would be most concerning and require immediate intervention?

## 보기

1. Mild hearing loss in the affected ear
2. Small amount of clear drainage from the ear canal
3. Blood-tinged cerebrospinal fluid draining from the ear **✔ 정답**
4. Tinnitus and ear pain rated 6/10 on a pain scale

**정답: 3**

## 해설

Blood-tinged CSF drainage indicates basilar skull fracture, a medical emergency requiring immediate intervention. Other findings like hearing loss or pain are common but less urgent.

## 심화 해설

Clinical Reasoning & Priority Setting

This clinical scenario presents a patient with a mechanism of injury highly suspicious for a basilar skull fracture, and the question tests your ability to recognize the most critical, life-threatening complication. The correct answer is blood-tinged cerebrospinal fluid draining from the ear.

When a high-velocity projectile like metal debris strikes the temporal bone, the force can fracture the skull base. The most urgent assessment finding is the one that indicates a direct communication between the sterile intracranial cavity and the external environment. Blood-tinged clear drainage from the ear, which tests positive for glucose or shows a "halo sign" on gauze, is pathognomonic for a cerebrospinal fluid (CSF) leak secondary to a dural tear. This finding demands immediate intervention because it creates a portal of entry for bacteria, placing the patient at significant risk for post-traumatic meningitis (PTM). A systematic review by Hussein et al. confirms that traumatic CSF leaks following skull base fractures carry a serious associated risk of PTM, making early recognition and management of the leak a clinical priority [1]. While the other options—hearing loss, tinnitus, and pain—are common and expected sequelae of temporal bone trauma, they do not represent an immediate threat of intracranial infection. A small amount of clear drainage could be mistaken for serous fluid, but the presence of blood-tinged CSF is an unambiguous sign of a high-risk leak that requires emergency neurosurgical consultation, strict precautions to prevent infection, and often surgical repair if the leak does not resolve spontaneously. Jung et al. further characterize basilar skull fractures as injuries that can cause debilitating complications without prompt treatment, reinforcing that a CSF leak is a primary driver of acute management decisions [2]. Therefore, while you will address the patient’s pain and hearing deficits, the finding that triggers the most immediate, high-priority action is the objective evidence of a CSF leak.References (research sources)

- [1]A Clinical Fallacy: Myth of Meningitis-Driven Dural Healing in Post-traumatic Cerebrospinal Fluid Leaks.Research articleHussein M, Msheik A, El Mohamad AR, Khater J, Illeyyan A, AlSaad N, Thabet A. (2025) · DOI: 10.7759/cureus.89179

- [2]Clinical Features and Management of Skull Base Fractures in the Pediatric Population: A Systematic Review.Meta-analysis/systematic reviewJung G, Xavier J, Reisert H, Goynatsky M, Keymakh M, Buckner-Wolfson E, Kim T, Fatemi R, Alavi SAN, Pasuizaca A, Shah P, Liriano G, Kobets AJ. (2024) · DOI: 10.3390/children11050564

## 임상 시나리오

CSF Otorrhea: Emergency ManagementRecognizing and Responding to a Basilar Skull Fracture
The priority finding after temporal bone trauma is blood-tinged cerebrospinal fluid (CSF) otorrhea, which signals a dural tear and direct communication with the intracranial space. This creates a high risk for post-traumatic meningitis.

Confirm the leak with a bedside halo sign test or glucose analysis. Do not pack the ear or insert anything into the canal. Instead, apply a loose, sterile gauze pad to absorb drainage and allow passive flow.

CautionNever suction or irrigate the ear, as this can introduce bacteria and cause catastrophic meningitis. Monitor for signs of infection, including fever, nuchal rigidity, and altered mental status.

## 핵심 개념

- **CSF Otorrhea** — Leakage of cerebrospinal fluid from the ear, indicating a dural tear and communication between the subarachnoid space and the external environment.
- **Halo Sign** — A bedside test where blood-tinged drainage on gauze forms a central blood spot surrounded by a lighter ring of CSF, suggesting a basilar skull fracture.
- **Post-Traumatic Meningitis** — A life-threatening infection of the meninges that can occur when a dural defect allows bacteria to enter the intracranial space following trauma.

## 같은 주제 문제

- [A nurse is assessing a 45-year-old client who sustained a blunt trauma to the left ear aft…](https://mymerci.kr/pages/nclex_q.php?qn_id=541719)
- [A nurse is assessing a client who sustained a blunt trauma to the right ear during a motor…](https://mymerci.kr/pages/nclex_q.php?qn_id=541720)
- [A client presents to the emergency department with a penetrating ear injury from a metal o…](https://mymerci.kr/pages/nclex_q.php?qn_id=541721)
- [A 25-year-old construction worker presents to the emergency department after a loud explos…](https://mymerci.kr/pages/nclex_q.php?qn_id=541722)
- [A nurse is caring for a client who sustained a traumatic injury to the right ear from a mo…](https://mymerci.kr/pages/nclex_q.php?qn_id=541723)
- [A 32-year-old client presents to the emergency department with a penetrating ear injury fr…](https://mymerci.kr/pages/nclex_q.php?qn_id=541724)
- [A client arrives at the emergency department with a penetrating ear injury from a metal ob…](https://mymerci.kr/pages/nclex_q.php?qn_id=541725)
- [A 5-year-old child is brought to the emergency department by parents after inserting a bea…](https://mymerci.kr/pages/nclex_q.php?qn_id=541726)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._