Injuries: extradural haematoma: practice question

A Forensic Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Forensic Medicine · Injuries: extradural haematoma

Sample item

A 20-year-old cricketer is hit on the left temple by a ball, loses consciousness briefly and recovers, then becomes drowsy 3 hours later with a dilated left pupil. CT shows a biconvex hyperdense collection. Which vessel is usually responsible, and what is the right management?

AMiddle meningeal artery; observation for spontaneous resolutionBMiddle meningeal artery; urgent craniotomy and evacuationCBridging veins; delayed burr-hole drainage after several weeksDBridging veins; conservative treatment with repeat CT

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Middle meningeal artery; urgent craniotomy and evacuation

An extradural haematoma follows a fracture of the temporal squamous bone that tears the middle meningeal artery. The lucid interval, rapid deterioration and lentiform (biconvex) CT appearance are classical. Arterial bleeding expands quickly, so urgent surgical evacuation is lifesaving.

Option by option

A. Middle meningeal artery; observation for spontaneous resolution
An arterial extradural collection with a dilated pupil does not resolve without surgery.
B. Middle meningeal artery; urgent craniotomy and evacuation (correct)
Correct. An arterial source with a symptomatic mass effect needs emergency evacuation.
C. Bridging veins; delayed burr-hole drainage after several weeks
Delayed burr-hole drainage suits chronic subdural collections, not an acute arterial bleed.
D. Bridging veins; conservative treatment with repeat CT
Bridging veins bleed in subdural haemorrhage, which has a crescentic rather than biconvex shape.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Forensic Medicine question

What is the answer to this Forensic Medicine question?

The best answer is B, Middle meningeal artery; urgent craniotomy and evacuation. An extradural haematoma follows a fracture of the temporal squamous bone that tears the middle meningeal artery.

Why is "Middle meningeal artery; observation for spontaneous resolution" not the answer?

An arterial extradural collection with a dilated pupil does not resolve without surgery.

Why is "Bridging veins; delayed burr-hole drainage after several weeks" not the answer?

Delayed burr-hole drainage suits chronic subdural collections, not an acute arterial bleed.

Why is "Bridging veins; conservative treatment with repeat CT" not the answer?

Bridging veins bleed in subdural haemorrhage, which has a crescentic rather than biconvex shape.

What concept does this question test?

It tests Injuries: extradural haematoma in Forensic Medicine. The lucid interval, rapid deterioration and lentiform (biconvex) CT appearance are classical. Arterial bleeding expands quickly, so urgent surgical evacuation is lifesaving.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Injuries: extradural haematoma?

Learn postmortem changes with their timelines, and toxicology as poison, sign, test and antidote. Then use the flashcards and the other Forensic Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.