A patient is admitted following a motor vehicle collision. On physical examination, the nurse notes bruising over the mastoid process behind the ear (Battle's sign) and periorbital ecchymosis ('raccoon eyes'). These physical findings are pathognomonic for:

Answer and explanation

Correct answer: B. Basilar skull fracture

  1. Step 1: Battle sign (postauricular ecchymosis) and raccoon eyes (periorbital ecchymosis) result from blood tracking along fascial planes from fractures involving the petrous temporal bone and anterior/middle cranial fossae.
  2. Step 2: They are classic physical examination signs of a basilar skull fracture.
Answer
Basilar skull fracture.
Why not the others: 'Cervical spine fracture' produces localized midline posterior neck tenderness and focal neurological deficits; 'Zygomatic arch fracture' causes facial asymmetry and trismus; 'Subdural hematoma' is an intracranial bleed that does not produce mastoid subcutaneous ecchymosis without skull base fracture.

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