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4. Which of the following statements is FALSE concerning
carcinoma of the prostate?
A. Annual digital rectal examination and serum pros-
tate-specific antigen (PSA) determinations are rec-
ommended beginning at age 55.
B. Lung metastasis is less common than bone metastasis.
C. Radical prostatectomy is associated with a 5% inci-
dence of permanent urinary incontinence
CHAPTER 40
Urology
D. Once prostate cancer has spread, it is no longer cur-
able but can be contained by lowering serum testos-
terone and/or by administration of androgen receptor
blockers.
5. Concerning ureteric trauma, which of the following
statements is TRUE?
A. Retrograde pyelogram is the most sensitive test to
detect ureteral injury.
B. Bladder mobilization is not integral to repair of ure-
teric injury.
C. Kidney mobilization is not integral to repair of ure-
teric injury.
D. Use of ureteric stents is not useful in preventing post-
repair strictures.
Answer: C
The American Urological Association has advised screening for men 55 to 69 years of age. The most common site of
spread of prostate cancer is to the pelvic lymph nodes and
bone. Radical prostatectomy is associated with early incontinence and erectile dysfunction. Incontinence improves significantly with time, with <1% of men, in experienced hands,
suffering severe long-term problems with urinary control.
(See Schwartz 11th ed., pp. 1774–1775.)
Answer: A
A retrograde pyelogram is the most sensitive test for ureteral
injury. Partial injuries can be primarily repaired, although
all devitalized tissues must be debrided to avoid delayed
tissue breakdown and urinoma formation. Ureteral stents
should be placed in this situation to facilitate healing without stricture. Midureteral-level injuries can be treated with a
uretero- ureterostomy if a spatulated tension-free repair can
be achieved. For longer defects, the bladder can be mobilized and brought up to the psoas muscle (psoas hitch). For
additional length, a tubularized flap of bladder (Boari flap)
can be created and anastomosed to the remaining ureter.
(See Schwartz 11th ed., pp. 1765–1766.)
6. All of the following are TRUE concerning priapism
EXCEPT:
A. Priapism is defined as a persistent erection for more
than 4 hours unrelated to sexual stimulation.
B. Etiologic factors include sickle cell disease, malig-
nancy, total parenteral nutrition, and penile shaft
fractures.
C. Low-flow priapism can be confirmed with a penile
blood gas determination.
D. Treatment may require injection of phenylephrine.
7. Prostatitis is typified by all of the following EXCEPT:
A. Pain, dysuria, urgency.
B. Fever in both acute and chronic prostatitis.
C. Treatment consists of long-term antibiotics.
D. Workup may include culture of expressed prostatic
secretions.
8. Which of the following statements is correct about
urolithiasis?
A. Stone formation is associated with diabetes.
B. Uric acid stones are the most common type.
C. Magnetic resonance imaging (MRI) is the most accu-
rate diagnostic test.
D. Lithotripsy is best for stones located in the middle or
distal ureter.
Answer: B
Priapism is a persistent erection for >4 hours unrelated to
sexual stimulation. Risk factors include sickle cell disease or
trait, malignancy, medications, cocaine abuse, certain antidepressants, and total parenteral nutrition. Low-flow priapism
can be confirmed with a penile blood gas of the cavernosal
bodies demonstrating hypoxic, acidotic blood. Injection of
phenylephrine (up to 200 mg in 20 mL normal saline) into
the corporal bodies may be required. (See Schwartz 11th ed.,
pp. 1769–1770.)
Answer: B
Acute prostatitis is marked by fever, suprapubic or perineal
pain, and new onset lower urinary tract symptoms, including dysuria, frequency, urgency, changes in stream caliber,
or difficulty emptying the bladder. Treatment consists of
a long-term course (4–6 weeks) of antibiotics. Fever is not
observed in chronic prostatitis, and onset may occur over
many months. Patients with chronic bacterial prostatitis may
also report recurrent urinary tract infections (UTIs). Differentiation between acute and chronic etiologies requires culture of expressed prostatic secretion to confirm the presence
or absence of bacteria. (See Schwartz 11th ed., p. 1761.)
Answer: A
Stone formation has been associated with obesity, metabolic
syndrome, and diabetes mellitus. Stones are most commonly
composed of calcium oxalate. A noncontrast computer
tomography (CT) scan is the most sensitive (98%) and specific (97%) examination to detect urolithiasis. Ureteroscopy
is the procedure of choice for patients with middle or distal
ureteral stones. (See Schwartz 11th ed., pp. 1762–1763.)
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9. Concerning benign prostatic hyperplasia (BPH), which
of the following statements is FALSE?
A. It is found in 80% of patients 70 years or older.
B. Complications can include renal failure.
C. Transurethral resection is the mainstay of invasive
therapeutic interventions.
D. Beta-blockers are the most common pharmacologic
intervention.
10. Which of the following statements is FALSE concerning
Fournier’s gangrene (necrotizing fasciitis)?
A. Mortality is 25%.
B. Risk factors include diabetes, obesity, and alcoholism.
C. Often polymicrobial.
D. Prompt surgical debridement mandatory.
11. Concerning testicular cancer, which of the following
statements are TRUE?
A. Second most common cancer in men ages 20–40.
B. Nonseminomatous variants are the most common
subtype.
C. Radical inguinal orchiectomy is the “gold standard”
of treatment.
D. Workup includes biomarker assays for mutated p53;
overexpression of matrix metalloproteinases, and
estrogen receptor.
Answer: D
The prevalence of BPH in men over the age of 50 is estimated
at 50% to 75% and increases with age with a prevalence of
80% in men over the age of 70. Complications of BPH include
urinary retention, incontinence, renal failure, hematuria, or
recurrent infections. The first line of treatment is most commonly pharmacotherapy for those men with bothersome
symptoms; alpha blockers work by relaxing the smooth muscle of the prostate and bladder neck. Transurethral resection
of the prostate (TURP) remains the mainstay of endoscopic
procedures. (See Schwartz 11th ed., pp. 1763–1764.)
Answer: A
Fournier’s gangrene is a necrotizing fasciitis of the male genitalia and perineum that can be rapidly progressive and fatal if
not treated promptly. The mortality rate is as high as 67%. Risk
factors for Fournier’s gangrene include perirectal abscesses,
diabetes, obesity, and chronic alcoholism. The often polymicrobial infection spreads and can dissect along Scarpa and
Colles fascia. Prompt and aggressive surgical debridement of
nonviable tissue and broad spectrum antibiotics are necessary
to prevent further spread. (See Schwartz 11th ed., p. 1769.)
Answer: C
Testicular cancer is the most common cancer in men age 20 to
40 years and the second most common cancer in young men
age 15 to 19 years. Standard initial workup includes scrotal
ultrasound and serum tumors markers (α-fetoprotein, quantitative human chorionic gonadotropin, and lactate dehydrogenase). Radical inguinal orchiectomy is the gold standard
treatment for excision of the primary tumor. (See Schwartz
11th ed., pp. 1771–1772.)
CHAPTER 40
Urology
12. All of the following statements are TRUE of renal cell
carcinoma (RCC), EXCEPT:
A. Renal CT imaging with contrast is the definitive
radiologic test.
B. Risk factors include smoking, obesity, and hypertension.
C. Familial syndromes should be suspected in younger
patients and in patients with bilateral tumors.
D. Renal masses of any size, if suspicious for malignancy,
require excision as the first therapeutic maneuver.
Answer: D
Most patients diagnosed with RCC in the modern era typically present with an incidentally discovered renal mass
on the abdominal radiographic imaging. Renal computed
tomography (CT) imaging with intravenous contrast remains
the single most important radiographic test to determine the
nature of the mass. Major recognized risk factors for RCC
include obesity and hypertension. Familial RCC subtypes
with classical clinical manifestations are also well described.
Management options for small renal masses (<4 cm) include
active surveillance, thermoablative techniques, or surgical
excision. Percutaneous or laparoscopic techniques (cryoablation, radiofrequency ablation, high intensity-focused
ultrasound) have been used to treat small renal masses, but
they are associated with an increased risk of local recurrence.
(See Schwartz 11th ed., pp. 1772–1773.)
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CHAPTER 41
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Gynecology
1. Concerning uterine leiomyoma, all of the following are
TRUE EXCEPT:
A. It is most common pelvic tumor.
B. It has a racial predilection.
C. It is classified according to anatomic location.
D. It rarely necessitates hysterectomy.
Answer: D
Leiomyoma, also known colloquially as fibroids, are the
most common female pelvic tumor and occur in response
to growth of the uterine smooth muscle cells (myometrium).
They are common in the reproductive years, and by age 50, at
least 60% of white and up to 80% of black women are or have
been affected. Leiomyoma are described according to their
anatomic location (Fig. 41-1) as intramural, subserosal, submucosal, pedunculated, cervical, and rarely ectopic. Most are
asymptomatic; however, abnormal uterine bleeding caused by
leiomyoma is the most common indication for hysterectomy
in the United States. (See Schwartz 11th ed., p. 1795.)
Intramural
Intercavitary
Pedunculated
Subserous
Submucous
2. Typical indications for cesarean delivery include all of
the following EXCEPT:
A. Questionable fetal status.
B. Breech presentation.
C. Cephalopelvic disproportion.
D. Maternal coagulopathy.
Prolapsed
FIG. 41-1. Types of uterine myomas.
Answer: D
Typical indications for cesarean delivery include questionable fetal status, breech or other maIpresentations, triplet and
higher order gestations, cephalopelvic disproportion, failure
to progress, placenta previa, and active genital herpes. (See
Schwartz 11th ed., p. 1806.)
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3. Pelvic floor dysfunction includes all of the following
EXCEPT:
A. Urinary incontinence.
B. Pelvic organ prolapse.
C. Fecal incontinence.
D. Dyspareunia.
4. All of the following are TRUE concerning stress inconti-
CHAPTER 41
nence EXCEPT:
A. It can be due to lack of urethrovaginal support.
B. It can be due to intrinsic sphincter deficiency.
C. Goal of surgical repair is to create a partial urethral
obstruction.
D. Urethral rein plantation is sometimes necessary if
other approaches fail.
Gynecology
5. Concerning vuIvar carcinoma, all of the following are
TRUE EXCEPT:
A. Etiology may be due to an human papillomavirus
(HPV)-dependent pathway of carcinogenesis.
B. Approximately 50% are squamous lesions.
C. Hematogenous dissemination is rare.
D. Staging and primary surgical treatment are typically
performed as a single procedure.
Answer: D
Pelvic floor disorders can be categorized, from an urogynecologic perspective, into three main topics: female urinary
incontinence and voiding dysfunction, pelvic organ prolapse, and disorders of defecation. (See Schwartz 11th ed.,
pp. 1807–1809.)
Answer: D
Stress incontinence is believed to be caused by lack of ureterovaginal support (urethral hypermobility) or intrinsic sphincter
deficiency (ISD). ISD is a term applied to a subset of stressincontinent patients who have particularly severe symptoms,
including urine leakage with minimal exertion. This condition
is often recognized clinically as the low pressure or “drainpipe”
urethra. The urethral sphincter mechanism in these patients
is severely damaged, limiting cooptation of the urethra.
Standard surgical procedures used to correct stress incontinence share a common feature: partial urethral obstruction
that achieves urethral closure under stress. (See Schwartz 11th
ed., pp. 1808–1809.)
Answer: B
Evidence supports a HPV-dependent pathway of carcinogenesis. Vulvar carcinomas are squamous in 90% of cases. Spread
of vulvar carcinoma is by direct local extension and via lymphatic microembolization. Hematogenous spread is uncommon. Staging and primary surgical treatment are typically
performed as a single procedure and tailored to the individual
patient. (See Schwartz 11th ed., pp. 1809–1810.)
6. Which of the following is FALSE concerning epithelial
ovarian cancer (EOC) risk factors?
A. Risk factors include early menarche.
B. Risk factors include late menopause.
C. Risk factors include previous hysterectomy.
D. Risk factors include nulliparity.
7. Concerns human papillomavirus (HPV) vaccination,
which of the following is TRUE?
A. Vaccination generates high concentrations of neu-
tralizing antibodies to HPVL1 protein.
B. There is only one FDA-approved vaccination available.
C. Vaccination should start at age 11 for girls, and age
13 for boys.
D. Two doses are given 3 weeks apart.
8. Concerning endometriosis, which of the following is
TRUE?
A. It causes elevation of serum CA-125.
B. Biopsy is routinely performed due to variability in
appearance of lesions.
C. It is a premalignant lesion.
D. Symptomatically mild cases are best treated with
gonadotropin releasing hormone (GnRH).
Answer: C
Risk factors for development of EOC include events that
appear to increase the number of lifetime ovulations (eg, early
menarche, late menopause, nulliparity), whereas events that
decrease the number of ovulations decrease risk (eg, pregnancy, breast feeding, oral contraceptives). Additionally, a
history of tubal ligation or hysterectomy also decreases EOC
risk. (See Schwartz 11th ed., pp. 1815–1820.)
Answer: A
Three HPV vaccines have been approved by the US Food
and Drug Administration (FDA). Vaccination generates high
concentrations of neutralizing antibodies to HPV L1 protein.
Current recommendations include HPV vaccination for boys
and girls at age 11 and 12 years, respectively. Two doses are
given 6 to 12 months apart for patients with an intact immune
system. (See Schwartz 11th ed., p. 1790.)
Answer: A
Endometriosis commonly causes elevations in serum CA-125.
Definitive diagnosis usually requires laparoscopy and visualization of the pathognomonic endometriotic implants. These
appear as blue, brown, black, white, or yellow lesions that can
be raised and at times puckered giving them a “gunpowder”
appearance. Biopsy is not routinely done but should be
obtained if the diagnosis is in doubt. Those with mild symptoms can be managed with oral contraceptive pills and/or
anti-inflammatory analgesia; moderate symptoms are treated
with medroxyprogesterone acetate. Severe symptoms are
treated with gonadotropin releasing hormone (GnRH) to
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induce medical pseudomenopause. Although endometriosis
is not generally thought to be a premalignant lesion, there is
an increased risk of type I ovarian cancer in women with a history of endometriosis. (See Schwartz 11th ed., pp. 1802–1803.)
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9. Which of the following statements is FALSE concerning
pelvic inflammatory disease (PID)?
A. Etiology is sexually transmitted organisms.
B. Sequellae include increased risk of ectopic pregnancy.
C. Initial therapy requires intravenous antibiotics.
D. Clinical criteria include an oral temperature >101° F.
10. Options for management of stress urinary incontinence
include all of the following EXCEPT:
A. Creation of mid urethral sling.
B. Urethral bulking injections.
C. Mesh reconstruction.
D. Bilateral urogenital diaphragm plication.
Answer: D
Sexually transmitted organisms, especially Neisseria gonorrhoeae and Chlamydia trachomatis, are implicated in many
cases, although microorganisms that comprise the vaginal
flora (eg, anaerobes, Gardnerella vaginalis, Haemophilus influ-
enza, enteric Gram-negative rods, and Streptococcus agalac-
tiae) have been implicated as well. Because of the psychosocial
complexity associated with a diagnosis of PID; when possible,
additional criteria should be used to enhance the specificity
of the minimum clinical criteria. These include oral temperature >101° F (>38.3° C). Several outpatient parenteral and
oral antimicrobial regimens have been effective in achieving
clinical and microbiologic cure. Hospitalization for intravenous antibiotics may be necessitated in cases where surgical
emergencies cannot be ruled out. (See Schwartz 11th ed.,
pp. 1803–1804.)
Answer: D
Stress incontinence is believed to be caused by lack of urethrovaginal support (urethral hypermobility) or intrinsic
sphincter deficiency. Despite wide acceptance of midurethral
sling procedures, a retropubic urethropexy procedure called
the Burch procedure is still performed for stress incontinence.
A transurethral or periurethral injection of bulking agents
is indicated for patients with intrinsic sphincter deficiency.
Pelvic reconstructive surgery frequently uses polypropylene
mesh to augment procedures in the hope of providing longlasting repair. (See Schwartz 11th ed., pp. 1808–1809.)
CHAPTER 41
Gynecology
11. Concerning vaginal cancer, which of the following statements is TRUE?
A. Squamous lesions are associated with in utero expo-
sure to DES.
B. Staging is by a combination of clinical and pathologic
assessments.
C. Early disease prognosis is >90% 5-year overall
survival.
D. Surgery is indicated for stages III and IV disease.
Answer: C
Vaginal carcinoma is a rare gynecologic malignancy and
accounts for about 3% of cancers affecting the female reproductive system. Rare clear cell carcinoma of the vagina is
associated with in utero exposure to diethylstilbestrol (DES).
Vaginal cancer is staged clinically by pelvic examination, chest
X-ray, cystoscopy, and proctoscopy. External beam pelvic radiation is the mainstay of treatment for stages II, III, and IV and
may be followed by intracavitary and/or interstitial brachytherapy. Prognosis for treated early stage disease is excellent with >90% 5-year survival rates. (See Schwartz 11th ed.,
pp. 1810–1811.)
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CHAPTER 42
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Neurosurgery
1. Which intracranial pathology is associated with the correct sign or symptom?
A. Medialization of the uncus and compression of the
midbrain leading to uncal herniation
B. Increased intracranial pressure (ICP) causing men-
tal status decline due to compression of the bilateral
frontal lobes
C. Choroid plexus production of cerebral spinal fluid in
excess of 1L/day leading to subfalcine herniation
D. ICP classically presenting as hypotension, bradycar-
dia, and irregular respirations
Answer: A
Increased ICP can injure the brain in several ways. Focal mass
lesions cause shift and herniation. Temporal lesions push the
uncus medially and compress the midbrain. This phenomenon is known as uncal herniation. Masses higher up in the
hemisphere can push the cingulate gyrus under the falx cerebri. This process is known as subfalcine herniation. Diffuse
increases in pressure in the cerebral hemispheres can lead
to central, or transtentorial, herniation. Increased pressure
in the posterior fossa can lead to upward central herniation
or downward tonsillar herniation through the foramen magnum. Uncal, transtentorial, and tonsillar herniation can cause
direct damage to the brain stem (Fig. 42-1). (See Schwartz
11th ed., Figure 42-4, p. 1831.)
1
FIG. 42-1. Schematic drawing of brain herniation patterns.
1. Subfalcine herniation. The cingulate gyrus shifts across midline
under the falx cerebri. 2. Uncal herniation. The uncus (medial
temporal lobe gyrus) shifts medially and compresses the midbrain
and cerebral peduncle. 3. Central transtentorial herniation. The
diencephalon and midbrain shift caudally through the tentorial
incisura. 4. Tonsillar herniation. The cerebellar tonsil shifts
caudally through the foramen magnum. (Reproduced with
permission from Wilkins RH, Rengachary SS: Neurosurgery,
2nd ed. New York, NY: McGraw Hill; 1996.)
3
2
4
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2. The lesion that can cause mass effect and rapidly kill the
patient is:
A. Inferior fossa lesions.
B. Posterior fossa lesions.
C. Progressive obtundation.
D. Bradycardial lesions.
CHAPTER 42
Neurosurgery
Answer: B
The posterior fossa (brain stem and cerebellum) requires
special consideration because the volume of the posterior
fossa within the cranial vault is small. Posterior fossa lesions
such as tumors, hemorrhage, or stroke can cause mass effect
that can rapidly kill the patient in two ways. Occlusion of the
fourth ventricle can lead to acute obstructive hydrocephalus,
raised increased intracranial pressure (ICP), herniation, and
eventually death. This mass effect can also lead directly to
brain stem compression (Fig. 42-2). Symptoms of brain stem
compression include hypertension, agitation, and progressive
obtundation, followed rapidly by brain death. A patient exhibiting any of these symptoms needs an emergent neurosurgical evaluation for possible ventriculostomy or suboccipital
craniectomy (removal of the bone covering the cerebellum).
This situation is especially critical, as expeditious decompression can lead to significant functional recovery. (See Schwartz
11th ed., p. 1833.)
FIG. 42-2. Maturing cerebellar stroke seen as a hypodense
area in the right cerebellar hemisphere (arrowhead) on head
computed tomography in a patient with rapidly progressing
obtundation 2 days after the initial onset of symptoms.
Swelling of the infarcted tissue causes posterior fossa mass
effect. The fourth ventricle is obliterated and not visible,
and the brain stem is being compressed.
3. Post trauma day 4, a 19-year-old man with significant
facial trauma and associated temporal bone articulates
which of the following symptoms?
A. Double vision and facial asymmetry
B. Headache, light sensitivity, and fatigue
C. Anosmia and rhinorrhea
D. Vertigo, ipsilateral deafness, and facial paralysis
Answer: D
Fractures of the skull base are common in head-injured
patients, and they indicate significant impact. They are generally apparent on routine head CT, but they should be evaluated
with dedicated fine-slice coronal-section CT scan to document and delineate the extent of the fracture and involved
structures. If asymptomatic, they require no treatment. Skull
base fractures requiring intervention include those with an
associated cranial nerve deficit or cerebrospinal fluid (CSF)
leak. A fracture of the temporal bone, for instance, can damage the facial or vestibulocochlear nerve, resulting in vertigo,
ipsilateral deafness, or facial paralysis. A communication may
be formed between the subarachnoid space and the middle
ear, allowing CSF drainage into the pharynx via the Eustachian tube or from the ear (otorrhea). Extravasation of blood
results in ecchymosis behind the ear, known as Battle’s sign.
A fracture of the anterior skull base can result in anosmia
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(loss of smell from damage to the olfactory nerve), CSF drainage from the nose (rhinorrhea), or periorbital ecchymosis,
known as raccoon eyes. (See Schwartz 11th ed., p. 1835.)
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4. In regard to the halo test, a positive indicator for cerebrospinal fluid (CSF) is when tinged with blood will show
which of the following when dropped on an absorbent
tissue?
A. A single ring with a darker center spot containing
blood components surrounded by a light halo of CSF
B. A double ring with a darker center spot containing
blood components surrounded by a light halo of CSF
C. A single ring with a lighter center spot containing CSF
surrounded by a darker halo of blood components
D. A double ring with a lighter center spot containing CSF
surrounded by a darker halo of blood components
5. Which of the following closed brain injury is paired with
the correct description?
A. Contusion, bruise of the brain from breakdown of
small blood vessels and extravasation into the brain
most commonly affecting the posterior fossa
B. Diffuse axonal injury, due to acceleration and decel-
eration leading to axonal disruption and/or detachment which is not visible on magnetic resonance
imaging (MRI)
C. Concussion, temporary neuronal dysfunction lead-
ing to susceptibility to secondary brain injury
D. Traumatic brain injury, diffuse intracranial hyperten-
sion with parenchymal hyperemia visible on MRI
Answer: B
Copious clear drainage from the nose or ear makes the diagnosis of CSF leakage obvious. Often, however, the drainage
may be discolored with blood or small in volume if some
drains into the throat. In indeterminate cases, it is important
to consider radiographic findings on the computed tomography (CT) scan near the fracture that suggest CSF leak, such as
pneumocephalus, subarachnoid, or intraparenchymal blood
at the fracture site. The “halo” test assesses for a double ring
when a drop of the fluid is allowed to fall on an absorbent
surface, but it has been shown to have poor clinical utility. The
fluid can be sent for β-2 transferrin testing, a carbohydratefree isoform of transferrin exclusively found in the CSF;
however, these tests often take 1 to 2 weeks to result and also
can be difficult to incorporate into clinical practice. (See
Schwartz 11th ed., p. 1835.)
Answer: C
A concussion is defined as temporary neuronal dysfunction
following nonpenetrating head trauma. The head computed
tomography (CT) is normal, and deficits resolve over minutes to hours. Definitions vary; some require transient loss of
consciousness, while others include patients with any alteration of mental status. Memory difficulties, especially amnesia of the event, are very common. Studies have shown that
the brain remains in a hypermetabolic state for up to a week
after injury. The brain is also much more susceptible to injury
from even minor head trauma in the first 1 to 2 weeks after
concussion. This is known as second-impact syndrome, and
patients should be informed that, even after mild head injury,
they might experience memory difficulties or persistent
headaches. Return to play guidelines after sports-related concussions are controversial and are under active debate. (See
Schwartz 11th ed., p. 1836.)
CHAPTER 42
Neurosurgery
6. A patient who withdraws from pain, is mumbling inappropriate words and opens his eyes to pain has a Glasgow
Coma Scale score of:
A. 3.
B. 6.
C. 9.
D. 12.
TABLE 42-1 The Glasgow Coma Scale score
Motor Response Verbal Response Eye-Opening Response
Obeys commands 6 Oriented 5 Opens spontaneously 4
Localizes to pain 5 Confused 4 Opens to speech 3
Withdraws from pain 4 Inappropriate words 3 Opens to pain 2
Flexor posturing 3 Unintelligible sounds 2 No eye opening 1
Extensor posturing 2 No sounds 1
No movement 1
a
Add the three scores to obtain the Glasgow Coma Scale (GCS) score, which can range from 3 to 15. Add “T” after the GCS if intubated and no verbal score is possible. For these
patients, the GCS can range from 3T to 10T.
Answer: C
See Table 42-1. (See Schwartz 11th ed., Table 42-2, p. 1830.)
a
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