Florida State Paramedic Practice Exam

How do pupils typically present in Cushing's triad?

1. Small and reactive

2. Unilaterally unequal and non-reactive

3. Symmetrical and dilated

4. Unreactive and pinpoint

The correct answer is: Unilaterally unequal and non-reactive

In Cushing's triad, pupils typically present as unilaterally unequal and non-reactive due to the increased intracranial pressure that characterizes this condition. Cushing's triad itself is a clinical syndrome that consists of hypertension, bradycardia, and irregular respirations, often indicating brain herniation or severe brain injury. When there is increased pressure within the skull, it can affect the function of the brainstem and the pathways that control the pupils. This results in the pupils being unequal in size (anisocoria) and often non-reactive to light. The non-reactivity is particularly concerning, as it highlights the extent of neurological compromise, indicating that the brain is under significant distress. The other options present pupil characteristics that do not align with the physiological responses seen in cases of increased intracranial pressure. Small and reactive pupils are more typical in cases of normal intracranial pressure or other conditions like opiate use. Symmetrical and dilated pupils can occur in other situations, such as severe brain injury but do not specifically signify Cushing's triad. Unreactive and pinpoint pupils are associated with different clinical scenarios, such as opioid overdose or pontine hemorrhage. Thus, the presence of unil