AEMCA Practice Exam

What would you expect the pupils to look like in a coma caused by structural issues?

1. Symmetrical and responsive

2. Asymmetrical and unresponsive

3. Small and reactive

4. Dilated and non-reactive

The correct answer is: Asymmetrical and unresponsive

In a coma caused by structural issues such as a brain injury or mass effect from conditions like a stroke or tumor, the pupils typically appear asymmetrical and unresponsive. Structural damage to the brain can affect the pathways that control pupil response, leading to pupillary irregularities. Asymmetrical pupils, known as anisocoria, often indicate that one side of the brain is more severely affected than the other. Additionally, pupillary unresponsiveness suggests that there is significant impairment in the brain's function, as the reflex pathways required for the pupils to react to light may have been disrupted. This is particularly pertinent in cases of severe brain injury or herniation where brainstem function is compromised. While other options describe pupil characteristics that might be expected in different medical scenarios, they do not align with the presentation seen in structural issues that lead to a coma. For example, symmetrical and responsive pupils would indicate a functioning brainstem, and small, reactive pupils usually denote certain types of drug intoxication or physiological conditions rather than structural brain damage.