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Which of the following is not a sign of a basilar skull fracture?

  1. Battle signs

  2. Raccoon eyes

  3. Displaced pupils

  4. Clear fluid from the nose

The correct answer is: Displaced pupils

A basilar skull fracture is a type of skull injury that occurs at the base of the skull, leading to specific signs and symptoms that result from the trauma. The presence of Battle signs, raccoon eyes, and clear fluid from the nose are all indicative of potential basilar skull fractures. Battle signs refer to bruising behind the ears resulting from bleeding that has tracked down due to a fracture at the base of the skull. Raccoon eyes, characterized by periorbital ecchymosis, indicate bruising around the eyes and are another classic sign of this type of fracture. Clear fluid from the nose suggests the presence of cerebrospinal fluid (CSF) leak, which can occur when the protective barriers of the brain are compromised due to a skull fracture. Displaced pupils, on the other hand, are typically associated with intracranial events such as increased intracranial pressure or direct trauma to the brain itself, rather than specifically pointing to a basilar skull fracture. Therefore, displaced pupils do not fit within the classic signs associated with such an injury and indicate a different underlying problem that may require additional assessment.