A 10-Minute-Old Boy Is Being Evaluated in the Delivery Room

A 10-minute-old boy is being evaluated in the delivery room.  The patient was born at term to a 30-year-old primigravida woman.  Pregnancy was unremarkable, but labor was complicated by recurrent late decelerations necessitating vacuum assistance for vaginal delivery.  Apgar scores were 6 and 8 at 1 and 5 minutes, respectively.  Temperature is 37 C (98.6 F) , pulse is 170/min, and respirations are 40/min.  Scalp examination shows large, fluctuant swelling at the occiput that extends bilaterally to the ears, superiorly toward the crown, and inferiorly into the nape of the neck.  This patient's hemorrhage is most likely located between which of the following structures?

A) Arachnoid mater and dura mater
B) Brain and arachnoid mater
C) Dura mater and periosteum
D) Periosteum and galea aponeurosis
E) Skull and the periosteum

Correct Answer:

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