Which finding is an indication of a basilar skull fracture?

The presence of clear fluid coming from the nares is an important indication of a basilar skull fracture. This clear fluid could potentially be cerebrospinal fluid (CSF), which leaks out due to the breach in the protective bony structures of the skull. In the case of a basilar skull fracture, particularly involving the anterior cranial fossa, there is a risk for CSF to escape through the nasal passages. This condition is medically significant because it can lead to serious complications, such as meningitis, due to the direct pathway for pathogens to enter the central nervous system.

The other findings mentioned do not specifically indicate a basilar skull fracture. A butterfly rash is typically associated with conditions like lupus, pain behind the ear may relate to other kinds of skull or ear injuries, and loss of smell can occur for reasons unrelated to a fracture, such as nasal congestion or other neurological issues. Thus, the presence of clear fluid from the nares stands out as a hallmark sign of this serious injury.