MCQS 176-179 :the presence of a palpable gallbladder in the jaundiced patient is known as

A 12 year old girl develops a right sided proptosis. An MRI scan reveals a infiltrative lesion involving both the anterior and posterior compartments of the orbit with poorly defined margins and with little or no contrast enhancement. Multiple fluid levels of varying signal intensity are seen. A repeat examination reveals slow growth with expansion of the bony orbit. A likely diagnosis is ::
a) Pseudotumor
b) orbital teratoma
c) Optic neuritis
d) sarcoidosis
e) Optic glioma
f) Lymphangioma
g) Rhabdomyosarcoma
h) retinal vascular shunts
i) Retinoblastoma
j) Mucormycosis

12 year old boy ran into a glass door receiving a puncture wound .A very sharp piece of glass had lodged into the side of his face. He did not require sutures and the wound healed well. However, 6 months later, his mother noted that he would sweat profusely on the skin of his face at the site of the old injury. He was diagnosed to be suffering from Frey's syndrome. It was decided that the best treatment would be to avulse the nerve carrying the parasympathetic nerve fibres to the region. Which nerve was to be avulsed?
a) Accessory nerve
b) Trochlear nerve
c) Vagus nerve
d) Oculomotor nerve
e) Trigeminal nerve
f) Great auricular nerve
g) Auriculotemporal nerve
h) Olfactory nerve
i) Abducent nerve
j) Facial nerve

the presence of a palpable gallbladder in the jaundiced patient is known as
a) Brudzinski sign
b) Faget's sign
c) Trousseau's sign
d) Auspitz's sign
e) Courvoisier's sign
f) Babinski sign
g) Grey Turner's sign
h) Chvostek's sign
i) Carvallo's sign
j) Allen test

Correct Answer: F
Of the orbital tumors of children and young adults, lymphangiomas often have poorly defined margins, and they show little or no contrast enhancement. Although benign, they are infiltrative lesions and often involve both the anterior and posterior compartments of the orbit. The cystic components are often characteristic on MR, with multiple fluid levels of varying signal intensity. Since lymphangiomas are characterized by slow, but relentless growth, expansion of the bony orbit can occur. Acute proptosis may develop secondary to an upper respiratory tract infection or from intratumoral hemorrhage

Correct Answer: G
The glass had damaged the parasympathetic secretomotor fibres to the parotid gland and also branches of the great auricular nerve which supply the overlying skin. On regeneration some of the parasympathetic fibres had crossed over and joined the distal end of the great auricular nerve. A stimulus normally producing salivation stimulated the sweat glands instead. he best method of treatment is avulsion of the auriculotemporal nerve which carries the parasympathetic fibres.
Correct Answer: E
A visible or palpable gallbladder, which may be somewhat tender, can be detected below the liver margin in patients with cystic or common bile duct obstruction. In pancreatic carcinoma with common bile duct obstruction, the presence of the palpable gallbladder in the jaundiced patient is known as Courvoisier's sign.


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