Question 30.1

a) What clinical sign is illustrated here?

b) What does this indicate?

c) List 2 other clincal signs which may be present which might support your answer in b?

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College Answer

a) What clinical sign is illustrated here?

Racoon or Panda eyes

b) What does this indicate?

Frontal base of skull fracture

c) List 2 other clincal signs which may be present which might support your answer in b?

Haemotympanum

CSF rhinorrohea or otorrhoea.

Discussion

This question depicts a well known clinical sign and does not require a massive amount of cognitive effort.

I shall not waste too much time on this; only to point out that these signs have a very high positive predictive value for the presence of fractures and intracranial lesions.

Features of base of skull fracture are better covered in Question 14.3 from the second paper of 2010.

References

Herbella, Fernando AM, et al. "‘Raccoon Eyes’(periorbital haematoma) as a sign of skull base fracture." Injury 32.10 (2001): 745-747.

Pretto, Flores L., C. S. De Almeida, and L. A. Casulari. "Positive predictive values of selected clinical signs associated with skull base fractures." Journal of neurosurgical sciences 44.2 (2000): 77-82.

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