306.A very concerned mother brings her teenager into your pediatric
office. The teenager awoke in the morning with a large swollen mass that
filled part of his upper eyelid and medial forehead just above his left eye.
His eyelid was so swollen he could barely keep it open. His history reveals
that he suffers from indoor allergies and a head cold of about a week’s
length. During your physical examination you note purulent nasal dis-
charge and extreme tenderness to percussion over his paranasal sinuses.
The large swollen mass in his eyelid and forehead is quite pliable. You pre-
scribe intravenous antibiotics and give which of the following explanations
to the very concerned mother and the teenager?
a. He suffers from trigeminal neuralgia that affects the ophthalmic portion of cra-
nial nerve V
b. He suffers from tic douloureux that affects the ophthalmic portion of cranial
nerve V
c. He suffers from sinusitis, which has eroded through the wall on the frontal
sinus, and since the frontalis muscle is not attached to bone, allowed pus to leak
into the upper eyelid
d. He has Bell’s palsy, which is generally caused by herpes simplex virus infection
of the facial nerve within the facial canal that caused the loss of ability to raise
the upper eyelid and thus allow fluid to accumulate within it
e. He suffers from a sty, which is an inflammation of Meibomian or tarsal glands,
which lies on the inner surface of the eyelid
307.During a prenatal ultrasound, images suggest that the fetus has a
defective spinal cord. Alpha-fetoprotein (AFP) levels are two standard devi-
ations above normal. The mother elects to deliver the child via a C-section
so as to reduce the chances of damaging any protruding spinal cord and
meninges. After birth, ultrasound is used to determine that the covering of
the spinal cord, along with the intact spinal cord, forms a saclike projection
through a dorsal defect in the vertebral column. What would you call this
condition?
a. Rachischisis
b. Anencephaly
c. Meningocele
d. Meningomyelocele
e. Hydrocephaly
Head and Neck 423