This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Gall Bladder & Bile Ducts, Subject name: Surgery
All are among Charcot's triad except: 
Select and explain. 
A. Fever, B. Vomiting, C. Jaundice, D. Mental obtundation
D: Mental obtundation
Answer: D: Mental obtundation 
Explanation: Ans: d (Mental obtundation)Ref: Sabiston, 18th ed.Charcot's triad of ascending cholangitis is seen choledocholithiasis (stones in CBD). It consists of: Intermittent pain Intermittent fever Intermittent jaundiceThe stone impacts in the CBD and causes obstruction leading to pain and jaundice. The stasis leads to infection, bacteraemia and fever. As the stone moves, obstruction is relieved and hence the intermittency of the symptoms.If the obstruction persists, it can lead to suppurative cholangitis manifested as Reynold's pentad.Reynold's pentad Persistent painPersistent feverPersistent jaundiceHypotensionMental obtundation Important triads in surgerySaint's triadCushing's triad (raised ICDDiverticulosis of colonHypertensionGallstonesBradycardiaHiatus herniaDecreased respiratory rateVirchow's triadMurphy's triadHyperviscosityPain RIFEndothelial injury stasisVomiting Fever