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NBME 17 Answers

nbme17/Block 2/Question#4 (8.4 difficulty score)
A 28-year-old woman is brought to the ...
Area labeled with letter 'C'🔍

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submitted by cassdawg(580),

This individual has horizontal conjugate gaze palsy, likely intranuclear opthalmoplegia which is commonly a symptom of MS (hence her relapsing remitting history) [FA2020 p543]

Intranuclear opthalmoplegia can be caused by a lesion in the medial longitudinal fasciculus, which is located at "C" on the diagram. Here is a picture pointing out the MLF, which cooresponds to C on the diagram.

The Medial Longitudinal Fasciculus is what allows for cross-talk between CNVI and CNIII for conjugate gaze.

waitingonprometric  INO is named for the eye with weak adduction, therefore, right INO In this example. And, the problem is in the ipsilateral MLF, therefore, the right MLF in this example. +2