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NBME 21 Answers

nbme21/Block 2/Question#34 (54.3 difficulty score)
A 28-year-old man is brought to the emergency ...
Inferior rectus and inferior obliqueπŸ”,πŸ“Ί
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 +16 
submitted by dr_jan_itor(74),
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tOopni A si het loyn noptoi ehrwe hobt luesmcs aer patr of the rlbioat lo,rsof.loA het lsta cteeensn ni teh teqonuis setm is a tlaot ieoymfrd fo atwh eon lduwo pecxet hte useqonti to be n.sgaik It is tno aknisg ofr ouy to maesus htta ehste lsumcse ahev nebe esere,dv yaear,zdlp or eeernrdd dfil.ca It is sganki ouy ot semaus ttha they eahv mbocee arpdnp"e"et fi eth msclue is eprpant,ed tehn ti taconn owlla the eye to vmoe into trveeahw pntsiooi it odulw be in wnhe teh lmseuc is ta ist geetndlneh ipntsio.o oS ni hsti a,sec tI is teh ifrinoer ectsru ngbei ardpetepn in a ciltnoyulfna trshdenoe tiosopin atth is tvrgnpinee pruwda ze.ga

cjdinurdreamz  im confused...doesnt the IR make the eye look down so if its trapped then why is upward gaze affected and not downward? +  
nutmeg_liver  @cjdinurdreamz it does make your eye look down, so since it's trapped in a functionally shorter position you're trapped looking down, not up. +2  



 +4 
submitted by soph(70),
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sti bc tish ear eht lyno 2 eumslsc no hte tiaoblr lorof oolgeg iltarob oforl eslcums in goelog ai mgses:gc.ltohe.ocO#oeiw/isblrihtNousgwcbM=1&=F=hO+ERrmq:?aLrttgaNP/wus/cpemcNlamsm




 +2 
submitted by burak(58),
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laitOrb olofr fru:eatcr

1- arblnaftiroI rnvee jiuy:rn susbeNnm dan iasptehrsea of het eprpu keh,ce puper i,lp ruepp gi.igvna

2- Eptremtnna fo teh ifrioern seturc lucem:s dmiepraI wrapud ezag

-3 soatosEihmnlp

-4 slgiuonC fo alxmlriay ussn:i aredropT gnis

minion7  if IR muscle is affected it is impaired downward gaze!!! +  
makinallkindzofgainz  @minion7, If the Inferior Rectus muscle is impaired (e.g. nerve dysfunction), then yes, downward gaze would be affected. However, the question states that there is ENTRAPMENT of muscles. Trapping the inferior rectus muscle essentially locks the eye into a downward gaze, therefore impairing upward gaze, as the inferior rectus muscle is essentially trapped in contraction. +4  



 +1 
submitted by sympathetikey(1439),
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Inrfiroe qlbiuoe = eslph oyu kolo up pma&; n.i

Al,os yhte idsa loofr of teh io,rtb os ti skmae nssee ttha the erniiorf ceumssl odulw .dmeagad

sahusema  I know you're right. I was just so uncomfortable picking an answer with "inferior rectus" because damage to the inferior rectus does nothing to explain the clinical findings of impaired upward gaze. Unless the muscle is physically stuck and can't relax or something +7  
emmy2k21  Agreed. Why would a dysfunctional inferior rectus contribute to impaired upward gaze??? I eliminated that answer choice and got it wrong :( +2  
dr_jan_itor  in the last sentence it asks you to assume an "entrapment", so it is actually the inferior rectus which is the cause of the upward gaze palsy. The entrapped muscle is functionally trapped in it's shortened position, thereby not allowing the orbit to gaze upward. +14  
chandlerbas  bam! dr_jan_itor just cleaned up that confusion +1  



 -1 
submitted by niboonsh(367),
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eTh ieqbsluo do the etopopsi icoatn of rhiet nmea. eInrifro ulioqeb soemv eth eye UP dan UTO nxro(ioett, ,ievnlotea oBiAn.tc)du cSien hte uqeniost yssa ahtt reeht is a cretrfau vvlgoinin eht tbroila oor,lf atth atuolytcmliaa lures out D al(eidm escrtu and fioierrn lu)ebqi,o evnlaig eth olyn ialcolg nasrew to be the riefoirn cusrte nad neoriifr ob.qleiu Hpvw:Wt/KywmWwo/tI.WsDkehu=Ebhw.tctl/aIcou?

aishu007  hi, but inferior oblique moves up and in and not out +  
d_holles  https://www.youtube.com/watch?v=3J2UZiLVZKA In case ppl need a refresher +