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NBME 21 Answers

nbme21/Block 2/Question#34 (44.5 difficulty score)
A 28-year-old man is brought to the emergency ...
Inferior rectus and inferior oblique🔍
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 +13  upvote downvote
submitted by dr_jan_itor(63),
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pnitoO A is hte olny toionp wereh ohbt seucsml are prat fo the artliob orAolsl.of , het astl ceesnten in eht tesnuiqo etms si a latto rmdeoiyf fo awht neo lwoud tepexc the uitosenq to eb .inksag tI si otn ksnaig rof you to masues tath ehste uscelsm aehv eneb erdvee,s ,aylpzreda ro neddrere ifdlac. tI si kansig uoy to ausmes thta yeht vahe oeebmc t"pea"nepdr if teh umselc is ,aterendpp neht ti nncoat oallw eht yee to voem tnoi rvhwatee intosopi it dluow eb ni newh hte cmelsu si ta tsi ehnetgnled .opsontii So ni sith ,caes It is teh fironrei erscut inbeg etdepranp ni a tnylilaoufnc shotrdeen itspoino atth is tnieprnegv aupwrd egaz.

cjdinurdreamz  im confused...doesnt the IR make the eye look down so if its trapped then why is upward gaze affected and not downward? +  



 +4  upvote downvote
submitted by soph(49),
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its cb isht rae het ylno 2 uemslsc on hte aboiltr frool go loeg ioabtrl lfoor scemlus ni loogge esgiamoNt#LFoOw/p+mu.sNwebcNh?am/mae==R:tseagwP:i=Mi/OusbcE1g&rtogr.hcrslhcqllcmtiso




 +2  upvote downvote
submitted by burak(41),
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liaObtr loorf eca:rftru

1- oiarbalrnfIt neevr nujriy: ubsnemNs dna aessetaphir fo the erppu ek,che epupr l,ip eurpp ivggina.

-2 nrnmtetapE fo eht irnfioer eusrtc els:mcu dripaeIm rwupad gzea

-3 saospimtonEhl

-4 gCuiolns fo amxirayll ussin: eprTdrao sing

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. +3  



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neirrIfo lboiqeu = hslep ouy oolk up m;a&p n.i

slAo, ehyt sdai rloof fo hte tio,br os it eamks snese that hte nirfoeri culsmse oldwu daa.gmde

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 +5  
emmy2k21  Agreed. Why would a dysfunctional inferior rectus contribute to impaired upward gaze??? I eliminated that answer choice and got it wrong :( +1  
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. +13  
chandlerbas  bam! dr_jan_itor just cleaned up that confusion +1  



 -1  upvote downvote
submitted by niboonsh(280),
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The buqolsei od the epsiootp aontic fo eriht me.an Iirrfneo ilouqeb meovs het eye PU dan UTO o(ontetirx, envae,otli uniB)Aocdt. inSec eht oteusinq ayss atth rethe is a ufrteacr nivnigvlo eth obriatl olrof, htta laaitutclaymo relsu uto D idl(eam uecstr dan frroinei ueq),lboi eiglvna eht noly ocllagi srneaw ot eb eht orienfri rucste adn oinrerfi uo.libeq Ehw.b:Kov/IcmW=ho.kwltwuw/putctH/tsaID?eyWW

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 +