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NBME 23 Answers

nbme23/Block 4/Question#44

A 44-year-old man is brought to the emergency ...

Entrapment of the inferior rectus muscle

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Patient has a fracture to the inferior orbit. This can dmg V2 or entrap the IR muscle. Only IR entrapment would impair vision.

nlkrueger  if this isn't a globe rupture than idk what is tbh +2  
mousie  the air in the center of the globe made me think rupture too ..... +  
sajaqua1  There may be some global rupture, but impairment of one of the ocular muscles causing diplopia would still be the best explanation for this patient's double vision. +1  
catch-22  Globe rupture leads to entrapment of the IR muscle which causes diplopia. The question is asking what is causing his visual complaints, which is diplopia, not loss of vision. +  

This patient has a orbital blowout fracture. see the tear drop sign.