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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 +8  
mousie  the air in the center of the globe made me think rupture too ..... +1  
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. +6  
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. +1  

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submitted by diabetes(11),

orbital floor fracture lead to entrapment of IRM leading to diplopia,we can see air in the orbit plus displacement of eye tissue and the muscle in maxillary sinus .

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submitted by adong(28),

tricky image but question is asking more specifically about his visual complaints which is just "double vision" so IR entrapment is the best answer

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