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Retired NBME 23 Answers

nbme23/Block 4/Question#44 (reveal difficulty score)
A 44-year-old man is brought to the emergency ...
Entrapment of the inferior rectus muscle ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +4  upvote downvote
submitted by โˆ—thomasalterman(181)
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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.

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nlkrueger  if this isn't a globe rupture than idk what is tbh +17
mousie  the air in the center of the globe made me think rupture too ..... +4
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. +13
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. +3

UW QID# 11742 had the same question. Fracture of the orbital floor causes displacement of the orbital contents through the floor and can cause enophthalmos and entrapment of the IR muscle (diplopia when looking up). Also, damage to the infraorbital nerve (a branch of V2), which exits through the infraorbital foramen, will cause numbness of the upper cheek, upper lip, and upper gingiva.

+1/- fatboyslim(118)

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submitted by โˆ—diabetes(31)
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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 โˆ—adong(144)
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tricky image but question is asking more specifically about his visual complaints which is just "double vision" so IR entrapment is the best answer

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submitted by โˆ—charcot_bouchard(574)
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This patient has a orbital blowout fracture. see the tear drop sign.

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