NMS Q&A Family Medicine

The Eye in Primary Care 3715. The answer is C. In orbital fracture, an extraocularmuscle may become entrapped and limit the range ofmotion of the ipsilateral eye. Although diabetes is a causeof cranial nerve VI (abducens) palsy in diabetics, diabeticVI nerve palsy is not precipitated by trauma, and the gazeerror is failure to follow laterally as opposed to medially. Arupture of the eye would likely result in sluggish gazemovement, but the hallmark of an eyeball contusion ishyphema. The latter may lead to secondary glaucoma. Arupture of the eyeball may cause an irregular pupil, notfound here. Iritis could occur after trauma if there were acorneal injury or foreign body, but it would not be foundimmediately after the trauma.16. The answer is D. 45 degrees. In this version of confrontationalfield checking, the acuity of the peripheralfield is being testing as well as the range (i.e., discriminationadequate to count fingers). For detection of motiononly, the angle from the central axis should be limitedonly by the anatomic barriers, which are the nose, brow,lateral orbit, and cheek below.ReferencesGariano RF , Kim CH . Evaluation and management of suspectedretinal detachment . Am Fam Physician . 2004 ; 69 : 1691 – 1698 .Savory LM , Krasnow MA , Terry JE . Problems of the eye. In:Rudy DR, Kurowski K, eds . Family Medicine: House OfficerSeries . Baltimore : Williams & Wilkins ; 1997 : 57 – 70 .Wilson SA , Last A . Management of corneal abrasions . Am FamPhysician . 2004 ; 70 : 123 – 130 .