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NBME 23 Answers

nbme23/Block 2/Question#43 (reveal difficulty score)
A 2-week-old girl is brought to the physician ...
Iris ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +39  upvote downvote
submitted by โˆ—hayayah(1212)
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Coloboma is an eye abnormality that occurs before birth. They're missing pieces of tissue in structures that form the eye.

  • Colobomas affecting the iris, which result in a "keyhole" appearance of the pupil, generally do not lead to vision loss.

  • Colobomas involving the retina result in vision loss in specific parts of the visual field.

  • Large retinal colobomas or those affecting the optic nerve can cause low vision, which means vision loss that cannot be completely corrected with glasses or contact lenses.

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mousie  thanks for this explanation! +1
macrohphage95  can any one explain to me why not lens ? +
krewfoo99  @macrophage95 Lens are an interal part of the refractive power of the eye. Without the lens the image would not be formed on the retina, thus leading to visual loss +5
qfever  Do anyone know why not choroid? +1
adong  @qfever, no choroid would also be more detrimental to vision since it supplies blood to the retina +3
irgunner  That random zanki card with colobomas associated with a failure of the choroid fissure to close messed me up +13
mnemonicsfordayz  Seems like the key to this question is in what is omitted from the question stem: there is no mention of vision loss. If we assume there is no vision loss, then we can eliminate things associated with visual acuity (weird to think of in 2 week old but whatever): C, D, E, F. Also, by @hayayah 's reasoning, we eliminate E & F. If you reconsider the "asymmetric left pupil" then the only likely answer between A & B is B, Iris because the iris' central opening forms the pupil. I mistakenly put A because I was thinking of the choroid fissure and I read the question incorrectly - but it's a poorly worded question IMO. +2
mamed  Key here is that it doesn't affect vision- the only thing would be the iris. All others are used in vision. Don't have to know what a coloboma actually is. +5
azibird  The extra section of that Zanki card specifically says that a coloboma "can be seen in the iris, retina, choroid, or optic disc." Don't you dare talk trash about Zanki! +3
fatboyslim  Honestly, I didn't understand what they were trying to ask...NBME has some weird wording sometimes +1
weirdmed51  you are a smart boy @mamed +
weirdmed51  @azibird ...upvoting @irgunner cos you went crazy there buddy๐Ÿ™ƒ +



 +8  upvote downvote
submitted by โˆ—chaosawaits(92)
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Who else read that last sentence 100 times and still had no idea whether it was even English or not?

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