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NBME 23 Answers

nbme23/Block 2/Question#43 (45.7 difficulty score)
A 2-week-old girl is brought to the physician ...

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submitted by hayayah(1057),
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oboCoaml is na yee amnylratibo ttha osrccu boeefr h.rbit erhy'Te iinmgss peiecs of sseuit in tsecuusrrt taht form het ey.e

  • alooCsbmo icnefgtaf eht isr,i whihc tluser in a l"eeo"khy rnaaeceppa fo teh upilp, lrlangeye do not adel to siovni s.lso

  • olsoobmaC nongvlvii eht ietnra tuselr ni isionv ossl ni spccieif prsta of the ivsalu lid.fe

  • Leagr tlreina lombcooas or tehos ftcagenfi eht optic nerve acn seacu owl no,vsii cihwh nmsea oivisn slso htta nnatco be elpmeltcoy oecrcdrte tiwh aglssse ro notcact .enssle

mousie  thanks for this explanation! +  
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 +4  
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 +2  
irgunner  That random zanki card with colobomas associated with a failure of the choroid fissure to close messed me up +11  
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. +  
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. +2  
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! +1  
testready +