Nose and paranasal sinuses: trapdoor orbital floor fracture: practice question

A ENT question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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ENT · Nose and paranasal sinuses: trapdoor orbital floor fracture

Sample item

A 9-year-old struck by a ball has vomiting, bradycardia, pain on eye movement and marked limitation of upgaze, with little bruising. CT shows a linear orbital floor fracture with the inferior rectus herniated. What is the appropriate management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Urgent surgical release of the entrapped muscle

The white-eyed blow-out fracture occurs mainly in children because the flexible bone springs back and traps the muscle. Muscle ischaemia causes pain, vomiting and bradycardia through the oculocardiac reflex. Urgent release prevents permanent fibrosis and diplopia, unlike adult blow-out fractures that can often be repaired electively.

Option by option

  • A. Urgent surgical release of the entrapped muscle (correct)

    Correct. Entrapment with an oculocardiac reflex needs urgent release to save the muscle.

  • B. Antiemetics and discharge home

    Treating the vomiting alone ignores the entrapped muscle that is causing it.

  • C. Observation for two weeks for oedema to settle

    Waiting allows muscle necrosis and fibrosis.

  • D. Elective repair after six months

    Delay of this length leaves permanent restriction of eye movement.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More ENT questions

Questions about this ENT question

What is the answer to this ENT question?

The best answer is A, Urgent surgical release of the entrapped muscle. The white-eyed blow-out fracture occurs mainly in children because the flexible bone springs back and traps the muscle.

Why is "Antiemetics and discharge home" not the answer?

Treating the vomiting alone ignores the entrapped muscle that is causing it.

Why is "Observation for two weeks for oedema to settle" not the answer?

Waiting allows muscle necrosis and fibrosis.

Why is "Elective repair after six months" not the answer?

Delay of this length leaves permanent restriction of eye movement.

What concept does this question test?

It tests Nose and paranasal sinuses: trapdoor orbital floor fracture in ENT. Muscle ischaemia causes pain, vomiting and bradycardia through the oculocardiac reflex. Urgent release prevents permanent fibrosis and diplopia, unlike adult blow-out fractures that can often be repaired electively.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Nose and paranasal sinuses: trapdoor orbital floor fracture?

Learn tuning fork results and audiogram patterns by sketching them. Then use the flashcards and the other ENT questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.