Injuries and wounds: orbital blow-out fracture: practice question

A Forensic Medicine 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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Forensic Medicine · Injuries and wounds: orbital blow-out fracture

Sample item

A man struck in the eye by a fist has diplopia on looking upwards, enophthalmos and numbness of the cheek. Which injury is likely?

AFracture of the zygomatic arch onlyBIsolated fracture of the nasal bonesCLe Fort III fractureDFracture of the orbital floor with entrapment of inferior orbital contents

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

The answer and the reasoning

D. Fracture of the orbital floor with entrapment of inferior orbital contents

A blow to the globe raises orbital pressure and breaks the thin floor, trapping the inferior rectus so upward gaze is limited. The infraorbital nerve is injured causing cheek numbness. A zygomatic arch fracture affects mouth opening instead.

Option by option

A. Fracture of the zygomatic arch only
An arch fracture limits mandibular movement and does not cause diplopia.
B. Isolated fracture of the nasal bones
Isolated nasal fractures produce deformity and epistaxis and not diplopia.
C. Le Fort III fracture
Le Fort III is a gross facial separation and not an isolated punch injury.
D. Fracture of the orbital floor with entrapment of inferior orbital contents (correct)
Correct. A blow-out fracture entraps the inferior rectus and causes limited upgaze.

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.

Questions about this Forensic Medicine question

What is the answer to this Forensic Medicine question?

The best answer is D, Fracture of the orbital floor with entrapment of inferior orbital contents. A blow to the globe raises orbital pressure and breaks the thin floor, trapping the inferior rectus so upward gaze is limited.

Why is "Fracture of the zygomatic arch only" not the answer?

An arch fracture limits mandibular movement and does not cause diplopia.

Why is "Isolated fracture of the nasal bones" not the answer?

Isolated nasal fractures produce deformity and epistaxis and not diplopia.

Why is "Le Fort III fracture" not the answer?

Le Fort III is a gross facial separation and not an isolated punch injury.

What concept does this question test?

It tests Injuries and wounds: orbital blow-out fracture in Forensic Medicine. The infraorbital nerve is injured causing cheek numbness. A zygomatic arch fracture affects mouth opening instead.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Injuries and wounds: orbital blow-out fracture?

Learn postmortem changes with their timelines, and toxicology as poison, sign, test and antidote. Then use the flashcards and the other Forensic Medicine 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.