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This 13-year-old male is sitting in the waiting room as you walk into the examination area.  You will be seeing him during the course of the morning clinic.  He is reading a sign on the opposite wall.  While doing this he appears as shown in the picture.

1.	If you had only one guess as to the diagnosis, what would be your first choice?
	a. left sixth nerve palsy b. sternocliedomastoid tightness on the left c. Ciancia syndrome d.  Duane I left eye e. none of the above
2.	The boy enters the examination room twenty minutes later.  What is the first thing you would do to arrive at the diagnosis as quickly as possible?
	a. ask about a history of trauma b. ask the boy to look to his left and then the far right c. check his vision d.  determine if fusion is present e. check his refraction for an off-axis astigmatism
3.	How would you answer the mother who asks if this condition is likely to require surgery?
	a. No; surgery is not likely. b. Yes; but on the neck muscles. c. Yes; surgery is likely. d.  It will depend on the results of refraction. e. none of the above

For answers to the above, click here on or after November 20, 2007.