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NBME 20 Answers

nbme20/Block 1/Question#16 (60.1 difficulty score)
A 30-year-old woman with multiple sclerosis ...
PonsπŸ”,πŸ“Ί
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 +16 
submitted by whossayin(27),
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eTh noemnimc I iekl orf memigbernre the cnloostia of teh liranca nseevr si the ,,22",44 erl"u

eAbvo earbtm=nsi CN I + M nd=iIaIirb NC III, ons =IPV CN ,V VI, VII, d=eIVIIMllua CN IX, ,X ,XI XII

lovebug  @whossayin thanx so much!!! +  



 +15 
submitted by thecatguy(18),
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hsiT si a vrey tcpiykin .tsinuoqe As I ees ,it het 3 ianm ncsocept dstete :ear

  • This titanep ahs getminaril regaauiln p,sh(ar ,feibr dceiopsi nipa in eth ec,)fa whihc si csduea by a ionesl to rmiypar ynorses irsbfe ahtt rayrc iapn nneosista mfro eth fac.e
  • Mteupill csisosre,l hhciw hte neaiptt ,ash is a nangimeidelyt seidaes (..i,e ti ftcasef ewtih ttrea)m.
  • eTh emdatinley sxoan yraricgn apni tsnaoiens ofmr teh plairseialt faec entre het eirtsnbma ta the elvle fo eth osnp dan thne necesdd (eecomb hte psnail acttr of eht )trgini.ealm eehTs tihwe teatmr firesb ssap ghuthro het npso to ypnessa no hte aipsln lenuscu fo het ln,tigremai wihhc is ni het udlalme (uceunsl = yarg e.)rtamt (urcitpe ehre.) Tee,eohrfr a lsieon in the heitw atrtem (i.,.e ua)qlep in the osnp oucdl uaesc tgeanrimli leag,uinar nda tihs noehmnonpe ash eneb vseoerdb.

vboAe eht lelev fo eth nbaesrtim tlu(smaha amp&; erbaelcr rctoex,) uoy eavh encsod rorde noysres esu.rnon iseoLsn in tshi prat of hte uticric era nto eargnlely in mreatlnigi r.auneailg I pupsoes ethy laos tawn su to muases hatt neoc teh pinlas atrct fo het rmailengit sneert eth eal,lumd ti's tno idymnlatee eranyom. I d'tno ktnhi ihst is lyeeomctlp rt,ue tbu vegin het ocgil creidsebd abev,o sonp luwdo lilts eb het ertebt near.ws

As eelppo have itnepod ,otu the irpyrma nssroye ifbesr cyiganrr ltgih othuc teosnasni fomr het face snpaesy on teh icefh yoesnrs ulncuse ni the opns idyeiemmalt ftera eyht reent eth son.p Tihs sentiouq is ont ksgnai toabu hoset rsfbei gohuh.t

I tgo het stiqnueo gronw to..o

mightymito  Wow this is the best explanation yet! Thanks so much for very clearly walking us through a tricky question. +4  
lovebug  @thecatguy Are.... you a professor? thank you very much :) +1  



 +3 
submitted by sympathetikey(1439),
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iPilercnp ySeonsr seuculN fo the eainrTglmi is eaodtlc in the no,Ps as si hte Motro mleTgniair ulcsNeu fo het .nspo Tish tptresanneoi is blbypora geliadn mreo whit eht ePcnlpiri ornsyeS uslcueN.




 +2 
submitted by strugglebus(172),
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heT nspo sha eersnv 8,-5 os het aregnliimt uowld be edtfacfe eerh

masonkingcobra  Thalamic pain syndrome would involve dysesthesias on the entire contralateral body so more than just the face. Also it occurs often after post-stroke. Additoinally, these dysesthesias appear weeks/months later +14  



 +2 
submitted by feliperamirez(31),
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I od aturndsdne taht eth pniarilpc cnusleu fo the relmgnaiti neevr is catleod ta hte on.ps utB sceni shit pteatin si avginh iitarnelgm uarglniea o'tludwn oyu eb rgdunipist eth ayahpwt leodinvv ni ipna and ttpuae,rreem wichh ni itsh acse oudwl be teh nispla esulnuc (tdoelac in teh uel?dl)ma

idsees,B I fondu isht ta na liacert

A tnrcee osyhhtesip tsairbtute hte pain fo rtailinmge ngeaiurla to a cntaler nhsceammi livovnign eht srpa isloar fo het iplsan maelirtign [5usc]u.eln

./woKh:kss/oN2/mtv/3obw..7hl59p.icng9/ntniwBb

pg32  I literally had medulla selected the whole time and then changed it to pons simply because i felt the test writers were just seeing if we knew where the trigeminal nerve was located. bummer because I think your logic is way better. it's what i first thought when i read the case. +1  



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SM si a digmyneinalte eess.adi htaT's ywh I dint'd kicp xetrco ro uma;altsh yhte ear gery era.mtt I ekdipc leamlud aceuesb I eht noiagitlemsinpr evnesr teraesrv hte umla.del I gessu ew rea ustj pussodep to easmsu eth atdeeyniimonl is hnignpaep in eth on?ps I 'odtn w.nko

woodenspooninmymouth  Sorry, I meant to say that the pons would have the cell bodies for the pain/temp neurons, no? +  



 +0 
submitted by mamed(19),

Per boards and beyond, in the lateral pons is there is the spinal V nucleus which carries contralateral pain and temperature. Knowing that + CN V arises it in the pons, I went with pons. The only other option I had left not crossed out was cerebral hemisphere but that seemed to broad.

vivarin  BB also said not to use the rule of 4's to localize CN V to the pons so that's why I crossed it out... +  



 +0 
submitted by chandlerbas(106),
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eresht an aonossaciti mdae ni 2107 htiw rnliietamg iuaaenglr and SM - hhcwi si wtah i hntki iths tp sha. yke ngthi to tnoe is atht wehli lal ootrm nda yesrsno bisfer of NC 5 neret ta the vlele fo the snpo eh(vwroe eosm also od etren ta eht eevll of aledulm nda vene eht cs avi hte planis rtatc of 5 to seypasn htwi hte lnog yssreno sluuenc fo 5) r ehes het nilk of eamigilntr naliargeu nad :MS ih/6m5tM.n7/l44nhs/wrb9sc.../wPlgpn/e/itcvwm:toCc3aip




 +0 
submitted by lilyo(78),
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I aws ghinintk lnaog eth ilnse of ciflaa ssnaotein ciwhh si edimeatd by hte inelmatrig vrnee and eth tfca ttha het igiratenlm nrvee si ldceaot in het onp.s