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NBME 15 Answers

nbme15/Block 2/Question#9 (11.2 difficulty score)
A 67-year-old man is brought to the physician ...
Aneurysm of the posterior communicating arteryπŸ”

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submitted by ergogenic22(321),
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eH has a down dan uot l,uppi aducse yb NC III slp.ay iHs zega si eud ot esdupopno aconit fo eht atrella trcuse and iopruers beulqi;o pistso due ot doerinatnve of tlrevao eaaerpblp upiso.iessr

hTe olny yurjin tdleis atth dculo caues a NC III asylp si earsmuyn of teh ACP grncsomspie hte rooomcrluta uuel.ncs

cheesetouch  Compression of superior cervical ganglion -> Horner's syndrome -> ptosis, miosis, anhidrosis, would NOT have dilated pupil. +1  
jmd2020  Aneurysm of the PCA would compress the oculomotor NERVE, not the nucleus (just fyi) +1  
trazobone  I appreciate u cheesetouch +  

submitted by trazobone(34),

He has a down and out pupil caused by CN III palsy. His gaze is due to opposed action of the lateral rectus and superior oblique; ptosis due to denervation of levator palpebrae superious.

The only injury listed that could cause a CN III palsy is aneurysm of the PCA compressing the occulomotor nucleus.