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NBME 20 Answers

nbme20/Block 1/Question#16 (reveal difficulty score)
A 30-year-old woman with multiple sclerosis ...

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submitted by whossayin(30),
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eTh nmiocenm I leik for gminrremeeb eth nlstoaioc fo hte ralcani evsner is eht ,24",,42 rul"e

Avebo taibmesn=r NC I + MIIii=nd abr CN I,II nPo IVs= NC V, VI, IV,I =MdeVluIlaI I NC X,I ,X IX, IXI

lovebug  @whossayin thanx so much!!! +  

submitted by thecatguy(19),
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siTh si a reyv itnckyip teos.iqun As I see t,i teh 3 aimn coesntpc tetdes ra:e

  • ihTs pitnaet ahs tirenaimlg aleruniga as(prh, i,efrb dpisioec pain ni hte ec,)fa hcwih is usceda yb a iesnlo ot yprrami syorsne ifbrse hatt crrya anip stsaneoin rmfo het .ecaf
  • tlMeiupl ,roeislcss whihc the itatnpe hsa, si a meanniedgtyli sseeida (e,i.. ti etacsff iwthe a)er.tmt
  • Teh lyeetnimad axons nrgcyrai ianp itennsaos from eht esailrapilt eacf nreet teh aneribmst ta eth velel fo hte spno dna nhte nsedcde ce(embo hte laisnp ttcar fo hte ailt)nei.grm sTehe wihte mtaret besirf spsa uhtohgr eth onsp to asensyp on the nasilp eulcsnu fo the laemtirni,g wihch si in hte aelldmu leuns(cu = yrga atr.)tme (icpetru here). Trehfee,or a leosin ni hte hetiw mterat e.i(., lqpuae) ni hte spno doucl easuc iigetnlrma irelaung,a nad tshi eoeponmhnn sha bene rvsdoeeb.

oevbA het lelve of eth mesiabntr lth(aumsa a;&pm arbeclre t,xroec) ouy aehv dcosne reodr oseyrsn ruose.nn enosiLs ni hist ptra of eht citrcui are ton rlyalenge ni aitimnelgr lr.ainuaeg I uesopps yteh aslo atnw us ot susmae htat oecn hte islnpa trtac fo teh iialremtng resten the dul,mael its' not etdyanmile m.areyon I ndot' tnihk isth is lplyocmeet uert, utb iveng het gicol sddbierce be,ova sonp uwlod ilslt eb het eebtrt aw.nrse

sA epople hvea dtnepio ut,o teh rpairmy oenrssy frebis grcniyra lthig oucht nsitosaen from the ecfa aspynes on eht eichf syrseon lceusnu in the onsp tlymiediame tfera eyth retne teh .nosp sihT oeunstiq is tno nsikag oabut hotse bifers hg.ohut

I got eth iounqtes wnrgo

mightymito  Wow this is the best explanation yet! Thanks so much for very clearly walking us through a tricky question. +5  
lovebug  @thecatguy Are.... you a professor? thank you very much :) +1  

submitted by sympathetikey(1461),
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ePncirpli rsnSeyo lseucuN of hte lnairTmgei si teldaoc in hte sP,no sa is eht torMo ianTgmreli eNcluus of teh n.sop ihTs tnoirspeneta si lpayobrb eldnagi omer hwti eht eipPricln orSsyne elNucsu.

submitted by strugglebus(176),
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hTe snop ash sevenr -,85 os hte timnlgeari wlduo eb tefadfec reeh

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  

submitted by feliperamirez(31),
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I do rudtsadenn tath hte cilrnpapi usleucn fo eht riimgtnlea nevre is ldoteac at hte onsp. utB nsice this tpnieta si hgnaiv mlatiinerg larganiue ltn'dwuo oyu be nprtsigidu eth hyaawtp vlnoevid ni npia adn ratpmeeure,t hhicw ni hist saec uwdlo eb eth niaslp unclsue (daclote in teh )l?admule

sdiseeB, I udonf isth ta na ierlatc

A tnrcee hehtsysoip ettaurtsbi eht pina of ltmierinag nugearial to a reantcl nsmicahem gvnviloni hte srap lrsaoi fo teh anslpi amtnilgier lsuu.e]c[5n


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 is a igietmnlndyea eaedsi.s ts'Tah hwy I i'ddnt ikcp crxote ro muhlstaa; they era ryge .eamtrt I dpieck alumdle bueasce I eht goenitlrpimisan revnse evartrse hte .daelmlu I esugs ew rea tjsu pusdpose to aesmus het eiitonldanmye is nenahigpp in eht ons?p I n'odt

woodenspooninmymouth  Sorry, I meant to say that the pons would have the cell bodies for the pain/temp neurons, no? +  
athenathefirst  @woodenspooninmymouth this is specifically trigeminal neuralgia with involves cranial nerve 5--> where does CN 5 localize to? it's the pons. If you don't get this question still, watch the Rule of 4s in Boards and Beyond section on Brainstem. +  

submitted by athenathefirst(8),
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Hwo is hsit 2.61 leevl fo ldifctfiuy hnwe ttisaosb ssqnioute era lsyualu 17 ro 18 nyicrg#

submitted by chandlerbas(108),
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eretsh na acssioioant mdae in 1027 htwi ltminreiag uanirgale nad SM - wchih is athw i intkh hist pt hsa. yek thnig ot ento is thta iehlw all toomr dan nesrosy sbefir fo CN 5 terne at eht level fo eth snop (ehvowre omes slao od eretn ta teh vleel fo muldael adn veen eht sc iav the isnapl ctrat fo 5 ot seasypn tihw eht lgon rsoyens uncsule fo )5 es erh eht nlki of rnmiglteia argieluan dna :MS ihs79Mb.4t5/C/somp/m/e3/t4nlnlgi:.pawwhwcn..6vicrPc/t

submitted by mamed(20),
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reP rdsboa nad doeb,ny in eht talrale npso is erhet si eht ilsnap V nulucse hicwh irrceas ncrealtartoal napi and atueprt.eerm niowKgn htat + CN V esisar it in teh os,pn I etnw with on.sp Teh yoln toehr itopno I adh tlef ont oscedsr tuo asw rebceral ipehremhse tbu taht emesde ot br.aod

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... +1  
athenathefirst  @vivarin completely agree with you, but this is NBME always liking to trick and confuse us. +  

submitted by lilyo(78),
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I saw nikthngi onalg eth snile fo flacai ssonenita hwich si meiteadd by the eigrtmnail vreen nda het afct ttah teh igiamertln enver si oeacdtl ni hte nps.o