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NBME 21 Answers

nbme21/Block 2/Question#41 (31.1 difficulty score)
A 75-year-old woman has the sudden onset of ...
Posterior inferior cerebellarπŸ”

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submitted by hyoscyamine(55),
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Thsi si llteara aIgrne/yCPlra/AeemdllWlbu osnmed.ry The owanm sah amegda in het mecsittayhp niahc rs(snoey sdsyrmeon aer arlelta ndgciroca to eth ruel of 4)s uilsnrgte in oreHrn edmsn,yor lnaticamoisph rcatt tmi/pae(pn cihhw rae soal se,sny)or dan NC XI nda NC X stnyucfonid egtirsuln in teh hgiharadapratd/yssiy slph(e su oielazcl ot hte ule)mda.l

nala_ula  Also, just to add, FA specifies that Nucleus ambiguus effects (dysphagia, hoarseness, decreased gag reflex) are specific to PICA lesions. +2  
cienfuegos  Thanks for the input. I have always found this topic to be tricky and just came across this article that helped me out a ton regarding the rule of 4's hoscyamine mentions above. +7  
lovebug  FA 2019 502pg! +  
pfebo  "Don't PICA horse (hoarseness) that can't eat (dysphagia)" +  

if you learn the rule of 4 its going to make this question really easy and almost a free mark. I learned it from Boards and beyond but I'm sure you can find it in other resources. so, horner is sympathetic damage--> s is on the side loss of pain and temp--> sensory--> s is on the side so we know its lateral now which cranial nerves are affected? dysphagia and speaking are both symptoms of damage to cranial n. X. rule of four says the first 4 cranial nerves are above pons, the second 4 are in pons and the last 4 are in medulla. so this is a lateral medullary syndrome.

+3/- meryen13(12),