\[ P = \{1, 2, 3, 4\}, \quad Q = \{2, 3, 5, 6\} \]
The symmetric difference \( P \Delta Q \) is the set of elements which are in either \( P \) or \( Q \) but not in both:
\[ P \Delta Q = \{1, 4, 5, 6\} \]
\[ R = \{1, 3, 7, 8, 9\}, \quad S = \{2, 4, 9, 10\} \]
The symmetric difference \( R \Delta S \) is:
\[ R \Delta S = \{1, 2, 3, 4, 7, 8, 10\} \]
We now compute the symmetric difference between the two results:
\[ (P \Delta Q) = \{1, 4, 5, 6\}, \quad (R \Delta S) = \{1, 2, 3, 4, 7, 8, 10\} \]
Now combine and remove common elements (which appear in both sets):\ Common elements: \( 1, 4 \)
\[ \text{Final result: } \{2, 3, 5, 6, 7, 8, 10\} \]
\[ \text{Number of elements} = \boxed{7} \]