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NBME 21 Answers

nbme21/Block 2/Question#33 (53.0 difficulty score)
A 68-year-old man comes to the physician ...
Libido: normal; Nocturnal erections: normal🔍
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 +18  upvote downvote
submitted by imgdoc(127),
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I hgthotu atubo ti iekl ish:t tinPeta si vnaigh yccnogsehip ED - sti lla in ihs dh,ea biiold is rnlmoa and rntcuonal trcoeesni aer rmla.on

If ihs estsrooeTtne vlele wsa lwo - dobLii edd.aeresc If ihs eornvus eytmss raatpcaya)tchmeseiy(htmspt/pi swa gadmdae - antluocrn otcserein ra.deedsce

Hoep isth .shlep

sars  Idk about this. My thoughts: -libido is a product of testosterone and emotions (psychogenic) -tumescence is a product of pelvic splanchnics S2-S4 (parasympathetic) -patient's issues are 1 month old (aka recent) and his wife died 2 years ago & testosterone is normal (therefore libido normal) -patient can jack off, therefore penile stimulation reflex arc is intact and pelvic splanchnics are working (nocturnal tumescence normal) +  



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He iesmss ish iewf ,mna t'sin aeyrd rof rtohe emn.ow iPncyegsohc D.E cllihpyysa she fnei




 +3  upvote downvote
submitted by haliburton(191),
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mfro AAFP DE fo edixm gnoicra dan csoenyipchg ginori is cmnmoo. yPghsinoecc acsues rea rmeo ylikel wenh the tentpai has oalnrm ntrioeesc ihwt otrtnaabiums or when oaurnntcl eilnpe eenceucmst is n.oraml

yotsubato  Couldnt a psychogenic cause reduce libido? +2  
home_run_ball  "Testosterone concentration is within the reference range" and the fact that he has no difficulty masturbating = normal libido. Low testosterone would contribute to low libido And if he had low libido he would have difficulty masturbating +7  
home_run_ball  whoops meant to comment on the other comment +  



 +3  upvote downvote
submitted by yotsubato(778),
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Why is ihs bodiLi ml?aron s'tI tyloatl dpecxeet htat eh aym haev uddecer odilbi taref ish iewf ddie 2 years oga omfr mseo lbrerhio ndgopoerl ellsn.is

nala_ula  perhaps it's more to do with the fact that he can get erections when masturbating, outside of nocturnal erections which are not mediated by sexual desire. So his libido must be intact since he has sexual desire evident in being able to masturbate. +  
nala_ula  At least, that's the way I saw it. +  
home_run_ball  "Testosterone concentration is within the reference range" and the fact that he has no difficulty masturbating = normal libido. Low testosterone would contribute to low libido And if he had low libido he would have difficulty masturbating +  
thisisfine   The way I made the decision about normal vs. decreased libido is also that he presented to his doctor due to difficulty maintaining an erection while trying to have sex - meaning he has the libido to try to have sex. Does that make sense? +1  
btl_nyc  It also says there are no signs of depression, which would cause the low libido after his wife died. +  
temmy  two years is a enough time to mourn...just saying +  
temmy  thisisfine, it makes absolute sense. That is the same way i saw it +  
dr_jan_itor  He misses his wife man, isn't ready for other women. Psychogenic ED. physically hes fine (can crank his meat) +  



Organic ED: ED during masturbation, no nocturnal erections, +/- decreased libido

Psycogenic ED: no ED during masturbation, yes nocturnal erections, no decreased libido

https://www.researchgate.net/figure/Clinical-differences-between-organic-and-psychogenic-sexual-dysfunction_tbl4_51760982