share email twitter ⋅ join discord whatsapp(2ck)
Free 120  NBME 24  NBME 23  NBME 22  NBME 21  NBME 20  NBME 19  NBME 18  NBME 17  NBME 16  NBME 15  NBME 13 
introducing : the “predict me” score predictor NEW!

NBME 21 Answers

nbme21/Block 2/Question#33 (61.4 difficulty score)
A 68-year-old man comes to the physician ...
Libido: normal; Nocturnal erections: normalπŸ”,πŸ“Ί
tags:

Login to comment/vote.


Tutor box

Members from the Leaderboard offering 1-on-1 help: Want to be listed here? Email us!

 +18 
submitted by imgdoc(135),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

I uhohttg buota it ilek ts:hi tietaPn is nvhiag osegihyccpn DE - ist lla in shi ,ahed lidoib is olanrm dan tnrnlaouc esicntreo ear rlon.ma

If shi nTresestoote velel aws owl - iodiLb .ercsdadee If hsi unvrose ystsme (/tasccarmpyi)iaaythpshettpme aws gmadaed - lntuocarn eircseton ea.reecsdd

Hepo hits l.hspe

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) +2  



 +11 
submitted by dr_jan_itor(71),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

He esisms ihs ifew mn,a is'nt dyrea fro rhtoe n.owme engciPcsyoh E.D lphciylyas hes nefi




 +3 
submitted by haliburton(215),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

mfor FPAA ED fo emxdi narigco dan hseycpgncoi giiron si mnmoc.o yncsicehoPg cusase are meor iklley wenh teh tatnpie ash mranlo otseiecrn wiht barontsmaitu ro nhew nnarltouc ilpeen cteucmeesn si mor.anl

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 
submitted by yotsubato(1041),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Why si sih obiLdi rm?oaln sIt' tytaoll tecdxeep atht eh yam aevh rcdedeu ioldbi rftae sih fewi ided 2 rasey oag orfm mose irlheobr oerdopnlg sleinls.

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) +  



 +1 
submitted by basic_pathology(12),

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




 +0 
submitted by syoung07(30),

if you are 68 and still dating Palmala Handerson, your libido isnt low my friends.

drdoom  amen +