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NBME 22 Answers

nbme22/Block 2/Question#11 (67.9 difficulty score)
A 52-year-old man comes to the physician ...
Sensation from the anterior surface of the scrotumπŸ”,πŸ“Ί
tags: anatomy 

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submitted by d_holles(198),
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I otg hsti one vai esoprsc fo tina.iilonme Not sure ohw yuo rae uspopsde ot eermerbm lla atth st.ih

submitted by socialismkills(6),
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mFro ueobcnm.HK

  • Lmaurb lxseup
  • Gfmianeeorlto nreev ;t&--g aiGentl abnhrc =gt&;= ATLOEANRETAL auserfc of rctumos
  • lioIiiulnang nerve t--g;& trnAroei tsrlaoc rveen t=&;=g OANEITRR fusrcae of scrtmuo
  • lSaarc lupxes
  • eduaPdnl erevn -&-;gt ePisrotro slcrato erenv ;&g=t= OTRERPOSI afcruse of ormsuct
  • reitsooPr ctuoausne rneev fo the hgith t;-g&- eiaPelrn sehnarbc =;gt&= RNFIREIO rufsaec fo eht sutrcom


submitted by meningitis(574),
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lucltay,A I ocrrtce eyl:sfm I okeldo oecsrl nad eth itenoG flmoera sha na xalrtnee eimtcrpSa rbnhca adn a bnuomLlgiauin c.hrban I uhhottg it swa hte rlaeGotinomef vnere ceseabu eht ltnegai rcbhan ssespa uhrtohg het pede gniliuna ngri, retsen teh inniugla cna,al soeg to mitprasec odrc and elupspsi eht ecrtermsa nad lsrtaco insk.

eHers eth meai:g uor/wgdaiomrcilnmsGd4kme:an//i/ooppgpia.//.yta8id2she.4/ewketip

coeCrtr em if I am ngrow ese.lap

gh889  I think you're right, FA2019 pp444 even states that sensory to the scrotum is via the Genitofemoral nerve +4  

submitted by hello(350),
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eTh Q si brndgiiesc eth tmlafreeiogno neevr, ihhcw usnr on hte nalexret crasufe fo eth epcsmiatr docr ta hte carslipefui iiunalng irng

Tsih Q si TNO irfergren ot iinllionaigu reevn -- eth iainlnoluiig nerve estix HUORTHG hte saelprcuiif iiuglnna aacnl aswrhee siht Q si skniag oatbu a enrev htta si RTXELENA to eht cruapilsfie uigninal a.ancl

See ofrettcpe.nvaoca/m.ia.pjntr.n/asiucdtpg:/cwsiiwegnhe/a/dkwilefg

trump2020  This is incorrect. You have it backwards. +3  
medjay7  Actually I think @hello is right. First, because that's the only way this shitty wording question makes sense, second cuz it says "that lies on the EXTERNAL SURFACE" that means outside of the spermatic cord, and the genital branch of GF nerve actually does: The genital branch of the genitofemoral nerve enters the inguinal canal via the deep inguinal ring. (, and then exits to innervate the anterior and superior scrotal skin (also the cremaster muscle). +  
medjay7  CORRECTION: Nevermind, everything I said is wrong. I hate this question +1  

submitted by mattnatomy(43),
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I eeblive e'etyhr nrgiefrre to orcoispmesn of snrcebah of the gliIaniinlou eNrev byspoils( the Anreorit lrStoca rvseNe.

ceSuo:r eioAncthw_a/neig:/askn/ioirotreidprkilrsstet.r._/vwep

armymed88  Ilioingual covers part of the medial thigh, base of penis and anterior scrotum Posterior scrotal nerves are a branch of pudendal and cover said area Doral nerves cover the dorsum of the penis which are also from the pudendal +1  
meningitis  I thought it was the Genitofemoral nerve because the genital branch supplies the cremaster and scrotal skin, but I looked it up and: The genital branch passes through the *deep inguinal ring* and enters the inguinal canal; also, Ilioinguinal wraps around the spermatic cord just like the question stem says. +1  
jean_young2019  "The structures which pass through the canals differ between males and females: in males: the spermatic cord[6] and its coverings + the ilioinguinal nerve." from wiki "Inguinal canal", which means the ilioinguinal nerve lies on the external surface of spermatic cord. The contents of spermatic cord includes, "nerve to cremaster (genital branch of the genitofemoral nerve) and testicular nerves (sympathetic nerves). It is worth noting that the ilio-inguinal nerve is not actually located inside the spermatic cord, but runs along the outside of it, in the inguinal canal." from wiki spermatic cord. +1  

submitted by rainlad(25),
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heT toerh rwsena oihcs:ec

otmro vinninaeotr ot het nuoosvebabcsurl sculme = ues/creamupdl bchnra fo eht elinrape enr,ev wihhc si bharnc of het epaulndd renev

orotm roeniantvni to eht erowl ptnoori of het retsuc ismibonda ecsmul = oda-alaonbmtorhic ve,nesr chwhi ear tioaionctnusn of the 7T11T- laionectsrt rvsene

seonantis rofm eht roadls srfuace of eht pesni = draslo enrev of teh ip,nse hichw is het deeestp oidvsnii fo teh uenaddlp vener

submitted by saifshaikh(13),
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I thikn tish ieructp naxlispe ti :llew


hello  Adding to this... The Q is describing the GENIOFEMORAL nerve, which runs EXTERNAL TO of spermatic cord at the superficial inguinal ring This Q is NOT referring to ilioinguinal nerve, which exits THROUGH the superficial inguinal canal +  

submitted by amd(2),
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It si hte yGIOsIugALNILUNI sotp ilamgsiden !plp nahiumolrngaeep/owsegot/siaa__/tawn:ol.iaathbtyipniw/sn.

submitted by skuutnasty(3),

after rabbit-holing this one for a bit.... this is the photo that demonstrates it best (to me, anyway). must be ilioinguinal n.


drjo  Ilioinguinal n. derived from L1 is mostly sensory supplying skin of upper and medial thigh root of penis & upper scrotum (males) **mons pubis & labia majora (females) it accompanies spermatic cord through superficial inguinal ring, great pic of this ^ @skuutnasty +  

submitted by kevin(36),

Just to clarify all the comments.

  • (B) Rectus innervation would not be as deep as the spermatic cord (thoracoabdominal/intercostal nerves)

  • (A) & (D) are both pudendal nerve, I think it's reasonable to exclude both as an answer choice as such

  • (C) Process of elimination. Sure, we can nitpick if it's genitofemoral or ilioinguinal but I think that's all we're being tested on here

submitted by diabetes(28),
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ehT rmnmaofipip exp,sul titesaurcl ,ertray rsacritcmee ery,atr yrreat fo teh utcsdu efed,ersn limcpyhta ,seeslsv ecsualitrt ahttscyeipm e,nersv and ucustd eneerdsf all urn eedp to the antrenli cpsamreti sfaic.a ehT ongnullaiiii nevre runs on het iucaflrseip aurescf of hte eralxtne capemsrti hT isaafec iiliiungnaol never si a ssnyore neevr tath nearsnevti teh insk over hte nogri roie,ng hte aidlem scepta of hte hgth,i het epurp ptar fo eht mtroucs and eht linepe otro. It is llmoyarn routceeednn idnurg peon iarper fo uaningil enarih.

submitted by mrizzle(0),

This book chapter describes this stuff well if you can access it through the library.

Regional Nerve Blocks in Anesthesia and Pain Therapy Traditional and Ultrasound-Guided Techniques pg.707

submitted by lovely(0),
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tI pspaare htat btho het aemglonrftioe vener liant(eg crhb)an nad eht giuoiililnan ernve ohbt ear neraltxe to the atmsrecpi ocrd nda ta teh irpuefaiscl alquiinn clan.a engeDpdni on cloaonti of eth oemitlnafgre evren mesak a endirecffe rof hwat it vrsi.nteena It paarsep atht the inoomlfeterga verne eat(ling )hacnbr itevnasrne eth reaallt earnrtio ufraecs of hte tu,srom liwhe eht lugoniliniia vrnee eeisnvrnta het nrreaoti uscfear fo eth rcstomu.


elGoog also syas hatt hte ltanieg hcabrn fo hte eotfrelnoagim revne nca veerintan het tnsaeinos fo teh isnk of the trenaroi fucsrea of teh oum.tcsr seDo it arseapp tath irhete ernve hociec wuold leda you to eht rrtecco n?sarew

submitted by lisa(0),
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The tqnseuio ssak tbuao a reenv hatt is no eht EERXATLN fsruaec of eht tecsmeiarp cord ta hte ellve fo ireacisfulp irgn, atth si eth niigiolnaiul vneer, cesbuea eth tneigal harcnb of teh otmfoanelgeir veern oesg disine.

The ktric is thta eht latreeofngmio si pssobelerni of earinintvgv eht rteonari racefus of eth str,oecmu ubt teh iealgtn rabhcn of the inaiulgn nvere ttah esog tlexenra si orbpssienle of the osperuri iaoetrnr fcuaser of eht osurtcm

rHee oyu nac ese hbot nesrve utideos dna isdien the prcametsi dorc epbc17a-9e-had1?a8scd08ei//e71a51l1oind3p04es2.-4s-5hr:6e3crn78rgdtesh0tm.3p/sg/dprh6=dmi2n2a.jia7e-/r5e dan eehr yuo cna ese het arnntiovie mfro othb serenv 2not/cdvl/ituaagrp/:dc7ofmttl/0ot.ptetmlaeunraa1enceetvhzs-awi/sa/ig0lmjp.e-c1urn-fie/roplmtoseeu--jtaeom