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Retired NBME 19 Answers

nbme19/Block 0/Question#0 (reveal difficulty score)
A 30-year-old man develops urinary ...
pelvic nerves ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: Pelvic

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submitted by โˆ—brasel(20)
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Overflow incontinence is present (bladder fills then leaks slightly), so either:

1.) something blocking outflow (e.g.; BPH)

2.) impaired contraction of bladder (e.g.; damaged nerves)

Only the pelvic nerve causes detrusor contraction, so it is the only possible answer. External sphincter, pudendal nerve, and skeletal muscle all does the same thing. Hypogastric nerve helps retain urine (relaxes detrusor) so it is clearly not damaged.

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solidshake  I agree answer is the parasympathetic Pelvic Splanchnic nerve, but don't forget there are 2 mechanisms that are affected when it's damaged: 1. Impaired involuntary contraction of bladder and also 2. Impaired involuntary relaxation of the internal urethral sphincter. Pelvic Splanchnic nerve facilitates both of those + voluntary somatic relaxation of external urethral sphincter via pudendal nerve allows you to pee +1
chaosawaits  @solidshake I may be just unable to search properly, but I found the internal urethral sphincter to be innervated by the sympathetic fibers from T10-L2 through the inferior hypogastric plexus (source: Wikipedia) Urination occurs by preganglionic inhibition of the sympathetic fibers via descending reticulospinal tract. Fact check appreciated. +2



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