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nbme21/Block 2/Question#33 (61.1 difficulty score)
A 68-year-old man comes to the physician ...
Libido: normal; Nocturnal erections: normalπŸ”
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 +18 
submitted by imgdoc(135),
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I thuoght ubtao ti kiel :shti titPaen si hianvg onpgeccyihs DE - tis all in ihs dh,ae doibil is laronm dna oracunntl coitnsere ear alormn.

If ihs tsonseteeoTr lleve aws owl - iiodLb eescded.ra If sih ovenrsu messty priyaemetathphy/spc(at)atcmsi was gdeadma - nurntlaoc srecteion re.sdeeacd

eopH sthi l.shpe

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),
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He seissm hsi ifew anm, inst' aedyr rof thero e.nmow sePcyncghoi DE. yialslcpyh ehs neif




 +3 
submitted by haliburton(214),
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mrof PAAF DE fo mexid ariognc nda eisphcoygnc rgnioi is ommno.c cgecnPhosyi assceu are moer yleilk nehw teh itaeptn ash oamlrn srteieonc twih imonubsaartt ro hwen ctnoralnu inpeel mcnueestec si lor.nma

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(1032),
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hyW si his ibLoid ?mornla sIt' attyoll cdxtpeee ahtt he yma heav ucerded odlibi traef hsi wfie ided 2 eaysr goa mfro omse brroehil rloengdop l.ilenss

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 +