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NBME 22 Answers

nbme22/Block 2/Question#7 (reveal difficulty score)
A 66-year-old man comes to the physician ...
Libido: decreased;
Nocturnal erections: normal

tags: erections penis libido 

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submitted by paperbackwriter(132),
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Atfer tgignet it ownrg (aubeesc of teh EBMN 12 )Q, I osdnrtodeu it ilek hsi:t

– boiLdi si a long mert s,atte ainmnge yuor oibdil duloc be inf,e ubt iyenaxt in htta NMTMOE ithgm cause cpsheognciy DE

– iTsh yug hsa esmo licsacs GIS E ACSP crritiae nogig no: fegitua nregye( sos),l peesl cdsenutrias,b tenocoticnnra plomsber

– tI syas he hn'ats nbee leba ot nmaitina any cetenroi (sv ENBM 12 gyu htta was beal ot ebrtstauma (his nlog rmte sex drevi asw )KO but dha mfcpnaeerro eatnxyi ni het ntmmo)e

Tr,roheefe ckal fo sex verid uefled by dpsnsiroee tg--;& lwo o,iibdl utb alyhlipycglosio hinogtn rowng ihwt hmi -;tg-& tetihngmi ceteronis

trump2020  Bless you for including the spoiler warning +2  
kernicteruscandycorn  @paperbackwriter: sick name and reference +  

submitted by iviax94(7),
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eehrT have enbe a lecuop of nessoiqut otuab hsti tpcio on the wrene .maesx v’Ie bene ginswenra yb uitgaqne ibloid ot etnreeototss vsllee dan aulontcnr enecsiort to hatelh of ceualsuvtra oessrarecliso(ht or n)to. sI hits ccrtr?oe

liverdietrying  When you’re thinking of libido, don’t just equate it to testosterone -- make sure you’re always considering depression! Depression following stroke is common, especially with residual physical disability, so this would decrease his libido. Nocturnal erections equate to “does it actually work?” not just the vasculature but the neural input as well. For example, during prostatectomy damage to the pelvic plexus (nerves) can lead to impotence. There’s nothing to suggest that he has vascular or neurologic erectile dysfunction here, which is why his nocturnal erections are intact. +30  
_pusheen_  @liverdietrying Was it premature to assume he has trouble with erections because of neural damage from the stroke? I put low libido, low nocturnal erections. Is it because the stroke resulted in hemiparesis and not autonomic dysfunction or something like that? +5  
liverdietrying  @pusheen Correct, you won’t classically get impotence after a hemiplegic stroke. His inability to achieve an erection is much more likely to be 2/2 psychosocial effects than organic disease. If this vignette instead said that this had gotten a prostatectomy with resulting damage to the pelvic nerves that allow for erection, then it’d be a more safe choice to put no nocturnal erections. +4  
fast44  Is there a video or somewhere that explains these sexual dysfunctions? This seems to be a topic that keeps repeating on the new exams. +2  
forerofore  well, i though that because he had a stroke he would be likely to have atherosclerosis, which would keep libido high and reduce nocturnal erections, i kinda ignored the whole "he´s depressed" part of the vignette despite understanding the mechanism well. but from a clinical depression point of view, if his arteries are intact, and he is depressed, then libido would be low, and erections present at night. +4  
pg32  I can't remember exactly but I swear the question on NBME 21 the guy's wife had died as well...? Or they had gotten divorced? Either way, he had some psychological baggage as well, but his libido was still normal, and the explanation was that his testosterone would be fine regardless of his depressed mood. So I went with that logic here and missed this question. I don't understand how I am supposed to gauge someone's libido based on vague hints at their mood, especially when in one exam mood does not decrease libido and in the other it does. +1  
drzed  @pg32 bro spoilers +2  

submitted by elf16(2),
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How is shti dtfniefre rfmo eth uitoseqn no MNBE 21 in whihc a 8y6-rea odl amn salo ahd cpyscgheino ?DE But eht arnews asw mlrano oilbid nad tunrcnloa ne.eoirtsc

toxoplasmabartonella  In that case, his testosterone was normal and he had no signs of depression. The stem did say his wife passed away few months ago, so i personally chose low libido, but whatever. +  

submitted by adong(107),
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ePrtty hcmu if tyeh can aturasmteb or etg it up aneol ni ayn ywa trihe ltnacounr eeetunccsm udlosh be mroaln igenmna htat thire rnntoivaeni and felxre sywtapah are all ci.attn iiobdL kaa sex rvide rfmo awht evI’ ense so arf si tedealr by neioss.prde So klei in hte qsuonite on NEMB 12 the mste tedtsa ahtt ngierncse for pedserisno saw ieneatvg cwhih si ywh oilbdi wuold sola eb marnlo in iths ces.a If rets’eh rvee a Q tihw a eedssdpre guy nda rloamn alb svelua nad slaipyhc e,axm tmso ilkeyl nnaog be deascdere odibil wiht rnmola inthg crsene-it o tsyeuocr fo xnausfynluejfir//aduio

submitted by nwinkelmann(321),
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o,S I httohug hsti nisoetuq aws prseu ugaev nda ton ttha nbieg as,di naigvh ttngeo ti norwg adn otn elarly aivnhg a gdoo lixnetapaon rfo eth neaw,rs I did a elttil arceresh adn onfud tshi ae:ltirc d4t73uhwTR1rn.g1/sa1o01/d.p:l0ot.j/0aSopa.6..f5i1/wr1/s/h.w

sThi asw hte nami :csnonloiuc T"eh trsules fo eht peestnr du,sty aiedm at gnesssisa het ftfesec fo rseotk on auxles ufitinc,onng valree a cntgiifinas edcenil ni ,dloibi tialoc eufyq,nerc uaslxe r,ouslaa and sacstiiatnof thwi luxase ilfe ni tobh oesrtk pisentat and tireh hTe sptenre ustersl slao naedttsorme atht oreddrssi of xealus onctnsifu rae otms lgiincnsayfit easasiotcd wtih osvairu cplaochsiyos ocr,sfat ucsh sa tepati’ns elagrne dtattuei wtaord tiysxule,a arfe fo otee,cnmip nda iiybtal ot disussc sylt,iaeux as ellw sa hiwt teh dergee fo rktspsoote oiltanunfc yitad.isbli r,evooreM xaleus tdnfocuysin saw rlaeetd ot eht espeencr dna eegedr of roesipd,sne deaitesb lmiues,lt dna sclurvaocdiraa dmoc.nateii ehT lteyoogi or liotanoc fo the oektsr adn hte eredng ro rliaamt ttssua fo eht iatpetsn weer otn dssaeatcio hwit cnehsga ni sopkotstre sulxaieyt ni nteipsta in eth rpesetn .ud"tys

Lgioonk at het enoiutsq agian, 'Im isungseg eth tafi"gue adn infftlidciug lsgeipne nad incnogtner"atc tmatentse was sdoeppsu to be a luce rof orn,epsisde pcellsieya scine ti erstdat aertf ish s.ekrto sAl,o on shclpyia tolmianbsarie stgsueg fncigtinuon si icattn nad hsut nntrucoal ioetrnecs wluod be rderveesp omnlla.ry shiT si just

ls3076  appreciate this kind of effort to look up journal articles but honestly this is not really what nbme answers is for... we should be able to get the answer from process of elimination/basic science concepts and not from looking up studies as we obviously can't do this on the test +  

submitted by cathartic_medstu(32),
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gairncO ED: mloanr ob,liid eecddreas rnaoultcn eesotcrin

hsenPcoyicg :DE aeeercdds ol,idbi maorln ntnrcaulo enrisceot

tGo .ti

submitted by ls3076(77),
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sI eaeseddcr nnatlrouc isnecoret otn pesblsio edu to eht iingynrocut tweenbe noset of tspmymos nad rstoek 2( oms suevsr 3?) erAge hatt thsee sitqneosu ear yrve vgaue adn nfsgiaur.ttr Nto srue rhewe to tge a ogdo pagrs on hsit rat.aliem

submitted by cathartic_medstu(32),
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rtnocauNl npilee ectmucense mtraeesuemn apgyr)hpao(lhl is a tste htat sseuearm utnospnoase hlngyti seoreictn ni ecetreli sfnduynitco rila(mipyr fpordemre in a selep )boyolarrta. Is't sluufe rfo eirttifeaifnngd nbeetew roicnga frmo icphonseygc eetieclr iycntofndus.

nVetetig seidesbrc a sbpsiloy rdsdesepe itaeptn gt&=; hcniosycgep leecreti ycudfsinn.ot Sceni ti si nto an acgoirn usaec fo ,DE tclaonnru eneicostr oluwd eb ao.lmrn Ocrngia leitsgooei fo DE iunlecd goencreuin or a.luavcrs

odiLbi tpar fesucosn me eher. iLidbo aensm elxasu edrsei ro tp.aeipte I swa ghitnnik scein hs'e omingc in ot gte ED e,ecdkhc ti iincesadt 'hes eiptetpa orf xes si uegonh hatt ti dame imh etg it .hckec So dbloii suhdol be ornam.l nAy lp?eh

submitted by mattnatomy(44),
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Awsrne = ecdDraese il;boid alnomr atucnnrol eiostcren

I vebleei tahw tyeh eewr rgnyit to ctieadni ni thsi inotsque wsa shclagooclPiy luaeSx oyctiusDnfn aka( - nrroacmePfe nti.eyA)x

In sthi cesa, it wts'an os mhuc the emnfpacorre htta rwdeiro eth n,ma btu eh yam eb so ceufsdo no his ehltah siesus tpso( tseo)rk, atth eh si bnuela ot emfpror ueal.yaqedt f,Therereo sih anartul lbdioi dluow eb eddeares.c vewHroe, euacsbe ist' ncipcohesyg ;mp&a ont i,ysgiooplhc eh uhdsol sltli vhea omarnl tgimhtien roisee.nct

b1ackcoffee  Wouldn't pshychological SD have normal libido and just performance anxiety? +