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Retired NBME 23 Answers

nbme23/Block 1/Question#30 (reveal difficulty score)
A 52-year-old man comes to the physician ...
Pelvic splanchnics ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—sajaqua1(607)
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The patient underwent removal of a rectal tumor which had involvement with the prostate. The prostatic capsule is rich with nerves including the pelvic splanchnic nerves, a set of parasympathetic nerves responsible for PNS autonomic regulation. Erections are a parasympathetic function.

A) Gray rami from the sympathetic chain- erections are a parasympathetic function, not sympathetic. Emission of sperm is a sympathetic function, and is directed by the inferior hypogastric nerve. C) Pudendal- the pudendal nerve is a somatic nerve that receives sensation from the penis, posterior scrotum, clitoris, and labia, as well as being responsible for some movement of the pelvic floor, and ejaculation. D) Superior hypogastric nerve- a sympathetic nerve, this contributes to the hypogastric plexus and may also contribute to sympathetic control of emission. E) Ventral ramie of S2-S4- These rami contribute to the pudendal nerve.

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focus  Diagrams here are pretty good too: https://obgynkey.com/introduction-of-pelvic-anatomy-2/ "Point, Squeeze, Shoot" Point- erection: pelvic splanchnic nerves (S2-4) Squeeze- emission: superior hypogastric plexus Shoot- ejaculation: pudendal nerve +2
weirdmed51  @focus diagrams there are terrible +



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submitted by โˆ—bend_nbme_over(37)
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Just remember Point, Squeeze, and Shoot

Erection - Point Parasympathetic NS (pelvic splanchnics S2-S4)

Emission - Squeeze Sympathetic NS (hypogastric nerve T11-L2)

Ejaculation - Shoot visceral and Somatic nerves (Pudendal nerve)

FA19 pg. 609 (nice)

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llamastep1  Emission, as the first phase of ejaculation, is a sympathetic spinal cord reflex and is defined as the deposition of seminal fluid into the posterior urethra. Ejaculation or expulsion is due to the combined action of sympathetic and somatic pathways. +2
mutteringly  actually on page 613 FA19 lol +
weirdmed51  I just got the difference between emission and ejaculation (facepalm). Thank you @Ilamastep1 +
weirdmed51  S2,3, FOUR keeps penis off the FLOOR! +1



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