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Retired NBME 23 Answers

nbme23/Block 3/Question#20 (reveal difficulty score)
An 82-year-old woman is brought to the ...
Decreased function of the puborectalis muscle ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—gabeb71(51)
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The puborectalis muscle, which is one of the muscles that comprise the pelvic floor and plays an important role in both fecal continence and defecation, is tonically contracted and maintains the anorectal angle at rest.

here is a picture: https://www.123rf.com/photo_46940875_stock-vector-the-rectum-and-anus-showing-the-puborectalis-muscle-part-of-the-levator-ani-used-for-the-control-of-.html

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gh889  How do you differentiate this from hypertonicity of the internal anal sphincter? +2
gh889  nvm. im dumb lol +
qball  Uworld Q ID 17004 +
focus  @gh889 I made the same mistake... fecal INCONTINENCE meaning she CAN pass stool-- in fact, way too well... more than we want. Hypertonicity of the internal anal sphincter would cause constipation-like symptoms. +4
weirdmed51  But unworld says decreased function of puborectalis leads to constipation! +1
akshat96  Exactly! Thatโ€™s I didnโ€™t pick decreased functional of puborectalis. +
melanoma  In the question of UW the puborectalis muscle fails to relax and in the question of NBME the puborectalis muscle fails to contract. +1



ley  Various pregnancies cause instability in the pelvic floor muscles(ex:puborectalis muscle). Since she is 82 years old we can guess she has at least 1 pregnancy. +



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