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Retired NBME 24 Answers

nbme24/Block 2/Question#17 (reveal difficulty score)
A 68-year-old man comes to the physician ...
Normal aging ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: repro Aging

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submitted by โˆ—m-ice(370)
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All of the features described of this patient would be expected of a 68-year-old man. Shorter, less intense orgasms, as well as increased time needed between sex could be related to a slight drop in testosterone with age. However, he continues to grow hair well (feet and toes), implying that he hasn't dramatically lost testosterone production. His prostate is slightly enlarged, which could imply benign prostatic hyperplasia, but this should not directly impact his sexual function.

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cassdawg  ^BPH threw me off: he probably does have BPH (slightly elevated PSA and diffusely enlarged prostate, common in men above 50), but BPH does not typically cause sexual dysfunction as described. BPH is more associated with urinary retention and UTI, and when it does cause sexual dysfunction urinary symptoms would be concurrently present (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1473005/ and FA2020 p654). +8
mikestix96  Normal hair growth on the toes could also imply that its not a vascular cause of decreased sexual performance (I.e. PAD with fine distal hairs) +4
bfinard1  What about the fact that it all started when he began dating the 40 year old woman 1 year ago? +
hivwizard  He says "his orgasms are shorter & he has to wait 2 or 3 hours before having sex AGAIN." when I read this I assumed that he doesn't have any psychological issues when it comes to having sex with this lady (my guy isn't scared) as well as they go multiple rounds +2



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