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NBME 24 Answers

nbme24/Block 4/Question#19 (37.1 difficulty score)
A 38-year-old woman, gravida 4, para 4, comes ...
Internal anal sphincter🔍
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 +15 
submitted by neonem(570),
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 +5 
submitted by masonkingcobra(338),
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All oubat sintg:iht

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charcot_bouchard  When i faced this ques i did some Kegel. Felt something in my pee pee but not in my b*e. I exclude all option because they are bigger muscle of pelvic floor except EUS & IAS. And also remeber Kegel can be used as a treatment of prem. ejaculation not premature defication. +17  
paperbackwriter  @charcot_bouchard Actually Kegels are used in the treatment of fecal incontinence as well because of effect on EXTERNAL anal sphincter and surrounding muscles which are under voluntary control (you can most definitely feel it if you do a kegel lol). The answer is internal anal sphincter because internal is not under voluntary control (tonically contracted via symp. --> parasymp. relaxes it --> gotta go feeling --> no incontinence because of external sphincter's voluntary contraction). +10  
am4140  @paperbackwriter - Honestly, this depends on how you do the kegel. It is entirely possible to not involve your external anal sphincter at all once you figure out how to isolate your vaginal area. So the internal anal sphincter is under involuntary control so that was especially right, but I was prepared to pick anything with “anal” in it at all. So kegels work for fecal incontinence only if you’re choosing to involve your external anal sphincter, or you don’t know how or are too inexperienced to isolate the muscles around your vagina. I don’t think NBME or USMLE would get this tricky because the external anal sphincter will not always be involved in kegels. +1