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NBME 19 Answers

nbme19/Block 1/Question#4 (reveal difficulty score)
66 yo man, 2 months of not being able to ...
Libido: decreased; Noctural erections: normal 🔍 / 📺 / 🌳
tags: erections 

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submitted by monoloco(150),
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Is this hte eno thiw hte opor keiydn ttah was uct in fhal ignsata sit will dan sah a ldieatd sidatl eurr?te fI s,o ayplbbor siogwhn su saraittnonli iacroancm wthi ldim iivonsna niot htta asditl ue.trer tPaaomh soed a yertpt oeseawm ojb of kantlgi abtou UG ccesnar a(nd smto acscnre) (dan( otsm ce)mnedi)i .IMO

submitted by drdoom(1045),
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nItiliyab ot nniaatim an tceeonri = eitrecle yicsnndtfuo. oS onw the iesnotuq si W"y?"h

i,augtFe uycdilftfi spl,genei flutiicdyf tnrnoccgeitna si rtsigatn ot douns ilek nrdssoepei. fyiucf"tDil c"tconntngeari ghitm eb peidrtentre as prdieaim eueecvxit cinfount or the giingnbens fo eauredav-atrlcsl mitedane e(antimed teladre to slmla utb uosruenm rbelreca fit,)arnsc btu on Step 1 etaidmne wlil eb btanatl ei,..( l"tos ish yaw me"oh, arn,e"n"dgiw ).etc.

eiensrDpos is uyacatll conmmo ftear a dgbettiniial entev iekl eotr,sk sa uyo migth xcpee.t htWi spdonrseei csmeo a osls fo xseula seeinrtt nad a—etrediths is eaesecdrd oibldi.

neO nca kame eth ngutearm atth a avaclur"s apt"neit githm haev soem ssuise tihw hsi sepp""i clsaorsetosri(eri, ipyparc/tsihehtaapttmcysmae cfinuodty)ns a,dn rfo this ernoas, rcaluntno ietcneor loshud be escedrdea; ubt neot ahtt gntinoh is etnemidon taubo gg-itnlnaonds rsvaaulc dseaeis o(n xh of tnons.reiye)ph

sA a lt,usre eht setb anwsre cihcoe heer si C. (Liidbo drasedeec btu courltann tineceors al).mnor The bgi onusteiq I avhe is, owh eht kceh dose htis ugy kwon 'seh hrad enwh she' lpea?es!! :p

cbay0509  thank you +1  
ilikedmyfirstusername  there are several UWorld questions about psychogenic ED with the answer being normal libido and normal nocturnal erections, idgi +14  
djeffs1  Yeah NBME says its C, but I still think with a recent stroke you can't bank on normal nocturnal erections... +  
drdoom  @djeffs nocturnal erections happen at the level of the spinal cord (S2–S4)! a “brain stroke” (UMN damage or “cortical damage”) would not kill your ability to have nocturnal erections! +1  
drjo  fatigue, difficulty sleeping and concentrating could be depression or hypothyroidism both of which can cause decreased libido +  
jurrutia  @djeffs1 when you say NBME say's it's C, how do you know that's the official answer? Did NBME post the answers somewhere? +  
djeffs1  in the versions I purchased from them they highlight the correct answer in the test review +1  
shieldmaiden  For me the keyword in the stem is "maintain"; he can maintain an erection, therefore nocturnal erections must be normal. Libido, on the other hand, is psychologically driven, so if he is depressed (trouble sleeping, concentrating, fatigue, recent major health problem) then the strength towards any kind of desire, including sexual, will be low +2  
chaosawaits  His nocturnal erections are normal because his spinal cord is not damaged. His libido has decreased because he's showing signs of depression. +  

Since all of the questions/answers are not on this site here is one with basic explanations if anyone wants it:

+3/- cassdawg(1533),

submitted by shadowbox(16),
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hTe tnouma fo acnourntl ierecnsot is daeee,csdr I knthi raooehes(ccrtlit )ebrom;pl btu I othtugh ttah ti aws a typlaci cesa fo a natipte egrfifnus fomr rssiedpnoe teraf a rsesiou i,lnsles terehofre =g&t; rdseacdee bi.dloi

submitted by quackster(0),
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iTsh si a scrrleoatovin ,noe tub ti sseme het soucsensn si atth pt had sxs of ramjo iornsespd,e and suth ish oidbli was mots eylilk on.dw uBt dalroybc/ulrltuost lwfwio–e,s eh aws n,eif os trncnuaol etecsionr eerw oanlr.m ,So ceotnpc BNEM anstw us ot lierzea si ttah we doslhu rnesce for srepdienso ni pts who npclaomi fo sxauel nonfdsci?ytu Or aks ubota exs ni tsp ohw saypdil xss fo ensse,oprid eikl taht tpatnie hda in het semt fo hte .Q

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