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Comments ...

 +9  (nbme21#45)

I just knew that sperm need fructose, not sure what disease process this is though. He was pretty normal so 5a reducatase doesn't present like that. I wasn't sure if there was any odd use of the other answers. here is a link. Feel free to expand.

https://www.labce.com/spg27422_question.aspx

Fructose makes up 99% of the reducing sugar present in semen. This sugar is produced in the seminal vesicles. Diminished levels of fructose have been shown to parallel androgen deficiency and the testosterone level. Following testosterone therapy, the level of fructose increases. Although the fructose test is not part of a routine semen analysis, it is useful in cases of azoospermia (absence of sperm in semen). In azoospermia secondary to the absence of vesicles or if there is an obstruction, no fructose is present. In testicular azoospermia, fructose is present. When azoospermia and low semen volume exists, the fructose test should also be done, on a postejaculate urine sample to check for retrograde ejaculation. This occurs when the ejaculate goes into the bladder instead of out the urethra. The procedure for determining the amount of fructose in semen involves heating semen in a strong acid in the presence of resorcinol. Fructose gives a red color (Selivonoff reaction) and may be read in a photometer. The normal average is 315mg/dL fructose.

sam.l  Thank you for the explanation. I'm still confused about this answer. I was in between Zinc and fructose. Zinc deficiency also presents with anosmia (pg 71 First Aid 2019). Fructose is used for the movement. His hormones are normal.
d_holles  Apparently diabetes, occlusion, and inflammation can result in ↓ fructose in sperm. Mauss et al, Fert Stert 25, 1974 https://www.fertstert.org/article/S0015-0282(16)40391-2/pdf
cienfuegos  Thanks all for the info, quick note on the Zinc reply above @Sam.I: anosmia = lost sense of smell.
sam1  Great find yo! I believe this question was alluding to cystic fibrosis and the congenital absence of the vas deferens. Here is a link to a NEJM article about it below: https://www.nejm.org/doi/full/10.1056/NEJM196807112790203
burak  zinc deficiency cause hypogonadism. there is no hypogonadism, sperms are damaged?

 +0  (nbme21#30)

Dang this question threw me off because it said female genitalia when I thought it would be ambiguous at birth. DHT still makes the most sense. Thanks.


 +0  (nbme21#34)

surprisingly good explanation and picture found on this site. something along the lines of micturination reflex (aka bladder is full and you piss reflex) is gone so the afferent fibers carrying the signal that the bladder is full aren't working. those fibers are carried in the pelvic nerves

ttps://www.toppr.com/guides/biology/excretory-products/micturition/

yo  if still confused, a better explanation can be found here https://courses.washington.edu/conj/bess/urination/urination.html
hyoscyamine  i found this image to be helpful in remembering which nerves do what on which receptor. https://i.ytimg.com/vi/JwaeWXhklio/maxresdefault.jpg

 +6  (nbme21#46)

under 8 years old for girls is a bad sign, 8 is okay. under 9 for boys is a bad sign.

just watch out for any 6 year old or something like that. beware of that GnRH either centrally or some some other source. -first aid 2019 pg 623

hungrybox  yo wtf i got my first dick hair in 6th grade wtf are they feeding these kids

 +5  (nbme21#22)

This occurred within 6 hours and caused some pulmonary edema and respiratory distress after a transfusion caused by the donor's anti-leukocyte antibodies just destroying the recipients neutrophils and respiratory endothelial cells.

while allergic/anaphylaxis can cause respiratory arrest and shock it has a somewhat different picture, no wheezing, itchiness or whatever and according to first Aid it happens within minutes to 2-3 hours which is at least double what we're seeing here. also beware of IgA deficient people in this choice.

PE, eh I don't think it affects Pao2 that often much according to this super duper high yield resource. but uhh yeah doesn't feel PE kinda question https://emedicine.medscape.com/article/300901-workup#c12

pneomina, right after all the infusion business and no mention of fever or anything? Nah.

go to page 114 of first aid. I'm pretty sure we need to know our infusion/transplant crap because it just keeps coming up in uworld but this whole exam is a crapshoot.

Forgive me if I made a mistake/wrong about anything, I mostly got info from first aid. plz correct if there is a mistake, good luck.

hungrybox  we gonna make it bro
hungrybox  or sis
nala_ula  I did the same, basically went through each one and the time of onset between each. Good luck on your tests!!
temmy  i don't think pulmonary embolism will cause bilateral lung infiltrate

 +2  (nbme21#15)

they're talking about a splenorenal shunt procedure

https://my.clevelandclinic.org/health/treatments/4950-distal-splenorenal-shunt

hungrybox  be honest did u know that before looking it up
meningitis  @hungry, because you didn't know it, doesn't mean he didn't. This is a forum for answering questions and helping out, not dissing or showing off. Grow up before becoming a doctor.
sympathetikey  Relax @meningitis. Hungry's just messin :)
sbryant6  Looks like somebody needs an enema to get that stick out.
chandlerbas  ya'll are too TP/(TP+FN) lol




Subcomments ...

submitted by lnsetick(38),

I just remember Sattar saying MVP tends to be asymptomatic. Also, I think the kid complained specifically of coughing, and that made me really lean away from MVP.

yo  he also has a family history of asthma. that's shit is genetic. +1 for asthma. +1  
yotsubato  Cheif complaint is SOB during exercise with coughing. Mitral valve prolapse is not going to do that so I picked asthma as well. +1  


submitted by beeip(66),

I might be the only person on earth who got this one wrong, but regardless:

"ITT analysis includes every subject who is randomized according to randomized treatment assignment. It ignores noncompliance, protocol deviations, withdrawal, and anything that happens after randomization."[1]

yo  You're not. I also goofed. +3  
seagull  https://www.youtube.com/watch?v=Kps3VzbykFQ This video is a pretty decent explination worth your time on the subject. +2  
hungrybox  I got it right but I was only like 50% sure. So I appreciate it. +  


submitted by yo(26),

surprisingly good explanation and picture found on this site. something along the lines of micturination reflex (aka bladder is full and you piss reflex) is gone so the afferent fibers carrying the signal that the bladder is full aren't working. those fibers are carried in the pelvic nerves

ttps://www.toppr.com/guides/biology/excretory-products/micturition/

yo  if still confused, a better explanation can be found here https://courses.washington.edu/conj/bess/urination/urination.html +  
hyoscyamine  i found this image to be helpful in remembering which nerves do what on which receptor. https://i.ytimg.com/vi/JwaeWXhklio/maxresdefault.jpg +2