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 +12  (nbme21#45)
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I utjs enkw htta rsmep dnee efros,uct ont erus tahw aessdei scsepro sthi si h.uohtg He was ttyrpe nlramo so 5a uaceestard edo'nts snetrpe klei htt.a I anwst' ruse if htree saw nya dod seu fo het eohrt rs.senwa erhe si a ikn.l leFe refe to


sucFtroe mksae up %99 of het enrgcidu rsgua epestnr in This asgru si cedduorp ni het smnlaie sveel.isc dshieDiimn llvsee of rutocsfe vhae bene wohsn ot aplelarl dnargoen eceyiifdcn nda eht stertotneeso ve.lle glwolFoin oesetentostr hta,rype hte evlel of sfecorut .anrhsehgAclot uise eht stfceoru tset si nto prat of a nreuoti nemse ylans,ias ti si usfule in cessa of oaserzopami c(basnee fo smerp in n.)esem nI rspemaazioo ocayrensd ot het acenebs fo sveecsil ro fi ehetr is an tubc,ontsior no tfecrsuo si penrts.e nI tstlaeuirc oeipazr,smoa reusftoc si etsnpre. heWn pozesramaio dna owl emnse elvuom s,siext the festruco tset holuds olas eb e,nod no a oluasettcejpa nriue mpesal to hckce ofr eorgrdrtea aluoteincja. sihT urscco enwh the etaealjuc oges otni hte bleddra adnties fo uot het Tt.ereuh rha druroeepc fro eidmgtnenri the uoantm fo ertfusoc in semne veovnlsi hgtaien nemse ni a sontrg cdai in teh cpeesrne of rioles.corn rosutecF egvis a der rcool nvo(iefSolf eriotnc)a nda yam be rdea in a emoeottphr. ehT nmlaor aevarge is 5d1g3/mL efc.torus

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. +3
d_holles  Apparently diabetes, occlusion, and inflammation can result in ↓ fructose in sperm. Mauss et al, Fert Stert 25, 1974 +4
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: +
burak  zinc deficiency cause hypogonadism. there is no hypogonadism, sperms are damaged? +
fatboyslim  @Sam1 but cystic fibrosis will show abnormal physical findings (clubbing, pulmonary crackles etc). The question says physical exam shows no abnormalities. +
pg32  Confused as to how we can rule out zinc... From "Zinc also plays a role in healthy sperm production. According to a 2018 review article in the Journal of Reproduction and Infertility, zinc deficiency may contribute to poor semen quality and infertility." +
bekindstep1  @pg32 I am not sure of how Zinc contributes to sperm production, but the question was asking about abnormalities in the semen and fructose is present in the semen. Maybe zinc plays a role in sperm development before it is mixed in with semen and so one with zinc deficiency wouldn't have low in zinc in their semen perhaps, but it their blood. This is just a hypothesis though.... +
brise  ^^ Yeah that's how I ruled it out. You can find fructose in the semen, but you wouldn't be able to find zinc in the semen! It might help the sperm, but it's not going to be chilling with them +

 +0  (nbme21#30)
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ngaD itsh ntoiqseu trwhe me ffo easuecb it disa leamfe aaetiignl hnew I httouhg ti dlouw be oguambuis at .ibhtr H TD tslil asemk het mots .ssene sTk.anh

 +1  (nbme21#34)
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priylgnsusir gdoo txlnpaanoie and epcrtiu ofdnu no itsh mihoetgns gonla teh nslie of tcimniunoarit elefxr kaa( dalbred si llfu nad uoy psis reelxf) si ngoe os het nrefftae fsrebi iycgrran hte gsalni tath the bdedral is lflu ntaer' krigo.wn sehto bfeisr ear rricdea ni het cvilpe erenvs


yo  if still confused, a better explanation can be found here +24
hyoscyamine  i found this image to be helpful in remembering which nerves do what on which receptor. +7

 +10  (nbme21#46)
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ndeur 8 syare dol ofr slgri si a dab si,ng 8 is oyk.a ru edn 9 rfo soyb si a bad

stuj cwaht uto orf any 6 eray ldo or ieshmogtn kiel at ht. brawee fo taht nHRG ehrtie aynetlrlc ro soem msoe throe f t.-issuocrre iad 9201 gp 326

hungrybox  yo wtf i got my first dick hair in 6th grade wtf are they feeding these kids +42
lola915  FA 20 pg.637 Defines Precocious Puberty as: <8 y/o in Females <9 y/o in Males +1
euphoria  In Caucasian is less than 7 years. +

 +12  (nbme21#22)
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isTh rdcoceur htiiwn 6 osuhr nad dsecua esom parlnmyuo edmea adn oprtsriaeyr diestssr rtefa a untosafrsin sdueac yb eht nodsor' uctkeaienoy-tl stiiendaob utjs todenriysg het ienrectips rhouseinptl adn rteorapysri aohntilelde l.csle

wheli acyn/ilaeixhlaaslprg can cusae pyetrrasori rserat nad coksh it sha a oeathmws rtneiffed ,upcitre no ,gnehzewi shsticine ro revtawhe nda cncgrdaio to ftris idA ti pnhpsea twnihi mtenisu to 23- hrous hihwc is at letas obldue twha ewe'r esinge eer.h sola ewbaer of gIA eniidcetf peloep in htis cieh.oc

P,E eh I don't khtin it cfafest oP2a taht oentf uhmc cairgocnd to hsit uresp dpure gihh ldyei sro.cerue tub huh yhea e'dtnso elfe EP knaid oineqtsuorrt.camw0pe-:pkt/e2tshdm/ca10/lp#/iiceseuee3.ni9cdmo10c

mpa,oenin rhtig artfe lal hte nifnsuoi esnsibus and no emnnito of efrve ro tg?aiynhn h.Na

og ot geap 411 fo srfit .aid m'I trpeyt user ew ndee ot onkw uor nnsoitsrua/ptnflian apcr uaescbe ti tjus ksepe mgiocn pu ni wurdlo tbu this lehow xmea is a opthcora.s

veiogFr em fi I edam a norat/mikgwse tbauo gyt,hinan I lmsoyt tgo fnoi omrf firts id.a lpz reocrct fi eehrt si a aekitm,s ogdo

hungrybox  we gonna make it bro +7
hungrybox  or sis +8
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 +6
athenathefirst  I hope you guys made it. Your post 9 months ago +1

 +2  (nbme21#15)
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eyrhe't atkgnil batuo a onnpesrlale thnsu reourcepd


hungrybox  be honest did u know that before looking it up +9
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. +30
sympathetikey  Relax @meningitis. Hungry's just messin :) +9
sbryant6  Looks like somebody needs an enema to get that stick out. +1
chandlerbas  ya'll are too TP/(TP+FN) lol +12

Subcomments ...

submitted by lnsetick(94),
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I stuj rreememb Sattra gsnayi MPV destn to eb aoiytpm.tsacm sol,A I hinkt hte dik endmplciao pealcfsilicy of g,hogcinu nda atth made em yrlael nlae aawy rofm .MVP

yo  he also has a family history of asthma. that's shit is genetic. +1 for asthma. +5  
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(124),
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I gmthi eb hte nylo psrone no aerht owh otg thsi oen wro,ng ubt egslar:dsre

IT"T siyslana idecsunl yeevr tseucbj hwo si reozimadnd agroinccd ot dzemiradon tmntteear s.mngateins It gnsorie cmlicnonp,eoan lcoropto t,siednvaoi ih,aarwltdw nda tgnhayin ttah nppheas raetf ndoonti"a.izmar[]1

yo  You're not. I also goofed. +20  
seagull 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. +  
drdoom  ^ linkifying @seagull: +2  
teepot123  ^ same video above used when I analysed my form 20 q which I got incorrect at time, its very clear at explaining this, helping me get it correct on this form +  

submitted by yo(86),
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splriyiusnrg dgoo itlaxenonap adn ucpiert uondf no stih t.eis iehogmtsn onagl the inles of tcmortianiinu felexr ka(a brdadle si ullf nad ouy psis erlfx)e is neog os the freafent besrfi cyrirgna eht lgains ttah eth abdeldr si flul ran'et wgn.kori toesh sbefri aer aecrdir ni het pielcv vnesre


yo  if still confused, a better explanation can be found here +24  
hyoscyamine  i found this image to be helpful in remembering which nerves do what on which receptor. +7  
drdoom  ^ linkify hyoscyamine +