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NBME 21 Answers

nbme21/Block 3/Question#45 (reveal difficulty score)
A 28-year-old man comes to the physician for ...
Fructose ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +11  upvote downvote
submitted by โˆ—yo(89)
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I stju ewnk ahtt persm nede csfer,out nto sreu htwa esisdae rcoesps shti is otghu.h He asw ttyrep nrloam os a5 uceretadas 'dstnoe sepnetr kiel ath.t I atsn'w suer if there asw ayn ddo esu of eht rtheo rses.wna ereh is a .kinl eeFl refe to .depnxa

owacew4e_sgt:sux/7nlhtbws2..sqiptpc2o.ap2//m

tFouercs amske up 99% fo eth crgnuedi arsug seetnpr in nme.se hTis agusr si erpoucdd in teh lismaen escieslv. nhimDsdeii sellev fo ouresftc veah eneb nowsh ot laralpel eogrndan icyieecndf and eth oneosesetrtt ev.lle nFloigwol tteroetosnes ehtp,ary hte evlle of ftuserco ig. oslhrenscAeuaht hte scfrtuoe ttse si ton aptr fo a nueorit emnes snaly,sia it is lfuseu in secas of meiaopszaro nesebac( fo emprs ni sene.m) nI aiersoomazp dsyaocner ot the anbseec fo lvcisees or fi eerth si an o,tcunirstbo on teusfocr si ree.npts In tiecatrlus ao,ozirapems ctoufers is eep.trns ehWn oseipazrmoa nad owl meens ovlume ,tissxe eht rfsceotu ttse dsulho loas eb ed,no no a jocaeteslaptu urine epsalm ot hkcce rfo roteargder ilauejoacnt. sihT srucco ehwn het jaueetcla esgo iotn eht eladbdr enastdi fo tou the eTh.tuer ahr dprerceuo rfo genterimnid eht uatonm of fotcsreu in mesen snelivov genhita smene in a ostgnr dica ni eth serenepc of .ioscnoelrr Fuoctesr gvies a erd rloco l(ooSfniefv )naieotrc nda amy eb erda ni a orotmpe.the hTe ormlna egraave si m1L5/dg3 rstou.efc

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sam.l  Takhn oyu orf the et.alxoinnap Im' llsit eusfcndo uaotb htis nwr.esa I saw ni neebwte icZn nda soetuc.rf cZin nyeiicfced osla nepssret tihw iaaomns (gp 17 isFrt dAi 1)0.92 urseFotc is udse for teh nvtmee.mo siH oehmnosr are arm.nlo +4
d_holles  yeprpntAla ebd,istae oc,cniluso nda nammlniofiat can ltrues ni โ†“ rutoefsc in sruesm.sM pa te la, terF ettSr 25, 7491 2hie4l//s:090w/r1c(dep50o/8sf-rfpt1trr).3tS-w2w.e0t6t/g1at2 +4
cienfuegos  saTkhn lla ofr het i,ofn uqikc teno on het ciZn relyp aoveb a.:ISm@ oansami = lost esnes fo lml.es +
sam1  tGaer idnf !yo I iebeevl hits onuqsite wsa adulgiln to tscyci ofbsiirs nda eth aclitnngeo eceabns of the sav e.denerfs eHer si a ikln ot a NMJE clatire atbuo ti lwe ob:m9eNwpJ.07/d1.Eo5n6l11t/Mw092/.//1r3o:2tlw7i00fjg1h80s/u6 +1
burak  nciz findeeiycc saeuc osiy.phdomgna ehtre is on hmiads,nopgyo srpsme rea ddame?ag +
fatboyslim  1a@mS ubt icystc sifbsroi lilw oswh lambonar hpiascyl dgfiinns n,cu(lbbgi pymnoarul lsreakcc .cet) Teh einuotqs ysas yhpscali amxe wssoh on bialmta.oisner +
pg32  Cesufndo as ot hwo we can rleu uto n..icz. oFmr iwdlcoacm.etmsedoayn: nciZ" lsoa pasly a erlo ni eahlyht rmspe orcdpnoitu. nrdgAcoci ot a 0218 eiervw eciralt in teh Jarluon fo roudtinepoRc nda Iirent,ltyif nciz ieiecyfncd aym cinbotteur ot roop emesn layiqut dan yr"intlitief. +
bekindstep1  p@23g I am otn rsue of woh cZin tbineusotrc ot remsp couion,tdpr tbu eht nqeiouts swa isnkga uoabt astmerbnlaiio ni teh semne and orcestfu is eentrsp in eth en.mse aMyeb cnzi alspy a oelr in srepm tedepeolvnm beeorf it si dmixe ni whti eesmn dna so oen twih incz enceidciyf ndl'wotu ahev wol in cizn ni teirh enmes rhpep,sa btu ti tiehr ol.dbo hTsi si jtus a yohseshitp .tuh..hog. +
brise  ^^ haeY 'taths hwo I ledru it .uot oYu anc nidf cusoeftr in hte en,mse tub uoy louwd'tn be able ot dnif zcin ni the mese!n It hitmg ehpl teh me,rsp tbu sit' not gogni ot eb ilgclhin wtih hemt +2

Increased WBCs indicate genital infection/inflammation, which can lead to poor semen quality due to the production of excessive reactive oxygen species by leukocytes.

Absent fructose concentration is an indication of a congenital absence of vas deferens/seminal vesicles, while decreased fructose concentration may indicate an ejaculatory duct obstruction.

pH > 8.0 indicates inflammation of the prostate, seminal tract, epididymis, etc.; pH < 7.2 indicates seminal vesicle dysfunction or obstruction of the ejaculatory ducts.

+/- apurva(101)


 +8  upvote downvote
submitted by โˆ—nwinkelmann(366)
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oS I doeolk itno stih ruftehr oot seaebcu I tprtye mchu kwon gtnhino bauto hte make pu of emsen. Fmor eth rehreasc I of,dun sa sa tasedt weblo by ,oy ctousfer si eht somt moiaptnrt eutsncitnot of senem in rtems or presm intcuo.fn owleB is tirnnfaoimo I onfdu to aserdds eth rteoh ewarsn e.schcio

Znci ndfiiccyee (ni )e,usrm epr ,FA has nbee deiipmcalt in ydlaede noudw ,ghnaeli urspsdeeps ,mtnimiyu aeml gomapoins,dhy desceaerd ldtua hira y,laxlrai( ,ifacal ,pcb)iu ,adsgeiusy mon,saai rtarmcmosatiide oarpeentcaiht ec(tfed ni elinastnti nzic orptbioasn,) dan amy opespreids ot hollcoaci s.ircisroh FA idtdn' cspiyef eth esvell in het snm,ee utb rep teh lwobe e,alcirt nalemsi znic ecttonn swa ofudn ot vahe nro ictleoarrno to /smnesperme ie//catteltv.cvliey I otdn' wonk if 'ewer spopseud ot nowk thta, tbu own I ,od l.ol w553tnpm/nlv/t:mgsi7.dwhiweno/.p/.7huc.3b0b.

sA ounrbxygh dietmo,nen ieulmnsle si lony idomneent nceo in FA sa a etenrtmat fro ai,etn os I oelkod inot ti .uehrrft eelniumS si a etntnoc fo ene,sm btu eevlsl ravy so hmcu atht ti vrssee on sotngoircp laiclnc revneelac ot yilniierftt, erp hist crelia:t 3/.vmluh.tgsp/2ewiib0:/.1bww5np3dmt/n2nhoc..

To relu uot lal of eth eanwrss ab(uesce I idd'tn larley wkno ayihgnnt tuabo the tiqlauy fo es,nm)e I fodnu hist "yB s,ctsiast-tti tehre wsa on itcginfnasi rfefienedc ni hte menes Na ocartnnnicote gnoam eht ietednrff gpusor (7 orpsgu atlot dasbe no empsr t,u)onc taiiingdcn teh itgfnniisaicn elro of Na in esmrp iyti".m.otl 1md/ws1ht..tbmwniiec75wg2obpnn/v.2up//.:hl.

a,illFny I dto'n nhkti het a5pha-l ecsutedar enzmye is laltycua ni ,nmsee utb I lcoud eb rgwo.n ehEtir ayw, it 'owndult eb mnlylrabao leeavedt ro wol if hte oretotsetsne llsvee are .lnamro

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bartolomoose  sa erp l,nojga eelnmsiu is vedniolv ni oghiuntlaet diaxeopres +
chandlerbas  lieusenm hsa a lore in togalnuethi prsieo.eadx exssce mieulens = arilcg rab,the hair oss,l dna nlia chnsgea, mhtgi see errpielhpa eorauphty.n efeciyncdi tp( on P)NT = laedtdi mirtchoydayoap +
chandlerbas  sola zicn aisd ni ersmp iotmtliy l:ci/p879in./inhn3.Mt4ls1otCwmhe7rc/.s/mP/.wt/bcvapgw hstta yhw i cohes nizc but rvrawehret im ervo ti +



 +3  upvote downvote
submitted by โˆ—hungrybox(1277)
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ocrAgdcin ot the ,UMESL ns'imeulse only seu is ni sneiulme liufsde as a rtetnmtea for a ngfuus edlalc ieaszMlasa psp ena(Ti or)lvo.ceisr

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 +1  upvote downvote
submitted by โˆ—unknown001(9)
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tels odvia lngo lneoxansptia alhsl we .

p.t wtih tii.tiyrlenf ciuqk stte in efw ncsosed = sneem otucrsef

catf : meinlas lseevci mksea cu.fsorte

tbnircosuot fo sealmin sevciel or catienongl bceenas = olw rctofuse ni esmen = miebtoalc inabaelmc &;tg envicieeftf treaispgssonmee

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 +1  upvote downvote
submitted by โˆ—meirchod(1)
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I srdeoean rhthuog hsti noe nsice I eeralnd taht seimaln seecvsil aylevih use Sroilbot eyehnsgeaDdro an(d iaseorv m;p&a eirvl I bleeevi t,oo) whchi mnaes yeht baroblpy aveh a aalpriylutrc ntaripmto nede rof es.torucF So oarabmln ocfrteus ni nsmee si ybprlboa ton a oodg sig.n

S.P. I reodwn fi the estnniac ddi teh sattetst-e no hits n...oe e sm(eed to orkw wlle fro dbtae)ise

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 +0  upvote downvote
submitted by โˆ—apurva(101)
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drneacIse BsCW eintdiac talngei ne,atti/ncliomnaifnomfi whhic nac deal to roop ensem utlaqyi eud to hte dupnorciot of exesscevi evrticea gyonex sicepes by l.ykteocseu

tbeAns ocurftse nratnioncteco si an anctinidoi of a egoacniltn aseecbn fo asv /daflmieeseensnr li,ecssve wehli ceeesrdda ctsfroeu annceotctonir yam tianiedc an uaecraolyjt cdtu butoctnr.soi

Hp ;&tg .08 ditcnisea itamliamnfon fo hte topte,sar lnesmia ttcra, isemydiidp, et.c; Hp &tl; 72. siidtacen emnsila leiesvc yiftnsonduc ro nobuiotrtsc of eht reocjaylatu cs.tdu

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 +0  upvote downvote
submitted by โˆ—nwinkelmann(366)
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oS I olokde oitn itsh turhrfe too ecubsae I ttepry cmuh oknw hnoitng btoau eth kaem pu of enems. moFr hte rhsaerec I udonf, as sa atetsd lwbeo yb oy, escrfuto si the msot tripaomnt tncunoitste fo eesmn in esrmt ro rpesm nnic.fout Bowle si nifmnotroai I donuf ot edrdass teh troeh rnawse ociehcs.

cinZ eydeicfcni (in umr,se) erp FA, has nbee ltcmepiiad in aeedydl duown hlnigae, ueedsppssr mtynmi,ui aeml gsonmhadypoi, aceeddsre adltu iahr axrayl,l(i aflic,a ,cuipb) eudsy,aisg snioaam, iiarmmosatctdre hpaieatecrotn e(efctd ni ntaitesinl incz nobto)sir,ap and may esersdpiop to iolaccohl .riiscosrh AF tnd'id iypecfs eht svleel in eth mes,ne tub erp het lbeow ,lriaetc silanem znci ettnonc swa fdnuo to aevh onr aoernroclti to pesmernm/es eti//tlvyetilvc.cea I ond't wonk fi rwee' sopdpeus to kown ,taht tub nwo I do, o.ll .cib7nonet3hv0wb/hwpw:.sm/.7u5/gn5.mdp3l/it.

As buyghxrno tdieemnno, inmesllue si olyn mineeondt ecno ni AF sa a rtmneteta rfo eiat,n so I lokode toni ti .frhuert imeunleS is a tnnceto of ee,nms tbu velesl rvay so uhmc atht ti srevse on icgprnsoot lnclaic lnacvreee to iirilt,yfent pre sthi rtcael:i 5h/u/g2i.2.bo1e/m3hlvsnwtwpn.mc:pw0dtb/in3..

oT ruel tuo lla of het nsewars beuacs(e I dn'itd arelyl knwo tayinnhg about eth qytialu of nmee)s, I dnfuo tish B"y sitstti,t-sca eterh was no iniacftsgin fernecdief in eth esnme Na encnctiootanr goanm het ffdntiere suprgo 7( rgopsu attol ebdsa no erpsm to,cn)u cnitinaidg teh gsniticnaifni elor fo Na ni respm .itlyiomt". tv5/thwwh/clniwpm/1.:bd/1nm2i.eo7unb2pg.s..

lF,nliya I dn'ot inhtk eth -aphl5a rteusaecd nemeyz si aulyatlc in emen,s ubt I oulcd be .gonrw Ereiht awy, it 'dtlunwo eb nloylbarma devtalee or lwo if hte teeootstesrn lsleve are rmlona.

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 -1  upvote downvote
submitted by flexatronn(5)
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uyo all rae ilkonog ayw oto pdee into sthi.

hisT swa a milpes ftac llarec oseuqint. hneW uyo ese ensme + lniifetryti in a teusonqi nda oreutfcs in hte sesa;wnr ist emens = rfsuotec

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