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Retired 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 usjt enwk thta sprme ened cfroe,ust tno suer atwh dsiesae csprsoe hist is ohugth. He asw tetyrp maorln so 5a aurtcseaed sod'etn pertnse keil a.tht I wnt'sa urse if teehr wsa yan dod ues of het eroht ew.anssr hree is a nikl. leeF reef ot enda.xp

/spaestgntiups2l.s2aeh4oc.w.twmbc7/pq_:/w2xo

couFestr makse pu %99 fo eht edcunrgi rsgau rneetsp ni emen.s hTsi rguas si oupercdd in hte asnmiel icelsve.s ideDnmiihs lveles fo eosurfct avhe nbee snwho to lallaper nagorden eiycndefci and hte eeroonetsstt eev.ll logiwlFno nsosetrteoet yteprha, the eelvl fo utrefcso hireacg teun.Aolhss eht rufsotce tets si otn trap fo a rnuetio ensme nlaia,yss ti is euuslf in acses of aozsiomrpae nabc(ees fo emrps ni e)mn.es In amepizasoor nodyreasc ot hte sbcneea fo scsivlee or if eethr is an uotcbt,snori on fcsutero si ree.sptn In rtetlscaiu amois,arzeop utefscor si septern. nhWe oomrizaepsa dan wlo smeen mluveo s,esitx hte soctfuer tset oshdlu olsa be ,odne on a ujeloptseatca nrieu lespma ot kchce orf taoerrrgde tujicna.leoa Tish ccosur wenh het tluaecaje sgeo iton hte ealrdbd aetsdin fo tou eth aThtr. ereuh redecruop fro gtneiiedmnr het mutona of orecsuft in nseem vviloens hinetga eesmn ni a torngs iacd in eht recepens fo onclerr.sio rotsuFec svegi a rde roloc enivoSo(lff ctaer)oni dna yam eb dare ni a reopme.ttoh Teh rlnmoa grvaeae is /mdg53L1 sef.oucrt

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sam.l  hnaTk uoy rof eth eaix.antopnl 'Im lsitl ufedncso otuba stih swnear. I saw ni bneetwe icnZ dna furcse.to cZin eiyfnicced soal tpnseesr wtih oiamnas g(p 17 iFtrs iAd 0)19.2 soreFuct is sued rof eht ommvnt.ee iHs rsonhmoe rae rnolm.a +4
d_holles  rpapltnyeA t,esdeiba lo,coucnis and mfnniloatmia cna treuls ni โ†“ suceotfr in Map ms.eruss et l,a treF Stret 52, 179 4acwtfe3w//hStrt1/leet(t:.2201062400o/tsfsgd1-ip9w/pr5).8-rr +4
cienfuegos  kTnhas lla rfo the onfi, uqcik note on the iZnc erypl ebvao a:@.SmI mnsiaao = tslo esesn fo .lmsle +
sam1  tGrea difn o!y I eeelibv hsit oeqstinu asw glnidlau to ticcys isfsiorb and the cgnolineat ensbace fo the sva fenre.eds Hree is a nilk ot a NEMJ litaerc uatob it o b:elwtwMo/ht01l/w0/2N/o2.E1Jngu161d:e0sw18.693im59pjr//0f.770l +1
burak  nzic efcceidyni eucas .yodpmisngoah etehr is no p,myahdgsnoio smpsre era eadadmg? +
fatboyslim  1maS@ tbu itcscy sisrfiob liwl sowh rlmonaba ycaihlsp gdisnnfi ,ic(nlbbgu pamoulrny kcelcsra ce).t eTh iuoetnsq says cshaplyi meax sswho no a.nirbsmaeitol +
pg32  ndfoesuC sa to ohw ew anc eulr otu .ciz..n Frmo cmosyedcatm.anideowl: nZc"i sola lpsay a orle in lehtyah srmpe norcp.tuoid gcAcrodni ot a 8012 wreiev citrale in het alJnour of iRucrtpeoond adn lteyniItrfi, czni necefiicyd yma tonubitcer ot poor smnee tyuqail and .tef"itnyliri +
bekindstep1  g3p@2 I ma otn eurs of woh Zicn ntcboiresut ot rpmes con,pduirto but hte seqoiutn asw nagisk about alsaoentbriim ni eht menes nda stefuorc si pteersn ni the em.ens baeMy nicz plays a orle ni esmpr dmlevtnoeep feoreb it si mixde ni twhi eesmn nad so neo htwi czni nefiyicecd dt'wlnou haev low in nciz in hrtei eemsn heprsap, tub it trhei loob.d hisT si ujst a hisotyhesp .hohg.t.u. +
brise  ^^ Yeha ht'ats owh I rlude ti ou.t You nac nfid urcteofs ni teh nsee,m tbu ouy un'dotwl be elba ot find cizn in eth e!nmes tI imhtg hlpe the srp,em but t'si ton gnogi to be linhlcgi tiwh hetm +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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So I keoold otin ihst urehftr too bcsueae I rttyep umhc nowk nnghoit aubot teh keam up of es.nem morF the eaerchsr I ,noufd sa sa steatd ewlob by ,yo ursocfet is het tmso iptnmtoar tsiotnuntec fo esmne ni remts ro persm t.unonfic lwoeB si tioimnafnro I onudf ot sdesrda hte reoht rsnewa cieoch.s

Zinc iyfednecci (in emsr)u, per F,A ash eebn ltapeicidm ni ddleeya noduw ehn,gial eursesdspp iit,umnym lmea pamhiosno,gyd dsdaeerce auldt iahr ixaa(l,yrl aa,fcli i)pbc,u sigsu,deay asimnoa, ctmidisorrteama ronitpeaeathc tedfe(c in ntntilaeis zicn )i,aosbtnpor nda aym rseppedois ot licacohlo ohrc.ssrii FA d'nitd efycips teh leslve ni teh seenm, tbu rpe eht wboel ,critela nimlase nzci ttocnen asw donfu to veha nor nclriroeota ot esm/ersnmpe e.clt/veyt/ctviaeli I to'nd wnko if re'ew euossppd ot onwk that, tbu wno I do, .llo edw..p3.bwin503uw:7/7hh.lti//5bncmn/svmtgpo.

sA yogubnxrh tenmoei,dn luiselmne is only neenmdito neoc in FA as a emtraettn ofr eaint, os I kodoel iotn it .ruetfhr Seemunli si a tncnoet of nme,se tub vlslee ayvr so hmcu hatt ti esesrv no irtpncsoog iclcaln lverceane ot ienftyrli,it rpe hist tielc:ar gw5he/slmnw2.n.m./vctwd1pp2ou3th3bib0/.i:/n.

oT reul tou lla fo eth rensasw cees(bua I dndi't rylael konw ginnahty aotub eth auqtiyl of sene,m) I fndou tshi "By ttssiitcats,- ehret was on inncigfiats ffeedcenri in eht eemns Na acconnonertti oganm hte reeftnfdi gsporu 7( soprgu otlat bdaes on rsmpe u,t)onc ncidngaiti het ngitiainficns lero fo Na in pmesr .i."ttoyiml m7wip5h2nb/wn.u/:lb/.vo.2.t1gtshwcnm/d1epi.

yln,ialF I d'ont kinth het h-alpa5 redsctaeu ezmeny is latucyla ni sn,mee btu I lduoc eb rowgn. eirhEt y,aw it d'wlnuot be bolrlymaan teveedal ro low if eth tsoonesertte leeslv era .maonrl

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bartolomoose  sa rpe lgn,oaj lieunems si vinledov ni hgliaotnute rodpeixsea +
chandlerbas  nselumie has a eorl in inugahtelto deaps.exior csxese nielsmeu = rgcail btareh, riha ssl,o and ainl ,gchnaes higtm ees peprraheli rehnoy.ptau edceicyfni (pt no )NPT = deitadl hopaodyraymtic +
chandlerbas  oals inzc asdi in erpsm ittmliyo 9n:w8/t4gPrw/vMmi..nclm/.iblci/oc/7p3hss7hnCtwt./1ape ahtts why i soech cinz but erathverwr mi roev it +



 +3  upvote downvote
submitted by โˆ—hungrybox(1277)
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droAccign ot hte SML,UE sis'eumnel yoln use si in leuemins sfiuedl sa a tmeetntar ofr a gufsnu daclle elassazaMi spp (ieanT rols)oriv.ce

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 +1  upvote downvote
submitted by โˆ—unknown001(9)
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stel dvaoi glno exaolpnstian lhals we .

.tp ihwt lryetnf.iiit cqiku estt in wfe sdecsno = meesn utfoescr

tafc : imnasle vlecies amkse cof.tersu

tucsioobrnt of mialnse ecvleis ro tnagcolnei benceas = low ftrceous ni enmse = tlbmoicea bailnamec t;g& teivfcieenf oransesemsteipg

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 +1  upvote downvote
submitted by โˆ—meirchod(1)
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I eorneads ouhgtrh hsit oen senci I rladnee that mlenias eicslsev lveahyi ues rtiSobol Dsyogahendere n(da resiova a&;mp vreil I ebviele )ot,o wcihh snmae htey lrpbaybo ehav a cuiyrrlltapa ttaniorpm eden ofr uscF.reto So abrmnlao estorucf in mnees is aypoblbr nto a ogod .ngsi

.S.P I dwroen if teh iecnants ddi teh -statttese no hsti .e..no sedee(m ot wkro wlel rfo etasdebi)

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 +0  upvote downvote
submitted by โˆ—apurva(101)
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edersncIa sWCB dcniaeit etngila imnilnfntamooafe/cin,ti hwihc can elda to proo enmes qatulyi deu to eth itncrdopuo of sexivscee rvcteaei egxyon spsicee by syeceultok.

btnAes fruotsce ontnreaticonc is an cianoindit fo a nnlctoiaeg bncseea fo sva seeiael/sefndrnm vseicl,se iehlw cadresede ufcrseot ctcnnnrtooaie amy ditaeinc na cetljuaroya tdcu .tirbontsouc

Hp gt&; 08. dciaesnti imatnlaomnif fo eht setapro,t leamins tct,ra msidie,ydip ;t.ce pH ;< 7.2 endicaits nlismea ilevsec scfotduynni ro bconustotri of teh jlocutaerya csu.td

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 +0  upvote downvote
submitted by โˆ—nwinkelmann(366)
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oS I dokole toni itsh erthurf oot esbcuae I rttyep mcuh konw gnhiton batuo het maek up of em.sen morF het aserrche I od,fun as as estatd lbweo yb o,y oeturfsc is teh tosm rnmtiapot uitonnectts of nmsee ni sterm ro msper nfc.uonti weoBl is oamitnorifn I ufdno ot sdersad the tehor anerws .cseiohc

icZn efciicndye ni( umr),es pre ,FA sah eenb ciaptmiled in ldaedye dnuwo einghal, udsesspepr ,utimmyni mela dihsmpnaoy,og sdedcreae udalt iarh ,l(yliaarx cafi,la ,bcpi)u gia,ssuedy amon,asi immeroaadtrcsti atrhoeipecant cf(eetd ni ltnnaetsii iczn )nrotpbasoi, adn yam rpssepdioe ot loaclioch ric.ihssor AF tnidd' eycspif eht selevl in eht esm,ne utb rpe eht owleb elratc,i inmeasl zcni ncetton swa fudon ot aehv nro carleontiro ot prenese/msm /tacve/ivlytcelie.t I nodt' nowk fi we'er pduspsoe to owkn t,tah ubt wno I do, llo. c.n.o5.ids3:u/wwpempb7.bhhnt3tv//wilgm750/n.

sA obhgyxnru n,tdmnioee ieemunlsl si ynol edntneomi ocne ni AF sa a mtetnrtae ofr anti,e so I eodkol toin it refrtuh. lSnuieem si a ctonetn of ,emens tub vseell rvya os umch that ti veessr no cipoogsrnt nlaccil canveeerl to nrti,iylifet rpe shit ctlar:ie 5c.ngiws.2.nhnlmw//m/uitb3hw:d3.1b20optp/ve.

oT lure tou all of eht sarnews ubsa(eec I d'dnit eylarl owkn tyannghi aotbu the yliuatq fo ,e)mesn I nuodf sthi yB" ,-ititttscssa eethr wsa on ftgsannciii reciefefdn ni eht nseem aN nccinroeoantt oagnm eht ftrdineef urgpso 7( upsgor tolat dbaes no resmp untc),o tdaniigcin the finisacnntgii relo fo aN ni ersmp ttiiy.ol"m. :/thhd/ebnsnwicmn.p1u.b/.lo2v5/wgmpw1.t7i2.

yinlF,al I 'dnot ithnk teh 5al-hap dtsurcaee mzneey si culalaty ni smen,e tbu I odclu eb ogrw.n rEithe y,aw ti ludotwn' eb oaalmrnbyl leevdeat or low if teh otnrtoesstee lleesv are lm.aonr

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 -1  upvote downvote
submitted by flexatronn(5)
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oyu lla rae glkonoi awy oto eepd noit .ihts

hTis saw a meilps fcat lelcra ou.sqiten neWh oyu ees nmees + elttnyriifi in a sqnieout and sceotrfu ni het anersw;s sit sneme = trofsuce

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