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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 kwen hatt erspm deen fcsotrue, not seru htwa esadise ocspesr sith si ghtuho. eH saw rytpte lanrmo os a5 dauteecras dneo'st reptens ielk .atht I wnsat' ruse if hreet asw nay odd esu fo hte thoer .snrsaew eehr is a .ilnk eFel eerf ot depn.xa

wwciqe/4p2naotssl7.gp:_c.uhp.tm/2bosex/sa2wt

ucotresF kemsa pu 9%9 fo the uecnrdgi argus etnepsr ni ees.nm sThi argsu is uoddpcer ni het nalmsie silc.svee ideiDihmns seevll of uofsertc eavh nebe wnhos to lapellar ndaegron eicfcneyid nda het ossteenortet lle.ev wnlioFlgo steoetrtones p,atrhey eht vlele of toscfuer l.t ashohgAnuiscree hte csforetu ttse is ton ptar fo a uerinto enems aysinsa,l it is efusul in aecss of oorimzpasae ecea(nbs fo rpsem in )ns.eme nI meoaoizsrap sedconary to teh easnbec fo evsliecs ro if rehte is na rtuitocsobn, no ucersfot si set.pern nI rclisatute opzraaeio,ms ortucfes si rtneps.e Whne iprzsaaoome dna low nsmee oelvmu txs,sei eht fcrosetu tets oshdul laso be ndeo, no a atajtolsceeup eniur lpames ot hecck for orrdartege .atjainueolc This cursco when the jteeulcaa sgoe toin eth deadrbl astedin of tou the tehaeruT .hr crpeeudro ofr grnidnitmee eht mtunoa of fstcureo ni esnem vlneivso ightane enesm ni a sgront adci ni teh epresenc fo r.rceoinosl turceosF vsige a dre locro lvenfSfio(o ctaeion)r nad aym be ader in a peomttrhoe. ehT anlrom eaegavr si 51L3mdg/ fur.ostec

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sam.l  ahknT yuo rof hte xltopenin.aa I'm lsitl cunfsdoe uatbo sthi nwae.sr I was in eewetnb Zcin dan fos.uetrc cZin idccenfiye osal npeserts hitw manioas gp( 71 siFrt Aid 9)20.1 sotecrFu si uesd orf the vmoenm.te siH eohrmons ear om.lran +4
d_holles  prelyAnpta ,atbeesid nlocoscu,i nad fltnminmoaai anc tsrlue ni โ†“ sretocuf ni smrs paM.eus et al, ertF teSrt 5,2 791 4wotw1ts-50t38./ht:rptera/1S29l)/2gef00pic2(ew/t/6r-1sdr.f40 +4
cienfuegos  nskhaT all rof hte fin,o qkuci tneo on teh iZnc lprye eboav S:Iam.@ aionasm = slot eessn of sell.m +
sam1  erGat nfdi !oy I ieelbev tihs ontsueiq aws lindluag to stcciy bssrifoi nda hte aeoitlnncg ecensab fo teh avs sed.nreef ereH is a nilk to a JNEM tcerlai baotu it :lwbeog/w/dt1M9N8/p.j/u252tE:i0n/1w037fJ.lem1sr.10061wlo/7096oh +1
burak  icnz efiednycci eacsu .ohanposmgdiy hreet si no gomisy,odanhp erpmss aer maag?dde +
fatboyslim  Sa1@m tub itsccy sbfirois iwll hwos mbrnolaa laypshic idfsning uil(cnb,gb mualnyopr rckeacls e.t)c The suiqeont ysas csyaphil eaxm owssh on ntlaimi.robsea +
pg32  feodCsnu sa to ohw ew cna lrue uto ..zic.n mroF w.olesdeynaacodmcmti: inZ"c aosl aplys a oerl ni hythale prems otncopiur.d cgdcroiAn ot a 0182 eeirvw raliect ni hte lonJrua fo ouidtpecRron adn lrytfiIet,ni znci diifecnyce yam uboentrcit to roop nesme uiyaqlt nda ini"lr.teifyt +
bekindstep1  gp3@2 I ma ont eusr fo owh inZc einstrbtcuo ot smpre tcrodnui,po but hte qosetnui asw aiknsg bouta bsmaolaiitnre ni eht esnme nad oesfcutr is enpsert ni hte sme.ne ybeaM nczi aylps a orle ni pmser etolpdeevnm broefe ti is xmeid ni ihwt enems dan os oen tiwh cnzi eyiieccndf odnlwtu' hvae wol ni nzic ni reiht nemes h,pepsra tub ti rthei odbl.o hsTi si ustj a hseoypsiht og..uh.ht. +
brise  ^^ Yeha ttas'h woh I lured it t.ou You nac fndi ucrseoft ni eth emne,s utb uyo tlnuod'w be beal ot find cniz ni eht enme!s tI gitmh lhpe the es,prm but i'st ont ognig to eb nhlicilg whit htem +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 eldkoo noit thsi thrfuer too bseuace I rtpety umch kwno nhnoigt oubta the kmae pu of sneem. rFmo eht rehacesr I dno,fu as as detast ewolb yb y,o utoscfre is teh msot patromitn ottinscentu fo nmsee ni rsetm ro pmres ntocf.uin lBeow si ornnioitamf I fdnou ot desrdsa the teroh nrwsae csec.iho

Zcin cindfeyeci ni( r,u)sme rpe FA, ash bnee pieiclamtd in ddeyale ownud ,lainghe updesepssr tym,mniui leam ognipmysadoh, eecarsdde tluda hair lixla,(yar fa,clia ,)bupic ,gayduiess aoanms,i iacesdrmrattomi teoinpracthae e(dtcef in etaiislntn incz tonob,rpsai) and yam dspireesop to lccoohlai iiorhss.rc FA 'tdndi ipcseyf the eeslvl ni eth ,ensem tub rep teh olebw cetrila, mslaein czin eotntcn swa ufdon to ehav ron alcoetirnor ot rsseemenpm/ tl/veaci/eitltye.vc I ot'nd nkow if ere'w sdpopuse ot nwok aht,t but onw I d,o llo. .p:odtwnnungi0s/7pw.5h5ewm.lbib/v37.ch/tm/3.

sA gnyohxbru ,ninmeodet lnmelsuei is oyln tidnneeom neco ni AF sa a ratmtente fro eia,tn os I olkedo onti ti rhtr.fue Sunieelm si a ttnnoec of ,seenm btu llesev yrva so hmuc ttah ti ervsse on sgoonptcri clncail calvreene ot fit,lrientiy rpe stih atcel:ir .he:t2ws.nwnbd0/mw1oi..cp3ulnv2im/5b//3ghtp.

oT rleu otu all fo het raesnsw uaceseb( I 'tndid layerl wnok ytianngh taobu eth talquiy fo )em,nes I fondu tsih B"y ,-tsassiicttt ehter aws on cnaiftigsni frdiecenef in eth esemn Na tcroonaecnint oangm hte ineretdff urosgp 7( prosug totla aesbd no espmr nutc)o, ntiacdnigi eht nctiagifinisn loer of aN ni mspre i."mytlti.o i.:bn/w./5nl1op/gbtv2mwhwhntis/e17.c2mdpu..

ilynFal, I ndo't tnkhi teh h-5plaa tcesuedra yezemn si aylaultc ni snm,ee btu I ouldc eb .wngro heErti wya, ti wlto'nud eb ynrolmaalb aetevlde or lwo fi eht eetrsotetosn eesvll rea ma.olrn

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bartolomoose  as rpe lo,agjn umeelsin si eovdnvli in hniottgeula saeioxrpde +
chandlerbas  euniesml hsa a lero in tutgeihanol .eepasxroid xscese nlsiemue = lairgc reb,tha rhai slos, nad lian sne,aghc mhigt see parelhiper e.uytpraohn eedfncycii pt( no P)TN = deadilt amhdyrpatcyioo +
chandlerbas  aosl nciz siad ni rmpse yliomtti ./lt74C//icwotvmt:piwrn/isbhhs9P3.wap/nec/71c8l.nmM.g ahtst why i ocshe nizc ubt ehwrrtvear im vreo ti +



 +3  upvote downvote
submitted by โˆ—hungrybox(1277)
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noiccArgd to het LSM,EU sisumelne' lyno esu si ni nmleisue ledusfi as a tmtreanet orf a unsgfu ldleca zMiasasale spp eiTn(a rroie)soc.lv

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 +1  upvote downvote
submitted by โˆ—unknown001(9)
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tsle oiavd olng iaospaxletnn lhsal we .

pt. htwi tinryieif.lt kuciq etst in few dessonc = ensme tsforecu

actf : anlmsie lvcseei emask fte.rcous

urnbsotiotc fo msaienl secevli ro lecnogiant ceebasn = olw ustfcreo in mnees = emtalcobi cibamlean &t;g eftficivnee imoseasetresgpn

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 +1  upvote downvote
submitted by โˆ—meirchod(1)
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I eosrande ugtrohh stih eno cnies I enraedl taht niamsel eslceivs eyhlvai use oroiltSb ogDeeeshryadn dna( iraoves ;p&ma ilver I eleibve to),o which amens ehyt bpoyarlb vahe a rutaillrypca tmropatni dene fro Fs.oeutcr oS nmlbraoa rcosteuf in emens si olrbpyba not a oogd i.gsn

.P.S I nrwoed if teh csinaent ddi teh sttasette- on tsih o..en. emse(e d to wrko lelw orf bia)estde

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 +0  upvote downvote
submitted by โˆ—apurva(101)
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edrcIneas CsWB niticdae tenglia ,tmolnncaioit/namffiien ichhw nca elad to poor smene quatliy edu to eht nduocrpoti fo eevsxiecs taireevc xeogny pisesce yb eysotlkc.ue

snAetb rsucteof noanconertcit si an acntioiind of a agntonicle ebasnec of vsa esemslenaied/rnf c,sveleis wleih aeseerdcd rtfesouc eintaoconcrtn aym aniicedt na ujaeoryclta tucd .tniuosrcobt

pH t&g; 08. idcsinate latifmmnnaoi of teh pte,toras aiesmln ,ttcra dmpdysiiie, e.c;t Hp &t;l 2.7 tnceiasid lmisnae sceevli suicnfoydtn or uornttocibs fo the yalcaoutjre s.tucd

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 +0  upvote downvote
submitted by โˆ—nwinkelmann(366)
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So I odokle iotn ihst rrfuhet oot ebuscae I reytpt hcum owkn gnothni bauto eht kmea pu fo .mesen morF hte recersah I uf,odn as as adtest lobwe by o,y cofeutsr is eth msto tminptrao nntetoicust of meens in sremt ro psemr niufo.ntc Bwelo si omaofitnnir I odufn ot dsresad teh htero nrswae i.seocch

ciZn fceidiecyn in( m)ues,r rep F,A hsa enbe tiidlacepm in edeylad wnudo ig,lnahe eupsrsespd mniytum,i amle dgsnhyooa,ipm acdersdee utlad hira l,xryalai( c,afial ),bcupi se,ygudsai sno,miaa ctmrasdmirotaie recahaitonpet fdtcee( ni innaeitslt izcn paibo,nstro) dan aym dressipeop to olaoccilh iriossr.hc AF ddn'ti pciyesf eht llesve ni eht e,nmes but pre teh oebwl licrae,t iamesnl icnz tnontce was fnuod to heva onr iocrnarleot to prsmesmene/ /vellat.ee/viyctcti I 'ondt nkwo if r'eew seuspdop to onwk ,ahtt utb onw I d,o oll. 7bnht:c..emuldnhw/mi5p.73w3bs/vinp/wgt./0o5.

sA yonrubhgx dnem,ionet uelslmnie si lnyo mieoendtn cone in AF as a tntmreeta fro taine, os I kdleoo otin ti uthrf.er unmliSee is a tnctneo fo eme,sn but sellve rayv so uhcm atht it rvsese on grstocponi nlacilc erleeavcn ot tynel,iiiftr rep htsi tacelr:i ibl.:.0nnm5htbpc/ud/.n2pw1tg/sm3.w2ohw3/iev.

To leur tou lal of eth rswaesn esb(caue I d'ndit lyaerl okwn inyhagtn botua eth qtluyia of )sm,ene I ofudn iths "By ctist,stat-is rehte asw no csantfigiin reniffedec in the smnee aN onentinrcotca mgano eht iffrdenet gpruso 7( rusogp tltoa aesbd on smrep )cont,u iinnaictgd eht sifgnatiiicnn oerl of Na ni rmesp t.imt".lyio .2hbns/17cppmt.m.lb2.ii:u5wgw/1n/won/vdeth.

l,ailynF I nt'do kinht eth laa5ph- eesaudrtc ezmeyn is aayultlc in esnme, ubt I culod eb rogw.n Etrihe w,ay it l'utwnod be alnalrmyob adveelte or low if eht eroeetststno ellves are rao.nlm

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 -1  upvote downvote
submitted by flexatronn(5)
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oyu lal are gnlokoi wya oto deep nito h.sit

ishT swa a ilpsem tacf lcalre .ntqueosi hnWe you ees nmese + leifyrttini in a etuqosni dan trufecos ni eth wsaens;r sit snmee = ceurstfo

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