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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 just nwek ttah pmesr edne us,ocfetr ont reus atwh asidees csrpose thsi is hohutg. eH was ryeptt nlroma so 5a euadstcear ns'otde eenptsr eikl atht. I naswt' esru if heert wsa yan ddo seu of eth oerth e.naswsr here is a i.lkn leeF reef to .axnped

sp2h_gswnb2t.tssetw//4m:coiwa.ac/xe2uoplp7.q

utsFeroc skema up %99 fo hte ncdguire sgrau rspntee in .eensm ihsT ruags si pddrcoue ni hte namlies ev.lscesi nimDdihsei vlelse of turfscoe heva enbe hsnow to alerallp nenraogd yfieiccnde dan eht eoottetnerss le.vle Fwooinlgl oettneoestsr ehar,typ teh llvee of rfoectus csnaghehiAo.t lresu teh csofretu etst is ton prta of a uretoni mesne snails,ay it si euuslf in csaes of ozospremiaa ebeancs( of emrps in se)ne.m In aisazromeop ndcayreos ot hte besnace of eevsilcs or fi tereh is an ortnst,coubi on ertusofc si .eterpsn nI ieaclsutrt ipomoesz,aar cruofset is n.rtpese eWhn sroimpaozea and owl eemns moeulv esis,tx het csfureot etts huolsd osla eb nde,o on a caleapsetjtou rniue pseaml ot hkcec rfo grorretead no.itejcluaa sThi crusoc enwh eht cjtauleae soge ntoi the rdbdale teisadn fo tou eht ueaeTr. trhh pedrcureo for ritneemdgni the anmuto of tfeuscor ni enems evnvisol tnihage nmees ni a rnotsg cdia ni hte cpsrneee fo .rrcsleooni teFrcsuo sevgi a erd rlooc ie(lfoonSfv cireao)tn and aym be read ni a ht.teoomerp heT lonram gaverae is 3md1g5/L eourtc.sf

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sam.l  Thkna ouy for eth nxa.etpolani I'm tlsli ocfseudn oautb htis r.easwn I asw ni ebwntee Zicn dan ots.creuf Zcni ceindiyfce osal sserentp wthi amniosa p(g 71 rsitF Aid )09.21 ceourFts si udse rof eht tmeovmen. siH oorhmens are nrlmoa. +4
d_holles  eayArpltnp i,etedsab ncsouic,ol nad lnnmiaamitfo nac tsurel in โ†“ crouesft ni erMupsm.sas te la, Fetr terSt 25, 4 971rg9/ds8Spt-/rf(41t)2wwts/0ar6f.e/0.w5p3ci:heel21/o21-0rttt0 +4
cienfuegos  nTshak lla for eht ,nfio icukq nteo no the nicZ lpeyr eaovb @.mSIa: insaoma = olst sseen of ellm.s +
sam1  atreG fdni oy! I veiebel this qeosintu was idulngla to isctcy ofisbris and eth nntlcogiae nseebca of teh vsa fe.dneres ereH si a nilk ot a NEJM ecraitl abuot ti w:bo el.131gi/8whEf.sn92lj11m/900/0/0NopJdw2/o066u57tt:7.1ew/lrM +1
burak  nzci eeyndcifci secua m.dipogyashno eerht si no hnsoad,piogym mpsser are ae?agddm +
fatboyslim  Sm@a1 utb ystcci isosfrbi lliw swoh lnmboaar isachlyp insdifng i(cgl,nubb arlnmpoyu ralsekcc et.c) The tqueinos ayss lshcayip xmae swsho no anb.moiliasret +
pg32  Cfudnsoe sa to ohw we nac erlu otu nz.ic.. mroF lwmoyadeitcda.ecmsno: Zic"n lsao pyals a oelr ni heaylht emrsp orpudicnto. dcgciroAn ot a 1820 wierve iceltra in eht nolraJu of Roidutrenpoc dna ,yftIeitriln cinz ndcifeyeci yma iotecurbtn ot rpoo eenms ialuytq nda nytriti"lf.ie +
bekindstep1  g2@3p I ma ton eurs fo woh niZc nteisutbcor ot esmpr u,tnocdpiro but hte iteusoqn was ngkasi about aeliabsrtnmio ni hte neesm dan rfuoctes si eetprsn in eht nemse. eMaby nizc splya a role ni repsm eoempdtnevl eofbre ti si xidme ni htiw enems dna so noe itwh nzci eycniicfed n'oldwut veha wlo ni incz ni rhiet esenm hspper,a tbu it iterh bl.doo Tshi is just a teysphshoi ho.g.thu.. +
brise  ^^ aYhe thtas' ohw I edurl it t.ou Yuo can ifdn rstufceo ni teh e,emsn tub uoy nloudtw' eb bela ot nfdi czin in eht ese!mn tI mthgi elph teh merp,s tub s'it ton ngigo to be hglnicli thwi ehmt +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)

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 +8  upvote downvote
submitted by โˆ—nwinkelmann(366)
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So I keoodl niot tsih thurefr oto cesbaeu I terpyt much wnok nohntig buaot eht kame pu of nesm.e rFom hte sreerhca I unf,do as sa asdett bewol by yo, eofustcr si the tosm aimtptrno tnettuinosc of esemn in ertms or pemsr nuoft.inc eBlwo is ofiioanmntr I onduf to sasddre the ohtre wrsnae hosc.eci

niZc ndcyiefcei (in )uer,sm rep ,AF hsa eenb iptcdmlaie ni yldaede udonw agel,nhi uspsdeserp nyi,umitm elma hoiynosm,apgd eddeaercs adult rahi lyi,ax(lar c,lifaa u,cp)ib asuide,ygs maaso,ni romascraidtitme teaipthenoacr fectd(e ni tanlteisin nczi t,npo)rosbia dna aym rsppidsoee ot coailochl ihiors.crs FA ntdd'i cisyfep hte lelsve ni eth emsen, btu rep eth woleb alt,irec sinaeml zcin tncneot saw nuodf ot ahev nro rnoriealtco to semp/smreen yetclvaiete//tvli.c I odn't wnko fi 'rewe epdsspuo ot wnko tt,ha ubt nwo I ,od lol. hibw:.7w.oel35i3pwu/tcmvs0bn/p..nn/tm7dgh/5.

sA uygnobhxr ni,eentmod uemelsiln si lyno dteeniomn coen in AF sa a etamrnett fro t,naie os I elookd tino it ehrt.ufr ineSlume si a otnenct fo emns,e tub slelve yarv os chum atth ti svesre on cntpgsiroo cncllai cvaleenre to nfritlyt,iie rpe iths eal:tcir bdn/vbpt.2/n/.gn3cm/1lmwi02wiowhe.ph:.t3su5.

To rlue uot lla fo eht snrwesa (aeseucb I 'dintd rlaely wkon ityhngna outba eht uaylqti fo sene)m, I dfnuo hsti y"B t-itsstsc,tai rthee aws on cntangfiiis ecdnrfifee in the smnee aN eitnnoonacctr noagm the feedtrnfi rpgous (7 surpgo tolta sebda on pmser ,tn)uoc iainndgtci the ciingfinnasit olre fo Na in mpesr "yiltm.t.io dw1/np5wwuiimcln.eg..2bn:.hhbpmst1v7t///o2.

alF,nily I tnod' nitkh teh a-p5lah cuaedters nmeyez si atycuall in e,nmes tub I olcud eb .wrong Eirthe ,way it o'wtdnlu be rllboaaynm aeevdlet or owl fi eht setteeroston eelvsl rea .nomalr

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bartolomoose  as erp ,ganjol ieumseln si vdvoneli ni tihlutongae oaxeidesrp +
chandlerbas  enlimsue ahs a roel ni ilogueatnht eea.rpixosd cssxee unesemli = alcgir rabthe, arhi o,lss and lnia nch,esga mhitg ees eapherripl n.uyhpretoa ncifyeecid tp( no T)NP = adtlied payoihmcyatrod +
chandlerbas  sloa nczi said ni rpmse toymitli ht.nmitewrtioi/w.c8b79pM/.c1PCwnsp/:la/s/l7mghvc3n./4 satht hwy i ehocs znic btu vhwrterera mi evro it +


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 +3  upvote downvote
submitted by โˆ—hungrybox(1277)
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coAdrgnic ot het SLUME, usemliens' oyln sue si in nlmieuse useidfl as a ttemraetn for a ufnsgu cllead Mazsalasie spp eT(ain vo.r)crleios

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 +1  upvote downvote
submitted by โˆ—unknown001(9)
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tsle voaid gnol aasntxlieopn sahll we .

pt. twhi .ftrlineytii cuiqk estt in wfe csdsneo = eesnm ftorucse

fact : masienl evecils maske orfsc.teu

ubrtsotncoi fo aiemlsn vsilece or egiatnclno ecebnsa = lwo frosuetc in nesem = omcelbita aeblcnami &g;t nfiitceevef anegsisrtsompee

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 +1  upvote downvote
submitted by โˆ—meirchod(1)
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I dnroease ghtouhr ihst neo isenc I aerlden ahtt eslmian lscesive ilyhave use rotobilS rDeeagdonshye and( ieaosrv am&;p evrli I elbivee o,ot) hhiwc nesam ythe lybbparo vhea a plcirarutlya rtatmopni eden ofr .ercoFust So lamobnra rsuotcef in mesne is byplobra ton a good gsi.n

S.P. I wodrne fi het iceannst ddi eth tseetsta-t no hits ..eon. ds (eeem to rokw well rof sabteedi)

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 +0  upvote downvote
submitted by โˆ—apurva(101)
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drseIcena CWsB decaitni atigeln ifotci,nofammnlatii/enn hwihc nca ldae to oopr enmes yluaiqt edu ot het oinputdcor fo xevesceis recviaet yoegnx epscies by stuk.cyeelo

ebtAns ruostcef otcrentaincon is na iiondniact fo a nnegitolca abscnee fo vsa m/nieesreenafdls ec,issevl ewhil earecedsd ftoecusr taroicnnectno aym atndceii an oyuatajlerc dcut r.cbttouison

Hp ;&tg 80. dsiniaect lmoniaafnimt fo eth tao,rteps niemlsa attcr, ,yisdeiimpd ct.;e pH l&;t 27. etdisniac imlenas ileecvs csyofduintn ro btriuocnots fo het uyortalcaej .sduct

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 +0  upvote downvote
submitted by โˆ—nwinkelmann(366)
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oS I lkedoo oint hsti trhrfeu oot uebcaes I etprty ucmh ownk tnnhgio tobau het emka up of se.nem mroF the aecrhres I udo,nf as as eatsdt lwboe by ,yo oucrstfe is eth mtos itmrtonpa sinttoctuen of smeen in merts or esrpm nictf.nuo oelBw si mrnfnaiioto I fnuod ot sredasd het orhte searnw hc.iosce

cZni nieeycdfci ni( mesu,r) per F,A hsa bnee apmlicdtie in laddeey uwond egnihal, depsurepss tnmmi,yiu meal hyn,ooagsdpmi deedsarec tlaud riha a,axril(ly laf,ica ,pc)ibu ue,gidyass isnama,o esacmomirtriatd rnetoehctaapi tfdce(e in natinteils zcni o,ns)rtapobi and amy erpopiessd ot oclaicolh isrochi.rs AF ditnd' ycipesf hte evsell in eth emsn,e but rpe het eblwo la,ctrie mlnasei cinz tentnoc aws ondfu ot veah nor reoalrotnci ot snermemp/es ev.tleacti/y/itvlec I dtn'o kwon if e'wre epsdpsou ot know h,tat but nwo I od, l.lo whn5w3ub./t/ntiplns:5.w.b3epmhv0.o//m7cdig7.

sA uryobgxnh nodnte,iem lsinueelm si oyln nomeidnte ocen ni FA sa a atretmnte ofr ,ieant os I odekol iton it rtuefr.h eSeilumn is a otntecn fo smen,e btu leeslv ayvr os mhuc taht ti evress no ocngrtposi liclcan leneeavrc to rifiienytlt, pre shti ictreal: bwwpmt3/.it:2.m5d03p.il1vonn/nbhh/.wegcs/u2.

oT lure otu lal of hte esnawsr seaubce( I tin'dd aelyrl kwon nnihtgay ouatb eth tqlyiua of ,enm)es I unodf isth By" ,sitti-atscst rhete saw no giacsnfiitn cefnrefied in eth nmees Na cniteocnnrato gmano eth tdrfneefi osgpur (7 opgusr otlat dsbea on smrep n,ocut) aciindngit the gastfnciniiin lroe fo aN in seprm .mt.yit"ilo ./nsbtdpwt5mi2m/1/gv.iclh2./.nbwupn1owe:h7.

nlia,lyF I nt'od ntkhi teh -5ahlpa eudtacers ezeymn is ulyacalt ni ensem, but I clodu be nr.wog rEehti ya,w it lwtd'nuo be ayrlnamlob edaetvel ro olw if teh eoetrsetnost lselev ear .amolnr

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submitted by flexatronn(5)
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oyu all rea iolnogk yaw oto eepd tion .hits

shiT aws a miespl fatc lealcr eq.nsuiot ehWn oyu ese meens + nftyirileit ni a tnuioseq nda efotrcsu ni eth sesanr;w tis nemse = tucrsefo

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