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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 stju wnke htat rspme eend orcs,teuf not esru waht aeiedss cosspre shti si otghu.h He aws rtyept rmnlao so 5a eacesrtaud ntsedo' sntreep liek .ttha I 'santw uers fi erhet wsa nay dod seu of hte thoer sanre.ws erhe si a .nikl Flee erfe ot dnxpae.

s2n.tmp2wu//xslgqs.twa7_wtoip2esh.:4bop/ecac

Furetcos keasm up %99 fo hte cgeuirdn gusra tepesrn ni .mnsee isTh aurgs is opcurdde in eth imlnesa ec.svisel enDhiisimd elselv of srtfcuoe aevh eneb hsnwo ot elpraall noadegnr cnieyedfci nda eht toeseotstner .leevl lolFiwgno eroteseontts yrth,ape the vlele fo rueftsco ehA.slsacohut rineg het sofurect ttes si ton tpra fo a utnrieo emens isayl,asn it si usuelf in sscae fo aoreizomsap (easbnce of espmr ni .ensem) In oresmzapioa yrneodsac to the necaseb fo slseiecv ro if rethe si an cbis,nttoruo on rsetfcuo si pres.ent nI elsauicttr e,azoarosipm coreutfs si nt.esper eWhn iepozrsmoaa and wlo eenms mloevu ,xsseit hte esrfctou etst suohdl olas be neod, on a poetcjluateas nuire elmspa ot eckhc fro tgrraoeerd julnaae.cito ishT succor wnhe hte jcetauela gsoe nito the bderald anidset fo tou het hh rTeetrau. eorepudcr rfo nieiemndgrt eht numato of cfuroest ni emnse velnsiov aegihnt msnee in a ronsgt cdia ni eht recpsnee of nroosceilr. tescuroF viesg a rde corol ovi(fSelonf trei)acon nda may eb daer ni a otho.rtpeem ehT nrmalo graevea si 5/L31gdm c.tfsoure

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sam.l  akhnT you orf het oatnp.xlnaei mI' listl fnoduesc aubto ihts eraws.n I asw ni eetbewn cZni adn .fsroutec cniZ edefinyicc sloa esrpsent twhi aaosmni gp( 17 Fitrs dAi .9201) urstFcoe is edus rof hte .mmtveoen Hsi oohesrnm aer amrlon. +4
d_holles  Appeyltarn ,sebdteai oos,luncci and niinlmfmaato anc esrlut in โ†“ rosuftec in raMsmesp.us te la, Fetr trtSe 5,2 4971 9ctf/2.t53/aet-(6/)wrett1t0dhw1So.s1/2repr:lg-40w0/r8f2isp0 +4
cienfuegos  Tnahks lal for teh oif,n ikuqc toen on eht icnZ eplyr vbaoe Ia@S:m. amnaois = otls neess fo eslm.l +
sam1  etaGr fdni o!y I eelbevi sthi eisnquot asw ilguadln ot iysctc sfsioirb dan the acintgelno snaecbe fo hte avs eeesfrnd. Hree is a link to a ENMJ ilcerat utboa it wlo:be Ehj25t7lwpw06J7u.1:19e3//0g20t96.1l/iw108/o0Nf1ds/M.m/onr +1
burak  znci enciifedcy csaue ypdnsgiomh.ao erthe is no ,odsomnphyagi srmpse ear ?aamdedg +
fatboyslim  1Sma@ tbu iycstc sbfisoir lliw wohs olarbamn salyichp fningdis bilucgb(n, loapyunmr caeckrsl .tc)e hTe niteqsuo yssa ylhspica xmea hwoss no ao.misblertina +
pg32  seunfdCo sa to ohw we acn ruel tou c..zni. mFro moycetnmdcaasd.woiel: cZni" saol ylpsa a olre in tlhhyea emrps rnduptoco.i dccirAong ot a 2108 rwevei iaetrcl ni teh aorlJnu fo pnuterdiocoR dan lniif,ttyrIe cizn eiindccfye mya iceutnotrb ot ropo smene ltiayuq and .lryittien"if +
bekindstep1  2@3pg I am ont seur fo woh iZcn tbeotsnicur to epsmr odncp,ruiot tub eht tsoienuq swa kgians aoutb rilotemiaasbn ni teh snmee adn escrtouf is etpnesr in het sneem. Mbyae nczi slpay a role ni resmp dneeotlvmep fobeer ti si exdim in ihwt smeen dan os oen hwit incz iinfccdyee dnt'uolw aevh owl in icnz ni irhet semne rps,peha utb it rheit lb.ood ihTs is sujt a hshypesito hh.go.tu.. +
brise  ^^ heaY atst'h owh I elrdu ti o.ut ouY nca find cruteofs in the ,mesne ubt uyo wtoul'dn eb bael to fdin zinc ni het !eensm It itgmh leph het e,psmr ubt s'it ton gniog to eb ciigllhn with emht +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 oleokd toin hsit frreuht oto cuesabe I rtptye hcum nwok otihnng atoub eht ekam pu of sme.ne mFor teh sarerhce I dfo,un as as etdsta bloew by ,oy ucrefots si hte omst tiponamtr tunetstionc of msnee ni mrets ro pemsr .onfcnuit eBwlo si tminoanofir I udonf to edssrad teh orthe sernwa hocices.

cniZ icefidnecy i(n )umsr,e pre AF, has eneb itdmplciea in daleyde oudnw n,eiahlg uedrpsesps umtimyn,i emla mon,hadoipygs sreeeadcd taldu ihra xl(aal,yri ,aiclaf bup,c)i ydsesg,iau aiosmna, mmiarcaiteodrst poeaaetcihrnt (edceft in nlsaietnit iznc n,a)piorstob nda mya dsesprpoei ot laociohlc s.croihsri FA ditnd' esyicfp hte leeslv in the ,msene ubt rpe hte lwoeb iraetc,l ensmail zinc tnonect was duonf ot have nor reortalicno to /spmeseenrm cley/iiavetve.l/ctt I ndo't know if ree'w psoupeds to okwn h,tat tub nwo I od, lol. uh/pcowvnlimg/.ebnm7w/ti3tsd.b0:5h53.n/p.7w.

sA xybhurgno nedtimeo,n ueislemln si loyn nodmteeni coen ni FA sa a ttamrnete fro ani,et so I eokdol toin ti rrh.uetf lSuneeim si a etnntoc of esnm,e but elslve rvay so uhcm hatt ti rsevse no srigpnocot nlcialc aevcreeln to tientr,iifly per tihs iaclt:re .dwmhnup2cg5b.bnt.:0i2m/3th1wowi/s/.vl/ne3p.

oT lure uot lal of eth esrnsaw (uebecsa I td'din ellrya nwok nahytnig uatob hte luyaitq of )mne,se I fduon tsih "By ,t-sitsactsti etrhe was on sinagitincf denrffeeci in hte ensem Na tciencrtnnooa gomna hte fidtrnfee rupgos 7( gursop tatlo sbade no mrpes oun,)tc itcgindnia eht iannsnicifigt elro of Na ni mrpse io"itt..mly /dpm2mwn11:/vhg5p..w/btel27snb.hw.u/iintco.

nyilalF, I 'tond hiknt eth a5plha- euestdrac zmnyee is ayutlacl ni ,nseme tbu I udclo be wor.ng tEierh wya, it owdt'lun be oyanlbrmal avledeet ro wlo if eht settonotrsee lsveel ear na.lmro

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bartolomoose  sa per jlao,gn liemunes si noevldvi ni hauoetgitnl oderxeiasp +
chandlerbas  semeilun ash a leor in golutethain epaixsr.doe escsex nuelsmie = agiclr arbe,ht irah sols, dan ilna hsncag,e tmigh ees arrhpepeil aruohet.ynp icecidfney (pt no T)PN = daieltd hmoiarodacyytp +
chandlerbas  salo nczi isda in ermps yiioltmt /lM.hm:m8iw4.gnotpcw./nPt79i7rl1iach/bcvt.n3///peswsC satht why i shoec incz btu rwtaerehrv mi orve it +


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 +3  upvote downvote
submitted by โˆ—hungrybox(1277)
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cngidoAcr ot hte MESL,U uneimsles' nyol sue is in iesuneml edufsli as a tremnaett fro a gufsnu llaedc lMsseaiaza pps (aineT )viocorr.esl

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 +1  upvote downvote
submitted by โˆ—unknown001(9)
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tles vidoa nglo taisxanlenpo hlsal ew .

.tp htwi etiyrf.nitli uqcki etts ni wef nsocsde = esemn eufrtsoc

cfta : slmiaen eclivse maske .ufecstro

boritsctuno of ielmnsa icleesv ro genltnacoi saceenb = wlo eotrufsc ni nmese = iabotemlc maeinbalc ;&tg ivnctefefei ipgatseeomnsers

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 +1  upvote downvote
submitted by โˆ—meirchod(1)
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I nearedso rthuhog tihs eon ecsin I arenled ttah lismnae iesslcev aiehvyl seu rioobSlt ogDsneyhaeder (adn svieora ap&m; elvri I bevelei ),too hhwic nsaem htye pabolbry eavh a iulptarracly ntitoparm ndee ofr ruc.otesF oS alaonrbm sreuofct in mnees si lorypbab ont a godo .sgni

SP.. I onerdw fi teh ctnasien did eht t-sstetaet no siht no..e. (eee smd ot orkw wlle rfo eeitdasb)

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 +0  upvote downvote
submitted by โˆ—apurva(101)
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dIanscree CsWB iitcnaed tilange nettiiio/analncf,mnofim cihhw acn leda to proo esemn yqlutia edu to hte otdicnorpu fo exvseisec craiteve xegyon ispcees yb t.lkeesuoyc

tbneAs uortsfec oetcnitacrnno is na dniiitocna fo a lgcatennio esbecna of sva /fsnlnieareeesdm eeli,sscv while adersecde uoefctsr iantncetronco yam iateindc na uecjratloya tcdu oicsb.nuttro

pH &t;g 8.0 intaecsdi fatmonaiinlm of het etaro,tps inamlse ,tratc ips,yeididm ;e.tc pH l&;t 2.7 nitsdeaic sniamel svlecie fcnudintyos ro iootcusrtnb of the acyotaeljur cdsut.

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 +0  upvote downvote
submitted by โˆ—nwinkelmann(366)
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So I edkloo itno shit hrefurt too aseuecb I pytetr umch wokn oigntnh obatu eht kame up fo ne.mes From teh srcerhea I ,doufn sa as stdtea olebw yb ,yo serfutco si het tmos ariotntmp etttuncnosi fo emnse ni sterm or mpsre .cionfnut Bweol is taroininfom I fndou ot ssadedr hte horet wnesar iochesc.

Znic dnfciyceei i(n ,mus)re epr A,F sah bnee daclitiepm in daleeyd uowdn h,inaleg epussredps i,tnmumyi emal hsdinapoy,gom drecdesae autld irha xa(yl,iarl ilacf,a uc)pi,b ,egisyusda ioa,snma timiecdrmtsaaor aheetrtcpniao tde(efc in ianenttsli icnz sno,opai)btr and yam irodpspees ot chcilaolo h.rsrcisio FA t'idnd cypseif teh evesll ni the mee,sn but per eth eolbw l,reacti mleians iczn ncttneo saw onufd ot eahv onr ienorrclato ot neps/sememr v.lvleatitite/ycce/ I 'tndo nwok if wree' spuoepds to kown th,at ubt nwo I o,d lol. i3/w.pvu5nh.oetcww7p./bsnm.7t/bi3lgm/0d5n:h.

sA yhunxrobg edo,nnimte umleelisn is lony dnntoemei ocne in FA sa a ttetrneam for naeti, os I okeodl noti ti e.rtrfhu uSeenlim si a ttoncen of em,esn ubt eslevl rayv os mhuc ttha ti eevssr no oosnirctgp clliacn nreleveca ot flyttieiin,r epr tihs acil:tre 3e5.cb1p2tuivhn3:p.l0/wmsm.//2nbwot/wh.ignd.

To lreu uto lal of hte rwsensa (ebaeusc I 'itddn ylrale owkn gtyniahn obaut hte yalutiq fo n,s)eme I nuofd htis y"B ,stci-saittts ehter aws no ficigntinsa neeifrecfd in het sneem aN cartennctonio noagm eht fndtefrei guspor (7 rogusp ltoat ebads on esrpm ouct),n daninctiig hte gitsinfanncii role fo Na in sprme itymol"..ti p.nbwcmst/nht25gew:m..lw/ho/1diubi7v/pn.21.

alyin,lF I 'notd hknti eht aph5-la seteaudrc mzneey is aulayctl ni e,nsem tbu I lcdou eb gr.now itEher wya, ti t'onuwdl be abalmyroln tldeevae or olw fi teh soreteotenst ellsev era .mnrloa

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submitted by flexatronn(5)
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oyu lal rae ikgolno ywa too eepd otni hi.ts

Tish saw a meilsp fcat lcaelr uqinoes.t neWh oyu see mnees + rftyiinielt ni a ontqueis dan trufceso ni eth ans;resw sit nmese = urftoces

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