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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 ujts nwke hatt mreps nede e,sorcftu otn erus wath adesies cpssore tsih is th.uogh He wsa etyptr rnlmoa os 5a tdaeeurcas etd'nos ntepsre liek att.h I tawsn' ruse fi ehtre saw yna dod seu fo eth hreot nersaw.s rehe is a lnik. lFee rfee ot ndea.xp

im.e4.wtalwp2tsg2o/s/xh2sb/qptnc:oc.p_ua7esw

uetrcosF eamks up 9%9 of het durniceg ursag persnte ni emens. ihTs asurg is eodrucdp in the isnalem scviee.sl iihdinDems vsllee fo urcosetf veha ebne snwho ot aplelarl goraendn iicnefcdye adn eht etteonsesort v.leel liglnFwoo tteesonsteor yt,ehpar teh velel fo sotruefc rltA .seghhnousieac eht eotrscfu tste is not ratp of a ertuoin sneem asnaylis, it is sfluue in ssaec fo iposozeaamr cas(been fo mpsre in seen)m. nI eaoimoazrsp cedsonyra to eht bcseena of issclvee ro fi ether si na trboutc,snoi no tsrfceou is se.epntr nI esaltticur zraoa,spmoie frtucsoe is ptene.sr heWn ozmoeiapras dna wlo ensem evlmuo e,stixs teh srueoctf tste dlusho aslo eb oe,nd on a jolpcettsauea ieunr splaem ot chkec for dtrerrogae oj.aunalietc siTh ouscrc hwne eht tjaculeea gsoe into eht dleardb diatsne of tou teh .utraeTehrh ouepdcerr ofr egidnnteirm eth uoatnm fo tcsrufeo ni sneme vevnoils ihtegan nesme in a grston daic ni eht penrcsee of rnoirl.soce surFcteo gvies a rde olroc elfnivfoS(o roecnt)ia adn yam be aedr in a eoetmo.phtr eTh noalrm eaervga is gL53m1d/ eructfso.

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sam.l  nTahk uoy orf hte opaea.nnxtil Im' itlls efsdcnou batou stih n.esawr I aws ni beentwe Zcni and .stoeucrf nZic icfdeiyecn loas ptsrnese tihw snaiamo pg( 71 triFs Aid 2.91)0 scroeuFt is edsu rfo hte nvmem.teo Hsi noerhmso rae narlo.m +4
d_holles  ylpneAratp es,tideab ls,icnuooc nda namlonfatimi nac tlures ni โ†“ efcutsro ni Mmp saesusr. et al, etFr erttS 52, 4971 58.tlghfwsta11twr/pt:/2rice/t0dfSee.-/204s6(wtor/30r1p2)0-9 +4
cienfuegos  shTank lla ofr eht ifn,o uckqi oent on het Zcin erlpy avebo ma.:IS@ anaosim = stol seens of s.lelm +
sam1  etGar idfn o!y I eivleeb stih qnsioetu wsa gdllniau ot cstcyi srfsboii nad eth gcntoilena seacneb fo het sav f.renedes eerH si a knil ot a ENMJ eicrtal uoatb it low :be6g/t20f/wp/.ti1n//m.090o11hoMljl7520E1983us7N:wre0w.1/Jd6 +1
burak  nizc diyciefcen secua pys.niooamghd ehter si on iypa,gdnhomos repssm are d?gaaemd +
fatboyslim  a1m@S ubt cyctsi fsrsobii liwl hswo obalrmna pycisahl snifnidg i,n(lbcbgu nuplaormy rskeccal t).ec eTh insueotq ssay lsaiyhpc eamx whoss no in.atalrbomsei +
pg32  odsCefnu as to owh ew cna erul otu ..znic. romF eyiomms.wddlaeactnoc: ic"nZ osal ysapl a rleo ni hhaltye psrme du.prtincoo Accigrnod to a 1820 eeirvw crailte in eht nuaJorl fo oitucopRndre dan tniyr,ltIife cizn nfidcicyee yma iuobttncre to opro mesne uylaitq and yitn"firi.let +
bekindstep1  @g3p2 I am ton esru of hwo nicZ tcsnobeuirt ot psrem ,ntiudroocp ubt eht oinqteus swa kigsan obtua msiolrbtaaein in het eemns dan urecotfs si ertpsne ni het nee.sm ebayM nciz lsypa a elro in ersmp oeltemedpvn foreeb ti is emdix in iwht mnees nad os oen wtih cizn idyciefecn l'unwdto haev owl ni zcin in trehi eenms pph,reas ubt ti erthi l.oobd shTi is sutj a hespthiyos u..to.hhg. +
brise  ^^ Yeha tast'h owh I reudl ti o.ut oYu nac dnif ecsofrtu ni eth s,neem btu you d'nwluto eb able ot dfin inzc ni eht ee!nms It mthgi ehlp the er,msp tub i'ts ont gonig ot be cilghlni twhi ehtm +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 koeold tino itsh rrfuteh too esbaceu I tertyp mchu onwk ontihgn tabou teh kmae pu of ensme. Fomr eht rasecerh I donf,u as as dtaset wboel yb o,y orecustf si het smot npaitomrt nostecuittn fo esmne in smetr or persm nont.cuif Boelw si noinrtfaiom I udnof ot sasddre hte rhteo rweans choc.ise

niZc eiifeyccdn i(n esu,r)m rpe F,A sha eben cmiplaited ni eeladdy odnuw alghni,e epsespurds miytun,im laem spnhm,gdiooya rcesededa atdul rhai yrall,iax( cafal,i bc)ipu, ysiesa,dgu a,misaon tsdoriaeimrcmat oantrpehiceta cd(etfe ni lteistnina nicz p)oaoibrs,nt nda amy rdespiospe to cociollha criiosr.hs FA i'dtdn cpeysfi eth eelvls in the ne,ems btu rep teh loewb acreil,t laimsen cinz tcnonte aws dufno ot ahve rno carlnoteori ot /semrmepnse evlicytc/eeit.vtal/ I d'nto nkow fi rwee' spepdsuo to onwk t,hta btu nwo I ,od l.ol mew.3dc.5vuw/nh5ppi3ob7whst:nib.tm/70/l/.gn.

As ryxgbhuno dnmot,enei einuellms is lnyo inetemond neco in AF sa a nerttmeta orf a,nite so I okdleo onti it rhreu.ft uilSemne si a tenotcn fo nms,ee btu eellvs rayv so cmhu thta it eersvs no coinpogtrs anlcilc nleceearv to ,efiliytrnit erp tshi ilt:ecar .l./w/bpw/.hnu:o022vinc3emtb.t1wmg5phdn3i/s.

oT relu out all of hte wsnsera uecaeb(s I dndt'i elryal nwok innyhtag bauto hte aqyiltu of mesne), I odfun ihst B"y -,tasctstiist ereht aws no ninfiiatsgc nfrieefdec ni the emnse Na citortncnanoe mnaog eht rfftednei grsuop (7 urospg oltat dbase on rpesm ctun,)o idcainigtn hte iiaitgcnfnsin olre of Na ni mrspe liytim.to". wh2wtmb7hue2.5pn/miw.vnp/os1.dl.gbit/c:n/1.

naylFl,i I tnod' ktnhi het aa-5lph asteedcur meznye si tyuclala ni nemse, btu I dlouc eb .orgnw trihEe a,wy ti utlnw'od eb olanrmyabl aeveedtl or olw if eth ntoteseoerst seevll era manrol.

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bartolomoose  sa per gla,ojn ienesuml is vlvendoi in itlehountag rdespeoxia +
chandlerbas  mlnuseie has a elro ni hgiatoutlen rpod.saiexe esesxc mieesunl = rclgia ht,erab arhi s,los nad ianl c,angshe mtghi see rrpplaeieh .ornypathue encdcyiefi p(t on )NPT = dleidat oyyartdiomhpca +
chandlerbas  slao zcin aids ni rpems lmtiotyi 8.rhstPnt9t7lln3/m/M:./C.hoceaicw/pv1pnswi4icb/.7w/mg sahtt why i ohces czni but erwevrahrt mi orve it +


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 +3  upvote downvote
submitted by โˆ—hungrybox(1277)
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ncAgcdior to eth LEMSU, nuse'elmis noyl sue is in esniulme lusdfei sa a entetmart fro a usfung ladlec ssaleaziMa psp aen(iT so)r.lroeciv

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 +1  upvote downvote
submitted by โˆ—unknown001(9)
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ltse ivoad gnol ipoetlnnxasa lshal ew .

.tp wthi rttfyi.liein kcuqi tets in fwe ssednoc = esmne foerscut

acft : ensmali sleicev akems etfu.rcos

cnbtutroosi of snemali csilvee or tnanolicge ecebasn = owl tesrofcu in smene = mibcoalet caablemni > cefeviiften nmespogtsirsaee

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 +1  upvote downvote
submitted by โˆ—meirchod(1)
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I anoesred htougrh ihst noe scine I redalen ttah enimsal lsecivse vahyeli ues oroSiblt gonDehdareesy adn( vorisea m;&pa vleir I veeblie oo)t, hiwhc nasem yteh boybprla vahe a rialaruclytp ttmnriaop eend rfo o.Frtuesc oS norlbmaa stecoufr in enesm is alrbybop ton a dgoo n.isg

S.P. I noderw fi eht nnicsaet idd teh staetttse- on hsti oe.n.. eseem(d ot kwor lelw rfo tisbdeea)

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 +0  upvote downvote
submitted by โˆ—apurva(101)
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esncIeard WCBs citidnae ailnegt itticinlfnofmamiaenno,/ iwhhc nac leda ot opor ensem uyatiql ued to the rdtnpuocoi of xevssceei cirateve yoegnx ipssece yb lsoeetuck.y

tbAsen furoscte earnctncnotio si an ctinoinida of a ictaoelnng sncbaee of asv nl/emesafdiseren isvc,seel ihlwe aredesedc ofectsur nciatentnoorc mya aidctein an olrctjueaay tcud tcrosi.tuonb

pH t;g& 0.8 endsciiat ainmmiotafln of eht toa,spert ilmenas t,rtac ipiyiddsme, c;t.e pH t;l& 2.7 tnseiacid aslmine ecvseli fsntncyoudi or tirtscbunoo fo eht loajecarytu u.tdsc

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 +0  upvote downvote
submitted by โˆ—nwinkelmann(366)
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oS I kloeod tnoi tish ehtrufr oto ubaeces I rtteyp cuhm knwo tgoinnh obtau eht kmea up of .nesem omFr hte hrscreea I fdou,n as as staedt ebolw by oy, otfseurc is teh stom niomttpar tuneoitnsct fo enmse ni merts or rpsme fu.itcnno ewlBo si omonfnirtia I uofdn ot dsradse the ohter eswarn hico.cse

Zcin efnyciidec (ni )rmsue, rpe FA, sah nebe pteamicdil ni adydlee wnoud ingaleh, sepdusepsr iy,imtunm mael dihgm,oysaonp rcaedeesd dautl rhia ryila,(axl alca,if bpci),u aydesugi,s iamoa,ns mstdtoamiarreci apecniotetrha tfe(dce in nietniaslt czni bn,oitaor)ps dna may oppirsseed ot looacilch srhroi.sci AF it'ndd ysfecpi teh eevsll in teh s,emen tbu epr eht bowel cti,laer enismal cnzi tetonnc swa donfu to ehav ron areoiontlcr ot pees/nmmsre t/ctveic/l.iyveelat I o'ndt nowk fi 'rewe pupoessd to okwn a,tht but wno I do, .lol cs73/wn..7it3.p0vwhi/bm/no5b5pultdmw/.:hegn.

As oruxhgbyn ,nitedenom llsunieme is nylo oeindemnt oenc in AF as a etneattmr rfo ,atnie os I dekool toni it rtr.ufeh Seniluem is a oncntet fo ee,mns tbu sllvee rvay so mchu thta it ressve on consrpgito incacll reeevncla ot nieilrfttiy, epr ihst tia:lecr i3h.mdewtm/0pv:p.iw/t1cn.uswo22bnb5n.gh//l3.

To ruel tou lal of the esrsanw euacesb( I ind'dt ylarle wkon ntnyhiag tuboa teh laiyuqt of mesn,)e I udofn isht B"y t-tstts,iaics heetr aws no iagiftcisnn fdcnieeerf in eht nseem aN iotnatennccor gonam teh rteeffidn urpsog 7( rpogsu atotl aesbd no prems n,)ctuo ictgdinnai eth icntnagifsini lreo fo Na ni mepsr imy.tit.o"l gnw.2imhppiwtl/esubn:2/ow5/m./.1d7tn1hcvb..

aFyllni, I 'dtno nhikt het lhpaa-5 trduceesa yzeenm si yaactllu in mne,se btu I odcul be wngr.o thEeir ,awy ti nwo'utdl be lmbnyalrao leeaevtd or wlo fi hte sorosettntee lvesle ear lam.orn

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submitted by flexatronn(5)
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uyo lal aer oonlikg way too edep inot .tshi

hisT saw a mpelis ftac calelr qotnusie. ehnW oyu see enmse + tylnrfiitei in a etisuonq nad cefutosr in the aenr;wss ist eesnm = fsteocur

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