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Comments ...

 +12  (nbme21#45)
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I tsuj wnke taht psmre ende troufsc,e otn resu hatw esasied spoersc itsh is .huhgto He swa erptyt amlnor so 5a eatausdecr no'sedt setpner klie tath. I wsant' esru fi ehter aws yan odd sue fo het eotrh srnseaw. erhe is a kin.l Feel efer ot pa.denx


Fsruetco meaks pu 9%9 of eth dcreguni saurg petenrs in eensm. This gasur si cpordeud in eth enlsmai elscsvi.e mdeiiihnsD lvslee fo cseufrot aevh nbee nowsh to apllaler gnnareod ednfiicyec dna the ttronessteeo vllee. ogiwFlnol eoertststeon eh,ratpy eht lvele fo cstfoeru i osncltaAhrsgeeh.u hte esrucfto etst is ont atrp fo a rointue msnee ,lsiyansa ti si fsulue in seacs fo emrazaosopi ensae(cb of espmr in )s.neem In eopmiosraaz ysrdconae ot hte beceans fo secevils or if three is na ,utnstbicroo no sotrucfe si ep.sentr nI ceuilrttsa raoem,spziao scftueor is e.tpnsre Wneh ziaoaesorpm dna lwo eemns ovlemu ex,tsis the fcrouste ttse suohdl aslo be o,nde no a tsltopecuajae riuen leamsp to cckeh for eortarregd hTsi ucorsc nwhe eht acejtalue ogse inot eth derbdal daentis of tuo the rharuT. eeth orucredpe for tengmreidni hte aoumtn fo ofseurtc ni eensm enosilvv ngaiteh msnee ni a sntogr acdi in het eeecsrpn fo snlrcir.ooe seoctruF sgevi a erd olorc (oieSnffvol eionr)tca nda amy be rdea ni a hmtteoe.rop eTh lnroma rveagea si L1/m3d5g sreoft.uc

sam.l  Thank you for the explanation. I'm still confused about this answer. I was in between Zinc and fructose. Zinc deficiency also presents with anosmia (pg 71 First Aid 2019). Fructose is used for the movement. His hormones are normal. +3
d_holles  Apparently diabetes, occlusion, and inflammation can result in ↓ fructose in sperm. Mauss et al, Fert Stert 25, 1974 +4
cienfuegos  Thanks all for the info, quick note on the Zinc reply above @Sam.I: anosmia = lost sense of smell. +
sam1  Great find yo! I believe this question was alluding to cystic fibrosis and the congenital absence of the vas deferens. Here is a link to a NEJM article about it below: +
burak  zinc deficiency cause hypogonadism. there is no hypogonadism, sperms are damaged? +
fatboyslim  @Sam1 but cystic fibrosis will show abnormal physical findings (clubbing, pulmonary crackles etc). The question says physical exam shows no abnormalities. +
pg32  Confused as to how we can rule out zinc... From "Zinc also plays a role in healthy sperm production. According to a 2018 review article in the Journal of Reproduction and Infertility, zinc deficiency may contribute to poor semen quality and infertility." +
bekindstep1  @pg32 I am not sure of how Zinc contributes to sperm production, but the question was asking about abnormalities in the semen and fructose is present in the semen. Maybe zinc plays a role in sperm development before it is mixed in with semen and so one with zinc deficiency wouldn't have low in zinc in their semen perhaps, but it their blood. This is just a hypothesis though.... +
brise  ^^ Yeah that's how I ruled it out. You can find fructose in the semen, but you wouldn't be able to find zinc in the semen! It might help the sperm, but it's not going to be chilling with them +

 +0  (nbme21#30)
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gnaD sthi nqtsieou rehtw em fof cesaueb it iads maleef latniaegi hwen I thghout ti dlwou be smubagoui at .ihrbt D HT tisll mskae hte stmo seen.s asThk.n

 +1  (nbme21#34)
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rpslgiuirysn good elonanitxpa dan ceptriu dfuon no htsi ihegostnm aogln teh sienl of iiiaourmntcnt lxfeer a(ak erddalb is lufl nad uoy spsi )reelxf si gneo os hte aerffnte brifes airrgnyc hte ngisla htat het rebaddl si ulfl rt'nae ogknwi.r ohets ebsifr rae riredca ni eht ilvcpe nrseev


yo  if still confused, a better explanation can be found here +18
hyoscyamine  i found this image to be helpful in remembering which nerves do what on which receptor. +7

 +10  (nbme21#46)
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erndu 8 syera old orf rslgi is a dab i,sng 8 is kaoy. dn rue 9 rfo soyb is a dab s.ngi

sjut awhtc tuo for nya 6 raye lod ro goemsnhit leki ttah. ewraeb of atht GnHR hieret tarelclyn or esom semo rohte sisu -rot.refc dai 1920 gp 326

hungrybox  yo wtf i got my first dick hair in 6th grade wtf are they feeding these kids +37
lola915  FA 20 pg.637 Defines Precocious Puberty as: <8 y/o in Females <9 y/o in Males +1
euphoria  In Caucasian is less than 7 years. +

 +11  (nbme21#22)
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Tshi cedcruor hwniti 6 huors adn acudse soem amronyupl deeam nad aroriyptres tsersdsi rafte a sfoiuntrans uadces by teh srndoo' otetylcnika-eu setdobnaii jstu otrniesydg het eriientcsp htrupoilsne nda rrsiorapeyt enilaetoldh lsce.l

elwih pa/sgaeiynralllahxci anc uasce yosirrparte rartse dna hkcso it has a mtowehas ditfefrne piteuc,r on ngwehe,iz hsneticsi ro hwvetrae nda irodcgnca ot ifstr dAi it anphesp whitin euitnms to 3-2 husor ichwh is ta astel uldeob waht 'reew isnege saol wreeba fo gIA ftceeinid eopelp ni tshi chc.ioe

,PE eh I otd'n khtni it ecfsaft oaP2 hatt etonf uhcm ccnadogir ot iths surpe repdu hhig dyeil roceusre. utb uhh yaeh toesd'n efel EP ndaik onsqtui e3p0mpe1lt#ie0pc0esc:out/cme/o-m/atwhikr2aes9decc/.ndi1r.

om,paeinn hirgt freta all eht nfsuioni issbeuns nda no enmtoni of ferev or hnagy?nti ha.N

go to aegp 141 fo itrsf ia.d I'm pttrye reus ew ened to nkwo our atlastspnifnnu/nior carp cubaees ti usjt kpese comnig up ni dwlour tub sthi holwe emax si a oc.rhsotpa

eFrovgi me if I dmae a /nkmwarotsgei baout nthia,ngy I oymtsl got noif fomr ritfs id.a zlp rrtcceo if eerht is a iastemk, godo .kluc

hungrybox  we gonna make it bro +7
hungrybox  or sis +8
nala_ula  I did the same, basically went through each one and the time of onset between each. Good luck on your tests!! +
temmy  i don't think pulmonary embolism will cause bilateral lung infiltrate +6
athenathefirst  I hope you guys made it. Your post 9 months ago +1

 +2  (nbme21#15)
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eye'trh nktliag obtua a ollerpnsaen hnsut decurpreo


hungrybox  be honest did u know that before looking it up +9
meningitis  @hungry, because you didn't know it, doesn't mean he didn't. This is a forum for answering questions and helping out, not dissing or showing off. Grow up before becoming a doctor. +23
sympathetikey  Relax @meningitis. Hungry's just messin :) +9
sbryant6  Looks like somebody needs an enema to get that stick out. +1
chandlerbas  ya'll are too TP/(TP+FN) lol +11

Subcomments ...

submitted by lnsetick(90),
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I tsju berremem tratSa gnsaiy MVP nsedt ot be pttacmai.yoms ,solA I khtni the kdi decploiamn falsyelicpic fo ggnhoic,u and thta edam me yllare neal aayw omfr .VMP

yo  he also has a family history of asthma. that's shit is genetic. +1 for asthma. +5  
yotsubato  Cheif complaint is SOB during exercise with coughing. Mitral valve prolapse is not going to do that so I picked asthma as well. +1  

submitted by beeip(123),
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I tgihm eb het nyol epsonr no htrea how tgo hits oen ,gwnro ubt rdes:gersal

TIT" ysinalsa ineldusc eveyr sejbcut how is mainddrezo dcngcaoir ot nzoiddamre nmeteratt gintsnames. tI nsoiger c,lnomnepocnai ocolprot osatniivde, ditl,awahwr nda gyanhtin tath epshnap farte odari"zna.mtnoi[1]

yo  You're not. I also goofed. +19  
seagull This video is a pretty decent explination worth your time on the subject. +2  
hungrybox  I got it right but I was only like 50% sure. So I appreciate it. +  
drdoom  ^ linkifying @seagull: +2  
teepot123  ^ same video above used when I analysed my form 20 q which I got incorrect at time, its very clear at explaining this, helping me get it correct on this form +  

submitted by yo(78),
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pnrurlsysiig ogod ainalneotpx and itcperu ufond no tshi s.iet hgtseimon lngoa het slein of rtiacuimtinno elrxfe a(ka blddrea si lful nad uoy pssi frxeel) is gnoe so het nteaffer fesrib rgyrican teh alings taht eth rdadbel si ufll ret'an onkg.iwr tseoh sbifre are rrdecai ni the cpevli ersevn


yo  if still confused, a better explanation can be found here +18  
hyoscyamine  i found this image to be helpful in remembering which nerves do what on which receptor. +7  
drdoom  ^ linkify hyoscyamine +