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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 ujst newk ttha smerp ndee ,ctfusreo ont urse what seiasde spsrceo shit is .hghtou eH was yeptrt lronma os 5a raduescaet d'snteo psernet keli h.tta I ns'taw uesr if erhte was ayn dod use fo eht reoht eher is a Flee feer to x.napde


scrteuoF aksem pu 9%9 of teh unidecgr sgura pesntre ni msen.e siTh agrus is orcpdude ni hte lmneasi .csselvei iisdemhDni lleevs fo tceufosr have eebn snhow to lleraalp eannrgod iefcendyic nad teh esteoeorsttn lowlFigno eerostteonst rtphyea, eth elelv fo efsocrut chegnA.ors listaheu hte soecufrt tets si not rpta of a oenirtu eesmn ysas,inla ti si esluuf ni ecssa fo oasmepiaorz c(sbneea fo prsem in s.e)emn In aroamopseiz ryecdnaso to the cseneba fo eecsslvi or fi treeh si an cinotut,bsor on ceroftus is .eepsrnt nI etlascurti rzaoipose,ma eotuscrf si r.eetnps Wehn mazroaspoei and wlo mnese leuovm tssi,xe eht orusctef etts dsouhl sloa eb o,dne on a csujlaepateto rieun spemla to khcce ofr redegatorr ajuatei.nolc hisT ocscur wenh het ceajltaeu oegs ntoi teh rebaldd sedtina of uot teh T h.rhurtaee epueorcrd ofr dgeimetnrni het utoman fo cesfutro ni msene vienlsov aghenit msnee in a osnrgt iacd in teh nprceees fo oci.srorlne ceFtsour ivesg a dre oclor f(ovofilenS nietao)rc dan may be eard in a eoetpmhtro. eTh lroamn eargvea is 3L1m5dg/ cuteofs.r

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sam.l  Thnka ouy fro het panxinla.oet Im' itsll donusfec oabut this se.wanr I asw ni weneetb Zcin and rutesoc.f nicZ ycecdeifin lsoa espsnrte iwht nmsaoia g(p 71 tsiFr iAd )1.029 tueFoscr si uesd ofr eth .voeemtnm sHi sreonohm rea mor.lna +4
d_holles  pnyrAaelpt b,etdseia uc,snlioco adn maifnlaonitm nac sterul ni โ†“ cuoeftrs in Muspersmas . et la, terF ttSer 25, 7 419e/w/d1:wtp0i58ta9r2(6lg20cs.-02-r//tf11wS/r3stttf)04er.ehpo +4
cienfuegos  hskanT lal rof teh ifon, ukcqi etno on teh Zinc plrye avobe .a@I:Sm snaaimo = olts esnse fo ll.mse +
sam1  Getar find !yo I evliebe isht iqsuoten asw uilnlagd to cictsy oiirfbss nda het iolntcaneg aneesbc fo teh vsa .eerdfens reeH si a likn ot a NJEM teclria aobtu ti le:ow bwfNtlM8g/r/1/tw17.o06502lwe1//hudjp9Ei0:9o/2m613sJ.n0170. +1
burak  nzic eenyciidfc ecsau .nshoigydmapo etrhe si no pgsnaoyhod,im espsrm aer agaddm?e +
fatboyslim  am@S1 tub yiccts obsifirs illw sowh anblramo hislcpya ndgsiinf (i,gcbnlub mloprayun skccrael )ect. eTh qiuoents syas hasiyplc maxe hwsso on bineomtsi.alra +
pg32  unfdCeso sa ot owh we acn urel uto omrF cenowcayisemlodadm.t: nci"Z slao asylp a lore ni ehhtyal pmsre tu.doicnrpo dAocnirgc to a 2180 weevri iretalc ni het runJaol of iorcRodtpneu dan tytr,Ieifiln nzic efcidenicy amy icotrubtne ot rpoo esemn atlyuqi nda .niitel"irtyf +
bekindstep1  p23@g I am ton srue of woh ncZi niestutcrbo ot pmrse oicd,onrtup but teh oeusitqn was isgnka utboa oranmilsiabte ni het mnees and sforuect is sepnret ni hte ne.esm yabMe znic paysl a rloe ni pmrse oleevdnmept berfeo it si iexmd in wiht esmen adn so one htwi zinc niyedfceic wtdlonu' avhe wol in zicn in threi ensme pehrsp,a but it rthei do.bol siTh si jtus a oysiehstph h.o..g.tuh +
brise  ^^ aeYh atts'h woh I rleud ti .otu You nca difn sfuteroc in teh sn,eem ubt yuo w'tdluno eb elab to nifd cniz ni eht sn!eme It tmghi phel eth ,semrp ubt is't ton gogni to be gilhnlci htiw mteh +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 dolkeo oitn htis fuerhrt too eebscau I rttpye uhmc kown iongnth obuta hte eamk pu of me.nse Fmor the ehrscaer I odufn, as as eatdts ewolb by ,oy uferscot si eht stom tapintomr nticoutsetn of semen ni mestr or pemsr oewBl si rtnimfanioo I donuf to drasdes teh hrteo eswanr hsie.occ

Znci yeccenidfi i(n )rseu,m pre A,F has eenb itidcmpale ni ledeyda odunw lianh,eg esrudeppss uymim,int eaml amdongpisy,oh ceerdasde udtla irha laay,irl(x cfl,aia b),iupc es,gadiyus amin,soa taretsadrmimcoi htocterpaenia edtc(fe in nitneilats znci tnbspoi),aro nad aym peesordpis to lcaohlico srcoir.shi FA 'itndd sefiycp hte leesvl in the ne,mse tbu erp eth elwob iarlt,ce aemslni czin tnceton aws fudon ot eahv onr cnerotriola ot /eenmmseprs eit/ I todn' wkon if 'weer pdpsseou to wkno h,tat btu onw I ,od llo. .m.inclp/b5n0.pntmdbsu3i5hvwtw:7g7/h3wo.e//.

As ounbyrgxh ,mdennoeti luleenism is nyol iedenomnt ncoe ni FA as a tramneett for n,iaet so I oledok nito it rhretfu. enlSueim si a noecttn of nmee,s ubt eevlls vayr so mcuh tath ti ssreev no trogsocnip aclcnli cvareelen to tyiltef,inir rpe htis :ltricae .wnn.oismbch./wpu0i.//wnd:5g/b3petvhlt32m12.

oT rleu uto all of eth anewssr c(euesba I 'dtind ylelra owkn hgnianyt aobtu hte iqatuly fo n)s,eme I nofud siht y"B sacst-itstti, hrete asw on tiinscgfian eefdeirnfc in teh mnsee Na tnnceocntriao agnmo the fdeirfetn oupgsr 7( ousgpr tolta dabes no mesrp cno)t,u anidiingct the tiainfsicngni orle fo Na in mpser yoi..limtt" 12pb/i1bdntv.:.w5.mphmculn/.n/iwehso2/wgt7.

anlil,yF I 'ndot ktinh het lh5aa-p esedaurct menzey si uaallcty ni eme,ns btu I lcudo be Erieth y,wa it ntudwo'l eb aynobmrlal vetedael or lwo fi het rteosoetntes elelsv aer l.ramno

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bartolomoose  as rep ,jalgno mluiense is oledvivn ni aleoiuhgtnt asrpoedxei +
chandlerbas  islneume sha a rleo ni ueaghttnilo edprx.siaoe essxce suileemn = gilacr re,thab raih ss,lo dan inal h,scgane gtmhi ese hrleireppa oraenpyhtu. ineccyidfe (tp no PN)T = ieadltd oodrtayiahpcym +
chandlerbas  lsao czin sida ni eprsm ttioyilm bm7/nwt8/Pwmsp/c4hic7tMgo../ ttsah wyh i csoeh nczi btu rveewrrhat mi evro ti +

 +3  upvote downvote
submitted by โˆ—hungrybox(1277)
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crincgoAd to het U,SEML seenul'mis lony seu is in uilsmeen dlisefu as a taentmrte for a fsugnu ecdall lsMsazaiae pps ine(aT rco.evir)slo

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 +1  upvote downvote
submitted by โˆ—unknown001(9)
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etsl aodvi gonl seitnalpnxao hlasl we .

t.p thwi nirf.ieittly kqciu etst ni wfe ndescos = enems trsceuof

tafc : mislaen elcevis seamk fe.suroct

osbrinuttco fo nealsmi seicvel ro gioltnacen cbneesa = wol cesourtf ni eenms = cemailobt aealbnmic t&;g eceiffvinte ssrgmoptensaeie

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 +1  upvote downvote
submitted by โˆ—meirchod(1)
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I eadnorse hrohutg ihts eno nseci I alrdene ahtt nelsiam sevsilce heylvia seu ibotlroS hsenradeyoegD adn( rsoiaev ±a eilvr I bleeiev to)o, whihc amnse yeth bapblyro heva a cuillaatrypr ntaomtrpi eend ofr .usetForc oS laanbomr eocrfsut ni msene is roblypab nto a oogd

S..P I oredwn fi eht inncates ddi het testst-eta on sith .eno.. e mdse(e to kwro llwe rfo ad)bieets

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 +0  upvote downvote
submitted by โˆ—apurva(101)
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dcenIersa WsBC eciinadt nlatieg ianofemi/tmntlon,afcini cihhw can dael to poro smene aliutyq eud to eth pocintudro fo veescexsi vrtciaee yongxe psecise yb .seucetlkyo

Anebts orsuetfc ctienorntcoan is an oicainntdi of a cngatlnioe acebnse fo sva mrnesaeliese/dfn esle,cvis iwehl sreecadde rofctesu rncniactoteon amy iaetcdin na caoytraleju ucdt t.ooctbirsun

pH gt;& 8.0 niscidtae lmtnfmioaian of het rsoptt,ae mlensia crt,at dmidyipe,si ;e.ct pH &t;l .27 iesaitcdn enamsli clivees ntsoynicfud ro ubitrtcnoos fo eth ryaclaeoutj .dsuct

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 +0  upvote downvote
submitted by โˆ—nwinkelmann(366)
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So I oekodl into shit erfruht too csuebea I yettpr muhc nowk niohngt otabu het kame up of nemse. orFm eth erschrae I nfd,ou sa sa astetd ewolb yb oy, ouetcrsf is the toms toniaptmr tscntietnuo fo mense ni mtsre or psrme nnoufi.ct eoBlw is ioonfanrmti I nudof ot sradeds hte eorht nsewra ecih.cos

Zinc dyfieccine (ni uemr,)s rpe FA, has been icetdlamip in dlaeyde wdonu ie,lahgn ssdereupsp ymuimnti, emla igadynmos,pho aedscreed dtaul riah yi(laxrla, fai,lac b,pi)cu eisugd,ysa nimasao, mtartrcsadeimoi iorcnpahteeat fted(ec ni etsntnilia icnz n,r)bosptoia dna may irpdesespo to aolcoilch h.srsciroi FA 'idtnd yfeipsc teh selvel in hte nem,se btu erp teh eblwo arctli,e sniaeml zcni cnnteot aws onfdu to vahe nro trrcniolaoe ot r/sesempmen acetitvcllev/i./eyt I otn'd okwn fi 'rwee udsopesp ot owkn t,ath tub won I do, o.ll 7lim0tp.tb3bhsi5nup.7w:m.ogh5d/ev3cnww/n//..

As gnbyxuroh eoenidn,tm luienmels si ylon dteimeonn ocen ni AF as a etmtnrate fro at,eni so I ooekdl otni it errhutf. Siuemenl si a nenctto of es,mne utb elelvs arvy so much htat it vserse no ogsiprtcno acllcin eelveacnr to tiieynlt,ifr erp shti ical:ter c/bot/lm5dppg.h/0sb2n2w.iw3wnmu:ve31ti./h.n.

To rlue uto lal of eht rwessna uebasce( I iddtn' yrllae wnok igtaynhn oubat teh tlaiuqy of n,esem) I nudof hist y"B ittcs,i-tatss theer saw on fsgciiaintn fencfridee ni teh mnese aN nnooacttrecin maogn eth ffrtendei sopgur (7 uprgso atlto ebdsa no epmsr nout),c giticanind teh inannfsiicitg orle fo aN in mpsre t"iom.ylt.i /cl.1ntnsw./2dbtbnvhm1ipwog/e:h7m/

nyial,lF I nod't nthki the la5ahp- sduaectre zeemny is uatclyla ni ,esmne ubt I oculd eb orwg.n tehirE w,ay ti dlwn'uot be rymlbaalno ltdveeae ro lwo fi eht teonosetsrte slvlee rae rmnalo.

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 -1  upvote downvote
submitted by flexatronn(5)
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you all rea okniogl ayw oot edep niot tsh.i

Tihs aws a ipslme tfac llcrea nehW ouy ese esmen + tlietryfiin in a nuqtisoe and strefcuo in hte wrsneas; sit nmese = scfroute

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