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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 ujst knew ttah srmpe ende orufsect, nto esru ahwt idsease spsceor sthi si oghu.ht eH was erytpt almron os a5 ceueaasdtr det'nos epnters iekl atht. I wt'ans suer fi rhtee aws yna odd sue of teh hreto er.wssna eher si a ilk.n elFe rfee ot n.eadpx

i24etoxacmcbepnwqw/uot:..2/w_tas/lp7s.2hgssp

sectrFuo eksma up 99% of the rcigdneu grasu eeprsnt in nmse.e hsiT sraug si oerdcupd in het niaemls vessel.ic hdiiiemDns llseve fo rtucesof veha enbe noshw to lalparel nnrgoeda nyedficcie nad het rntesoesttoe e.lelv igolwolFn stsenoteetro pyhreat, eht vleel of ftcouser ahnAtolius gsrc.ehe teh tcsufore tset si ont aprt of a roiuten nemse ayinla,ss ti is ufusel ni acsse fo aoepziasrmo eebn(csa fo prsme ni .ee)smn In asmoazeipro cndoserya ot eth bnsaeec fo evslseci or fi teehr si na sorniouttcb, on otcefsur si etpse.nr In uttalecirs ezompsa,iroa estuocrf si enpst.er When sariepzomao adn low ensme lmeovu ,xetiss het sucefrot etts sulodh olas be en,do no a eseuactolpatj eunri epalms to eckch rfo grdaeertro lajoanicu.te shTi osrucc hwne het ajuceealt oegs inot het lrddbae enidats of tuo hte e.uhTeathrr rpcueoerd fro tdegnnrieim teh omnuta of ftruosce ni smeen svlnievo thaeing emens ni a gtrons icda in hte erceepsn fo irsc.enrolo Fuosctre segvi a red roocl Sin(foefovl octenair) nad amy eb eard ni a oohmt.tpere The oarnlm vagaree si m/d1Lg53 csuofet.r

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sam.l  nTahk uyo rfo teh xaloiap.nten I'm itsll uneosfcd aubot hsit wena.rs I swa ni nbtewee cZin nad uo.rcseft niZc nieycedfci laso sseptenr ihwt oamisan p(g 17 riFst iAd 2.091) soFucter is sdeu orf het tvm.omeen sHi orheosmn ear o.mnalr +4
d_holles  eyprAltapn dbeat,ise iocoslu,nc nad mialifantnom nac sertul in โ†“ teorsufc ni sspusm. raMe te al, etrF rStte 52, 9174t3r5ee1tw.hp0swr10t/0td4.cerl//tpS:o2/f2a2s-(8r)i6/9-1fgw0t +4
cienfuegos  khsaTn lla rof het fi,on uqikc ntoe no teh iZnc reypl ovaeb .@aS:Im msoinaa = lots ssene of slm.le +
sam1  erGat ndfi !oy I ilbeeve htis inseutoq asw gdnlilau to ystcci sisrfibo and the iatgnelnoc aecbens of het vsa ene.redsf reHe si a knli to a JMEN lirceta taubo ti lb: oweuoj1.0hl/.5/07pwwswf/d/Jt8l/7e91r2n0N9t13:61Moig01.2mE60/ +1
burak  znci iifccyndee scuea .myoosnahdgpi theer is no psnodohyiagm, merpss rea meg?adda +
fatboyslim  1amS@ tbu tyiccs orsbisfi lwil swho aobrnaml ihslpcay fgdniisn ,biucbgl(n olymranpu skarlecc t.)ce eTh qinuetos sasy phasliyc amxe hswos on btranesio.liam +
pg32  nsudefoC sa to ohw we nac rule tuo .nc..zi omrF .ostecmnyaemadldcwoi: "ncZi oasl sylap a eorl in lythhea sprem .irncodptuo Adrccongi ot a 0218 wierev alectri in eth urJlaon of Reiopcoudntr dna trteIiif,lny cniz ecnyifcdei yam icuotetbnr ot orpo mense tuayliq nda intel"iyrti.f +
bekindstep1  pg23@ I ma ton seru of who nZic oenubicrtts ot mprse druiopcno,t but the nioqsetu asw nskiga tobua anaielmirtsob ni teh meesn dna ocufsetr is seenptr ni eth se.men byMea nzci yplas a lroe in smerp lotdvpmeene eeofbr it is edmxi in hiwt esmen nda so eon twih cniz dyenefciic ltdnuw'o vhae owl in znci in eriht snmee peh,raps btu ti teirh lbdo.o ishT si tujs a hpesoyihst hu.t.o.g.h +
brise  ^^ aehY astht' who I urlde ti t.uo Yuo anc nfdi utfsecro in eth mee,sn but oyu w'noldtu be blea ot find cniz in the ensm!e It ghimt ehpl eth ,respm btu tsi' tno ingog to eb lcghiinl wiht mhte +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 oelokd iotn hits trerfuh oto esubaec I ettyrp hcum kown nnhogit uobta the meak up fo msnee. Frmo het eashercr I f,ndou sa as sadtet ewlob by oy, tceusrfo si eht somt rioatpnmt inoutstentc of senem in remts ro mrsep .otnnficu lowBe si ioinmtrofan I ofdun ot drdessa eht treho wneras e.schioc

icnZ yefncideic (in u)smre, erp ,AF hsa enbe iadmtpilce ni eddleay wunod ,naiehlg rsppsedesu inimmy,tu eaml ghanopdomiy,s sdaedecer ludat ahir ,xaaylir(l aaflic, )c,upib ,gysisaeud oma,ansi craiodiattmerms atthaoincrepe cdetfe( in tnasnielti icnz p,osirt)abno nad mya spsroeiedp to clacohlio rhrosciis. AF itn'dd fypsice eth vleels ni eth m,esen ubt epr teh ebwlo ierca,lt sieanlm zicn ctnotne was oufnd to aevh ron rltraeoicno to nepee/ssrmm taty.iilcecevv/let/ I ondt' nkow fi eer'w spspoedu ot nokw ttha, tbu own I ,do llo. nu0v.i/3blsmgt:w7557hwhp/w.m./nt/i.bpdc3oen.

As nxuybgorh nidtmen,oe lsmuleeni si oynl entdoienm ncoe in AF sa a tnertmeta ofr ,ntiae so I elkodo itno ti thr.eufr Sluneemi is a ntetnoc fo s,neme ubt eellvs avry so hucm hatt it resesv on tosincrpgo lilcacn lvearcene to liietytinr,f per htsi irec:lat g2odhi.b.w/tewwm0.2hv/15:u/n33ls.nc/tpbimpn.

To reul uto lal of eht rssewna uabe(sce I td'ndi ealyrl oknw yiganhnt buota het qaiyltu of m)se,en I ndufo htis By" scta,s-stttii heret wsa no iiaifgsctnn efnrefdeci ni eht emsne Na rancooctiennt maong hte dneefirtf uosgpr 7( psugro ltota asedb on serpm ,tn)cuo nnagciitdi het actiiinnfisng lore fo Na ni msper "tt.ilyim.o nph5pbitwm.um/1b72giensclwnhw/2.:v/.d1/t.o.

n,laFily I tond' kinth hte p-aahl5 tsrduceae nyzeem si lcatyalu in esme,n tbu I cldou be rw.ngo hiteEr wy,a ti wutdn'ol be laorblnmay aedlveet or low if teh ontoestester sllvee are .alomnr

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bartolomoose  sa epr ,olangj euniseml si velvoidn in hauegtoitln xpoeseadri +
chandlerbas  ielesumn ahs a orel ni gleohattuin eoa.idsrpxe secsxe nlusmiee = lragic ,aerthb airh os,ls nda nila sge,hnac ihmgt ees eehrlippra ytorpehu.na decniiceyf tp( on TNP) = ealidtd myahpatyoodcri +
chandlerbas  soal nczi isda ni sermp ltiimyto i.pPMi4oc3/w98ts./Cmn/i1/.bvnclegta/.l7srwhc/ht:mnp7w tatsh ywh i ocseh nzic btu vhrerraetw mi eorv ti +



 +3  upvote downvote
submitted by โˆ—hungrybox(1277)
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cArdogcni ot het USML,E slmienesu' lony use si in eunlimse ldiesfu sa a ntatemrte orf a ugufns cdlael Milszeaaas psp n(Teia )vo.elrcsoir

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 +1  upvote downvote
submitted by โˆ—unknown001(9)
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stle odiva gonl tplaseoxnina sallh ew .

p.t iwth .ifttenlyiir iqkcu ttse in efw csdonse = smnee secoutfr

ctaf : linmsae livcese kmase uo.srfcet

cntouiobrts fo mislnae lecisev ro ceagntloin senaebc = wlo cfreusto in msnee = bailotmec leaabnmci &;gt evtifencief sseinaoetermgps

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 +1  upvote downvote
submitted by โˆ—meirchod(1)
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I oeedsnar rohhgtu hist neo siecn I dlenare thta aslienm scievles vlayieh sue lootrSib gdreenheoDsya dna( servoai a&;pm virel I eelbvei )ot,o iwhhc aesmn yhte alyobpbr avhe a laiartulrycp anomtitrp ened rof .Feuoctrs oS mboalnar osrceutf ni emens is laybbpro ton a good .gisn

..SP I dwnero fi eth acnsteni did the tsetae-tst no shit e...on e (eemsd ot rokw llew rfo tidasee)b

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 +0  upvote downvote
submitted by โˆ—apurva(101)
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Icraesdne sWBC atdciine iaelntg ninmimoiilne,ofcanatft/ hchwi can aeld ot poro meens tqiyalu edu to het dotucroipn fo vxciessee aerticve oyxeng sipesce yb o.yeceklust

tnbesA etfsucro tnnrootiaeccn si na iicaditonn fo a egatcinoln ebscnae fo sav leisfe/dearnsnem vsesi,cle wihel drdeescea teufsocr ootcnnentarci mya tcdienia na jeucrylaota tcdu uoibttr.ncos

Hp t&;g 0.8 taendsici inamlniafmto fo eth p,reostat saeilnm tcat,r mdyiedpiis, e.ct; Hp &;tl 27. sdniceita nalemsi vciesle ouidsytfncn or sontbcituor fo the raotcelajyu .tdcus

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 +0  upvote downvote
submitted by โˆ—nwinkelmann(366)
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So I elokdo itno stih rheuftr oto sbaceeu I ttyerp mchu wnko iothnng atoub hte akem pu fo s.neem oFmr the erhaescr I onu,fd sa as astted woble by oy, csotrfue is eth most nmpitatro oenttntcius fo smene in smert ro msrep uctin.fno elBow is foanmiointr I ofnud to drdsase hte ehrot arwens .eshoicc

iZnc ndeiycfeic i(n mrsu)e, rep A,F ash nbee ietacdlimp in eedyadl odnuw ,lngaieh sdpperseus tmymi,uin elam h,ygdoisoapnm sadrecdee ltuda rahi ,ylalrxi(a ci,aalf ,bu)icp ,yugsdieas osnaima, scamemdtaririto eacaioetnrthp cdtef(e in intasliten cnzi pb)tirnoas,o adn mya erepdiossp ot olccoahli r.ssocihri FA td'ind iecfpys teh esvlel in eht mnse,e utb pre the weblo ril,tcae eanislm zicn tntcnoe aws ofndu to veha nor roeicnotalr ot npremee/sms tivevcc/t/laet.iely I dtno' kown if ewe'r epodsups ot owkn aht,t utb now I o,d .lol lw03ww7ocie/dh.umpin.v7hbpm5:t5/3.n.gnsbt//.

As hrgxboynu eon,dietnm einmelslu is nloy ieotndenm enoc in FA as a nemttraet fro ea,itn os I ooelkd toni it hf.ruert inleSeum si a ecnntot of n,mese tbu lelesv ryav os uhcm htat ti vssree no tcosgirnop lcaicnl enlevrcae to iyittrlfe,ni rep htsi rce:ialt tmvnsdtww3c/b./.5n/ihw0.npe31.22oi:ph/buglm.

oT reul out lal of het eswrnas ceebs(au I nidt'd ylealr nkow hntyiang uabot eth iytlauq of )ee,snm I ufnod thsi "By its-sitcas,tt hrtee was on aisiftngcin iedeercffn in het neems Na nntaoentcroic nagmo het ffedniert sgrpou (7 uospgr tloat aedbs on epmsr ,otnu)c indgtiacin hte niiifcnagstin lero fo Na in erpsm li.m."ittyo 7w.2n2l5bnt:/1cigmwuo//hp1w..dvi.nhpmteb/s.

lnFya,il I 'tond hktni het p5hal-a edrucatse ezeymn is yactuall ni nm,ees but I uldoc eb .rognw Eeriht aw,y ti 'wntodul be alonlrbmya eatvldee or wlo fi het tooenetrsste eellvs aer lmnar.o

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 -1  upvote downvote
submitted by flexatronn(5)
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yuo lal aer logikno ayw oto epde toin is.ht

hisT was a pmisle ctfa leracl sqnt.ieuo hWen uyo ese eensm + tnlitreyfii ni a suitqeno adn suefroct ni the rensw;sa tsi nmese = sefotcru

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