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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 usjt wkne hatt eprsm ende uct,feosr otn seru hatw dseisae spercos ihts is t.guhho eH saw rttpye amlonr so 5a aeedsrcuat netos'd etresnp lkie t.aht I tawsn' reus if terhe was yna ddo ues of the eohrt wsnea.rs ereh si a nilk. eFel eefr ot nxed.pa

iwpt2.7_scbtea/mosx/24l.usgatw/pcph2swq.neo:

eturFsoc skema pu 99% fo eht iuenrgdc gasru ntrseep in msn.ee Tihs uagsr si dureocdp ni hte asnlemi iscves.el dsiheDmnii llesve of srcufeto evah nbee shonw to rpaallel anndoreg ifcediycne nda het oroettnsetse v.elel owonlFigl testorstneoe te,ahyrp teh evlle fo esuoctrf ete lnguhsor.saihcA teh fotscreu tste si ton ratp of a tuioner mnsee ,alsiansy ti is sufule in asecs of spzarooaime eac(sneb fo mserp in en)sme. In mpizraeoaso osyrdacen to het necbsae of eevcissl or if reteh is na sirouontbt,c no eutcrofs si eprs.nte nI isutctlera s,mroaaezpio otfecsru is n.rtsepe ehWn mesoaoaprzi dan owl senme veumlo ,stesix eth tesocurf sett slohdu soal eb on,de no a topaatujeecsl nuire pemasl ot kecch rfo oarteerrgd ueitac.jnloa shiT crousc ewnh hte ajteulcea gose ntio eth dbaerdl isdaent of tuo the .haTerrtue h prredouce orf mgtrenidnie teh aotnum fo cesoutrf in mseen ievlnovs tgeihan enmse ni a rtosng dcia in eht pcsreeen fo riorncol.es eourcstF gsiev a red olcor veoo(flSnfi nract)oei dan yam eb edar in a rhmpoete.to ehT lroanm arvagee si 5g/3m1dL rfc.toseu

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sam.l  hTkan uoy ofr eth .tlxaaennoip m'I tslil cdounfes buota ihts naw.sre I wsa in webetne icZn nda eufcs.tor icnZ ncyfeiceid saol teesrnps twih moanasi g(p 71 itFrs dAi 9)02.1 rucFsote si uesd orf teh eovmte.mn His nrhooesm are anor.lm +4
d_holles  Aaneylrptp sdteiabe, loucosc,in dna tnfimalomani can rlstue in โ†“ tcureosf in .esms spuraM et ,la erFt Setrt 25, 9741 :tdo3gt.rr/w-f20p18-tt60/ps4S/t2w/e1f.lri0eh(0re2t)/5sa91wc +4
cienfuegos  hTkasn lal rfo het f,ion uikqc teno on teh iZnc reply abeov @ma.:IS aamnsio = olts ssene fo .elmls +
sam1  arGte fndi o!y I lveeebi sthi ensituoq asw guiadnll ot tccysi isibrfso and eht igtenlnoca abesnce of het vas e.snrefed rHee si a knli ot a JENM icatelr uboat ti oewb: l/00u6fgtdr90i.lww//J2590./j.7w/m1h16Mp07:noloe31Et/281sN1 +1
burak  nciz ediyccifen saecu goshynaomdpi. heetr si on synih,opomadg emsprs era daamgde? +
fatboyslim  @1Sam utb ytsicc issbiorf lwli oshw labmaron ahcylips dfnsgnii ubic,(glbn lumnoayrp lscerack et.c) hTe qetiunso ssya claysiph eaxm sshwo no oimratlabies.n +
pg32  odfnCsue as ot owh ew can elur tuo i..nc.z Frmo ltddecwoams.icoemyan: cZi"n osal aplys a lreo ni hlaheyt pesrm .uotcpridon ocAingrcd to a 2180 vieewr letcira ni the Jnauorl fo rodutnpeiocR nad yi,rttneilIf czni yndiieccef aym rinctuotbe to opro emsen iaqlyut dna ti.in"yirltfe +
bekindstep1  23@gp I ma nto reus fo how nZci oseuncbrtti ot rsemp rticon,puod but eth qntsuioe aws agnkis buaot ebosilatrinam in het semne dan uscoefrt is nsrtepe ni eth mnees. Maeby cinz ysalp a elro in mpser noltedveepm boefre it si imedx in with neesm adn os eno whit iznc edyfenicci nudlo'tw have wlo in inzc in threi eemns pepr,ahs but ti ihert .oobld siTh si ujts a pshteiysho th.u..h.go +
brise  ^^ aeYh 'thsta owh I rdule ti u.ot ouY acn ndfi esuoftrc in teh m,enes btu you wn'uotld be leab ot find nizc ni het mesn!e tI imgth lhpe eth ,pesmr utb si't otn onggi to eb iginclhl ihwt 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)


 +8  upvote downvote
submitted by โˆ—nwinkelmann(366)
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oS I edlkoo itno ihts huftrer oto abeecsu I trpyte cmuh nkwo igonnth tuoba eth eakm pu of .smnee romF teh rchesera I nu,dof sa sa aetstd lwobe by ,yo urfstceo si the mots mtpnioart ectsuitnont fo seemn ni ermts ro rsmep cint.ounf Below si nmnfritoiao I onfdu ot sdderas het retho awsren ciceosh.

inZc fcieecydin i(n )eur,ms rpe ,FA has eben ectiladpmi ni dedaely wduon l,eganih epsperudss uymitn,im elma ,onydogpiamsh scdrdaeee autld hria a(xilr,lay flaai,c iu)b,cp seysuda,gi naio,sma cesatmritirodma hteepoaacritn etdcf(e ni nelitinast cniz ap)osbiotrn, nda mya pipserdoes to aohiolccl soicrhs.ir AF ni'dtd pesycfi eht lelsev in eht senm,e tbu epr het elwob al,irtec lsmeain zcin eotcnnt was ufdon ot eavh nro tcleonrrioa to emmss/epren cilyctev/v.leteti/a I to'dn nkow fi rw'ee dueppsso to onkw th,ta tbu onw I o,d oll. wwin/li5p.dhnm:.7/cntvg.m7sto3p0w3eb//.b5uh.

sA xrnygbohu dt,nemione sluelmeni si lyon eiodnmnte oecn in AF sa a terntetma ofr a,enti os I eokold ntio ti .rfeuhtr unlemieS si a eoncntt of ,emesn but lseelv arvy so hucm tath it vesres on osgtopncri lailccn neralvece to iy,enirtfitl erp isth tera:lci .ow/3n2/dpmpwbcn1h5/u0e/3thngmitw:ls2ivb....

oT rule uot lal fo the neswrsa eascu(be I 'dintd lrlyae wkon atgiynnh abotu eth tiqyaul fo e)ms,ne I funod sith B"y tcsti-tiss,ta ehter aws on itfsanignic eeffecnird in teh snmee Na rticcnnantoeo magno eth nfeitfrde orgpus 7( orpgsu toalt debsa no mpsre ,)cotun inndcgatii eth igncanfntiiis eorl fo aN in mesrp oymtl".iti. dhg/uh1tni1..w/svn/b.mnp/owtwl25:cp2.ibm7e.

Fnyai,ll I ton'd htink the haa5l-p utreaecds yeezmn is cyaultla ni mese,n utb I ucdol be o.rwgn irEhet ,yaw it nodwl'tu be lnalyaombr aeedvtel or lwo fi eth tnootetseres vlsele rea m.anrlo

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bartolomoose  as epr no,ljga smlnuiee si nvleoidv ni hutgotalein aeeoisxrdp +
chandlerbas  suemnlei has a oler in ineahttguol io.espdarex xsesec usenmile = iglrca e,btrha hria ,sslo nda anli s,chenag imtgh ees parrphieel rpt.uaoyhen ieifecndcy (tp on )TNP = idadtle hodmpaotryiyca +
chandlerbas  losa cizn aids in pemsr mtiiotly hw4n7t1nP8bi.9CcMh3lslmiiw/./po/w/vgtsp.mcecn.//:tr7a httas why i ehocs czni but hvaerertwr im vore ti +



 +3  upvote downvote
submitted by โˆ—hungrybox(1277)
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diAgccnro to eht EMULS, uelnmse'si ynlo esu si ni smneilue fiusdle sa a tateetrnm rfo a nufsgu deallc azsaaeiMls pps i(Tean .eirlvroc)so

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 +1  upvote downvote
submitted by โˆ—unknown001(9)
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tels dvoia lngo tainxneolasp lhsla ew .

.tp ithw etrn.ifiltyi ukqic etts ni fwe csoedns = senem toceufrs

cfat : saelmin clseevi ksaem f.tuercso

utcirbsootn of alinmes ievscle ro tonlgneaci eabsecn = wlo teosfcru ni eemns = beimtclao lnabaciem tg;& efneciievft psemsrtogenieas

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 +1  upvote downvote
submitted by โˆ—meirchod(1)
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I neadrsoe hgohutr shti noe cneis I enaderl that laneims eceislvs lahveiy esu obStiorl gaoDesnredeyh (nad viseaor m;a&p vlier I vielbee )ot,o chhwi esmna ehty aprbobyl have a rlcuatpliayr matnprtio nede for roeuFtcs. So lmoanrab oscfuert in seemn si brylopba not a ogod s.ngi

..PS I enwdor if eth nicsatne idd hte esttat-est no ihts no.e.. edm(s ee to orwk lwle fro sbedati)e

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 +0  upvote downvote
submitted by โˆ—apurva(101)
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rIesaedcn WCsB itcdenai igneatl nmmatniniaoi/eficflo,tn ichwh acn aedl ot orpo nesme lyiaqut due to eth ncotuoirdp fo ecsxivees ceervati xyogen eesspci yb tuy.leoksce

sebnAt sfruceot ittorcanoncen is na iatnoidinc fo a oilcnngeat nsbceea fo avs erifma/edlsesenn secesl,iv liwhe ddeercsea oetrsucf etartnicnnooc yma iceditna an eraycjtulao dtuc bt.otusincor

Hp g&;t 08. cndiesati imfntoamilan fo het paetts,or naismle ctrta, iidyim,deps c.;et pH ;< .72 icnteasid elnmsai eviecsl ntiucndsfyo ro ntuotoiscrb fo the juoaceatrly s.cdtu

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 +0  upvote downvote
submitted by โˆ—nwinkelmann(366)
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So I kledoo ntio htsi rrhfute oot eabcues I yrettp chum kwon inghont utoab het kaem pu fo .nesem Frmo eht errcseah I n,foud as as ttdaes oewbl yb yo, otesrcuf si teh sotm mpoattirn notstuentic fo smene ni emsrt ro srmep ifon.cunt eoBlw is itiaorofmnn I ufndo to dsrsdea het rheot naewrs so.ihecc

ncZi fednciceyi ni( rmues,) epr ,FA sah enbe amiiltedcp in yaeedld owdnu leig,han reupsssdep ,umiimytn elma o,ynmgdasoiph ercdseade ualdt arih ilr(ax,lya iaacf,l cp,ib)u uaysdgs,ie ,oismana iematasctimrrdo eatncatripheo fed(cet ni inslattnie czin nioto,rsp)ba and aym pesdsirpeo to aioohlclc srsihc.rio FA ti'ndd iesyfcp the lleesv ni het nee,ms utb erp eht obwle ial,cret amienls nciz ncteton saw dofnu ot vhae rno nlertiraooc ot eenrs/psmme yvit/ltcv/etcaeie.l I tond' okwn if 'erwe sudepops to kwno ,htta tub own I ,od ol.l swtl7bphd7b.wu/3gent.ih///0ivmnwnc.5m5po.:3.

sA xyhnburgo en,mndteoi uemsielnl si nylo omdientne enco in FA as a entmratte rfo nti,ae so I dkooel toin it fu.rrhte ulienemS is a otnnect fo esn,em tub vleels rvya os mcuh atht ti seevrs no ooisrcpngt nlialcc veelnearc to ytinlieif,rt erp iths elc:itra n..in.3//bhcwp2bm1the3sdtpi.l5u2w/mn:vgo0w/.

oT lreu out lla of eth ewsnsra aeubce(s I tdidn' lrylea konw agtnhniy oautb hte lityqau of em),sen I ofudn ihst yB" s-itats,ttsci tehre wsa no nficigsniat neferecfid in hte emesn Na inractotcnoen nmgoa hte fteifnrde spruog 7( posugr toalt daesb on erpsm to)nuc, ngtiicinda het tangiiininfcs relo of aN ni remps mt.yl."toii t.iwh/thnpni2vbpm/5es1/w.b.m:/nc2og17l.udw.

iFn,layl I 'dnot hitkn hte p5hlaa- ceratdseu emezny is ayltacul ni ,seemn tbu I ucold be org.wn Ehreit ayw, it onud'wtl be nbaylrlaom vaeleted ro lwo fi the eooestsrettn svelle are o.nmalr

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 -1  upvote downvote
submitted by flexatronn(5)
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oyu all rae loinokg ayw oot dpee itno his.t

hisT was a plsmei afct ecalrl oesqu.int nehW you ese nseem + finlyritiet in a itouqens and rsfueoct ni eht wsnrs;ae tsi nmsee = rcftuseo

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