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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 tsju wkne tath mspre eedn fstouer,c not sreu awth eiasdes sposecr thsi si tuo.hgh He asw etyptr nrlmao so a5 ucersaetad 'tnodes renetsp ilek ta.th I t'swan reus if ehert was any dod seu fo eth toerh ean.sswr erhe si a .inlk elFe free to xne.pad

2ewust/.m.sgpbhxaneslc7.qitwco2pwa2p:/o4_s/t

utreocFs skema pu 9%9 fo eht deucingr sugra erptnse ni enm.se sihT argus is eddpourc ni eth ilesnam esile.vcs ediinmihsD ellvse of uftserco ahev eneb hswon ot apraelll argnneod dnecyfiice and hte oneesttretso .lleev ligoloFwn eststonerteo ,hpyrtae hte leevl of ceuortsf eAelngtharouh s.isc het rfucesot tste si ont trpa fo a treuino esemn salasiyn, ti is usfelu ni ssaec of orsempaazio bnecase( of rmspe ni mee)ns. nI samiezaorop oyrcsneda ot the seenbac fo vclsiese or if ehrte is na cb,tosituonr no tsofrecu si .trpeesn In rtuetaiscl oemraspzioa, ecutofrs si sret.epn ehnW soaiomepzra nda wlo sneem veomul txsise, eht ftcuores sett ulsohd oals eb no,ed on a elatejsouaptc reiun mepasl to ekchc orf drtreaoger al.utcajoine ishT ucsrco hwen the tejaculae oges niot eth ddblaer eisnadt fo uot teh .hrhTareetu dureepcro orf iemdreinngt eth tuaonm of rufoetcs in emnse svvielno gihtnae nsmee ni a nrgsto cadi ni eth sceenepr fo ioleno.csrr utoFecsr ivseg a dre orocl on(ilevffoS icronet)a dna amy be rdea ni a tht.pomreeo ehT onmalr veagera si m/g1d35L .fretsocu

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sam.l  nkhaT oyu for hte eilapt.xonna Im' ltisl oecnusdf atobu stih wna.rse I swa in tnbewee nZci nda .tusecrfo Znci deyicfcein aols psertnes ithw osaamin gp( 71 trisF diA )902.1 orsueFct is dues ofr hte mnmveeo.t iHs oemrsnoh ear almon.r +4
d_holles  eyrntlaApp bsiaed,te coconisl,u dan mantniimoafl anc ulsret ni โ†“ ecfutosr in sssam.ru eMp et ,al erFt rettS 5,2 7 194w9osci1el4)2rr/e25g0:-r0hs321t/d(t/8fpt0p6.Sr/-f.wett0wa/1t +4
cienfuegos  Tkansh lal for eht fio,n ickuq eton no eth incZ lyerp voabe :m@SIa. amnsaio = stol ssnee fo ellm.s +
sam1  arteG dfni oy! I ebiveel tsih tsuniqeo wsa gaudlnli ot ysictc bsfiosir dan teh lgcteoinan nebaces of hte sav rfednee.s ereH si a lkin ot a JMNE riaeltc obtau ti le b:ow3//tstE/M81r.21092wlgjNwlm5:16w0d0.0/1eo/77o./9uhfpJ60ni1 +1
burak  icnz iieecyfncd uaces ayno.imhpgdos tehre si no admigsp,nyhoo rssepm aer ed?agadm +
fatboyslim  Sa1m@ but iytccs oifrssbi ilwl wohs amblonar hcpysali insdgfin b(ugnc,lbi nyoplmrua arceclks )e.tc ehT useqnoit syas scliypah amxe sowhs on .ornsimiealtab +
pg32  ouCefnds sa ot woh ew can elur uot .c..izn ormF ecsnilmooadt.caedwym: ci"Zn laos plsya a reol in yaelhth empsr opricundo.t oincrdAgc ot a 2108 ervwei eitrcal in hte runJaol of Ruecopiondtr dna ltnire,tIyif nizc cyneidfiec mya ricbountte ot orop eensm ulqyiat dan iir"fieytn.lt +
bekindstep1  gp@32 I ma ton resu fo owh nicZ tctsrniuboe ot mrpes ,roictpodun tub eth nteusoqi saw asgikn uobta lbtansmerioia in eth eenms nad cesotufr si nsteerp in het emsn.e ayeMb icnz splya a role in epsmr eepvemntodl foreeb it si xiemd ni iwht enesm nda so one wiht cinz cienicfdey towdl'nu haev olw in nizc ni terhi mesen aehsrpp, utb ti htrie l.obdo hisT si sjtu a shoyspetih gh.h.t.u.o +
brise  ^^ hYae stat'h ohw I ledru ti ot.u uYo anc idnf tofcrsue in the ,sneme utb you otlwu'dn eb labe ot fdni nczi in eth nemes! tI ihmgt eplh eth emp,rs ubt st'i otn ngigo ot eb ighcnlil ithw mhet +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 elokod iotn shit rruhtfe oot aebuecs I tyrtep hucm nowk noingth aobtu teh aemk up fo .enems From hte secrahre I ,fdnou as as etastd wlebo yb oy, crsotfue is eht otms nttaomipr nsectointtu fo eesnm ni emrst or mpesr nu.tcifon lBweo si ornintomifa I ndufo to assedrd eth toreh wnsrae coh.siec

nciZ icecynefid (in r,msu)e epr ,FA ash bnee aemdcpitli in ydalede nuowd anhl,gei puspdsrsee mn,imtuiy lmea sm,gnioopadyh eecedadrs atdlu riha ya,alxrl(i caif,al p)bi,uc dgsausiey, oasian,m daerirasmtocitm coaphreinteat tdfce(e ni laenstniti czin nitpb,)oraso and yma iespdsreop to lhiocloac rcosii.srh AF i'tddn fispyce teh svelle ni het es,emn btu rep the obwel e,railct nlimaes icnz tontcen saw uofdn to heav nro olatnrieroc ot spnmseem/re clectlet/eayitv./iv I td'no kwon if ewer' uodepssp to wnok ,htat tub wno I ,od l.lo :i/n.7om./3w5/3bcn0nlhi.5m/wswgtut.dehppvb7.

sA rghbyuxon ,nemndotei nelulisme is nloy dnmeteino nceo ni AF as a etntatemr fro aite,n so I loekod onti ti rufth.er nmulSeie is a oncntet of sneem, btu velles ayvr so chmu thta ti serves no tniorcspog cncalli laenveerc ot ytinlfriei,t per isth ie:ctarl v./2lnhnm/nic.eiust:.p1hgpmb2w5t/33wo.0w/bd.

oT eulr out all fo teh wnsaser us(eabce I d'nidt alylre kwon ayhinngt botau het qatiyul fo semn,)e I onduf itsh y"B st,a-citstsit reteh was no nnaitgfisci efdrieenfc in eht smeen Na otarencinncto omang hte eftnrefid gruops 7( gpsrou atotl asedb no emprs cu)no,t dingatiicn the icifigatnnisn role fo aN ni spmre ito.lytm"i. thoi/m/wm:ppg.5ei.172sn2w./w.nb1dbltnuhv/c.

ayliF,nl I ot'nd ktnhi the ah-lap5 seuctdaer eyzenm si alyutcal in n,smee btu I dclou be wo.grn Ehteir y,wa it otu'dwnl eb aolylarmbn dvtaelee or lwo if eht etetrnsosoet levsle rae oma.rnl

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bartolomoose  as rep ajlgo,n mielsune is dvonilve in ntuloghaeit diexoepsar +
chandlerbas  sueemnil sha a lore ni onhgaeittlu .paodeexrsi cesxse mesnueli = cralgi ra,ebth aihr lsso, nda ailn ensa,gch hgtmi ees eherlppria .yeoapntrhu eedyiiccnf (tp no N)PT = daledit piocaryyomtdha +
chandlerbas  osla nicz sida in erpsm itimotyl /rgh/p7liwv7i:tP/n.cm.sn/hote3Cpwwis1nbcl4/8c.9./aMtm ahstt why i hesco iznc but rrweeahvtr mi vreo ti +



 +3  upvote downvote
submitted by โˆ—hungrybox(1277)
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gArniodcc ot eht EUL,SM seeul'mnsi lyno sue is in sneelium selduif sa a tmeteatnr orf a suugnf claedl eaalssaMiz psp (inaeT l.)sicrrovoe

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 +1  upvote downvote
submitted by โˆ—unknown001(9)
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tels aidvo gonl ptoaailexnsn lslah we .

.pt ithw neil.ryfiitt ikquc ttes ni fwe sonsdce = enems oseufrtc

ftac : nieasml eesvilc asekm eftrusc.o

tsnobicourt fo isnemla eclsvie ro enotlancgi ensacbe = wol csfeourt ni mesne = loimtebac aniaecmlb t;&g vcfnetfeiie esmegoestanprsi

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 +1  upvote downvote
submitted by โˆ—meirchod(1)
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I esoander hhgtour hsti one neisc I rlnedea thta lmsiean slcseiev lyheiav sue rlbStoio agrDeehnseydo da(n reasvio &;apm lvier I bleevie ,oto) wihhc nesam yhet rbolypba hvea a alltyrirpacu iatnmrotp ndee fro ctreus.Fo So mroanlab cusferot ni eesnm si ayborlpb tno a ogod gi.sn

.PS. I nerodw if het etiasnnc idd het -sttteatse on tish o..en. ds em(ee to rkow lwle orf eaet)dsib

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 +0  upvote downvote
submitted by โˆ—apurva(101)
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rnsadIece BWsC cantiide tnlegai teincmaiamnflti/nifo,no chwhi anc eald ot orop nemes lqtiuya deu ot hte trionupocd of seiscexev evectira egonxy ecspeis yb kyu.leestoc

ebAtns rucfesot taorcntinonce is na iantcodnii fo a onlitaencg scnaeeb of vas eiseelre/nfsandm eevcs,isl hewli rdcdaseee uetsforc trceooanncnit amy dceainti an yaoctreujla dcut tnosroic.but

pH t&;g 8.0 taindscei onmtianmilfa fo the ste,topar amselni ra,tct iy,misdeipd t.c;e Hp l;t& 27. dceistian simlnea sevceil tndysfuiocn or urcinostotb fo hte jotyreacual dstc.u

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 +0  upvote downvote
submitted by โˆ—nwinkelmann(366)
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So I oekold noti htsi htuerrf oto ceebaus I eprytt uhcm nwok gointnh obtau teh amke pu of .nmese rFom hte hsercrea I ,ounfd as sa ttesad below yb y,o turseofc is hte tsom iatpronmt tutoenctnsi fo enmes ni metsr ro smpre no.tfnicu Bowle is tnoafrnimoi I nfduo to sddersa hte heort wrnsae chiseo.c

Zinc enecidycif in( )ru,sme pre ,FA ahs been ipdtalcmie in edldaye owndu ,hlageni uppssedsre iitymmn,u lema ipo,mygsdonah eredcesda utald hari xa(lyl,ria c,aifla icpbu,) iy,guasdse ,onamsai tdirrsotaiamemc hetairctanope eftedc( in inttnlsaei cizn npros,)tbiao nad mya pseeispodr to oocclihal c.srsirhio AF 'iddnt isecyfp teh seellv in the emesn, tbu pre hte olweb iarlcte, linesam czin ttnocne saw dfoun ot avhe nor oarceoltrin ot /seemepnmrs elicyet/vtticae.v/l I 'tnod nowk fi 'rwee usdpopes ot nwko ha,tt utb own I do, ol.l /wvpn3s/5h5iw:m/bw7o../bn37.gi.hp0luctdntme.

As yrnbguoxh dneitemno, elinluesm si nloy iomnteedn ceno in AF sa a atrmettne for tiane, os I dokole iton it u.efrrht emlSnuei si a ocnntet fo ,eesmn tub elsevl vray os chum thta it vesser no iporgcostn clicnal aelvrecen to t,nrteifiiyl epr hsit elcriat: vdm.p3/ww315ince2lh2t.tbm/gih/w.snbo0:p/u.n.

To lreu otu lal fo hte earsnws besuca(e I tdn'di eyalrl nokw ynanhtig buota het yalqitu of ene,)sm I onduf htsi "By s-itstscti,at ethre swa on scitaifnngi rifnefcede ni eth nmese Na iteootncnarcn noagm hte eefnfidrt psugro (7 srguop attol edsba no esprm ,uton)c giaidncnit eth nifngatiiscni orle of aN in prsme tm.lti"iyo. tng/wu.v12:dpe.lwmnc2./hb/mion/i1swh75bt.p.

lliaFny, I notd' khitn the hlp-5aa uardscete myenze is llcuyaat in msene, ubt I uoldc be .ogwnr irehEt w,ya ti wtn'dluo be nryalamolb aedlteev or low fi hte otnstteereos elslev era on.mral

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 -1  upvote downvote
submitted by flexatronn(5)
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oyu lal era lnikoog awy oto eped otin .shit

sThi was a ispmel caft larlec ouseqitn. ehnW you ese nseme + nitifltyrie ni a sutneqoi nad csuoertf in eht ra;ewssn its mnees = foesruct

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