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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 juts ewkn atth seprm edne usfoc,ter tno erus whta esaeisd ospsecr ihst is otuhgh. He swa ttpyer rmolan os a5 tdcraeusae ontsd'e eprtesn kile th.at I twan's seur fi rethe was nya odd ues of hte heort .nrswsea hree si a i.lnk eleF reef ot da.xnep

2.xwiwa/:2ppss4qm.hoetcpoa/sl.w_ngtt7ecubs/2

ocsueFtr kames pu 9%9 fo eht dnrgciue ugars serepnt in esnem. isTh agurs si ddecpuro ni the nslmaie vclsesie. hesDiimdin slleev of stucrefo ahev nbee ohwsn to learllpa agndoren fyieccined adn hte tonttoesesre .level owFlnligo eotstronetse yptrea,h the llvee of sfuorcet Ahuclroenshigs eat. het ecrtfsou ttes si ont arpt of a rieuton meens s,ailynsa it is eulsfu in caess fo osazmepairo saee(bcn fo mpsre ni ne.)mes nI aosareoimpz crensayod ot het ncasebe of sevelics or if hteer si na brsoicnottu, on ecurofts si .senertp nI uetaltcirs zioapmorsae, fcouerst is pterse.n hneW orzpeaaismo adn olw smene lvoeum sitxse, hte seocuftr estt dlohsu salo be ,enod no a ujepaeltoscta urine samepl ot cekhc rfo egorradetr aeaucjit.nlo This rucsoc nehw the ajcatulee seog iton the dabedrl tdneasi fo tou eht ee hruatThr. pcedrroeu ofr iegendnrtmi the omanut of cetsurfo ni ensem nsvilove gitehan mense ni a tsogrn iadc ni the reepencs of cln.oerosri tecosrFu gveis a edr ocolr foSl(oinefv tnorcie)a dan yma be ader in a mope.ttoreh The nrloam vaaeger is 1Lg3m5/d .eocurfst

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sam.l  ahknT oyu rof eth oiepaxnalnt. m'I ilslt dfsueonc tbuao isht nwasr.e I swa in enewtbe incZ dna ufteocr.s cinZ cydfineice oals stenpsre hiwt aomsnia g(p 71 rFsit iAd 129).0 cstourFe is sdue for het m.onvteme Hsi heromsno era lmanro. +4
d_holles  etpanylArp bstidaee, siuolc,noc nad ntoamfimnail anc sulter in โ†“ uorstefc ni epsaumr.ssM et la, rteF rtSte 25, 74911rp2-4ettr10e96i(:0rpdtewa/2g//-o1/.tc8wttr3w0fls2)s.f5/h0S +4
cienfuegos  Tkahns all rof het fn,oi iqcku oent no the icZn yelrp vebao Ima@.:S anosima = sotl neses fo ell.sm +
sam1  Geatr idfn !oy I belivee itsh iotqunes aws uigadnll to tyiccs foisrbis dna teh oilctgnane eaebnsc fo teh vas enfedrs.e erHe si a inlk to a JMEN ctraiel obuta ti eobw l:e/0t89.1h/jfM//.26Jdigw:1.m5ol30rn/w71s1E/210t6owl09N07pu +1
burak  nzci icedfciyen acuse yonmagspioh.d eehtr si on gopoi,ymnadsh sprems rea g?dadeam +
fatboyslim  @am1S utb cisyct oiirbfss ilwl sowh raabmlno ayslchip singifdn cbnigb,(ul ronymaplu serlakcc etc). The itsonueq ssay iysalpch exam wshos no abm.siltneraio +
pg32  nCduoefs as ot hwo ew nca lreu otu n.c.iz. Frmo de.atscwlamdoonieycm: "cZni osla pasyl a leor in hyahlet rmsep cntodurip.o rncAdogci ot a 2081 ewvrei letcrai ni eth rlaonuJ fo octRudirenop dna rfnIlytetii, iczn ficnecyide may cutrniboet to opor ensme tqiyaul nda r"tieftilin.y +
bekindstep1  g23@p I am not eusr of hwo ncZi otuesctrbin ot repms ,rdoinoctup tbu eth eoqituns aws aksing otbau einlaombstrai in teh neems nad fsreocut is trpnese ni het e.msen bMeya nicz slapy a orel in pmsre lvnpodeeetm orebef ti is ixdme ni htiw mnsee and so oen whti nciz iyncedeicf ol'ntduw evha owl ni czni ni ithre esmne pspa,rhe tbu ti terih bo.dlo Tsih si jtsu a tpohhisesy hu..gt..oh +
brise  ^^ Yaeh htas't ohw I ueldr it uot. uYo acn nfid ocsuefrt ni eht emn,es ubt you loudw'tn be bael ot ndfi zcin ni eth m!snee tI tgihm lhep teh merp,s ubt t'si tno ongig ot eb glnilhci htiw emth +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 odloke itno isht terruhf oto usebeac I rypett mchu oknw thniogn tuabo het emak up of .enmse mroF hte rescaehr I nodf,u as as eatstd lbewo yb oy, rcfesuto is the toms ioantptrm cetiosnuntt fo nseem in ersmt ro rspme iotfnun.c wloBe is otfoninimra I nfudo ot ddesrsa teh tehro swenra occhies.

Znci fiiyccdeen in( u,mre)s rpe AF, hsa nebe eitpcmaidl in yleadde wduno gnlha,ie resupspesd yniuimm,t elma hsoyomapi,ndg ecasdered tudla hira yara(lxl,i c,lfaai u,cpb)i aesydugs,i nom,aais dsimtamtiocerra centpohaaitre t(eedfc ni tenitalnsi cniz aponrt,i)bos nad may erpspdsioe ot oclclaiho o.scirirhs FA 'dtndi espficy the veesll ni teh msen,e ubt rep het owlbe rilec,ta laimnes inzc tetnnoc swa nfodu ot veha nro ltororaneic ot sepsmeen/rm /ctei.lva/ttiveelyc I otdn' nowk if er'ew spsuoedp to konw ,ahtt utb wno I ,do lol. bm7uw.vd5w..05/7pmlnps3n.3n/b/hweti:/hgcoit.

As ogbryhnxu iont,mdene eslenmiul si noly dmtoieenn ocne in FA sa a aentmtert rfo teina, os I lodeok oitn it .rtrehuf nSeeimul is a ntnteco fo em,esn tbu lvlese yvra so hcmu ttha ti sverse on orpsignotc cllacni cnraleeev ot tnieyifil,rt epr hist retci:la 0/52/wbwnn.p3p:hdbv//mih.nmg2cu.tsi.1owt3le.

To ulre uto all fo het rawnsse acee(sub I ddni't alyelr knwo ihntygna uboat eht tyaiulq fo e,sm)ne I fodun htsi B"y ,-tttsicsstai rehet aws on ctnsnifgiia fcdefrinee in teh snmee aN ortncanenocit onagm teh feiredtfn ousgpr 7( gspour altto sabde on mpesr nu),otc tiaicgdnin the tiiifacgnsnni olre fo Na in emprs ytiomt.li." tbniwd..5/n.hhv:2wpgscui2/1lm7te/1/p.nobmw.

,aiylFnl I dn'to ihtkn eht lha-ap5 tuerdaecs mneyze is cayltula ni ,emens btu I uldco be wgnro. itrEeh y,wa ti t'odwuln eb yoalblamrn tldeeeva or olw fi the eretsotntsoe leslve aer .mlnaor

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bartolomoose  as per alng,jo ienluesm is nveliodv in agotthnlieu saexdiepro +
chandlerbas  suieelnm has a elro in uaotnihlteg orexse.apdi esexsc mnseiule = grcial bhraet, arih s,osl adn nila gcnhesa, mtgih ese airhleeprp npeyrtauh.o nyifeciecd p(t no )PTN = eatldid aotaychdiropmy +
chandlerbas  also nzic idsa ni rpems ytmioitl g.//s3.hast8prtwp/9i4hnnbwmel:/o7wcic.1m7i/cPnvClM/t. ttsha yhw i ehsco czin tbu rvwtreerah im erov ti +



 +3  upvote downvote
submitted by โˆ—hungrybox(1277)
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Anodcrcig to het LEUSM, smlniue'se noyl eus si in mueenlsi sdulefi as a netrtatem rfo a nuufsg lecdla eaazslaMis psp aTni(e ierc.rsvlo)o

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 +1  upvote downvote
submitted by โˆ—unknown001(9)
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lset dvaoi nogl nltipsoanxae slhla ew .

tp. thwi tyliitnir.fe qkcui ttes ni ewf soecnds = enmes osrtuecf

ftac : lsaiemn eicesvl amkes utofesrc.

rubniscotot fo inaeslm lsieevc or gtoencnila naebcse = low ftouscer ni mesne = temicaolb enabmclia tg;& eefeiicntvf samnogpserisete

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 +1  upvote downvote
submitted by โˆ—meirchod(1)
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I erdsaneo hgutrho isht noe senci I eadlenr hatt iseanml eeislvsc lavheiy use trolbSio hneegoareDyds dna( ievsora a;p&m ilver I beieelv o),ot cwhih samen ythe yorbapbl aehv a ucatiaylprlr trpnamiot deen for uFoertsc. So bamolnar coutsefr ni nesme is yrlbopba tno a godo g.nsi

P..S I rnewdo if the ntiacsne idd het tt-taetess no sith .on.e. meeed(s ot kowr ewll for betsdi)ae

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 +0  upvote downvote
submitted by โˆ—apurva(101)
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Iarednsce BsCW ndieatic nletgia toc/nffanno,imaneiimlit hhiwc anc laed ot poor nemes taqliuy due ot teh dornuioptc fo ivxescees vtcieaer xneyog cepiess yb yukeeclos.t

netbAs eoscfrtu tarineconocnt is na adnictiino fo a lgaconneit abences fo sva nrssm/dneefeelia veil,cess iewlh ardseedce urtsecfo ceniotonrcatn yma ditincea na uycalojtera ctud c.tbnriotuso

pH &g;t 0.8 nciitsaed ifonaamnimlt fo eth treo,taps mieansl c,tatr imdipdys,ei c.et; Hp &tl; 2.7 sainditce amiesln vlceeis sofdynuicnt ro incrtsuotbo fo eth ctraauljyoe s.tcdu

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 +0  upvote downvote
submitted by โˆ—nwinkelmann(366)
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oS I keolod into stih rrhutef too eascbue I tpyrte uhcm wkon igonhnt tuoab hte meak up fo s.emen Fmro het ceahrrse I n,udfo as sa sdttea beowl yb ,oy ousrefct is hte tsom morttnpia tnuseotcnti of emnse in smret or epmrs onu.ftnic eBwlo is inrifoatnmo I ndfuo ot dedrsas eth hreto nasewr ichse.oc

iZcn eindcefyci n(i e,r)sum epr FA, hsa bnee piilcetmad ni yddeela downu eglha,ni edsppsseru mtin,yuim alem iagyn,phsodmo ceraeedsd ltadu riha r,laa(iylx aai,cfl ,i)cbpu ysiad,gseu ,aiamnos rtesrdiatmamico aratoeicehptn detec(f ni insinlatte inzc pisnro,b)ota dan yam srepidosep ot ciolocalh irihscs.or FA ddn'ti pcfsyie het esellv in hte mn,ese utb per the ewblo ,raitcel msianle znic ottnenc swa ofudn ot veah orn rarnteioclo to p/resemnesm le.evi/ctyltcea/vti I odnt' wonk if re'ew sspedopu to onwk htta, utb wno I ,od .llo i/sopmb5wh/e.3t5.nl7hdgw7n/tp:cm/uw03i.bn.v.

As xbgnryohu ndim,etneo elnsmeiul si lony diomenten once ni AF as a nearttetm rof ian,te os I oldoke onti it trh.uref euenlSmi is a totnnec of ne,mes btu lveels ravy so umch ahtt it rvssee on srniotgcpo ccllani erlncveea ot intrfiiey,tl pre this a:erclit n.h5ngtp.cwu1m.ld/2ihmti2s0p//e3.novb:/wwb3.

To ruel uot all fo the srwneas eabcseu( I di'tnd layelr nwko nigytnha bouat eht iluqyta of e,mn)se I foudn sith By" tacs-,titists hteer wsa on gatisniifcn eecffeidrn in eht msene Na ctaooceritnnn agmon het efnrdietf gouspr 7( uprsgo atlot bdsae no epsrm ,)unotc ncitganidi het cnianifsitgin loer of Na ni pmsre yli"t.o.tmi m/thw.sun25c1gi/h.bvpin2bl/ont:.wdp7e/m1.w.

l,laiyFn I on'dt tihkn eht lhap5-a sdruacete nemezy si alatuylc ni mnee,s tub I duolc be n.wrgo Eherit wy,a ti owu'ndtl be byaorlamnl dealteve ro wol fi eth tetsorosntee lleves era rm.nalo

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 -1  upvote downvote
submitted by flexatronn(5)
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oyu all rea oknglio awy too depe oitn ths.i

iTsh saw a pilmes cfta lrealc eit.sqnuo eWnh uyo ese meesn + tnrifiiltey ni a etisnqou nda oeustrcf ni eht esr;aswn tis msnee = frcoseut

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