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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 tusj nekw htta pesrm eend tsurco,fe otn esur thwa sieesda socserp siht is oh.tugh eH saw ptyter aonlmr so 5a arsuaecedt tsdnoe' eprestn lkie .thta I nwst'a eusr if heert asw nya ddo esu fo het torhe snsra.we erhe si a .kinl lFee erfe ot .pxenad

m2./s/cussttp:awnxoawt2.c/w4._pelgoqp2iseb7h

Fuosrtce askem up 9%9 fo eth udgcirne ragsu tepnser in sm.een Tihs rasgu is ddouperc ni het mnaseil vlesis.ce niemihsiDd slelev fo ofesrtcu vahe neeb wsohn to leaplral onneadrg ciyiefencd adn the tesnsteotore .veell llnFogiwo teretntsoose pat,yhre eht ellev of esrcofut glahrAeh uic.nosset het uefcorst tets si ton ptra of a rnietuo esnme sisy,alna it si lsueuf ni casse fo emrpoozsaia esbcean( fo rpesm in es.)enm nI maoepozrias aodcsrney to eht bsaecne fo eevcslsi or fi hrete si na ntutboc,rios on coerufts is etnspre. In rtctsaiuel ,oeosiramzap rectuofs is eptnsr.e nheW aoieopzrsam dan lwo nseem ulvoem xessti, het stocruef tste uolshd aosl be onde, on a psltajceaetuo erinu pamlse ot echkc rfo grdtraeoer uoaatilncj.e shTi rocsuc hwen teh ajelueatc oseg onti the drdebla aditnse of uot eth .hueta rherT udeorrecp orf nieinrmgted het mtuano fo ercostfu in mnees svleonvi angeith msene ni a nsgrot adic in eht cesenper of .sncoreroil rFeoscut ivges a edr olcor Svlnfoi(eof trcenaio) and may eb reda in a topr.mteeoh hTe lnroma avgraee is 3g/mL51d er.stcouf

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sam.l  hnaTk you for the xen.oltipana mI' tsill cfuoedns oabtu isht nsrwea. I asw ni ewntbee Zinc dan trfeosuc. niZc defiiecycn aosl peesntsr hiwt onasami pg( 17 rFtsi idA 291.0) utroFces si sdeu ofr het mo.teenmv iHs sohenomr era molra.n +4
d_holles  tpanApelyr eidabest, olcnoui,cs dna ointflanmmai cna lutsre in โ†“ uorstcfe in se.aumprsMs te al, tFer trSet 5,2 1749 iaet2wc-(4eowrpfS0eg3pht28st1f/0/rtt9rw1.:2t-l5)r0//1.6s0d/ +4
cienfuegos  hsaknT lal ofr hte ,niof ucqik tnoe no eth Zcin pryel eaovb .@maSI: imasnao = tlos ensse of lml.es +
sam1  tGrea ndfi o!y I ebevlei itsh sioetqun swa ungdiall to scityc orbisfsi nda teh oanclegitn ebncsea fo eht vas fedr.esne erHe si a kiln to a EMJN ilrteca ubato it : oelbwjm/iJM0657tsw1h1wur0o1n2/:/fg1N.pe0o/7l0810/d3l2E..t69/9w +1
burak  zcni eiifcndcey sacue hodsm.angypoi ehert si no a,poyidgomhsn psemsr rae emag?add +
fatboyslim  1amS@ tub stciyc ssbfirio illw oswh lrbmnaoa lsyipahc iingndsf bng(culi,b rulmaonpy lcarecsk .t)ec ehT tsnqieuo ssya cailhysp xaem sohsw no saornemibt.lai +
pg32  onufdeCs sa ot how we nca reul otu icn..z. rmFo woydm.dclaemacesoint: iZnc" osal laspy a elro ni hhyatle erpms tridc.uopno droccngAi ot a 8201 eiverw itcelra in het lrJnaou of cenpdRiuoort adn y,tltfeIriin cizn fdiyeecnic yam nretuoictb to orop senem qaiyltu and lte.y"niftiir +
bekindstep1  3@pg2 I am ton srue of ohw incZ nosrbuitect ot sperm opitn,drcuo tub the ieotsunq aws aigskn ouabt ltbeamarnoisi in het nseem and ofusrtce si trepsen in the ee.mns bMaye znic spaly a lore ni pesrm vneplomedte obfree ti is xdmei ni twhi eenms nad os oen ihtw nczi cicenfeidy lwu'tdno vahe lwo in zcin ni terih sneem srea,php tub ti rehti l.obdo hTis is tsuj a shoihytpse .hu.hog.t. +
brise  ^^ aYhe 'sthta who I durle ti o.tu uoY nac infd cfrusoet ni eth eme,ns tbu ouy 'twudnlo eb aebl to nifd cizn in the sneme! tI gtihm help eth ps,mer ubt s'ti ont niggo ot eb hginllci htwi hmet +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)

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 +8  upvote downvote
submitted by โˆ—nwinkelmann(366)
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So I oeokld ntoi isth uhfrtre oto beasecu I tyerpt hmcu wkon ghnntio buaot hte meka pu fo menes. orFm hte rershcae I fdno,u sa as sdaett bolwe yb yo, ctuseofr si het mtos oprttainm sntiucotnet fo nseme in erstm ro msepr uotfinnc. leoBw si roaftnioimn I fdnou to dssedra the tohre nsewra iscche.o

ncZi cdifyeeicn (in u,res)m per AF, sha eneb mitpalecid in aeelydd downu neghali, spepuersds yni,mmuit eaml gpoo,hnmiydsa arddsecee ludta aihr ayllxa,r(i cfi,ala c)i,pbu ,easysgidu mon,aais aidtirorcsatmme aeioptenhratc et(fdec ni nttinsiale iczn rs)btnooa,pi dan yma edrsspeiop to lchaciolo i.corshisr AF tdind' ypsefic het leevsl ni the seenm, tbu per eht wbeol ,arteicl salenim incz neonttc was fudno to veha rno cotrroalnie ot nsspeerme/m yi.lettcvatviel//ec I dto'n kown if 'rwee sopuepsd to nwko t,hta tbu own I ,od lol. //.w.w/tp5nld7bv.ihig3t/bunn5hps0oe.mmc7w3:.

As guhyorxnb mn,iodeent suinlleem is lyno tennioedm eonc ni AF as a tetremnat for ,tneia so I lkdeoo ntoi it ertruh.f eSlminue si a nenctto of eem,sn btu lelesv aryv so cumh hatt ti sveesr on oiorcgnpst lcalcni ecraevnel to rltnif,etiiy pre htsi r:ilceta u5hbg0.tentwp./h//sic.3wpnm22mio:wb1.v3/ldn.

oT lreu tou lla fo teh sarnesw eeusc(ba I dt'idn alyrle wnko thgnniay ouabt eth yilutqa fo ,)mense I ufnod itsh y"B asstsiittc-t, teerh wsa on niifngcsiat nefedeifcr ni eht eemns aN rncoentcinota namgo eht neifetdrf uspgor (7 sorgup oltat ebsda no sprem ,)octnu tnnigdicai eth citinfgnsaiin rloe fo aN in repms til.yi".omt seipnthuw/.:2bdn.1/1l7m/t2c/n5phgvw.iwmob..

naiyFl,l I t'don tknhi eht -lphaa5 teuesadcr ezmyne is ltyuacal ni nee,ms ubt I udloc eb wnogr. erEiht way, it d'tnwolu be omlnlraaby aleetdev or owl if eht sereosttotne lelsve rea mol.nar

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bartolomoose  sa epr jnalog, sluimene is vvlodnei in getotiuhlna posrdaiexe +
chandlerbas  elueisnm ahs a orel ni teaignlhuot px.osedriae csxsee uesilmne = cligar rtaeh,b ahri ss,ol dna ianl ,senghac htmgi see erihpalerp toheurpa.yn ceicynedif tp( on NT)P = dedliat iyaaptmcyorodh +
chandlerbas  osla czni adis in rsemp tomyitli ec/agnmirs:whl7c.n14otn/8lh.twiCp7swP.bp/3/tm9v/ciM./ tshat hwy i ohesc nczi btu rvetahwrre mi evro it +


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 +3  upvote downvote
submitted by โˆ—hungrybox(1277)
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crAdgnoic ot eht ,ELSUM sls'eiunem lyno seu is in liemesun ifsedul sa a amnrtteet orf a uugsnf laedcl lsMazaisae spp (Teain r)voeorcls.i

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 +1  upvote downvote
submitted by โˆ—unknown001(9)
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tsel divao long sixotelnaapn ahlsl ew .

p.t wtih .ytifientrli qckui etts ni wfe enscosd = smeen cotsurfe

catf : eamlsin leseicv mkase ero.usftc

btcrouonist fo lmaenis eclesvi ro gcoanetinl eacesnb = lwo tcosurfe ni esemn = oaclmebit enacibmla g;&t fefetieivcn gsosainrpteemse

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 +1  upvote downvote
submitted by โˆ—meirchod(1)
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I seorenad huorthg thsi one sncie I daelern htta islenam silsvcee yhealvi eus Srtiobol oDysehangrdee a(nd ioraevs &am;p leriv I velebie ,oot) iwchh esanm heyt blyorpba vhae a riapulrlycat imotrntap ende orf ec.osFutr So orblnaam trufosce in eemns is bpraybol otn a odog gs.ni

..PS I rwndeo if hte senatnci ddi eht tsets-teat on tsih no...e s em(ede ot owrk lelw ofr de)ebstai

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 +0  upvote downvote
submitted by โˆ—apurva(101)
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eacdrIesn BWsC nedticai ignltae a,caoofnmteilnfiniit/mn cihhw cna eadl to opro nmsee taiyluq due ot teh nocodutpri fo ecxsisvee caetirev exgnoy cieesps yb lkeeoyctsu.

tebAns sfoctuer nrcttocenioan si an nicoatniid of a incelotnga bcaseen fo vsa lnreeaem/fdenssi seice,lvs whlie ceeardsed soufertc ornctnaoentci aym edanciti an taolrauecjy ctud tuorb.snocit

pH gt;& .80 aiinstecd naiotnlmfiam fo eth oae,rptst sleinam rtt,ca i,esmyidipd e.t;c pH ;< 2.7 iciatedsn lseiman csievel tcysdnifnou or nisuorottbc of eht olarcutajye ducs.t

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 +0  upvote downvote
submitted by โˆ—nwinkelmann(366)
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So I kelodo iton tshi erfrtuh too cbeesua I etyptr cmhu knwo gonhitn abotu eth mkea pu of enem.s From the rerasceh I o,fudn sa as tsdeta wlboe by ,yo csreoutf si eht somt toptinmar soticutnnte fo senme in tsrem ro smper unnc.tiof ewBlo is tiomfonnria I ufdon to sdsrdae het rhtoe nsrwae esicoh.c

cinZ eeciyfdcin n(i r)s,meu per ,FA ahs eebn dieptimalc ni yddeeal oundw ihn,aegl sduprepsse yitnuim,m eaml ipda,ohsynomg deecserda dtaul aihr a,raxlliy( ,ilcafa ubp),ic deiasgsyu, na,aosmi tmramaioedstirc ecpaeatrihont d(efcte in nisnailett incz osr),pnatobi and aym eperpossdi to lciolcaoh rcishoisr. FA 'tnddi cysfpei the elvesl in eht snee,m btu pre het lwobe lreaic,t mnsilea iznc ntconte wsa ounfd ot ahev onr ntreooicalr ot mr/enspseme /vceeyli/.lcvtttaei I 'dotn nkow fi ew'er seodppus to nkow ,htta tbu nwo I od, .lol w3.dvctshi//wmg5tbim.ohp5p7l../nn3wn0:u/be7.

As gxhuroybn ,noteedmin smneellui is noly enetiodnm neoc ni FA as a ttrtanmee for aei,nt os I odleok onti it htfe.urr Sumleein si a toncnet fo nsmee, tub evells rayv os umhc thta ti erssve no orctnoisgp icalnlc neeveclar to lintiiryf,te per tihs ecr:ltia wmhi2/dbp/5bcoh0/nun3tt...3iw.n2gv/1em:wspl.

oT eurl uot lla of hte easrwsn (ceasube I 'ntddi lrlyae nkow htnanigy utbao het iuqtyal of esn),me I dfuno tish "By c-isststa,itt htere asw no gsntiniifca fnefeicedr in eth mnese aN otcaennnroict omgan the etrnfiedf srugop 7( orpsug tatlo dbaes on msepr ,uno)ct dignicniat teh fgicnininasti oerl of Na ni prmes oimlt.".tiy dtnvb2nop1ewh.pw/t7:1bl/u.sm/n/2c5h..iwgmi.

nF,ayill I to'nd hnkti the h-5paal suetadrce yzenme is ltcylaua ni emnse, utb I lcodu eb ngro.w etiErh a,wy it dwoultn' be yrlbmlaona tdeevlea or lwo if hte orseettstneo ellvse rae lom.rna

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submitted by flexatronn(5)
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you lal are likongo way oot pdee iton .sthi

shTi saw a selipm atfc claler ensqit.ou hnWe yuo ees emnse + ytiieitfnlr ni a ueoniqst and fcestoru in hte wsaes;nr ist menes = fcuoster

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