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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 just kwen tath rspem edne r,sofuect ont sreu hatw iasdese srpsceo itsh si go.thuh eH wsa yettpr nolmra so 5a treuasecda dnseot' esretpn ikle tath. I 'santw uers if there wsa yan dod sue of teh rohte srse.naw rehe si a .klin leeF eefr to nxep.ad

usp4gsplqt//hse2.ttiow:x.cn/27epswaw2bao_c.m

rucosteF easmk pu %99 fo eth dcginure sraug retpens in .esnme Tish rgsau is cuorddpe in eth liesamn .ecslisev imsdeiDinh llevse of orusecft eavh enbe nowhs ot llprelaa nneargod ceicieynfd dna het rsotettensoe lel.ve llogowiFn trteseetoson etyahp,r het velel fo crtsuoef elnoir hhge.suacAst the oerftscu estt is ton atpr of a rouitne mense lnsayi,sa it is lueufs ni cseas of smrezoopiaa eas(encb fo ermsp in s.eenm) In aazmroeosip senorcday ot eth cbaenes of ievesscl ro fi ether si na urisobc,ttno no rctfoseu is t.nserep In tuecsrlait amesorzip,oa tscfreuo si eretn.sp hWen zseraopomia dna owl smene olvmeu xet,ssi eht resufoct tset lsduoh salo eb eno,d no a teojpascaleut iurne plesam to hecck rfo rtraoergde ita.euclnoaj sTih rucosc nehw eht cateaeujl gsoe noit eht debdalr aentids of tuo het utha.hr ereT eepdruorc for inimeengdtr hte tmnuao of stuorcef ni smene vovinsel atehgni esmne ni a stogrn caid in eht ceesepnr fo neilo.crosr rctFosue vsieg a rde orolc fofiSlven(o )coateirn nda aym be ader ni a mhoerptote. hTe ronmal gaaveer is 3/1mLd5g oef.tsucr

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sam.l  Tkahn uoy rof teh t.eananxilpo 'Im isltl ufncsedo utboa shti era.wns I aws ni tewnbee cZni and fosrtecu. nZci fedyicecni slao tesernps tiwh asaimon g(p 17 trisF idA 2.1)09 sceutoFr is esdu for eth vmot.eenm isH rehnomso era lmnra.o +4
d_holles  eatAlrpnyp at,ibseed iscou,clon dna atnfminaimol acn eutsrl ni โ†“ roecustf in umapsse.Ms r te ,al trFe etrtS ,52 941 7-ih2t0r3rp4w:w.)sdetc910/etr./e8ot16/Spfs0ta-52(1t2rg/f/l0w +4
cienfuegos  Tashnk lal for het ,foin kiqcu otne no hte inZc epyrl vboae IS.:@am sanomai = tslo eesns of ls.mle +
sam1  eGrat fdni !oy I velbeei ihts oinstuqe aws ludiglan to csycti sisifrbo dna eht ltcoaennig nbacese of het vsa .rensfdee eeHr si a nlki ot a MNEJ tiarlce btauo ti o:ewl b761o18/dho0t/gnmtl15.w0/i32rsw2wf7j./p99Ne/:/lJ06E.1001uM +1
burak  nzic cifecnydei asuce dos.nmaogyphi rethe is no ism,ohgydopna psemsr rea ed?amadg +
fatboyslim  ma@1S utb scytci fosirsib llwi ohws oabmlarn ahyipscl fnisdgni gln(uicb,b plymaonru eckalscr .cte) eTh otqnisue ayss pyachsil amex owshs no oislrti.eabman +
pg32  noufesCd as ot how we acn relu tou .cin..z Fmro eaanyemodcdmol.sicwt: Zi"cn slao ypals a oerl ni tyhhlea rpems rdotnp.cuoi gonArcidc to a 2018 eevwri tcilear in the onaJlur of iprdetunocRo nad tlrntfI,yiie icnz einecciydf mya ioetbnurct ot roop enmes tluyaiq adn "tir.teiilnfy +
bekindstep1  @g32p I ma ton rues of who niZc bintuesrtoc to empsr ronutciodp, btu teh sqniueot aws gsnaki toabu mtioslbriaean ni eht enesm adn rofeucts is rpesten ni eth s.mene Mayeb icnz lpysa a erlo ni remsp ledveotmepn ebeofr it is imxed in tiwh nsmee nad os noe thiw czni cefindeiyc 'ondtlwu avhe lwo ni znic ni theri esenm hrsa,epp but ti ehtir .bdool Tsih si tsju a htepoyhsis ...hgu.toh +
brise  ^^ heaY hastt' owh I edrul ti tu.o Yuo can fnid torecusf ni eth mee,ns tbu ouy n'wolutd eb aebl ot ndif cniz in het eemsn! tI tmihg ephl het remps, utb 'tis ton ingog to eb ilhglcni iwht htem +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 kdloeo oint tshi ufrrhet too ebauesc I yrtpte ucmh wkon htgnino buoat the mkae up fo .enmse moFr hte hrceraes I dounf, as sa stdtae lweob yb oy, stfecruo is het toms rtatimopn ncunseiottt fo nsmee in rsemt or sprem nint.uocf weolB is mtrofoiinna I noufd ot ssddear teh thoer ewrans scoc.ieh

Zcni eidicencyf (ni us),mer erp F,A sha nebe pecaiidltm in aeyddel uwond h,igelan eedpssprus iiymntu,m lame giy,oadosphnm dsacedeer uldat riha llayai(,xr ,aiaflc )ip,buc ysg,duaise ino,amas rtemcatasiimdro eicaenhtorpat de(tfce ni intanlstie znic snoritap)o,b adn yam rsepedisop to aolichlco osihiscrr. AF di'tnd yscpife eht lvlsee in teh snm,ee utb rep het bewol eltc,iar eiansml iznc nntoect was ndufo to haev nor catrleiorno ot rmns/emepes cleaiy/ctvltt.ei/ev I 'tdno oknw if ree'w sepdspuo ot wokn ta,th but now I od, llo. g5to0pmvw//d7p:ni7t.bwli.5nmwb.nu//3se.h3hc.

As ugynxhbro tem,iendno lenmseiul si onyl nodemeint enco in AF as a natteterm fro ,naiet so I oekold otin ti rtufhr.e eulienmS is a ncetotn fo mense, tub vselle yavr so hucm hatt it sreesv no gtoionspcr cicanll leceenrav ot iftti,lyrnei erp isht tli:ecra .wh2hpe./lw.0mn1.p/cbg/:uonit35dwb/inv2t3ms.

To lrue uot lla of eht awssner sab(euce I idd'nt elyrla nkow atginhny ubtoa the aulqtyi fo ms,n)ee I nuodf tish B"y s,ttstcts-iai etrhe saw on sfacinitngi eeercfndfi ni het eesmn aN tctornncoeian amogn hte feeniftdr ogrspu 7( rpgsou oltta bdsea on emrps tonu,)c gindintaic eth isicnnigtainf lore fo aN ni mrpes o"lymit.ti. muw/sgmect/1ovn.n:ih.5w2/bh1t27pli./bwn.dp.

Falyln,i I ntdo' ntkih eht 5aa-phl scaretued nymeze is luacylta in esnem, btu I ocldu eb gnorw. rEthei ,ayw it uotwn'ld eb nlbroaylam dlteveea or wol fi eth tnoreoetsets slleev are .loanrm

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bartolomoose  sa per anlj,go meeunsil is nodlvive ni gtaoinehutl reaoisxepd +
chandlerbas  esuimeln sha a leor ni tltnuheigao esdxepairo. xcesse eemlunsi = rlgica rah,teb arhi ls,so dna nila ahgse,nc htmig see arhiereplp yehaoptrn.u ecdiiefycn (pt no )NPT = dltiaed omahdptyroicay +
chandlerbas  olas nicz sadi ni esmpr lytmtioi hCcwn///esltini.P4M.tpv:c79wibrw./hmlmc1san/3g7/.t8op thsat wyh i escoh cnzi but rhrwvetare mi voer ti +


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 +3  upvote downvote
submitted by โˆ—hungrybox(1277)
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gcoAindrc ot teh ES,LMU eeumsilns' ylon eus si in iesmleun efdsuil as a tteamtenr rfo a uugsnf lacdel sizlaMaaes pps (nieaT siorv)role.c

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 +1  upvote downvote
submitted by โˆ—unknown001(9)
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stel iovad lngo palniatonsex hsall ew .

t.p twhi lf.einiitryt quikc etst ni fwe nscsdoe = sneem oecrutfs

tfac : lnsaime vseecil easmk eocf.usrt

nriootcbuts fo ilaenms lvcseei ro icoalnngte nbeeasc = owl focersut in mnsee = miebotcla bnalceiam t;&g eievicnftfe nssesiaeegprtom

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 +1  upvote downvote
submitted by โˆ—meirchod(1)
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I adonsree rghouht htis neo eisnc I ndrlaee tath mnasiel svceiels viaelhy ues lotoirbS hnosedrgaDeey d(na ivarsoe a;&pm lierv I beeevli to,o) ichhw menas yhet brblpyao heva a alcultyairpr mrpanoitt eend for seuForc.t oS blamoarn scetrfou in mesne si baypbrlo otn a odog ng.si

.P.S I wdorne fi eht iaencnts did eth aest-ttets no ihts o..ne. es de(em ot wokr lwle rfo sabd)etei

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 +0  upvote downvote
submitted by โˆ—apurva(101)
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nsdraIcee sWCB ectandii tlgneia nfcnomlf,nitnaiit/aeiom iwhhc anc aedl to opor nesem iqtlyau due to eth oiruotdnpc fo ecixevsse erciteva neogxy ipseesc yb ukleoyetc.s

tsbnAe sfueroct otncnrnotecai is an ioinatcnid of a naeitcolgn nscbeea fo avs eenrsedaisln/mfe vc,sieesl lewih erddascee efuoctrs inenarctoontc yam iceaitnd an tojrcaeuyal tdcu nrbio.ocutst

Hp t;&g 0.8 tsecniadi mnimlftnoaia of eht toatrse,p emsanli ,ttcra yieipsmddi, ;.cte pH ;lt& 7.2 esiatdinc malinse lceevsi cndfonyusit ro ostbuinrcto fo het ujyaaocrtel .sdcut

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 +0  upvote downvote
submitted by โˆ—nwinkelmann(366)
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So I okodle onit ihts rrufthe oot sebucae I tyeprt hucm okwn intghno autob het kmae up of .emsne rmoF het erceahrs I u,dofn sa as tsdate lwboe yb yo, reustofc is eht stom tiorptmna neitsttnouc fo mesne ni ersmt or mreps ucn.tnfoi elBow is onnrtamoiif I nfodu ot sadesrd het ohert rwaesn c.soceih

cZni ccnidieefy (in ,usrme) pre F,A sah bene timepcdlai in dedlaye wdnou englh,ia duppesrses uitmn,yim alme dp,yhmoainsgo sedceaedr udtal irah yi,(rlaaxl acif,la ,picb)u asiysdg,eu snoami,a mastrieitmcaord hipnacaettroe fc(edet in taneniilts cniz o)nostrpab,i nad yma opspieedrs ot lcohcloai srhoc.isri AF dtid'n pysiecf eth svelel in eth ,neesm ubt per the lbweo r,latice nesimla zicn totecnn asw oudfn to vhea orn roloiecntra ot psremsnem/e vaielttc/tcyi.eevl/ I 'tond wkno fi e'ewr ssudeopp ot konw tha,t but onw I ,do .oll .7ib3n:sm.3u/gewwd.ppcn750.tib/twmnv/5lh/oh.

As nhuygbrxo ,mtneeindo luleesmin si lnyo nnteoedim oecn in FA sa a mtrtateen fro enati, os I lkodeo tino it urte.fhr nlieuemS is a tteconn of ms,ene but elvles ayrv so hucm htta ti srevse on tgsnroocpi lilccna ernlcveae ot ri,teftlyiin per tshi lcer:tai w3vngp0wbi.:d/5wn/nt/hmhi/.me2p.ulcstb3.1o2.

oT leur tou lal of hte ewsanrs eucbs(ae I 'dintd ralley kwno atnnyhgi btuao hte ayqliut of e),esnm I funod thsi B"y tcsti,ita-tss rehte saw on aigfntisicn efeifcrnde ni eth msnee aN otiarcencnnot anogm het efnedrift opugsr 7( gupsro otlat daebs on pmers )ton,cu nanicigidt hte nnifictsigian lore fo aN in eprsm li.oitmt."y l.1m.upc:.sbnt//7ewg/.h52ii2h1w/bnmvtwdonp.

y,ianllF I ot'nd kinht hte hl-aap5 cuesdtrea eynmze is laalcytu in ,enmse tbu I uodcl eb o.rngw trihEe awy, ti 'wtuldno be noblmrlyaa tvealede or owl if the nttseoseeort lvesle are .armlno

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submitted by flexatronn(5)
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yuo lla era noolkig way oot pede toni .siht

Tshi aws a ielpms aftc rlalec n.etuiqos enWh yuo see nesem + tifyeinritl ni a unoqtise dna tcfsruoe ni eth nw;srsae sit nesem = foetuscr

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