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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 jstu enwk ttha esrpm deen ,fuseroct otn esru htaw esaesid rpcoses iths is .tguohh He wsa ptryet nmlrao os 5a aauescedtr t'dones neeptrs leik hat.t I 'tanws erus if rtehe swa nya odd use of teh oehrt rsa.snew ehre is a k.nil eelF fere to pea.xdn

mihcn2s./.o/ast_2pt.beww7eog:4pwsc2pasxtl/uq

tsuoeFrc sekam up 9%9 fo het ceudrngi surga sentrpe ni mnese. ihTs rasgu si pocdedru ni eth snmiela cvissle.e sihdeDiimn svelle fo tosefruc vaeh nbee hoswn to alplrela dognrnae iceyicfend dan teh tresnestoeto vlle.e Flilnowgo toresstnoete hya,eptr the llvee fo rsecftuo r.Acilgaheoet sunhs eth fusctreo stte si ton tapr fo a irnouet emnse s,lsynaai it is lufuse in cases fo aomizpoeasr esenc(ba fo sepmr ni )nmse.e In aoeaizmorps yoesdncar ot hte easnceb fo seiveslc ro if ehter is an ,tsbrtciuono no efsouctr si en.ertps nI tsturiecal saipr,mazooe ruostcfe is persnte. Wnhe repoaiamzso dan wol enmse movlue ,sxtesi eht reuoctfs test ldsohu osal eb ,done no a pesjutcealtoa nreiu malpes to chekc for tdererogar aiucaj.olnte ihsT ruocsc hnew teh ulcjaeeta eosg tnio the lbdreda ansetid of out hte euth.r hraeT peocrreud fro rmtinineged the nuoatm of ostcefur ni mesne nvvloesi hgtenai emsen in a grntso cida in eht nsreepce fo .nlsoreocir crtouesF eivgs a edr cloro foiv(efSlno antcore)i dan aym eb dear in a otrmeet.pho heT mroaln aaegevr is /m5gL31d ufct.orse

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sam.l  Tahkn yuo ofr eth ti.napelonxa mI' listl soecdufn botua htis nwrsa.e I saw in weenteb nZci dan core.ufst nicZ cieydecinf osal ntssrepe whti mnsaiao pg( 17 stirF iAd 21.90) tFsurcoe is ueds ofr eth vnmet.meo His rnmosohe are rao.nml +4
d_holles  ylnretpAap sedeti,ba ,oocucnils nda namiatolfnim anc suretl ni โ†“ tcruefos ni smMssau.per et ,al reFt tSrte 5,2 74 91fr0-/o0p1ip.9.5w13twrse/0:8(g4e/tS1t2tc/el-a/d)62trsrhwt02f +4
cienfuegos  asTkhn lal rfo eht f,ion kcuqi oten on het iZcn rlyep evboa :@SaIm. maonsai = tsol eessn of elm.sl +
sam1  rGtea dinf oy! I eevlebi htis euontqsi wsa dinalglu to scticy rfibsois dna eth cnelaognit benaesc fo the sva e.enredsf eerH is a iknl ot a MNEJ eciralt uatob ti lbe w:ow9w5g.016t7ep/.f.t1830:/1rEn6/0J/mol1ji22doMl9s1/hu0/7Nw0 +1
burak  nzci ccydiienfe escua gyo.honipasdm ethre si no i,pdamsooyghn srsmep aer deg?dama +
fatboyslim  1a@mS utb ystcci iosribfs lliw whso anmolarb islhpyca sniifdgn b,nucg(ilb ylrmonpau ckesclar .e)ct heT nisqueot yass liacsyph mexa swsho no otailrimsae.nb +
pg32  efoCunds as ot owh ew acn urle out izc...n romF amieescdoycnwtmaold.: iZnc" soal lypsa a reol ni athyelh eprsm durtncoi.op godcrincA to a 8120 wrveei ctlriea ni eht oraJlnu of uiedrcpotonR dan teiItinflry, iczn ccidfyenie amy icutetbnor ot orop esmen yituqal nad iitryi.tenl"f +
bekindstep1  g3@p2 I am otn rseu fo hwo nciZ rttbcnuoeis to sempr tnuorcid,op utb teh stuoinqe saw sknaig taobu altiinamrebso ni the mnsee adn trcsofue si nesterp in the .ensem Meayb nizc aspyl a elro ni pesrm evledtnpoem ebrefo ti si exmdi ni iwth mnees dna os eon hiwt izcn cyfceeniid l'wdtnou haev olw ni cinz in irthe mnese peaphs,r tub ti herit .blood sThi is stuj a hehposyits ..ghoht.u. +
brise  ^^ Yahe 'shtta ohw I rlude it tu.o oYu cna idfn octsrfeu ni het sm,nee ubt yuo dwontlu' eb eabl ot nfid znci in the nm!ees It mitgh elph eth ,mpers tub tis' nto gigno to eb cnilhilg tihw 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)

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 +8  upvote downvote
submitted by โˆ—nwinkelmann(366)
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oS I ekldoo itno isth rteuhrf oot seacube I tpyrte humc onwk ihongtn btuao het emak up of senme. Frmo het recshear I u,ofnd as as staedt woebl yb yo, toersfuc si eht tmso onaitptrm ttouecstnni fo eemns in estrm ro mersp not.fcniu Blewo is anntmirioof I dnuof ot sadedsr the rhoet sarwen seohcic.

cnZi iecicydenf ni( r)smeu, erp F,A sha eneb mdcitpliae in ldyadee duonw nilhg,ea dsppuesrse imn,tmyiu amle oidgosnamphy, eredasced talud airh araxli(y,l liaacf, u),cpbi dsu,iasgye aoisam,n demtamiostarcri rahetacpnetoi dtefec( ni linestnait zinc oonrtai)bps, adn aym rsepisdoep to lciooaclh i.shrricso FA dndt'i ysficpe teh eevsll ni eth e,snem utb rpe hte oblew ietc,arl imlasen izcn ttcenon saw unofd ot evha onr oiocnlrtare to esmre/pemsn /.cecivtteiv/llteay I nt'do kown if eewr' dsopseup to nowk ht,ta tub wno I do, .lol .lpe.b5mbg7n33p/5t.wtwwhcni/dni0:ouhvm/./s7.

As xnugybrho dnn,oeimte iulesmnel si ylno dniomenet coen ni AF sa a ameetnrtt rfo ,ineat so I olkdeo ntio it ehrrft.u meeniluS si a onentct of emn,es tub lsleev avry so chum ahtt ti vrsees on ognipcotrs cinlcal eaelrncve ot itfeinirlt,y pre tsih erlaci:t .nums0p/.2o3mi5.i:bhg/t1hwwt3//vwbncn.dlep2.

oT uerl out all fo het ssenraw (sueeacb I 'dntdi yallre kwno yagnthin abotu hte qulytai fo ),senem I nfuod tish "By tatistciss-,t eterh asw on fnnicigasit rfnedeiecf in eht emesn Na tncinotcernao gmaon teh frdetfnie uosgrp 7( rpugos loatt sedba on remps uc,ton) acnnidtigi het tsincianiifng roel fo Na ni rpmes l.ot"ii.tym wnbh.sime1v2/t/2/hp5.1wpltunm.i.7n:/obwdgc.

,layliFn I otn'd hnkit het lha-5pa catuersed emnezy is yaltlcua in emn,es ubt I duclo be owrg.n rtihEe ,ywa it wt'dounl be rybmalanlo deletvea or wol if eth reosnttsoete levles era lomn.ra

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bartolomoose  as per ogln,aj esnilemu is olenvivd ni tuitehoglna rdeeaxisop +
chandlerbas  suleniem sha a oerl in aetgohtluni oseaixdep.r cseesx mnuisele = garilc rbh,tea hair oss,l dna nlia ans,chge higtm ese plreprheia tr.npaeoyhu nefceiyidc t(p on N)PT = eddlati ocpymaohydatir +
chandlerbas  lsao incz said in srmep tmtiiloy gcv/:ec47ac1wnnr/pm9p7im3lslt/P/iihtbn..C.Ms8tho/.w/w tatsh ywh i ceosh incz tub teahrrverw mi vore ti +


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 +3  upvote downvote
submitted by โˆ—hungrybox(1277)
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dncrAgioc to eht UMEL,S 'isemseunl lnoy seu is ni leeuimsn udfeils as a tettnrame rof a fusgnu clelda zesaisaMal psp eaT(in iorver)col.s

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 +1  upvote downvote
submitted by โˆ—unknown001(9)
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tels dovia ongl nnaeilptoxas lsalh we .

.pt iwth reyfti.lniti icukq tset in wfe ssneodc = eesmn rfocutes

aftc : snimlea leeisvc emask ufrsc.toe

csoittnbruo of mlesain sliceev or lneicotagn nbaeesc = lwo tosrefcu in mense = omlacbite acmebanil t;g& ecfnfiveiet ertioenssgpsmae

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 +1  upvote downvote
submitted by โˆ—meirchod(1)
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I eaosndre tghrohu htsi eon encis I ldneera atht aelinms eislvcse aheylvi seu Sotlirob eeaesgnryDdho da(n risaveo &a;pm rilev I elbeevi )ot,o ihhwc masne ehyt pboylbar vhea a plryucirtaal rtntipoam eden rfo uFseo.crt So oambarln tsrfcuoe ni ensem is rolabpby ont a dgoo gsn.i

P..S I oednwr fi het ninsecat ddi eth -ettsaetts no tish one... emese (d to rokw ewll rfo set)diaeb

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 +0  upvote downvote
submitted by โˆ—apurva(101)
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reecndsIa CsBW acitdein anelitg iinalmnan,nfecttom/foii hhcwi nca deal to roop emsen tluiaqy eud to hte roduitoncp of seeevsxci eicaterv gonyex epescsi by .eolsuytekc

tenbsA cuoftrse ntnantioreocc is an ointacdiin of a ceatnolign enabsec of vas arfnele/nssmeide ilcvssee, ilwhe eddceesra tcrusfoe ncrtnootiance yma aeidtcin an etoalajrcuy uctd not.rbtucois

Hp t&g; 08. cdisenati lmoaiintfamn of the atpot,ser enilams c,trat dmi,dpiseiy ;.etc pH t;l& 27. icetiasnd nmsleia lceives nctdosynuif ro bonoicrutst fo teh atecoraulyj .sucdt

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 +0  upvote downvote
submitted by โˆ—nwinkelmann(366)
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So I eodlok toni tsih therrfu oot cuasbee I ptyert cmhu owkn tinhgno toabu het ekma up fo esmne. mroF het ehrecrsa I fdou,n sa as ttedsa elwob by oy, fsrtceou is eth most mrtoainpt ousttcnntei fo eesmn ni rmste ro spmre fnnciut.o oBwel is footnimnria I udfon ot rseddas eth orthe nrasew icesoh.c

Znci ecfdcyenii ni( ,urs)me per FA, hsa nbee pmleicitda in ydeeald uwdno i,elnagh ueesprdsps mni,tmuiy mlae nsooygh,mpida eceedsdar tuadl hira ,liryax(la laci,fa ib)cup, eyua,gdiss isoaan,m tsmairimtocarde eaierohnpcatt (eftced in titsaenlin cizn o,)borisptan dan mya oidsppesre ot loaolicch ishc.rorsi FA nid'dt fsicyep het veslel ni het e,esnm tbu erp teh lowbe trilea,c alesmin zcin tceotnn was nofdu to hvea nro rtroeinaocl to epenms/rems eevtc/l/ecatitv.yil I ntdo' nwko if wee'r psseopdu to nkow ,ahtt utb now I do, oll. uinmtl./o7nm05bv:c3b/7w./w5hn.pp/.tshid3wge.

As xoyurbgnh nne,tmodei uemesnlil is lyon ominntede oecn ni AF as a atertentm ofr atie,n so I eookdl noit ti r.futreh leniuSme si a tntocen fo ,esnme but llvees avry so much that ti rvsese on otcpiorsgn ilacnlc releavnce to ,iieityrlnft epr tsih crelia:t .vhiptshm/0.epn.bm3w3o:b2l.ni5gw1/tu2wdn/c/.

oT elru tuo lal of the easwrns ebusa(ce I id'dtn lraeyl kown tgiannhy atubo eht iqyulta of nse,em) I donuf isth "By ctssts-iatt,i theer aws on gicitnisafn fnfedicree ni het senme Na rconctnanoite ganmo hte edftifenr pgorus 7( oprusg tatlo deasb no pmers u,c)otn cdigniiant eht iacgnfsntniii elor of aN ni perms tomit"l.y.i hoin1.ibp.dl/t5/nhs71v/w2:bguwe/wmn2mct..p.

aFi,lnyl I odtn' nthki teh ap5-lha cuaetders znymee is uclatyal ni ene,sm but I oudlc eb o.nwgr eEthir aw,y it outwn'ld eb yoamlrabln leeveadt ro low fi eht otntoesrstee levsel rea amr.lno

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submitted by flexatronn(5)
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you all rea ngolkio way oto eped noit .itsh

This was a msplie tfca larecl eti.sqnuo heWn uyo ees nesme + tirnyfeitil in a inuotseq dan oucfsrte ni het ;wreassn tsi mesne = rsoufetc

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