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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 tjsu nwek htta psemr deen rfutce,so ton rues thaw dieases esposrc htsi is ho.uhgt He asw tprety mlnrao so a5 rcudseaeta ntdsoe' tpnrsee eilk .thta I sa'nwt esur fi eehtr was ayn dod esu fo eht erhto s.seranw eehr is a klni. leeF refe to p.naxed

_22s.7s4wa/:xt.w/siecapttelwq.o/hcnpspguo2bm

uscFoter skmea up %99 of eht ecinrdgu uasrg tsrpene in seem.n iThs grusa si dcoerudp ni hte esmanil evec.ssil ieshmDiidn eevsll of oecfstru vhae bnee oswnh to aleplrla ergannod fncyiicede dna eth ttosenoetsre .lleev lwnogFilo etoensetstor yptrae,h eth eellv of ofcretus hnealeuiAgs crosht. the eursfoct sett si ont rtap of a ernotui smnee slany,sai it si lfesuu ni aescs fo opozariemsa scena(be fo prems ni s)enm.e In esomriazpao eornysadc ot teh ncbaees fo eissvcel or if heert is na nisboructo,t no oucetsfr si tpnree.s In eucrltstia m,orseiapaoz ousectrf si rtsen.pe henW aspeormaoiz dna wlo sneme umevlo tsxsi,e hte eosfrcut ttse dsouhl sola eb o,dne no a jplcsoeaettua ieunr mpleas to check rof rtegeoardr .ojiuecataln hisT coscru henw eht ucaaetlje eosg tion teh brdaedl tdesnia of out het ar hutre.The rcdepuore for ergtdmneiin teh muotan of etfurocs ni esnme loisnvev ghntiea nseme ni a ntrgso idac in eht nerseepc fo .onlceorirs oecrtFsu svgie a der orlco eofvoS(flni icnaeort) nad yma be erda in a t.topmhroee Teh nloamr eeargva si Ldmg35/1 tcsrueo.f

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sam.l  hkTna yuo fro the .oanitneapxl I'm ltlis feosnucd atuob sith .wrasen I asw ni ewbneet Znci dan focr.uste cZni cecyeinfid aslo trpsense itwh nsimaao g(p 71 rtsFi idA .)9021 souFecrt si seud rof eht tmvemeno. isH romsnhoe aer lrna.om +4
d_holles  anppyeAlrt seda,biet oonculc,si nad iflaoatninmm anc elstur ni โ†“ retsucfo ni smu spe.Msar te ,al eFtr rSett 52, 947 1/e3tf0l-/8e1f1/.e95/w00/a2ps4t(tr.2tr0pti:rtgw)-schrd16o2wS +4
cienfuegos  Tankhs lla orf the nifo, iuqkc eont no hte Zcin eyrpl aboev @I:Sa.m amisoan = ltso senes fo lm.els +
sam1  Gater idfn !yo I liebeev sthi qusoetni saw lualdngi ot scticy osfsbiri dan hte cniolaetgn senbeac of eth vas fnedrsee. eHer si a klni ot a JNME tciaelr tauob ti le:o wb6.ih2l./w300tM/w0ft1EoN1n20j/6.s71g/ud7/le0/m11J:rop989w5 +1
burak  nzic iccenfydei sauce omodpsngyi.ah erthe is on ghosaoyn,dpim smespr rae ?egmadda +
fatboyslim  S@am1 but cciyst iofbirss lwil wsho rlaonamb hiapylcs sifgnndi nlbcibg,u( pnloymaru elccarks ec)t. ehT tusqnoei yass lsayphic xaem whsso no aetr.ilsboimna +
pg32  donseuCf as ot ohw we can urle tou i...ncz Frmo de.aooltwemadscimnyc: Znc"i alos lysap a rloe in yaethlh sermp oc.nrtopudi drciAncgo to a 1028 rewvie itercal in het noalJur of corodtRunpie nda Iy,tfetrnili czni iyecfeicnd yam btrcnuiteo to poor eesmn uiyaqlt nda nt."ireifilyt +
bekindstep1  2@3pg I ma not esur fo woh ncZi csttuboneri to mespr icounptor,d tbu teh uniseotq wsa ingska utbao tislroaeabmin in hte eesmn nad tsruoecf is tsrpnee ni het n.eems eaMyb nicz pylsa a eorl in psrem mlneoeedtvp obeefr it is miexd in hiwt enmse and so eon twhi icnz niiccdfeye nd'ouwlt haev low ni zicn ni thier mesen as,pehrp tub ti ethri od.olb iThs si ujst a hoyspethis .o..tuhh.g +
brise  ^^ ehYa atsh't owh I ldeur it ut.o ouY nac fndi scotrefu ni eth sme,en tbu uoy l'dutwon be blae ot fidn cizn in teh emens! It tgimh lhpe the m,srep tbu 'tsi nto gongi ot eb lngchiil twhi tmhe +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 kodole tnio thsi truhfre oot escueba I tyerpt cmuh kwon tginnho bouta eht aemk up of eemsn. From het cahrseer I dfnuo, as as ttdsae ewolb by ,oy efocutrs is teh tmso tanroitpm uentsotcnit of mnsee ni rstem ro remps tnc.uofni Bweol si oitonrfmnia I nudof to asrddse hte teorh nswrae csoiceh.

iZcn ceeydincfi i(n ur,s)me rpe ,FA ahs nebe iatlcdiepm ni addleye wondu ga,enhil pdrpseeuss iimnmy,tu laem yhsioa,omdngp edcdseare ladtu aihr ixr,(alyal ,caflia )ub,ipc seduasi,yg aanis,om eitratmoidmrsac aintetpeahcro f(ected in atnleitnis nzci tbsoa,pro)in dna yam opsedpeisr ot ilcoclaoh .irshoiscr AF di'tdn espiyfc het vesell ni eth emn,es tbu rpe eht oeblw la,eirtc alnemsi iczn etoncnt was dnfuo to ahve nor tcroernialo ot nrseepmem/s eyttlt/ie/c.elcvaiv I 'ntdo nwko fi reew' euppsdos ot knwo ,htat btu onw I do, o.ll igwmsei3/pwntbupm.7.l/vo:/.5w.t50/3cdnh7hbn.

sA xunghrybo oe,mdneint eeullnism si olyn tmdeinone nceo ni FA as a ettnertma for natie, so I oelkdo tino ti rthfu.re eilnSeum is a tencton of nm,ese tbu velsel yrav so chmu ttha it esrevs no sogtpriocn acllcni celnveaer to elytiitnrfi, pre shit treia:lc pn23g/.2bu/osinl.piwcbdv/5nhwttm..mh:0w3/1e.

To uler out lal fo eht nwrases (bsceaue I int'dd aylrle kwno nihnytag autob hte uqtlaiy of m,snee) I ofund hist y"B tsistas,tt-ci rehet aws on gfnaincitsi refenciefd ni het nseem aN nrocttneaonci ganom het feenidtrf sgurop (7 rgposu talot aedsb on srmep ont)c,u caidgtnnii eth insaciitngifn olre fo Na in empsr t.."tiolymi om2512/7/u1p.tbtm.wh/eiilsnw/n.g:b.vwhncdp.

lynFi,al I tdo'n nihtk het l5pha-a seuedatrc neeymz is lacautly ni nme,se tub I cdlou eb rowg.n hitEre ,ayw it wtlo'dnu be aaonlbylrm alvtdeee or olw fi eth sseooeertntt elvesl aer l.marno

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bartolomoose  as per n,ajogl meilensu si nveldivo ni ehnoilautgt eaexroidsp +
chandlerbas  elmiesun ash a lreo ni ntghiuatoel xd.paroiese ssxeec lneusime = aclgri rtebha, ahri ,lsso nad lnia g,aecnhs gimht ese ihelpprera youhetrnp.a icnyeefcid (pt on PT)N = ltaidde romtchiaydyopa +
chandlerbas  osla cnzi dias ni mspre olimtyit mb/l1oc.spMww/i87v/pr/aim./97.tPnw/e3hscCc:hn.tt4inlg hstat hwy i seoch znic tub rrretwvhae im reov it +


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 +3  upvote downvote
submitted by โˆ—hungrybox(1277)
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rcigdnoAc to the ,MLUES uisse'mnel nloy eus si in eulnemis uelsidf as a meettntra rof a fsungu dellac asMaazisle psp (nTeai oi.ovscler)r

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 +1  upvote downvote
submitted by โˆ—unknown001(9)
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tesl ivaod ognl isonltaepaxn hslal we .

.tp thiw yieil.rfnitt qucki tets in few sedsonc = eensm ocsfetur

fact : nelmias elvesci kesam ousef.ctr

cubtoirnost of iamesnl svilcee or oanneitgcl nseceab = low scrutofe in eemns = lcotmbiae claibenam &;gt tfecfvieein gsioatesespnrem

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 +1  upvote downvote
submitted by โˆ—meirchod(1)
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I enasorde hhogutr shti eno nesic I eldeanr tath lensiam elesicsv ielvahy sue boiortlS hdeDsnageyero d(na raevois &m;pa rveil I lebieve o)o,t whcih means tehy ryolbapb ahev a lrapytcilaur arnpmtoit dnee fro ec.Froust So abmrlona tsfcuore ni eenms is royblbpa nto a oodg .igsn

SP.. I rneowd if eht sntniace did teh teta-stste on isth n.o.e. d(eemes ot rowk ellw fro eed)istab

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 +0  upvote downvote
submitted by โˆ—apurva(101)
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Icnesadre WBsC dainteic ngiealt mia,ofilmitona/niefcnnt hicwh cna lade ot poro esenm yaltiuq edu to the cdtonuopir fo xeveescsi erieavtc yoexng scepeis yb teulco.ekys

nsbtAe orsetcfu coerntinoanct is na oaicintdni of a ogicnatnel nsbaeec of sav e/neisedsnlmaref isleev,sc lwieh racdedese utsfeocr onitconerctan mya anidctei an yaultaorjec ctud ibnsoort.utc

pH &;tg 80. nidsitaec mnflimataoin of het rpt,tsaoe esalimn ac,ttr mdi,iyidspe .;etc pH t;l& 7.2 iecisntda mlsniea lscviee ycniontsufd ro rsnubttoioc of the ayljrcueato ctsu.d

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 +0  upvote downvote
submitted by โˆ—nwinkelmann(366)
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oS I oodlke tion htsi ruerhft oot eebusac I tertpy hcmu wonk nighotn uaobt eth aemk up fo en.esm oFrm eht rarsheec I donf,u as sa tatdes lboew by o,y toeufrcs si the osmt nmpaotrti cneonitutst fo emnes in tresm or psrme icofnnt.u oeBwl si anooftirmni I dfuno ot dsdsear eht rohet werans ehoci.cs

ncZi cedincfyei ni( umse)r, per ,FA ash eebn aeimtpildc in dalyede uodwn ignale,h rssspedeup tmuni,iym lema mshgodipyon,a cdaedrese tdalu hrai rax,alyl(i ,liacfa ubicp,) adsisg,uye aamin,os arommedtcitaris pencohaetirta (tecefd ni esltiaitnn icnz norpsao)b,it dan yma eepdiporss ot cilhoaloc icss.rrohi AF 'idtdn ipceyfs the slleve ni hte eme,ns utb epr hte woble taecil,r ailnems nciz onnttce was ufdno to heva orn leairtrocno to rmempnees/s ti//.letvlteceacvyi I on'td wonk fi ew're poedpuss ot okwn hatt, btu own I ,do ll.o n5/3c5v3h/pd/p:7e.wow7.nsbib/h.gum0t.mitlwn.

As brughyxno dntiemn,oe umseeliln si lyno mneodnite oenc in FA as a mrteetnat fro enati, so I kleodo tino it uh.rterf iSemnleu si a nteonct of ,esemn utb leslve vayr os mcuh htta ti rveses on nisotocrpg lclican nracleeev ot tinre,ftiiyl pre tish arl:icte 5w/:is/b.w/ith2pwne0/3htgp.l2d.1cnnou.mvb3m.

To ulre out all of the nswsrea seuaceb( I nd'tdi lyrael onwk gtyaihnn tbauo het auitlyq fo menes,) I fndou hist "yB sitist,ast-ct treeh asw no cininstgfia nfrfedeeci in eht smnee Na enctnnoatcrio gaomn het ditnrffee gourps (7 upsogr olatt sdeab no srepm )unco,t cianigtnid het nisnigaifinct relo of aN in esrpm iiyt".mto.l 1:ivnw.1m7uhlh/s/.mpbbogwie5tn2/.n2t.cwd/p.

Filn,aly I 'odnt htnik eth pha5l-a erusdeatc eenzym si luatacyl ni eesm,n tbu I lcduo eb .owgnr itreEh w,ya it utnl'odw eb bolnyraalm tlevdeae ro lwo if hte otstoeeetrsn vleels era .ornlma

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 -1  upvote downvote
submitted by flexatronn(5)
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uyo all rea nokiogl awy too dpee toni iths.

sihT swa a lespim cfat rlcale qu.niseot ehnW ouy see neems + ylieirtnfit in a ioqnuste nda tusfcroe ni the a;rsnesw tsi snmee = ocusfetr

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