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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 tjus ekwn thta epmrs ndee ucerso,ft tno esru ahwt dsiaese crpsoes hist si ohhug.t eH aws erttpy aonmrl os 5a eeascrtdua dtes'on eetrsnp liek a.tht I ntasw' seru fi hrete aws ayn dod esu of het oetrh .rewssna hree si a .knil eelF feer ot danx.ep

esn2wgcc.u7_/e/sqt/24xts2bos:pwtla.pwp.ohima

rtusocFe kaems up %99 of hte cednguir ausgr retsnep in semne. hTis ruags is cpdoerdu ni eth eislanm cee.vlsis isdnDimhei esellv of ruftoces vhae bnee ohwns ot rplallea eadnrngo dncyieefci nda eth sseeetnoortt ell.ve olFognliw treoseeotsnt rp,tehya hte veell of esrcuoft eas g.ntAchlisherou the oectrfsu etts si not prta fo a etiornu nmsee ayliasn,s it si lfesuu in asesc of emrosaopiza eebsna(c of epsrm in n.e)sem nI emaoopirasz yrscdaeno ot hte neacsbe fo iclesesv ro fi trehe si an outstbco,inr on oftsrcue si nsp.etre In ttusacleir rpmooie,saaz oufsetcr si eprsnte. hneW omsaazoperi nda lwo msnee emuolv sex,sit the efurtosc ttse dolhus asol be ,ndoe no a aepstjelcatuo nieru mpeasl ot kecch fro oardrtrege u.ecjolaaitn ihTs sourcc ewnh eth jeceluata geso tion eht ardldeb sneatdi fo out het teuar.hrT he edceorupr rof gmeendrniit eth atomun fo utcrsofe in seenm ivnleosv agnhite msnee ni a tnsorg dcai in eht eeenprcs fo cr.eroilsno rueFscot igevs a rde cloro onevf(flSoi )iotnraec adn yma eb dare in a oeetrpht.om heT mornal vaeaegr si L/35gd1m suocfe.rt

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sam.l  Tankh uoy fro eht nalpointxae. 'mI lltsi foscdune utoab ihts rnsw.ea I aws ni bentwee inZc nda .cestoruf icnZ ecncdyiefi aosl spernste hitw masnaoi gp( 71 tsFir dAi )019.2 rutosecF is deus fro the .temomnve iHs oehrsmno rea nla.orm +4
d_holles  rpanyeptlA sbeai,tde ooncuscli, dan fnminiamloat acn etlurs ni โ†“ csouretf ni aseusr.p Mms et a,l erFt etrSt 5,2 91 74e-8209l0s1/gt0r(//1.hcdw1pe.trf2-r04trtw//t32safetSio5w)6:p +4
cienfuegos  hksanT lal orf hte fo,ni kicqu teno on eth Zinc leryp eovab S:m.a@I mnosaai = otsl essen of ll.sem +
sam1  rGate fndi y!o I beelive tihs euqoitns asw udlgalin to tscciy orsifbis dan eth nointgeacl neesbca fo teh asv rdesfene. rHee si a knil to a EMNJ tareilc abuot it oebl w:wE0l0121sj100t51o9ow6f/.r87//J9Ndm.t7/Mg/n3u60pwle.i/21:h +1
burak  zcni yieefdiccn sucea ihd.nmogoypsa rheet is no doaisnyph,ogm srpesm era mgeda?ad +
fatboyslim  mS@a1 utb tccysi fsirbosi wlil owhs bmoalrna lhisaycp dsnfnigi b(nucibl,g ayounrpml kelrccsa .)cet Teh oqtuesni asys lsapcihy maex hwsso on mel.airtsonaib +
pg32  usefCnod sa to how ew acn erul uot c..nzi. Fmro tm.nwadyicsmodaceleo: ci"Zn losa yapls a relo in lythahe eprsm pndtoo.ciur ircocnAgd to a 8201 wrivee aeilrtc in the ournaJl of nrdieRocotpu adn litei,trfIny czin ciefcdinye may ctontruebi to ropo esmen qlatuiy dna iylitirtnef". +
bekindstep1  p3@g2 I am tno ersu of how Zinc tbuinrctseo ot remsp turndoopci, utb hte tsnoueiq wsa isnagk btoau oabniirleamts in hte esmen dan cfotures si rspeent in the mne.se Mbaye iczn sapyl a erlo ni mpers edlmeenvotp oeberf ti si edimx in tiwh senem nad so neo thiw czni icdifceney u'lndwot vahe owl ni zcin in rieth mesen rpsa,eph tub it rtihe .blodo shTi is tjsu a seohityshp g...uohh.t +
brise  ^^ Yeah 'tsath who I erldu it out. ouY nca indf tuorcesf in teh ,msene tbu ouy olwntdu' eb blae to dfni izcn in hte se!men tI thmgi eplh the meprs, ubt sti' tno gingo ot be icghilnl wtih 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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oS I eolokd oint htsi rtefhur oto eacbeus I typter cmuh okwn tihgnon atoub hte make up of em.sne mroF hte rehcsrae I nfuod, as as sadtte blweo by ,oy frtesouc is hte mtos iaptotrnm cttoieunnts fo mnsee in terms or prsme n.cfutnoi Bloew is tfiamornoni I ufodn to rasesdd eth thero wsnrae co.eisch

nciZ yeicdfecni in( usem),r pre AF, has been alpmdcieti in ydledea dwnuo ng,leiha speudrpsse mtiun,imy aelm oydghsp,iaonm rscdeaeed dutal hira l,x(yailar ifa,cla ,ub)pci sy,iduegsa ,iaoasnm rmerittdoiaasmc earetichtanop ec(detf ni titeasnnli iznc po,srtnba)oi nad may drpiepesos ot ocliolcah shro.sicri AF ddit'n ycfpeis eht vselel in teh m,snee tub epr teh boewl ,cleitar msiealn iznc conntte saw onufd to aveh nro enrirolcota ot esemnsmp/re cviiytt.te/lelveca/ I 'dnto onkw fi r'ewe sdsupope ot wkno t,aht but won I od, o.ll w/pue73m7ombiihtd.n.h30gscb.w:/5/lvnwptn.5/.

sA brhxyuong tio,dnmene elsmuenli is lnyo emodnitne onec in AF sa a ntmtaeret rfo iaen,t os I ookled iotn it uhtr.rfe nuemiSle is a tncneto of ,enmse utb slevle vyar os hmuc ttah it rsvese on srtigncopo clanlci vneclreae to iyitle,rtfin pre tish :airectl 2dsi.cnbtw/l/ih.w3nv/1.pm0wmpg/.ent25bho:u3.

oT uler uot lal fo the nwssear u(eaebcs I di'tnd lelyra okwn ntghayin buato teh tyiluqa of eensm,) I found siht yB" c-tistasits,t hetre swa on ncnfaisgiit dceefefirn ni the neesm aN cnrnietotaonc gnoma teh tdereinff uogpsr (7 sorgup laott debas on prems cuo,)tn aitncndiig the tinfginnsiiac eorl fo Na ni epsmr miyi.tto"l. :i.ntwug.it22/nndm..wb1/hvewp1/5lc/m7ohbps.

,lyFnial I nt'do hkint eth -aha5pl esudtarec nzmeye si cauytall in senme, utb I doulc be worn.g reithE ,awy it nt'duwol be alrmnobyal letvdeea or low if teh sneteoerstot veesll rea na.roml

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bartolomoose  sa pre j,longa euenslmi is neiovvdl ni geutnotilha peresdoaix +
chandlerbas  menuseil has a roel in ottulgihnae e.adeosripx csexes snielmeu = cargli htre,ba irah loss, adn nial han,sceg mithg see pheprlriae phuynoeat.r ncceifyedi t(p on N)TP = ddltaie pthaamdrooyyci +
chandlerbas  asol cizn idsa in msper iyomtilt 4cch/9c.pprm/gM7/7wa:siP8mt.n3lon/sC/bth.iwi/vn1el.tw hatst hyw i coehs iczn tub ehwerratrv mi orev it +


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 +3  upvote downvote
submitted by โˆ—hungrybox(1277)
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dngroAcci to het EM,USL emu'eilnss ynlo use si in neemsuil ifdseul sa a nmtetrate rof a sfungu ldleca lessaiaazM pps enai(T olcsi.reor)v

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 +1  upvote downvote
submitted by โˆ—unknown001(9)
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estl idvoa ognl xliteaaopnns lalhs we .

.tp tiwh triflieit.yn kicqu ttse in few cosdesn = mense focurtse

fact : lnesmai eeclvsi ekmsa scout.efr

brcnousttio of eislmna eslveic or tgaonlenic eanbcse = wol ectsofur ni eemsn = bictlaoem ibeclaamn g&t; vcfeiefenit esgearnmietpsso

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submitted by โˆ—meirchod(1)
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I edoanesr htogurh sthi eon cenis I dlenear taht salnime isslcvee ylhaeiv ues Slitoobr eareedhnsgDyo d(na eisovar ma&;p rveil I vbeiele ,)oot wihhc ansme ythe abloprby ehva a tcilyarpular omptatinr dene rof octsFeu.r So anaromlb crusofet in neems is roybaplb ton a ogod g.sni

P..S I nwerdo fi eth anicsetn idd het attet-sets no siht e.no.. (medees to rkow lwle rfo dteiebs)a

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 +0  upvote downvote
submitted by โˆ—apurva(101)
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aIcnsered BCWs cdaietin glatine enta/iincnmootl,mfifina hcwih nca dael ot ropo menes ylquati ude to eth porioutcnd fo evexscise aicvetre oxnyge icsepes yb .olsteyckeu

Anetsb tsroefcu trtnceinanooc si na iitncdnoai fo a cnoaeigntl cseeabn of asv emfnnaedeess/lir se,lvesic wlihe decaedrse coesurft otcntecoiannr aym ncdieita na lroucjaetya tduc isrctoubno.t

pH &g;t 08. cedniiats ifnaimanotlm fo het oe,sattrp snliaem t,artc imyisdipd,e .c;te pH tl;& .72 anesciitd isamnel leeivsc snicouyntfd ro ioncsrtoubt of het rycleaatouj cdsut.

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submitted by โˆ—nwinkelmann(366)
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So I oolekd itno hist urefrht too beeaucs I prtety mhuc onwk tnnigoh ouabt eht mkea up of .meesn moFr eth rsraehce I ,noudf sa as atdets wboel by ,oy ofertscu si hte ostm rapomnitt cstutoteinn of senem ni tesmr ro pserm nfitco.nu welBo is ioomirnafnt I odnuf ot asresdd teh hoert nawesr ehocisc.

iZcn indeeiccyf (in um)ser, rep FA, ash bene deatlpiicm in dayeeld onwud ahleig,n edprupsses mmnui,ity lmae ,pgdmiyoohnas dedeesrac dulat riha lryaali,x( iacfa,l )cib,pu yug,aidess as,iamno tmaeioarrsmcdti ericphenattoa tce(def in nilnatesit inzc obs)aopr,nti dna yam opspsdeier ot allciohoc icrhrossi. AF dn'dit iescyfp eht svlele in eht snem,e btu pre het bwoel eitrla,c eainslm izcn nctnteo asw duonf ot haev rno rrnolaoecti to p/sesnremem eivcyce/vati/l.tetl I 'dont kwno fi w'eer sppdusoe ot nkow at,th tbu onw I do, oll. 3.7wu/.v.5h:pnin7bhpdc/sgbemi3t0.t5nwwlm/o/.

As yxrhbongu neitmeod,n unemeilsl is ylno nemodnite neco ni AF sa a ntteatmer orf eni,ta so I dokloe nito ti tre.hufr mSeielnu si a cnttnoe fo e,mens ubt lseelv arvy so uhmc that it vrssee no tiorcpgnso cllcnai neealrvec to etiytnirli,f pre stih r:actile lmuoetn.sm/gn.0icbw/n2t:15bwh3p..vdw2pi//3h.

oT lrue tuo all fo hte erassnw ausceb(e I idn'dt lyaelr nkow gntihnya uatob het laqityu fo n,eesm) I dufno sthi By" scts,ts-attii eehtr aws on isnintafcgi eredfcinef in the smeen Na ecttcrnaonion gmano teh iffdreetn spgour 7( sourgp totla seadb no pmesr t),oncu cniiiagdnt the ianicgftnsini orel of Na in spmer .mt.o"lyiit n/1w2/..lcbs:/i2i1wtnop/mhhe7t5gb.mwnpvdu..

alyinFl, I dtn'o tknhi the 5alahp- setdacrue mzeyen si yclaualt in msene, ubt I udocl be .wgron eirEth ,way it ltuonw'd be lylnmrbaao vtaeeeld or olw if the oestetesntro vselle rae mlnroa.

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submitted by flexatronn(5)
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oyu lla ear nogoilk awy oot deep oitn .tish

Tshi was a silmpe fcta relalc s.teiuoqn hnWe oyu ese smene + riiiefnyttl ni a iusnoeqt and curtfeso in eth war;snse ist nmese = tfersouc

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