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NBME 22 Answers

nbme22/Block 3/Question#5 (reveal difficulty score)
A 72-year-old man with multiple myeloma ...
Unrearranged immunoglobulin gene 🔍 / 📺 / 🌳 / 📖
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 +70  upvote downvote
submitted by sacredazn(101)
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The cetnocp is a vedcutonol ywa of kginsa fi you wenk who VJD bacnnerimooit s,okwr hciwh si thta it si ltalcyau an emleapx of giertanl the NAD of teh /BT pclyom.ehty

uonteSrh lbot eiuecnht:q oS enhw htey esu a eropb ngsiaat smeo rnego,i dna tnutgioptu a siez fo .51 kb or 6 kb, shti is inltegl uyo the zsie fo het AND mfgrenta in ceah lecl seont’(d teartm fi yeth say J prboe or nscnotta roenig reobp, ’heyrte utjs nysaig yeerh’t ggtineatr soem oudctleein queecens onufd ni het Ig slcRuT/oC ateb acihn culos vltsypreieec rfo TB/ s.le)lc

I thnik the ugfsinocn tapr oudlc be noigwredn how uyo oknw teerhwh ouye’r yraltp hhtugro mtrgnaaeenrer r(ewnas seicoch B utrh D) or if it hs’nta rodruecc at lla yet (crecrto .ew)nsar H,eer teh toecpcn is atht B llces unodrge )VDJ( neteaemnrrarg ni het oben mwrro,a wleih T eclsl do it ni eht ts,hmyu and it lal sapneph ta cno.e oS a msaapl lcel in hte doolb lkie ni iupeMltl omealyM uldwo evha ylful egodreunn rctio,miabneno wileh a T lecl ni hte ldboo docul eehrti eb ylufl detaeduc ad(n aehv dhsifine DVJ o)aircmtnoienb or rmieutam ’a(stnh drattse DJV.)

icenS hte T clel gnee wsa 6 kb adn lifidytene ibregg than teh .15 bk gnee, the T clle s’htna enregduon tbrmiacienoon .yte

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trichotillomaniac  yvre niec ptoail!anexn +29
nwinkelmann  Tsih saw !sawemeo aeMd os chum esesn and ehplyoulf I iwll be blae to thkni that liirytalcc atuob stsinoeuq ni het etfuur sa(uebec I REENV uwldo ahev eocm pu twhi sith no ym n,wo h).ha +5
eacv  GMO! NAKHT O.UY I DDITN KNWO TGYNANIH touab !i!sht poeH hist si ton sestdet no lrea nexema :p +5
ajss  ww!o isth ponaxalitne aws emawoe!s tnahsk! +
mrglass  loAs eht Tl-ecl -VD-J semnsget are tno het seam sa het l-clBe -V-DJ nesesmtg. heoeTrrfe a B-lcel J tesgemn sunorteh oltb olwud ookl fro eherhtw eth lclB-e iest JVD ntgesem in a lTcel,- chhwi wulod aaswyl nrden.-nagorrea +6
mynamejeff  nTkha uo!y So is sith basceue lmuitpel loeymma srodecup seveicesx aocnoonmll thgli nciha I?g Is shit eht 15. kb e?egn eserahW, lelscT- ahtt hvae tno gnoe tuhhgor reeiiofnfadtnti tey nda iethr J gnorie niulceds hitvyeergn DJV() .sv jsut VJ ni het ghtli icanh? A(F 0022 gp 4)01 +
peridot  shTi iaptleonanx is ia!amzgn erwH,ove ot fulyl tnaresddun tneraoh tesp fo htwa teh utseionq is gnitetg ta, elaesp teak a lkoo at osirhy'heblaair@sdswgdd odrn/a lssm@rag' annlpxoeiat as wlle - a veyr itornaptm dindoa!!ti +1
skonys  yM olcgi aws ornwg tub my wasenr rotcr.ec I am gufsferni rofm sccssu.e +
fhegedus  wo!w isht si !nagzaim nktah yu!o +



 +18  upvote downvote
submitted by highyieldboardswards(18)
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Sohtr :sanwer lAl neseg rea esrepnt in bhot B dan T lel,sc utb tyeh aeregarrn adn seexrsp ceptrrose htat ear pfseicci to teirh eleign.a rThie ear endptnendei VDJ irgenso fro B lelc rpceoetr aeoneigrnt nad T lcle oertrpec !gtinroneea hsTi ikiw cilrate hedss thgil on :stih

snwe)ceDgtirpolt_tTk_oe/i/pnw/e#bcisam(i.dtoi.er/olVknhaie_crrpi:J

I oot aglatrilcy dsmesi .ih.ts tub ti si yclltaua os melpis that we aer isnmisg the froste gthuorh eth teres lWie--h hobt B dna T ellsc ednurgo DVJ annreremetgr,a hte V, D, adn J esgne era EDNFFRTEI NGESE stepeid ebign godaeirzn adn efreeorht afislisedc in a lsrimai hsonaif ude to ehirt drahse eedn ot egnrteea serivde tctrsrsu.ue To eamk arsetmt rmoe gufocin,ns thob tsse fo VJD eegsn rea no hsommoroec .14

iTsh si ywh het NMEB ieepsficd ahtt tyeh rae gianggt EHT MSEA J EOIRNG whchi si that fo hte B llce ertcrepo ngee J engoir, ton teh T lecl eprretoc nege -tebaJ ongire s(ee wiki irtl.ae)c Teh B ellc etcorerp geen is ton randrgerae ni a T ll,ce fi ti aw,s T elslc ldouw vhea oasd!tinbei

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redstrat  s.ihT So humc si!th +1



 +5  upvote downvote
submitted by david_bball(5)
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The ayw I otthugh taobu tihs iseunqot wsa atht in MM eerth is a TNO of ndosbtiaei niebg ,made so teh DJV ngseetm is eigbn bnerko derauneeetrc//leagsrdp nmay iemts nad sah nbee nsrtdeeoh ot .1.5kb As fro eht T lls,Ce thta iegnro tis’n gienb desu csi(ne there is on oncall nnipesxao ro ice)toseln so tis’ illts tog eth lflu 6bk ghltne tdnheuu.oc

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d_holles  T cells tlisl euorgnd DVJ bnienrtacoomi ot fmro ihter RTCs. +7



 +2  upvote downvote
submitted by sam1(22)
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ihlWe T secll od ues the VDJ i,imbtecnooarn hte T llce rproeect sanhci era nitffeedr gseen ofrm het B cels'l avhye nda tghli scni.ha cSien yteh esdu a B elcl roJie-ng p,bore eth T e'lcls adbn lwli be cmhu arrleg as hsit raae fo sti NDA eh(t B lecl hvyea ro lthig ahcni gee)sn ehav ton enbe rraeganred -- tsandie tis T lelc ecorrpte geesn vaeh eebn .ngeaaredrr

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 -5  upvote downvote
submitted by welpdedelp(270)
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rnocpt4ewrcep./h/le/72aep__t/e.trntsoau/reoumon/bsbq_qwntes1mmodwtesi_sxzei/inllesntbdm/_ip_th2p:

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