Contributor score: 9

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lispectedwumbologist
That's so infuriating I stared at this question for 20 minutes thinking I did something wrong
+41

seagull
lol..my math never worked either. I also just chose the closest number. also, screw this question author for doing that.
+5

yotsubato
Why the FUCK did they not just give us a clearance of 0.1 if they're going to fuckin round it anyways...
+12

cr
in ur maths, why did u put 24h/1day and not 1day/24h? if the given Cl was 0.09L/hr/kg. I know it just is a math question, but iÂ´d appreciate if someone could explain it.
+

hyperfukus
magic math!!!!! how TF r we supposed to know when they round and when they don't like wtf im so pissed someone please tell me step isn't like this...with such precise decimal answers and a calculator fxn you would assume they wanted an actual answer!
+1

jean_young2019
OMG, I've got the 25.92 mg/kg/day, which isn't any of the answer choices listed. So I chose the D 51.8, because 51.8 is double of 25.9......I thought I must have make a mistake during the calculation ......
+4

atbangura
They purposely did that so if you made a mistake with your conversion like I did, you might end up with 2.5 which was one of the answer choices. SMH
+1

titanesxvi
I did well, but I thought that my mistake was something to do with the conversion and end up choosing 2.5 because it is similar to 25.92
+1

makinallkindzofgainz
The fact that we pay these people 60 dollars a pop for poorly formatted and written exams boggles my mind, and yet here I am, about to buy Form 24
+5

qball
Me after plugging in the right numbers and not rounding down : https://i.kym-cdn.com/entries/icons/original/000/028/539/DyqSKoaX4AATc2G.jpg
+1

frustratedllama
Not only do you feel like you're doing sth wrong but then that feeling stays for other questions. sucks so baad
+

fexx
'here.. take 50mg of vyvanse.. I just rounded it up from 30.. dw you'll be fine' (totally doing this with my patients 8-))
+1

submitted by seagull(840),

out of curiosity, how may people knew this? (dont be shy to say you did or didnt?)

My poverty education didn't ingrain this in me.

impostersyndromel1000
same as person above me. also bc arginine carbamoyl phosphate and nag are all related through urea cycle.
+

amirmullick3
My immediate thought after reading this was "why would i know this and how does this make me a better doctor?"
+5

mrglass
Generally speaking Glutamine is often used to aminate things. Think brain nitrogen metabolism. You know that F-6-P isn't an amine, and that Glucosamine is, so Glutamine isn't an unrealistic guess.
+2

bend_nbme_over
Lol def didn't know it. Looks like I'm not going to be a competent doctor because I don't know the hexosamine pathway lol
+1

baja_blast
Narrowed it down to Arginine and Glutamine figuring the Nitrogen would have to come from one of these two but of course I picked the wrong one. Classic.
+

submitted by hungrybox(579),

Long answer ahead, but bear with me.

**HINT:** v looks kind of like y, whereas k looks more like x.

y-intercept = 1/Vmax

- Vmax is the upper limit on how fast a reaction is catalyzed by enzymes.

x-intercept = 1/Km

- Km is a ranking of how good an enzyme is at binding its substrate. An enzyme with a ranking of 1 is better at binding its substrate than an enzyme with a ranking of 5. (Lower Km = better enzyme)

Note that Vmax, as a measure of performance, can be altered through many things. Meanwhile, Km is a set characteristic of the enzyme, and cannot be altered.

In this example, the enzyme performance (Vmax) is increased by increasing the vitamin cofactor so that it reaches a "normal" activity. However, the enzyme is still inherently shitty due to a congenital defect, so the Km stays the same.

ht3
wait line B shows the vmax doesn't change and that the km is getting larger (enzyme is still shitty so larger km) so -1/km would be a smaller number and would approach 0
+1

lamhtu
You say Km cannot be altered and its staying the same, but the answer of the graph demonstrates a higher Km value.
Needing "higher concentrations" of the B6 for enzyme activity is another way of saying Km is higher since more is required for 1/2 vmax activity
+3

Maintenance dose formula is (Css

Cltau)/F where Css is steady-state target plasma conc. of drug, Cl is clearance, tau is dosage interval & F is bioavailability.Neither dosage interval nor bioavailability is given, so ignoring those & plugging in the numbers (careful to convert units to mg/kg/day): (12 ug/mL * 1 mg/1000 ug) * (0.09 L/hr/kg * 1000 mL/1 L * 24 hr/1 day) = 25.92 mg/kg/day

...which isn't any of the answer choices listed. They must have rounded 0.09 L/hr/kg to 0.1 L/hr/kg, and doing so gives exactly 28.8 mg/kg/day (choice C)