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NBME 21 Answers

nbme21/Block 3/Question#37 (reveal difficulty score)
A 5-year-old boy who has homocystinuria ...
The line on the graph labeled ‘B’ 🔍 / 📺 / 🌳 / 📖
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 +15  upvote downvote
submitted by sahusema(174)
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YG!US Yuo rlyale ahev to kolo at teh sxia a.leslb hTe uteisqon asys het 'tsp. tytsniceihnoa ntayehss icvyatit )(ia-xys is LORNMA hwti an RECSEANDI anmuto fo irlpdaxoy ptohpaehs .xax-si() Yis-xa is teh msae as L,NRAOM xa-ixs issthf to teh grith sniwohg RASENDCIE larpyoxdi pahpestho

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skonys  Imam tsuj akte eth L no tihs eno if it cmeos p.u I swa blea to wnorra ti odwn to B a;&pm C eebsuac fi they ear cagennisri ryp hosp nad ta oesm oipnt hte atsycinteoh ssnteayh iitvatyc si lmoran~~ tnhe ti utms tctnesrei eht aomnrl oltp oypbbalr at hte Y sccsea fro oarssen I do'nt kown it stju eelfs ri.hgt D nedots iesnrtect ta .lal A ictetrssen ta sneliyesalt 0/1 vttyiaci kd(ie if ahtt askem sesen tbu ti just eookld )ss.u So tnhe I was teewben B nad C and bth at hatt ontip I think yuro esbt tbe is to 0505/ ti dan mveo no thiw uoyr lefi selsun ouy watn ot do emdr ro ihmtoengs nad edne to egt it eocrrct utb thaw od I wk?no I og ot nelatd osch.lo +
umpalumpa  I rsdgiaee wthi sshmaaue nlon.piexaat ehT ixsx-a hsa axl/dpr1yio ,seatphpho cwihh mneas thta gnigo ot het higtr no eth s,axix- vls of lapxydyor apheshotps aer eorlw d(an eht nvrse=ie p/ixldoar1y eo,pphasht soeg )igrhe.h +
sahusema  upala@mmup sit' eben a nglo iemt cseni I deptso hts,i btu whne uoy od htsi -/(,↑)1X you orpahpca 0 agmenni ouy disle het phrga to eht tgihr +1



 +13  upvote downvote
submitted by amirmullick3(76)
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The erLivenaew rukB tPlo is ilyman tdernptreei yb sti X nda Y e.ehiTentptcrs quotiens etatss ttah vgigin B6 eisesranc the icyivatt ot lroanm leel,sv ciwhh mesan teh ttayvcii lohdus be teh saem sa teh encorm,lHena . hiert Y ienrpttec uhosld eb het s,ame so we ear teewbne hiesocc B adn C. A adn D do nto hvea the msea Y eieptctrn sa rhl.irHnao gem nearsocctonint fo B6 uesdca ivtaticy ot moebce nrl,aom dan os xaVm lilw tno eb ghcagnin nad ew acn celnac A adn . AD ash a owlre mVxa nda D has a humc hgirhe eaxTV.hm cndrifefee beweetn B nad C is in rehti K.m ongviM ot het eltf no hte X isax kames het Km lrewo nda sllte uyo ttah fiitfnay si hogesihr uoy wlduo nto eedn rmeo B6. uBt in uro ecas yftiinfa of teh ymzene ofr 6B si lyelra low, wchih si ywh we edne a otn emro B6.

nI s,aummry we tnaw hte smea amVx and a hrgeih K .eWm awnt eth lma"rno" tvcaytii mse(a vmax sa anl)orm nda ew need iehhrg oatsunm fo B6 rfo ceucsss yanfts iifo of eht enymez ofr B6 is obaprlby ervy .low

ciCohe B hsa a )-(K/m1 vuale rceosl ot 0 wcihh nsmea Km si rleow adn iyftnaif of eth yeeznm rfo sti asuertsbt si peurs hTi ows.l eakms snees as gniivg iehrhg otnusam fo eth vtiempti""oce rsuatbets B6 is lnipge.h

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apurva  Tsih nxiaolenpta is !!rowgX!n sixa is nto k/m1 ni eht esitno,qu it si yp1raoxdil/ sethhpa.op k1m/( usohdl be onyt/c)s1mieoeh loAs hte tienousq si agnsik uoatb oitsclelra ncaioattiv fo ictehtonysa thansyes ude to dtnaiodi fo irpxldyao sath.ehpop hcWhi nmeas het Km oudlsh caeseder tf(nyafii easecrins atrfe itdoadin fo iipin.Cxdyeso riendog)rn eht x asix ot eb i1aplx/ydor ohhtpa,pse won yplpa pelims lcgoi fo samt,h rnecsiae dplaiyxro eophhtspa = bgiinngr ilne orem esclo to zroe uescab(e ti si a/ryx1doil-p aeoptshh.p) +13
apurva  Had eth X sxai eb mk1/, het sawrne suodhl eb C +1
pinkdinosaur  mK si versielyn etedrla to teh aifnyitf of et zehneym ofr sit tu eabeshtTs.r rlecos to 0 no het si-a,Xx het rhihge the F.Am K 2002 gp 320 +



 +12  upvote downvote
submitted by lamhtu(139)
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gneeNdi reig"hh cactsnoiotn"enr of het 6B ofr znemye tvtciaiy is nahteor ywa fo yiansg Km is ihhreg cesni rmeo si deirureq fro 1/2 mvax tcavyit.i asnecdIer mK svalue etrlsu in m/K1 begin lrmaesl oecsl(r to 0 no hte i),-xsxa ihhcw si estoademrntd in ewrasn ciheco B.

A amr"no"l znemey vaicytit in eth cnsperee of hrehig B6 craionnosecntt masne htat axVm si ont ngg,hcani tbu Km si.

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d_holles  In tehro r ,asolmwdorN yeemzn yaivictt = dVdgmxai nA roem 6B ot a medtuta mzneye will epvoirm ti kcba ot lonarm Vm(xa stsya onanttc,s so Km lliw cseaededr deu ot ↑ ytfaifin fo hte nm.ez)ye +3
jatsyuk38  ^^ TISH is the bets lntoeaxpnia +
drdoom  y8k3@satuj eth cmtnemo or teh eb?conmsumt +
drdoom  ,ho bodule reatc = buumppbm, = the emnmoct hl@ta(um) +



 +4  upvote downvote
submitted by trazobone(97)
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omSe fo ehset nlinapotexsa llraey ongdi het ost.m fI the nmeezy si able ot acnieres to laromn taviicyt with a hhegir llvee of het sbat,sreut ahtt nasme ere’w in a iiomtcevpet ionihirtb stao.ituin Civeoettmpi laywas csoessr on het rg,aph os ew acn emiianlte A nda .D

wNo ew aylzaen .mK eW watn lslma ms’K fro opettn ysemezn. Szei eosd tno lywasa rtemat .😉 peEctx in sith csea ew d’ton nwat ttha n,etcopy ew tanw to loko ofr a (llea/1yr ibg ,)Km eva(lu ttha si lrseco ot o,)zre cb ew anwt a kwea igb mK to be leba to eoeprvwor het teovteiicmp bnii.iroth rgmpiCnoa teh emngirian 2 ihcocs,e B has a mK aelvu rseloc to rezo os srehet’ ruyo rneaws.

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 +2  upvote downvote
submitted by navevan3(2)
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orF tsih suqni,oet I was ghintikn ttha ehty akdes oyu cmoerap to a rlnma”“o noe,rps os het xVam u’lnotdw hgecna iscen yeth tsaet taht shi tiyvctai trnesru to a ormnla ve.lel Oyln het xsiax- lowud nices ti uodwl be ta eascredin taoncnoeisnrct in posnocram.i

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 +2  upvote downvote
submitted by an_improved_me(91)
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So i odnfu hist sentoqiu c.ioisuu..rld the isxnnlatoeap edidvorp did otn yaellr larce ti pu rof ,em ubt i htink i aetdnrsdun ti own eaes(pl ecrcort em if m'i o)gw.nr

ristF nda toefso,rm mI' tno vnee resu if tish is uylrt a wvieeaeuekrlr-bn l,pot sncei hte -Xisxa si otn K./m1

But, mreo ,elglaryen I editr ot enrnddtuas awth hnaepdpe ta obht esrxteem fo PLP][ nad .oletVyci

sLkA:PP rseofuyl: heewr no het rpahg si [PP]L t?segihh lW,le fi hte isax-X si leaqu ot ,PP1L/ PPL ldwou eb ta sti ihgseth ta teh euvla tescosl to 0 no the xxa-is. ntki(h: thaw si 1 ididved by a bin?loli YREV COLES TO Z.ERO) Tish wludo srdncperoo to a tnpoi glaon het isxya- rof teh nezsmye yitcativ. In ehtro d,rosw PLP is at its shtehig oetnrinnaotcc at hte grpsha pt-e.icYnrte

bmRmeree tawh ew alos id:sa ewnh het ttduema nezmye is adruon tsol fo ,LPP ti sicablayl nfnitscou keil a nml .neymze iThs ea,nms taht the mVxa fo eth madtetu nzeemy is vlntaiqeue to het xmaV fo hte lnmoar n.eemzy efreerho,T heT aV1mx/ of bhto zymsnee are lunt..eeiqv.a ta het h-pi i!eTtyctsnre is b!gi fI uyo etg siht ar,f htne you acn enliieatm A() and ,()D iencs seeht agsrhp heav tnrediffe Yitrscpeen-t r(ifneefdt xsme-)Va for hrtie eciptevser smnzy.ee

nviMog ...no

Vietlcoy V)(: ne Wh V is at its hhegtis .i(.e mx,a)V eht vaelu of V/1 duwlo be ta tis l.osewt aA(in:g khitn of ti lipctlc:raya what si 1 videdid yb 1 lin?bilo 0~)! ,hoerrfeTe eht eluva fo 1/V si ta tsi eoltsw hwne hte siyxa- si uqale to .0 Tofe,rehre The axVm of isth oucsrc ehnw hte saxy-i is lecos to z.r.o.e erseH teh tgnih .hot. sehet mnseyez reeqrui rfedifent sevlel fo PPL ot atrpoee at a.-mxV Rm,eeebmr eht -mxaV fo hte EUTTMAD zmeyne ilwl phpena ta a muhc RGHEIH PP]L.[ rO sylvnroec,e teh Vxma- fo the RLAOMN emzyen wlli ehnpap at a cmuh EWRLO ..P][L.P

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an_improved_me  Mgi,nnea nwhe ew lkoo ta hte Xtntpircee- h(wen V is )ghh,etsi the aemdttu yezmne wlil eiqeurr erom P.PL oMer PPL mnesa a lrw"eo" uelva no teh xsaxi- orcsl(e ot )orez iateelrv to the lmrano mney.ez +1
an_improved_me  gtPinut ti ALL rtteoe:gh ictpteyn-er iwll be het asem fro boht truodamtael/mn imeterex-cptnne z will eb rscelo to 0 fro hte eutmtad zey,enm taelvrei ot eth roamln eyzen.m heT ynlo eswnra htta ahs hbot rcretco shieitranlspo si B.)( I nkiht i psten 5 numsiet no itsh ouetiqsn ygtirn ot fruegi it o.tu I lboarpyb wdoul have ededen 01 stiunem to taauyllc get rheet. luyHolpfe won I can etg ti iuqrkce if osnhigemt leki tish hswos up on hte aelr nihtg. +2



 +0  upvote downvote
submitted by minhphuongpnt07(5)
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eb waera tath eht x-saix fro shti otseinqu si nto "mK" (i6tBv is ton eht utbr's tseattah [t]i1/.VB6 to miy,sfip escubea eth mxVa is oanng atsy teh esam, uoy jtsu deen ot acreseni ]tiB[v6 ot egt hte asme Vxam (kaa tfsih ot gtihr on eth s-ax).xi ' Dont be lefdoo aunrdo by hte etqniosu rr.itwe

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poisonivy  tsih kasem eesns ot e,m X aocnnt eb !K!m ucebaes fi ti asw mK nhet neil B lodwu eb oswnihg a e"vteimcotip bnitihi"or ,effcte ihwhc ocntan eb hte case ensci ythe seatt htta het enezmy vctiyait sneaecrsi to lamnro rtefa 6B miaarstindtnio os it ovsfra het ienaoctr edsitan fo rdeeacsse it. I tgo hits one orwgn fo ,ucreso too yktrci orf !me +



 +0  upvote downvote
submitted by empem28(1)
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boydoN hsa wensarde ihst unioestq htghuro eth snle fo a lganrine eojetbvci uteqi tey so s'reeh ym 2 sn:ect m K is AESCERNDI cb hist paintet ash na emnyze twih an lelrvao LWORE iatyfifn can( eb rdtcceero ot arnmlo erfta an isaeencr ni rs)bttseua hcihw is crechaitcsaitr of ETOMIITPCEV biinniot,ih hcihw is hyw eth enli fo eth .tp is oen of etvmepiciot ohiintiibn on a BL otlp

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 +0  upvote downvote
submitted by stapes2big(16)
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The iqtonsue is yllbicaas tgsinte up a iiantusto slmirai ot ahtt of a pitctmiveoe oiiit.brhn eThy asy ahtt hiergh ionsnancerottc fo pdloryaix hspetpoah ieasnsecr het actyivti of eth mnzeey to lnrmao lve.lse ray,imliSl nwhe oyu avhe a ctoiepvimte ntioihrib and inercase the tionecactonnr of e,tbrtsasu eht yeezmn anc veeihac the amse Vxam as fi utowiht hte inri.ibhot

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 +0  upvote downvote
submitted by usmleuser007(464)
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meRebmre 1 ) pemeivtocti iibshonrit ~ elnsi oCssr at c)s 2y-etrtnie oine-ttioevcpNm shoiitbnri ~ no inle rsosc

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 -5  upvote downvote
submitted by hungrybox(1277)
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noLg wensar ,heada utb rabe iwth .em

HI:TN v skloo nidk fo kile y, weehras k klsoo emor lkie x.

eiy-tpcertn = amV/1x

  • xamV is teh preup imlit no how atsf a nroaceit is dlczayate by zyesenm.

n-ieetrpxtc = 1/Km

  • mK si a nrkinga fo ohw ogod na zmeeny is at nibgind sit rsebu.ttas An emzney hiwt a nrginka of 1 is ttereb ta iinbngd its urbasetst thna na emezny ithw a nakngir fo .5 ow(erL mK = ebrett )neemzy

oetN atht ,maxV sa a semerau fo reepocmrnf,a can be etdaler hrthoug many t.hnisg leehwnM,ai mK si a tes ahieaccttscirr of the ezy,men nda otnnca eb lea.dret

nI isth xpael,em teh eeyzmn crefpanoemr (a)xmV si endsciare by nacnigires teh vnatmii ctoorfac so taht it ascehre a lnrmo""a ci.tyvait eHrve,ow the myenez si tslli nnylreithe tsihyt ued to a niengoctla tcdf,ee os eth mK tssya eth s.mae

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mnemonia  Ae.osemw +
ht3  itwa lnei B sowsh teh amxv sot'edn nghace nad taht the km is gtgneti ralrge enm(eyz si ltils tthyis os lgarre km) so k/-m1 oduwl eb a lesralm unmbre and wduol hpaoprac 0 +1
lamhtu  You sya mK cntona eb dtaerle dan tsi gtaiysn het aems, but het wesanr fo hte rhpag taestomesndr a ieghhr mK d v gieN.eul nea hie"grh cinnnsoo"cttrea fo hte B6 rfo ymznee ciavttyi is noarteh way fo aginys Km is ighher ensci orem is rierudqe rfo 12/ mxav yictitva +18
sbryant6  ehaY hist ealaonxtpni is rn.wog +
kcyanide101  yeHsto,nl sith qnoieuts is bgrnubi em eht wgnor ..w..ay fI we go by the eiLn reaewv ukbr l,pto tenh C"" si eht rotrecc ean,rsw eeuacbs ""B is nsoighw etmocptivei ..iiito.nrb.h hTe eezmny heer is vteteipoyiclm at.tcigv ina noSoeme ednse ot inlapex ihts bertte selae,p emso of us aidp on thsi murof ot tge a fiamuennlg natxoilapen dna ont trunntiocobis ofrm fwlloe test .s..toel rlka. +



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