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Retired 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(173)
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YUS!G oYu lylare evha ot okol at eth siax ls.labe heT tiqeunos assy eth .spt' iaiysttoencnh ntsaesyh iacvytti ()yia-xs is MNROLA tiwh na CSEENAIDR aontum fo ixrdlyoap hahpeptso .)sx(xi-a sa-xYi is teh same as L,AMNRO ixs-xa tfshis ot the tghir niswogh RSEAIEDCN opilrxyad hpaesopht

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skonys  mmIa stju aket hte L no itsh oen if ti cesom p.u I aws elab ot rowran ti wndo to B ;&pam C uaebcse fi yhte rea icgranensi ryp hpso nad at semo pinto teh aesnihtoytc aeyssthn atitiyvc si n~oarl~m neth it umst ricsenett eht nrlamo polt prayobbl ta het Y eccass fro oresans I no'dt owkn ti stju felse tr.igh D oetnds esrettcni at l.la A entsresitc at alintsseyel 01/ yticaitv (kedi fi htat eskma snsee btu ti stju kdloeo ).ssu oS nhte I swa wtebeen B and C nda bht at ttah potni I itkhn oury tesb bet is to 500/5 it nad emov on twih ouyr lefi elssnu yuo anwt to do erdm ro sonmgheit dna ndee ot get ti cretcro ubt athw od I kn?wo I go to ltnead .ohcosl +
umpalumpa  I gseiader ihtw sueamhsa enptilnaoa.x ehT xsia-x has dpl/o1xairy hhpeopt,as hwich emasn ttah iggno to the igtrh on het as,xix- lsv fo ylroyadxp haophepsts aer wlroe ad(n hte rivene=s lxipa1ord/y sepht,opah oesg ihe).grh +
sahusema  upapmlm@ua 'tsi eenb a olng tiem iensc I eodspt h,its tbu wnhe oyu do isth ↑/X(-1,) yuo aaprchop 0 gnameni uyo lieds eht rphag ot the gtirh +1


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 +13  upvote downvote
submitted by amirmullick3(76)
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heT eeirLvnaew kuBr lPot si imanyl peritdteern by sti X nad Y eeT.henitpr tsc tqeiunso asetst atht gngiiv 6B rscieneas teh ivactity ot nlramo evll,se hwhci nmsae the ttvayiic dhouls be teh asem sa teh Hneon,aec l.rm rteih Y pertnciet sluodh be hte ,msae so ew rea bentewe hcoceis B adn .C A and D od nto veha eht emas Y tnpciteer as aireonlm H.grh ocatnentroisnc of B6 secuda atyiivct ot mcbeeo a,nmrlo adn os amxV wlli ont eb inagcnhg and ew cna nalcce A dan D. A sha a rwoel mVax adn D ahs a uchm igrhhe m. ThVxae fdnfeceire wnebete B nda C is in ehtir K.m igovMn ot eth eltf no eht X iaxs skmea het mK lrowe adn lelts oyu tath yifnfita is sh ihrgeo oyu wludo tno eend mero B.6 tuB in ruo sace iiyftfna of teh nyezme for 6B si areyll w,lo cihwh is yhw we eden a ont orem .B6

In srym,uam we tnaw hte emsa xaVm nda a irhghe Wme.K tawn eht aoml"nr" tivyiact aes(m mvxa as ml)nrao dna we deen rehihg usmatno fo B6 rfo scscues noyafitifs fo teh nemzye rof 6B si obbalpyr vrey low.

Coihce B sah a (-K/m1) leuav lrsceo to 0 hchwi esamn mK si wreol dna fyiifnta fo het zyneem orf ist retautssb is rsepu ilTh. wos mseka nesse as ggnvii iehghr somutna fo eth c"ipvt"eimeot asbtutser 6B si leginh.p

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apurva  Tsih pliantneoax si !n!w!Xgo r xias is tno /mk1 ni eht ,teqnuosi ti si ypr1oldaxi/ ha.esptoph /m(1k olhdsu be iomet)yec/ohn1s loAs teh etsiuonq si skinag autbo sterolical itovaiactn of yiahsnoctet nahsyets ued to oiidadtn of pilxyarod eaos.phhpt hihcW menas teh Km udsolh arecdsee iyantff(i sreinasec aetrf tiadodin fo n)nCrs.odod egiyipniixer hte x sxai ot be rxpdi/l1oay ,hoephsapt won pylap mpeils lgcio fo ha,mts sneeicar idaxporly ahpshetpo = igbnngri eiln ermo ocsel to oerz eea(cbus it is /rl1aoiydx-p p.aho)hsetp +13
apurva  Had het X axis be /1k,m hte rwesan uldohs eb C +1
pinkdinosaur  mK is rsiyevlen learted ot teh fifatiyn fo ezye tenmh for its rsaTeu h.esbtt lrosce to 0 no eth ix,-Xsa teh irehhg the mK AF. 2200 pg 302 +


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 +12  upvote downvote
submitted by lamhtu(139)
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egeiNdn ihrghe" tcaoinen"rotsnc of het 6B ofr ymneze ivcaiytt si enthoar ayw of nysgai Km si girhhe ecsin more si edrqueri for 21/ vmax tvci.atiy drsaenIec mK usvael lrsute in 1mK/ ibnge rlmlsea (rscleo ot 0 on het s)ixx-,a hihwc is tseertmoandd ni swrane hoccie B.

A ola"rnm" nezmye atciyivt ni teh eercspen of hhergi B6 tncnrcesnoaito sanme hatt Vamx is otn h,nagicng but Km si.

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d_holles  In oreht Nld, msaorwor nzmyee cyatvtii = xdVd naAgmi omer 6B to a deuatmt emzney liwl voeprim it bakc ot noamrl x(Vma sayst sttocn,na os Km iwll edsercaed edu to ↑ iytfinfa fo teh ezm.eyn) +3
jatsyuk38  ^^ TISH si eth sebt ioannxlptea +
drdoom  t8jy3sa@uk het tnemcom or the nc?memuostb +
drdoom  ,oh leubod ctear = u,bbuppmm = the enmtcmo a(m@l)hut +


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 +4  upvote downvote
submitted by trazobone(97)
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mSeo of etesh alixoepntans alelyr ongdi teh tom.s If het ymezne is abel to nceirsea to ronalm iytticav wiht a ghhire velel fo eht retua,ssbt tath emsan weer’ in a cottiimvpee rhitoinbi tiso.intau Cimtoveepti ywasal csesors on the hp,agr so we acn iaetenlim A and .D

Now we aeylnaz m.K We natw slmla K’ms for ptntoe .nseyzme Sezi odes otn aalysw rtaemt 😉. ctpeEx ni stih scae ew o’dtn nwat atth poc,neyt ew ntwa to lkoo rof a ey/r1lal( gbi ,m)K (uaelv htta si rocels ot e),zro bc we tawn a kewa big Km to be ealb ot wrropeoev het tticieeomvp ibhon.tiri nigmprCao eht naeiimgnr 2 hi,eocsc B hsa a Km uaelv crleos ot zroe so he’rets rouy reawsn.

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 +2  upvote downvote
submitted by navevan3(2)
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orF htis ,tnqseoui I asw nkitnghi htta eyth aeksd yuo ercopam to a oam“l”nr esnpr,o so eth Vxam ndoluw’t aghnec insce yeth tsaet hatt shi ititacyv rusnrte ot a oanlmr e.lvle Only het i-xxsa dwlou icens ti dwulo be ta ieedrcnas rscatenonotnci in pno.sacmoir

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 +2  upvote downvote
submitted by an_improved_me(91)
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So i fudno thsi otqusnei isd..uulc.iro eht onpstalanixe rpdevoid did tno lalyer alrec ti up for ,me tub i ntkhi i tnduernads it onw slp(aee oerctrc em fi 'im gwn)ro.

tiFrs nad rmofes,ot 'mI otn neev ruse fi iths si rltuy a iwanekel-reebrvu ,lotp eiscn het axis-X is otn /K.m1

,Btu rmeo arely,ngel I etird to rtdnundesa twha enhpapde ta hbot etesermx of [L]PP nad leVo.ytci

P sLAkP: :urfysleo erwhe no het hprga si P][LP egish?ht ,elWl fi teh s-Xaix is eaqul ot P,/1LP PLP wdlou eb at its shegthi ta teh leavu sescolt to 0 on eth x.xia-s (t:nhik thwa si 1 diddvei yb a inibllo? YERV CEOLS TO ZRE).O hsTi owdlu nspdeocror ot a oinpt alogn teh yisx-a rfo teh eznemsy cyii.avtt In horet s,drow PLP is ta tis hgthise oectinnonratc at eht rpsahg e.enYcrpitt-

bmeeemRr hatw we oals dasi: nhew het udttmea emynze is unraod tsol fo PPL, ti lscblaaiy nctfiunos ekli a lnm yeen.zm hTsi s,mena tath het Vamx fo eth uamttde ynzeme si etinuveqla ot teh Vmxa of the aronml yn.ezem ererohTfe, hTe amV/x1 fo ohtb smeeynz rea .qliun.vetae. at eht esrictyhepTi- n!t is bgi! If yuo tge htsi ,afr then oyu anc litneaemi A)( dan D),( nsice etehs hgsrpa heva ediffnrte estpir-cteYn dere(iftnf xe)a-mVs ofr erhti vpsceeerti zyesnem.

ovigMn ...no

eyVtiloc :()V When V si ta tsi gtehsih .e.i( a,mxV) the laevu fo /1V odlwu eb at sti wtlse.o aig(:An intkh of ti clcaiatrpyl: hatw is 1 dvdedii yb 1 ?lbiinlo )!~0 frheo,eerT teh uaelv of /V1 si ta sit ewslot enhw het siy-ax si lquea ot 0. oreref,eTh heT Vaxm fo itsh sorcuc ehnw teh ayxis- is eclos ot ..rz.eo erHes het gntih t..ho seeht ysmeezn irereuq fdfetnire elselv of LPP to aeerpto ta .x-Vma Rr,ebmmee het a-Vmx of eth MTTEDAU nmezye llwi panpeh at a uhcm HEGIHR L]PP.[ rO o,nvryclese eht xV-ma of the MORANL mzeney iwll peahpn ta a ucmh REWLO .[L].P.P

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an_improved_me  ,gMnenai nwhe we lkoo ta eth tretnp-Xeci wnhe( V is ,hthgie)s eth eudtmta yemnez ilwl iurereq moer PPL. Mreo PLP neams a wl"ero" velau no eht xisa-x l(ercso ot eo)rz aitrevel to eth nmorla .emnezy +1
an_improved_me  gntiPtu ti ALL gte:tehro ict-p reynet wlli eb the smae ofr hbto ruaa/donmlmett xiectnpemrezn e-t llwi eb slcoer ot 0 for eth emuatdt ee,zynm lteirvae ot hte rnalmo ymz.nee h Te onyl sanwre taht ash boht ctreorc nhsplrtsiaoei is )(B. I hknit i stepn 5 timnesu on hsit tqeouisn nyrgti to geurfi ti ot.u I opyarbbl ulwod ehva nedede 01 mtiusne ot ultlaacy gte the.er yfpluHoel onw I nac etg it eruckqi if intshoegm ilke iths wossh pu on teh lare .hngti +2


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 +0  upvote downvote
submitted by minhphuongpnt07(5)
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eb aearw thta eht x-sixa rof isht qteoiusn si otn mK"" i(tBv6 is ton eth tus atbtehra'ts t]61[BV.i/ to fi,isypm sbeacue the axmV si angno sayt the s,eam uyo ujts deen ot seeniacr i6]Bt[v ot egt eht smea aVxm ak(a shitf to ighrt no eht -sxxai.) otn D' be oldfoe uanrdo by eht onquesti iwt.rer

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poisonivy  tshi maesk neess to em, X nncota eb m!K! ebuasce fi ti aws Km hent inle B wodul eb gnshwio a "voecmetiipt nibroh"iit ftfeec, whhic connat eb hte aesc cenis they aetts htta hte ynzeme aticitvy eniscsaer ot mlaonr aetfr B6 arnsitidnoitam os it froavs hte ntaicroe eaitnsd fo ercasedse t.i I got this noe grnow fo ecusro, oot tyicrk ofr m!e +


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submitted by empem28(1)
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Nybood hsa sawdeenr hsit qoetisnu rhhuogt teh slne of a graneiln cvbjeeoti itque ety so eresh' ym 2 ncst:e mK si ECISNARDE cb ihst ntteaip ahs na nezmey ihtw an laelvor LEWOR ntyaifif c(an eb ertrocecd ot anrmlo treaf an sneireac ni rtabe)utss ichhw is itccrtacharesi of EPTETCMIVOI nb,tihniiio hwhci is yhw hte neli fo hte p.t is eno of eivtcepomit obniiinthi on a LB olpt

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submitted by stapes2big(16)
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ehT qnetsoiu is yalbialsc isttegn pu a aniittsuo lirsmia to atht of a teicpevitmo tiobiinr.h hTye sya thta higher nrosiaccnoentt of ixarodylp thasophep rasceensi eht ytiavitc of teh enmyez ot arnoml evse.ll Siriam,lly ewnh uoy heav a ptoimeevict obinhirti dan aecrisen het oertcaicnnont of tesrutb,sa het eymnze anc eivehac hte sema axVm sa if othtiuw eht bnhirioti.

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submitted by usmleuser007(464)
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rmeemReb 1) emectivpoit srnithobii ~ neils ossCr at se- )rctyeitn2 i-Notpteniocmev shoinbrtii ~ on nlei cross

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 -5  upvote downvote
submitted by hungrybox(1277)
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ngoL raenws ,hdaea tbu brea iwth e.m

HN:IT v lsook idnk fo ekil y, ewerahs k lkoos oerm elki x.

t-terpcnyie = mV1/xa

  • amVx si eth uperp imilt no hwo tafs a cnaoteri si dleatcyza yb yezsnm.e

-epnttxcire = 1/Km

  • Km si a nnrikag fo how dgoo an nmyeze is at nigndib ist suraettb.s nA ymenze thwi a rnagkin fo 1 is treetb ta bnindgi ist brestatsu hant na eyzenm whit a gkniarn fo .5 eroLw( mK = tteber )yzneme

oetN ttah m,xaV sa a urmeesa fo cafomre,pnre cna eb edtlear ghrouth aynm ishtng. Mwil,eaenh Km si a set ihrectarcsicat of eht ,zemyen nad antnco eb le.retad

nI htis exp,emla eht ynezem mneprreaocf ax(mV) si esnaecdri yb nirgeincas hte tnavmii caotocfr os atht it caserhe a nl"m"rao yvctii.at o,Herwev eth yzeenm si llist leytnnerhi htytsi ude ot a canointegl e,ctdef so het mK stays hte easm.

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mnemonia  oA.eswem +
ht3  twia nlei B shwso het mxav et'odsn chngae nad ahtt teh km si inettgg eagrrl zmene(y is siltl tshiyt os aegrrl )mk so /1mk- duolw eb a lmslare brunem dna wludo aphcpora 0 +1
lamhtu  Yuo ysa mK cotnna be eaetrdl adn ist syatngi teh easm, utb teh anerws fo eth pgarh tsosdtrnaeme a herigh mK ud a vn.Ne lege i ihhgre" cinontoner"sact of eth B6 rof eyenzm ivcittay si nharteo ayw of gisyna Km is hihgre cnsei emor si dreueqir fro 1/2 vxma ciiatytv +18
sbryant6  ehaY htis tnioxanlpae si on.gwr +
kcyanide101  Hneystlo, itsh uiqeonst is rgnbubi me hte rgown wa...y. If ew go by hte niLe reweva kubr ,ptol tehn C"" si the coetcrr ws,enar ecuesab ""B is noigwsh itmtopeievc nio.hi.t.i.br Teh emezyn eehr is tyltovmeceipi ti va.gtncai meneSoo dsene to nlaixpe sthi tertbe slaee,p osem fo us adip no iths uofrm ot gte a unmfaeigln neaiplatonx adn not itbontcnsuoir mrfo llwfoe ttse tlo..l.e.k rsa +


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