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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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GU!YS Yuo rlelay aveh to lkoo ta eth xsia sllaeb. hTe oeutsqni ssay teh ps.'t cstyoniiehatn ssethany itvaityc iaxy-)(s is LMNROA tiwh na SECAEDRNI otaumn fo iloxrdypa paphoehst (s)-ax.ix xa-Yis is het asem sa MRNL,AO isxa-x hfssti to eth rhgti oginswh RCEEIDANS xdoiplayr tsepohhap

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skonys  mIma just etak eth L no ihst eon if it cosme .pu I wsa blea ot awrron it onwd ot B am&p; C auebsec fi htey are isrignneca pyr hpso dan at oems noipt the ciaytthneos teshnysa ttacviyi is ~~manrol nhte it msut rstnceeti hte olmnra tlop baoplybr ta eht Y sccsae orf oresasn I t'ndo nokw it tujs flese i.thgr D tdseno neicstter at la.l A sttceresni at neeissllyat 1/0 vtayciit ei(kd fi taht aesmk nssee btu ti tusj koeold us.)s oS tneh I wsa eewbtne B and C dan bth at ttah noitp I ktnhi oryu btes tbe is ot 05/05 it nad ovme on itwh ouyr ifle nlusse uoy natw ot od emrd or msiohnetg and nede to egt it rrcoetc tub hwat do I ?know I og to aedtnl .lshooc +
umpalumpa  I rdgiasee iwht maahsuse xanleoti.nap ehT xasx-i ash /larxydpi1o ,hpoahpset hhwci enmas atht oingg to the rihtg no hte is-xx,a lsv fo pydoyxlar hsotpsaeph ear lrweo (nad eht irv=sene 1alypr/xiod eap,ohthsp oesg g.)riehh +
sahusema  pupm@amlua t'si ebne a olng ietm encsi I spoted h,sti btu henw uyo od hits ()1↑,X-/ ouy apparhco 0 geannmi oyu ldsei eht rgpah to het ihtgr +1



 +13  upvote downvote
submitted by amirmullick3(76)
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ehT wnveaiereL Bkur tloP is mnalyi tinerretdep by sit X dna Y ciTrettnp .eseh iensqotu taetss thta vignig 6B aeecnssri eht yatitivc ot alnrmo elsv,le wihhc amens eth tyactivi soudlh eb hte smae sa het nrecm, aone.lH rhtei Y itcrnteep dholsu eb het emsa, so we era twnbeee chsceoi B dna C. A dna D do tno heva the aems Y cenritpte sa nilhe rmaoHrg. rcsonntieocant fo 6B ueacds atvyctii to eceomb olnram, dan so xmaV wlil nto be nnggicah nda ew acn caenlc A dna D .A hsa a woler xmaV adn D sha a hmcu hgiehr xmahTV.e efifnecred enbteew B and C si in rthie m.K gviMon to eth ftle on het X xsai emska teh mK lerow nad lstel uyo ttah ftiafniy si rhshog ei you oudlw ton dene reom 6.B utB in rou aces finitayf of hte znmeye orf B6 si elrlya ,wlo hhciw si hwy ew need a not erom 6.B

In raymsm,u ew anwt het maes axVm dan a hrehig K .meW tnwa the nrlom"a" vtyiicat (esma mxav as r)amoln adn ew dene irehgh onutsam fo 6B fro sseucsc intafsi yof of teh zenmey fro 6B is bopalbyr veyr lw.o

ioChce B sha a 1-(K/m) avlue eolrsc ot 0 which mneas Km is weorl dna itnaffiy of het ymzeen orf tis stesubrat is esurp hloisT w. askme sense as invgig ehhgri notumsa fo hte toptvmciee""i tbtssruea B6 is egh.lpni

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apurva  ihTs enoailantxp si X!n og!!rw saxi is ont 1k/m ni eht qtu,nosei ti si dxp1ily/oar shepa.othp m(k/1 sludoh eb )eethoisnom/c1y sAol het tunesioq is ngkisa uotab ltsrcielao oviintcata fo setniathcyo aehtnssy ude to dnitaiod fo ydriolxpa h.thesppao chihW neasm eth mK osudhl eeaecsdr (anfyfiit esceansri tfrae idaiodnt of reo.irninpo Cdns)idgeiyx hte x aixs ot be oradyx/pi1l e,athohspp now pylpa peilsm igocl of msh,ta esaciner lxdoiyapr pehohptsa = inrngigb elin rmoe eolsc ot oezr uecbesa( ti si il/xor1d-yap o)tehp.ahsp +13
apurva  Hda eth X axsi eb /1m,k eth rsanwe dhosul be C +1
pinkdinosaur  mK is lseevyirn draetel ot the fyfaitin fo emezyhte n orf tsi ebhTtatseu.rs eolscr ot 0 no het iasx-X, the ierhgh hte FKm. A 2020 gp 230 +



 +12  upvote downvote
submitted by lamhtu(139)
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iegNden hieg"rh "tooartniecnncs of hte B6 fro neemyz ttiivcay is otearhn ayw of ynsagi Km is iherhg iencs oerm is reeuidrq rfo /12 mvxa taciiyvt. Icneesrad mK seulav usretl ni 1/mK bineg alslmre rce(ols to 0 on eth x),aix-s hichw is rastnedtmeod ni swerna oheicc B.

A r"lman"o myeenz tiyitacv ni the cneseper fo hriehg B6 ntntecocosinar asnme ttha amVx si nto nhgagni,c tbu Km i.s

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d_holles  In eroth arrd ,sNlomwo neemzy vaiitytc = A Vidxnmgad more 6B to a ttmdeua mnyeez wlli mroeivp it akcb ot arnlmo x(mVa aytss na,scntto so Km lwli ddcreeesa eud ot ↑ fnyaftii fo het )mny.zee +3
jatsyuk38  ^^ HIST is hte stbe xptoealinna +
drdoom  tujs3y@k8a het tomecmn ro het ctesmb?moun +
drdoom  o,h ulbdeo artec = ubmpbm,up = eht emtcnom )@utml(ha +



 +4  upvote downvote
submitted by trazobone(97)
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emSo fo sethe lxnataepoins reayll odign het tmos. fI eth meneyz is leab to aernscei to oarnlm atictivy hwit a rgeihh evlle of the taetsr,ubs taht measn ’reew in a ieemtotpicv thiobrini i.tsinutao Cpvtometiie syaalw cosesrs on the rpga,h os ew cna iaetminle A and D.

oNw ew yaaelzn mK. We awtn lmsla ’msK orf optten nzesye.m zieS odse ont asyalw metatr .😉 expEct in iths aesc ew o’ndt nwta atth ,potecny ew twan ot oolk fro a a/l(ryl1e igb Km,) (evalu htta si erlsoc to )ozr,e bc we nwat a kaew bgi mK ot be blea to rowoperve teh tietcmevopi rniti.bohi nprmoCgai het mgnainrie 2 chieosc, B hsa a mK uavel escrol ot oerz os ret’hse uyro are.wsn

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 +2  upvote downvote
submitted by navevan3(2)
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For shit esnuoqit, I aws tkninhgi atth ehty deksa you pmcaeor to a a”r“omnl osn,per so eth axVm dwn’uolt ehngca neics yhet etast hatt ihs vtiictay rneruts to a mlorna elvl.e lOyn teh xi-asx dulwo inecs ti uldwo be ta esdicearn nrsnnaotcitcoe ni cmarsonoi.p

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 +2  upvote downvote
submitted by an_improved_me(91)
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oS i udofn hist iestqonu lro.icud..siu het ieanptonsxla doverpid did nto lrlyea rcael ti up rof em, btu i khnit i unartednsd it won a(eselp ocrectr em fi i'm nwg.)or

srFit dna smtrefo,o I'm tno enev erus if iths si ruytl a ielabnvewuekr-er pol,t sinec hte sXaix- is nto 1K/.m

,tuB remo yae,lrgnel I drite to rndseaundt awth epnehadp ta obht resxmeet fo [P]LP nda lyico.tVe

kLPA:Ps olefyrs:u rwehe no eth prgah is [P]PL hetsh?gi Wlel, if teh i-saxX is uqeal ot /P,1LP LPP luodw eb at its ehhitgs at eth eulav scoetls ot 0 no eht s-axix. ik:(htn hwat si 1 ivdddei yb a nobl?ili REYV OLSCE TO R).OEZ Thsi wluod odcersonpr to a onpit gnlao eth -iayxs orf the ensmyez vitit.yca nI rohet d,srwo PLP si ta ist gsihhet nooncteinract at hte rgahsp Yt.neect-ipr

emebrmRe twha ew olas dais: enwh the mdttaue ezmeny si nroaud ltso of ,PPL ti yacibalsl cuotinsnf kiel a nlm ynm.zee hiTs asm,en hatt teh Vmxa fo the mdteaut zeymne si aiunlqteev to eht mVax fo hte amlnro yn.emez e,Tererhof Teh 1aV/xm of both mzysnee are viu.nt.el.eaq ta het i-r etptihysn!eTc si bgi! If oyu tge tsih fr,a enth yuo nca ilmaeinet A() dna D)(, csine ethse arghsp vhae neffrtedi Ysr-ttipenec (rftnfdeei e-xam)Vs rof their tieervecsp .mynseze

Mvoing .o.n.

tceoiyVl ):(V nehW V si ta tis tihghes i(..e axm,V) eth alveu of 1V/ dowlu be ta sit wtos.el ga(Ani: ktihn fo it rap:iylctlac ahtw si 1 idvdeid yb 1 ?libloni 0~)! eo,fheerTr hte aulev fo V1/ si ta sit leoswt ewhn hte -yisxa is alque ot .0 hf,eerroTe Teh mxaV of sith oscurc wnhe eht iyxas- is elcos to .r.oz.e eeHrs the ihgnt ..toh sehet eeyzsmn ruerqie refeftdni vleles fo PLP to eprateo at .xa-Vm emeRre,bm het xam-V of het EDUTMTA eyenzm wlil hppean at a hcmu RGHEIH .P[LP] rO v,renscolye het xVam- fo hte ARMLON myezne lwil pnpahe ta a mhcu OELRW PL.[P]..

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an_improved_me  Mn,eigan ehnw ew loko at teh -ripetXetnc ew(nh V si ghi)e,sth eht uattmed mzyeen lliw euirreq reom .LPP oerM LPP smane a ewolr"" aeuvl no eth xax-is scl(oer to e)roz ateiverl to eth rlmnoa n.eyzem +1
an_improved_me  gtntiuP ti LLA hge:ttroe -petyitcenr lwil eb eht msae fro hbot eamdota/umnrlt xnezntp-ieemtrec wlli be erlcos to 0 ofr the umadett ynee,zm aretvlie ot the rolanm n.eyzem Teh ylno wnrsea htta has btho rcetrco osisptrahleni si .B() I nikht i esnpt 5 esntumi no tshi ustnoeiq rngity to riefgu ti o.tu I lpbbryao owdul hvea eddeen 01 instume to cutallya etg heet.r ylfpueHlo won I nca tge it qkeuric fi seinmgtho liek shti ohsws pu no eth erla tihng. +2



 +0  upvote downvote
submitted by minhphuongpnt07(5)
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eb erawa that eht sxi-xa fro hist suietnoq is not "K"m Bivt(6 is tno het aera uttsb'shtt [1B./Vit]6 ot ,iympfis aeceubs eth Vmax is anngo stya het ea,ms you tjus dnee to resineac t][6vBi to tge eht esam amVx aka( ftshi to tihgr no the .as-x)xi Dno' t be oelfod rdonau by eht oisqeunt re.witr

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poisonivy  tsih smkea esens ot em, X noncta eb !Km! ecuabse if it aws Km enht nlei B owldu be wgsohni a ttic"oevpime "tinrbihoi ftef,ec hwcih oancnt be the aces escni yteh attse tath het yeezmn ctvaiyit ceissnrae to olrnam eaftr 6B antdsiniiramot os ti frovas the itcoanre tdisane of cesdseaer it. I gto tish eno rwgon fo ocersu, oto tycirk fro m!e +



 +0  upvote downvote
submitted by empem28(1)
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Noydob sha eewsdnra isht oqisnuet urhothg eht nsel fo a niagrenl beejctvoi itequ eyt so eesrh' my 2 s:enct Km is RESEDNCIA bc htsi aittenp sah an yzenme iwth an rvloela ROEWL antiyffi acn( eb rdoctceer ot arnmlo artfe na eeircnsa in eatst)sbur cwhih is crcishracattie of VTITIPOMEEC nhbiioi,tin wihch is hwy hte ieln of eht t.p si neo fo tceiveimpot hniibotini no a BL tlop

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 +0  upvote downvote
submitted by stapes2big(16)
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hTe qintsueo si claiasbly ttsgein up a iaoisntut aimrisl to ttah of a ttcvemopiei inhiti.obr Tehy ysa ahtt eghhir oinnrtctsenoca fo dixopyrla speaohthp rsceiensa the vitiycat fo teh zynmee ot alornm ls.evel iSi,rymlal ewhn oyu vhae a ieioptevmct itonibrhi and cnrseiea eth inccrotaotnne of stsbtaur,e the meneyz nca eviceah eth emas xVma sa fi howutti eht ibh.tnroii

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 +0  upvote downvote
submitted by usmleuser007(464)
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eeRrmbem 1) eevticotmip isriinhbto ~ elnis rsCos at ne)ctsy 2ert-i ve-tctmNpoioine isinhrtoib ~ on elni rcsso

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 -5  upvote downvote
submitted by hungrybox(1277)
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nLgo ewnars aah,de tbu aerb hiwt e.m

I:NHT v ksool dnki of iekl ,y eharwes k loosk omre ekli x.

eient-trpyc = /mxa1V

  • xVma si the pperu liimt no owh tfas a aetrinoc is ydacazetl by .enmeszy

pentxrtcie- = 1K/m

  • Km si a kgrnnia fo who good na ymeezn si ta dnginib tsi betss.tuar nA zmenye htwi a nnrgika fo 1 si teetbr ta igbnndi its stastubre ahtn an mzeeyn whit a nigknar fo .5 row(Le Km = eetbrt eye)zmn

Nteo atht ,mVax sa a emesaru of noaerprmf,ec anc eb atrleed hrthugo nyma .insgth eMhiwa,lne Km si a set tiarcairtchesc of eht mezye,n nad actonn be teel.rad

nI sthi x,eeplma het eezmny amerrcepfon (Vm)xa si sadcenire by csregniian het amivint oaoccrtf so atth ti hcersea a omrnl""a yciivtta. vw,Horee teh emyezn si lstil eyerlnniht itsyht due to a citanlgneo c,efdte os eht Km asyst eth .amse

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mnemonia  moeAe.sw +
ht3  iwat enil B hosws teh mavx nodte's hceang dan hatt teh mk si ngitetg alrger nzeye(m si lstli tistyh so lrerag km) so /m-1k uwdlo eb a elslamr rebnmu adn oudlw aopapchr 0 +1
lamhtu  Yuo yas mK anoctn be redleta dan its yniatgs het s,mea utb teh wnesar of teh raghp tsrostmandee a reighh Km udv eenN ael. ig hih"ger onse"ntncaoirtc fo eth B6 for zyenem viyaittc is ntrohae way fo iygnsa Km is hhrige sienc rome is rrudieeq ofr 1/2 amxv tiicvayt +18
sbryant6  Yhea isth otnnlaiaexp is wrong. +
kcyanide101  styH,nloe isht tqieusno is gnurbbi em eht rognw a....yw If ew go by eth Lnei rvaewe bruk l,pot then ""C si eht crector waesn,r beaecus ""B si hgniows ttcveoiiemp nbo.h.tir..ii heT ezneym heer is titliceypmove gaa. ivittnc meenoSo endse ot ieapnlx hsti rbette aepse,l emos fo us daip no isht mourf ot gte a inluagemnf xaopneatlin and otn toctbnriosnui rmfo lowelf tste lltreak..o s.. +



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