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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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!YUGS uYo lylare eavh to look at eth xisa al.lbse ehT entoquis syas eth p'.ts chsiattnieyno tahesysn vytctiai as-i)y(x is ANORML tiwh an EIDRCESAN auomtn fo doalrxpyi shaoeppht xx(sa-i.) sYi-ax is the mase sa ,MRALON xxs-ai hfsist to the tihgr sonwihg AERDNCSIE oplaydxri phstoepha

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skonys  mmaI jstu keat het L no hist neo fi ti cesmo u.p I saw labe to owarrn it nodw to B a&;pm C ebaecus if tyeh aer nigsarncei rpy spho and ta oesm tnpio teh theyatoiscn enahssty ttiyviac si ~rnamlo~ tenh ti smut nertsicet eht rlamon optl blbapyro ta eht Y aeccss for aeronss I d'tno okwn it ujst eesfl hirtg. D edstno snetcriet ta .lal A citsetnres ta tyllnisaese /10 vtyatiic (kedi fi atth eamks nsees but ti sjut edlkoo ss.)u So thne I asw wbeente B nad C nda hbt at atht nopti I inhkt yuro steb etb is ot 5/050 it adn emov no iwth your lfie seluns ouy tnwa ot od rmed or metgisohn dna ened to gte it ctcreor tub awht do I ow?kn I go ot lneatd csoh.lo +
umpalumpa  I isaredge thiw sesmhuaa i.neltnaxopa hTe s-ixax has roxia/ldyp1 hephospt,a wichh nmase atth ingog to hte rgthi on eht -,saxxi lsv fo pyxordyla haossphtpe are ewolr a(dn the =vsirene oliy/pxdar1 osph,eapth eogs )ige.rhh +
sahusema  m@amaulupp its' bnee a glno item cines I tesdpo sthi, btu when uyo od iths /(-,)↑1X uoy ropcapha 0 inmnage yuo eisld teh rpgha to het ihrgt +1


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 +13  upvote downvote
submitted by amirmullick3(76)
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ehT eieenawvrL Brku tlPo si ynmial ptdrrietnee by sti X nad Y e npsTrtt.ihcee eisqotun ststae that gvngii B6 easnricse teh cavtiity to amrlon v,eelsl icwhh msaen hte vaycitit lhsuod eb teh seam as hte eamro.nn,eHc l hrtie Y tripecnet luhsod eb het me,sa so we ear ebewent ccohise B nad .C A and D do ton veha eth mase Y etertnipc sa .glaoihHr rnem recianotoscnnt fo 6B sdueca iycvaitt ot omcbee ao,nlmr nad os mVxa lwli nto eb gncighan dna ew acn enccla A and D .A hsa a lowre Vmax and D sha a mcuh hrhgei haxTVem. dieecrnffe tnweebe B dan C si in hrtie m.K gonivM to hte lfte on het X sxai kaesm the Km elorw adn setll uoy thta tiynaffi is r ioehghs oyu lduow otn dnee rmeo .B6 tuB ni oru sace iantfyfi fo het eneymz rof B6 is lleyra ,olw ihwhc is yhw we eedn a otn meor 6.B

In umayr,ms ew twan het same aVmx and a ihhreg eW .mK wtan eth m"o"rlna tyavctii (aems vmax sa nl)amro nda we ndee geihhr onstaum fo B6 for scscuse tyonfi iafs fo eht emyezn fro 6B is rbpyolba yevr lw.o

oechCi B ahs a m(-)1/K avelu slceor ot 0 hihcw nsema Km is orewl dna iftnfayi fo hte zenmye orf ist rstsuetba is prseu iwosh lT. aksme eness as vinggi ghreih nsotmau fo het vcp"eimie"tto taeutbsrs B6 si nilh.gpe

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apurva  siTh xlaaotpenni is !g nw!!orX axsi is ont km1/ in eth osui,eqtn ti si 1riolxy/apd p.thsoapeh /m1(k oudshl be 1teo/)hnyciemos losA the sqontuei is gknais obuta tioclslrae nttioaavic fo yainhsttcoe eansthsy ude ot tdaoidin of lardiypxo t.epphosah hcWhi maesn eth mK dsuohl ecdaeser niy(taiff scnsereai efrta oaiiddtn fo eisorin.peyxn)ridid ngCo eht x aixs ot be pl/id1ryaox poasehpt,h won ypapl eslmip lcigo fo stham, rnaeiecs aoilrxypd osehptpha = rniggbni ilne remo olesc ot erzo cebeas(u it is r-1iolxpd/ay ahst.)eppoh +13
apurva  aHd teh X ixsa eb m,1k/ hte wasrne ulhsod be C +1
pinkdinosaur  mK si yneslevri aderlet ot teh iyintaff of ehetezyn m rof sti ub he.saserTtt slceor ot 0 on eht sxX,ai- teh hrhegi eth KmF .A 0202 pg 230 +


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 +12  upvote downvote
submitted by lamhtu(139)
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neideNg ehrihg" cntt"nonrosecia fo the B6 orf eznemy tictvayi si thranoe yaw fo syinag mK si ihrheg nesic roem is rqdrieue rfo 2/1 xmav yitcivt.a scIrendae mK eaulvs lurtse in K1m/ igenb asmlelr lroecs( ot 0 on teh x),x-ais wcihh si omsdedtnerta ni aesrnw oihcec B.

A ao"n"rml yeznem caiiyvtt ni eth rnpeeecs fo rhghie 6B scoionettrcann sneam ttha axmV si otn ncgiagn,h btu mK si.

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d_holles  nI ehrot ,Nmorradwlso neeymz vtiyiatc = Agxdadn miV rome B6 ot a amttued nzeyem ilwl irvmepo it bkac ot onralm Vx(ma ystsa sttnnoac, os mK lliw ddeaescre ued ot ↑ aitifynf of teh eezyn.)m +3
jatsyuk38  ^^ HSTI si teh etbs aexnontlpai +
drdoom  kau3yj@ts8 the memoctn ro the stm?onubcme +
drdoom  h,o eduolb eacrt = upubbpm,m = eth teocmnm l)(ua@htm +


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 +4  upvote downvote
submitted by trazobone(97)
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meSo fo eeths pnseatalxoin lyelra iodgn hte tsmo. If eth eemynz si beal ot erniaecs to lnmrao cyattvii htwi a rhhgie elevl of teh tbtassre,u that naems rwe’e ni a mvpettoecii briiohtin .ntsuitaoi Ctmeivteipo yalswa cssseor on hte h,rgpa so ew nca teinmelai A nda .D

wNo we nyzaeal K.m eW awnt lmlas sm’K rfo etoptn zeseny.m eSiz eods ton yalwas ettram .😉 txceEp ni htis seac we do’nt ntwa atth ,npecoty ew want to oklo rfo a 1(eylalr/ ibg mK,) l(veua taht is scroel to oze,)r cb we nwat a ekaw big Km to eb beal ot oovrpweer hte tipovceimet thiiirob.n gpoarnmiC het gimrnneia 2 ,eccihos B sha a mK euavl rolesc ot eroz so eths’re uoyr serawn.

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 +2  upvote downvote
submitted by navevan3(2)
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Fro htsi uneoqtis, I saw intknigh atth tyeh kades uoy oamcrpe ot a ”m“rlnoa prens,o os eth Vaxm duwlt’no gncaeh sicen yhte tatse thta ish iicvytta nrurest ot a rnoaml l.evel Onyl eht a-xsxi duwlo sneci ti doluw eb ta ianedersc ecsraoinontctn ni oarspcoi.mn

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 +2  upvote downvote
submitted by an_improved_me(91)
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oS i fndou isth uiqnotse uird.ouic.l.s teh stanaxilenpo ipedovdr did ton ayrlel alerc it up rfo e,m utb i htkin i nsunedatrd ti won laspe(e corerct me if 'mi ro)ng.w

sritF nad eoomtsrf, m'I nto enve esru fi shti is lrytu a uberler-ieewvnak l,pto isnce eth s-xaiX is otn m./K1

,utB meor yngr,eeall I irtde ot raddsnuten wtah deaehnpp at hbto mxersete fo [LP]P nad tlo.yciVe

PLPA:s k rsloy:uef erhew on eth gpahr is L[]PP sihg?hte llW,e fi eht i-xXas si leaqu to P,1L/P PLP wulod eb ta sit hhsetgi at hte alvue elsotsc ot 0 on het saixx-. i(t:hkn wtha si 1 iddvdie yb a oinli?lb EVYR OCSLE OT OEZ).R hTis ludwo ordseconpr to a notpi gaoln hte asiy-x fro hte smenzye tiva.cyit nI treho dr,wso LPP is at tsi heghtis ionotnaecnrtc at hte gphasr rnteYc.i-ept

emrbReme hawt we aslo aids: whne the dumtaet zemyne is odnuar otsl fo ,PLP ti cslaliyab tcnnfisou lkie a lnm nez.eym sTih emas,n hatt the mVax fo the etmuadt zmynee si uaqeieltnv to eht Vxam of eth anmorl n.mzyee rreefh,Teo The xam/V1 fo hotb esyeznm era .qnta.ueliev. ta hte nTi eshcrpt-!iyte is i!bg If uyo etg htis ,far hnet uyo nca aminieetl A)( and (,D) sinec ehets pshrag eahv ifefntred pceensYirt-t etfri(fnde -asm)eVx rfo ihtre iveesrepct z.msnyee

Mngvoi ..o.n

Vitylcoe (:)V hne W V is ta sti tehihsg ..i(e )xVa,m eth veual of /1V dwolu eb at tis losetw. Agi:an( ihtnk fo it yarltpialcc: twah si 1 eddviid yb 1 ilni?olb 0~)! oe,reeTfrh eht uvael fo 1/V si ta ist lwesto ewnh teh syxai- is qeual ot .0 ohrf,eereT The xmVa of sith sucocr wneh eth yix-as is secol to ..oezr. erseH teh hignt hot.. hsete ezeysnm ueeqirr tfnredfei llesev of PLP ot eeptora ta V-x.am eebm,emRr teh V-amx of eth TUATEMD zeyemn ilwl ephpan at a uchm GRHEIH PL[.P] rO rncvl,oysee hte ma-xV of the MORNLA nmezey wlil npahep ta a chum REWLO LP.[P..]

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an_improved_me  ineMgna, when we loko ta teh trpctnXiee- wen(h V si s)hihetg, het tdamute ymezne lilw qeiruer oerm LPP. reoM PLP nesam a ""eolrw vulea on het asi-xx erlos(c to eoz)r lavreiet to teh anrmol .eyenmz +1
an_improved_me  guntPit it LAL rgtheteo: tpe ry-tnice iwll eb hte esma rof hbto nroala/tmmdtue ecr-x itmzneeeptn lwli be cloesr to 0 rof teh dauetmt nme,yez aertivel ot eht rlonma ym.enze eh T onyl resanw hatt ash hbot otccrre esortilnhipsa is (.)B I think i snept 5 nsemuti on hsit nouqiets tyginr ot grifue ti o.ut I oylrpbba dlouw aveh eeeddn 01 eiunstm to ycualatl get e.erht lHueolyfp own I cna get ti uqekrci fi nhsietgom ekli hsit shosw up no teh lera tg.nih +2


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 +0  upvote downvote
submitted by minhphuongpnt07(5)
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be arewa tath eht xsxi-a fro isth uoiesntq si tno ""mK 6tiv(B si ont hte burttesa ha'stt [tV]B/6.1i ot sp,mfyii eaucseb teh Vxma is ngaon asyt hte mesa, uyo sutj need ot rcesanie vt]B6i[ ot egt eth esma axmV ka(a itfsh to gtirh on eht xs-)ixa. 'no Dt eb fodoel rdnuao by eht oqtiesnu wiret.r

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poisonivy  hsit skame seesn to m,e X oatnnc be !!mK esuacbe fi it was Km htne eiln B ulwdo be hsnigwo a topevecitim" bhitr"iino efct,ef hchiw ctaonn be the asec cinse ethy esatt tath the zneemy tyvticia ensricase ot maolrn tefra B6 tairnnsdamioit os ti soafrv eht ceiranot sdtinea of eesceasrd .it I ogt itsh eon ogwrn fo r,eosuc too kirytc fro !me +


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submitted by empem28(1)
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ydobNo hsa srwdeean stih etonsuiq hougrth eth nlse fo a laierngn ctejbivoe quiet tey os re'ehs ym 2 n:ctes mK is RCEESDAIN bc hsit pneaitt has an nmzeye htwi an lvorael OWLRE itayffni na(c be coerctdre to lmoanr teraf na saecnrie ni s)surtteba whhci si ritthiecacrasc fo IEVTCPOIMET ibtnion,hii ihwhc is hwy eht neli of het tp. is oen of tvmoiecetip iniitniohb on a BL tlop

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 +0  upvote downvote
submitted by stapes2big(16)
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heT oiutesqn si saalibylc tngeist up a aotuntiis simrali to htta fo a timtveopeci tibior.inh eyTh sya ttah ghhrie nintrscooacnet fo dalxpyior ahspehopt ernesiasc the tvcayiti of teh nzeyme to alnorm .eleslv ,mSilryila wenh you heva a otiemvptcei iinbrioth nad iaecsren teh ocennrnottcai fo ,trteassbu teh enmzye acn eicahev the mesa Vxma sa if wiuhtot the rbtiii.noh

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 +0  upvote downvote
submitted by usmleuser007(464)
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mbrmeRee ) 1 emotpectivi rtsobiinhi ~ eslni oCrss at r-tteiec)sy2n itpvmNotneo-eic rbnistoiih ~ no lnie srosc

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 -5  upvote downvote
submitted by hungrybox(1277)
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oLgn asnrwe aaehd, btu rbae thiw em.

ITHN: v slkoo kidn of like ,y srheewa k soolk omer kile .x

rtypncet-ei = x/1Vam

  • Vamx si eth peurp timli no owh atsf a aentcori si ctyleadaz by esem.zny

ip-cxtreent = m/K1

  • mK si a rainkgn of how ogdo an mzyeen is ta bigdinn tis b.etutsrsa nA emeyzn ithw a rgakinn of 1 si etbtre at gindbni ist tussrateb athn an myezne hiwt a ignrakn fo 5. ewLo(r Km = teebrt zenemy)

eNot ttah ,Vmxa as a ermaeus fo errnpeof,mac can eb taeelrd rgtuohh nyam gnith.s whaM,ieeln mK si a ets iaiearchrsctct fo eth yeemz,n dan anctno eb .laeretd

In ihst eemlxa,p eth zyenme fmerepcrano V(x)am is reesniacd by einacnrigs eth vtinmai facrocot so atth ti ehcsrea a lnro"m"a ya.ivttci eoHrwv,e eth ynemze si slilt nhiretlyne tstihy due ot a nitcoenalg te,ecfd so the Km syast het esm.a

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mnemonia  .mweeAos +
ht3  wiat enil B owssh hte xvma 'dnesto acenhg dan hatt het mk si gigttne lrgera z(emnye si litsl yitsth os eglarr mk) so m1-k/ ldwuo eb a reaslml mebnur and wludo coprhpaa 0 +1
lamhtu  uoY sya mK ntonac eb teealrd and its stgynai teh sem,a btu hte easwrn of eth pgrha eoatedrmsstn a hiregh Km uedalvg i e en.N ri"ghhe neanotscrc"noti fo het B6 rof ezeymn ivcattyi is athnroe way fo aisgny mK is eirhgh sienc erom si rrdieuqe ofr 12/ xmav ticvaity +18
sbryant6  heYa sthi noxeplniata si org.nw +
kcyanide101  Hyntsl,eo hsti eoqutnsi si bigrubn em the rnwgo a..y.w. fI ew og yb teh Lnie evware bkur lt,po tneh C"" si the ccterro sr,wane seabcue ""B is hsowgin oevctimeipt t.i.ob..inihr eTh eyzemn ehre si evittpoyimlce nta cviatg.i omSeeno ednse to anpxile tish btteer e,alsep oesm fo su piad on hist formu ot gte a uaglifmnne pnnaiteloxa dan tno ctrnisbtnioou orfm owflel sett ls...erol.kt a +


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