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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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SUG!Y ouY eylral vahe ot olko ta het aixs bes.all heT uiqoestn sasy teh s.tp' ncinehosattyi yhsasnet icavttyi (xi-ays) is ONALMR tihw an NICSAREDE touanm fo aoyxplrdi ahtphpeos )-axsi(.x aYs-xi is eth same sa ,NMROAL si-xax thsisf to the rtghi ishgnow IREANDECS liypxaodr apehopths

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skonys  ammI sutj keta het L no siht oen fi ti soemc pu. I was leab ot rnroaw it nodw to B &;mpa C ebucsea if hyet rea gsiiannecr pyr hosp dna ta soem otpni teh tchenoatyis hnatyses atycitiv is m~rn~lao htne it smtu scienttre the romaln tlop blrayopb ta the Y cceass rfo neasosr I dn'to nowk ti stju elfes hgitr. D snodet tetcensir ta .all A ernctistse at astinseylle 1/0 ivtyciat (dkei fi ttah eaksm esens btu it tusj kloeod s)su. oS tehn I swa wntbeee B dna C nda bht at atth oitpn I knhit uroy etbs bte is to 0505/ it dan emvo no ithw royu eifl ssleun uoy watn ot do mrde ro tmonhiges nad dnee to teg it rcector utb tahw do I w?kno I og ot adltne lc.ohso +
umpalumpa  I deeigasr ihtw umashsae tnpoxaealni. heT sx-aix hsa lo/xiay1drp psahpe,tho wchhi esamn ttah iogng to hte tihgr no teh x,ixa-s svl fo layxodyrp hoaptepshs aer owler nd(a teh =veneris /ilpyoadr1x psp,hteoah soge he)ihg.r +
sahusema  uppmam@lau t'is bene a glon tmei incse I opdset h,tsi btu nwhe you do this ↑)-X/(1, yuo apoacrhp 0 gimnnae oyu sldie het ahrpg to the rghti +1


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 +13  upvote downvote
submitted by amirmullick3(76)
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heT ivweenLear ukrB oPlt is lmaiyn tpierrnedet yb tis X adn Y Tctrensp.t ehie tqioesun tatses that givngi B6 aesciersn hte yivatict ot oamrnl sellev, wichh aesnm het ciyivatt uoshld eb the msae sa eht oemaHnlnce. r, eriht Y tpecnreit usldoh eb het ,sema os we aer wtnebee hoiscec B dan .C A dan D do otn avhe het mesa Y ttpenerci sa mn .raerihlogH ncsiretnotoacn fo B6 esduac ivcaitty to bcoeme ,oanrml dna so xamV ilwl tno eb ngniagch dna ew acn acncel A nda .AD has a rwelo mVxa nda D sha a mcuh hgeirh . aVeTmhx efedfrcein ebwtnee B adn C si in hteri mK. Mogivn to het etlf on the X axsi smeka eht Km ewlro nad ltsel you that fftnaiiy si eih hrosg yuo oudlw ton ende rmeo B.6 uBt in oru esac iyfatnif of teh ynzeme ofr B6 si llaeyr wo,l ihchw si hwy we ende a nto rmeo .B6

In usa,mymr we awnt teh esma xaVm nda a rghieh .W Kme wtan eht manr""ol tvaiycti sme(a mvxa sa )rnmlao adn we dene irhhge osamnut of B6 for esuccss f tfoiisany fo het yenmez ofr B6 is pryblaob ervy ol.w

Ciohec B sha a -/1Km)( aulev slcoer to 0 cwihh smane Km is lorew dna ffainiyt of eht mzynee rof its rbestusta si rspue ilsT.o hw seakm ensse sa gginiv ehrihg musanto fo the toceemptv"ii" bssautetr 6B is .einhlpg

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apurva  iTsh naliopnxeat is ngro!!Xw! sxia is ont /1mk ni het qo,iuntse ti si iy1dlo/arpx hepoha.stp (1/km olsdhu eb inst/mhoyoee)1c lsAo teh etsnioqu is aikgns tbuoa olisarectl aitacitvon fo aitecsyotnh entssahy due ot iiadntdo of rldypoaxi aopetpsh.h hWchi manse eth mK hldsuo csedeaer y(tainffi saesnecri afrte ontidiad fo )re.nsnyniodoiprdixCie g hte x saix ot eb yxiparl1/od eophp,ahts onw ppayl sliepm olgic of tasmh, naersiec rdxayopli etohsppha = rigngnib neil oerm lsceo to erzo sbc(auee it si /lx1y-opradi sp)ht.eapho +13
apurva  Had het X axis eb 1/,km het rsaewn lshoud eb C +1
pinkdinosaur  mK si eyilrvesn rleedat to teh fyianift fo yehmzeetn orf ist b.er tsusheatT creslo ot 0 no teh xXis-a, hte hehigr hte F AK.m 0202 gp 023 +


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 +12  upvote downvote
submitted by lamhtu(139)
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niNeedg h"hreig csnni"cootteanr of teh 6B for emzney tyaiticv si netaohr way of asygin Km si hiregh since mreo si erurdqei fro 21/ mvxa aicti.tvy daeIesncr mK ulvsea treusl ni /1mK bigen lmaselr lrceso( to 0 no teh )xi,xas- iwchh is nodedtartesm in srneaw iohecc .B

A na"r"lmo nezyme ctiaiytv in het psnereec fo erhigh B6 nritcncaooetns ansem htta xamV is tno igha,gnnc but Km si.

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d_holles  In hreto wars lNmoord, myneze tiviytac = AiddxmnaVg emro B6 ot a utdtame zenmye illw mpiveor ti bcak ot omraln xV(ma atsys noasttnc, os mK iwll dedasreec eud to ↑ yfatifin of hte nye).emz +3
jatsyuk38  ^^ HIST si eth stbe eptaxnianlo +
drdoom  3jautsyk8@ eht omctenm or hte stocub?emnm +
drdoom  ,oh uelbdo ecart = ,mpbbpmuu = eth memncot h)(t@maul +


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 +4  upvote downvote
submitted by trazobone(97)
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moeS of seeth nnetaaxsopli eayrll idngo eth smt.o fI hte enezym si bale to ncarisee ot lonamr ityvtaci itwh a giherh lelev of hte ebaus,ttsr hatt smane w’ere in a tvieeomtpci btoiinirh otnua.tsii Ctiepteiomv wsylaa cressso on eth ,gphar so we nca temianlie A dna .D

Now ew yaelnaz m.K We awnt lmsla sm’K for enttpo zenmy.se iezS eods ton asyawl trmeta 😉. etxpEc ni tish esca ew ’ndot tnaw ahtt ept,noyc ew awnt to ookl rof a 1e/(llary igb ,Km) laue(v thta is oslcer ot rzeo,) cb we wtna a ekaw ibg mK ot be aleb ot orrewevpo hte tmvoeipeitc oiibrtnhi. gpCraimno eth nnmargiei 2 ch,cseio B sah a mK elvau selcro ot erzo os htesre’ yuor ase.nwr

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 +2  upvote downvote
submitted by navevan3(2)
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roF stih u,ietsnqo I saw tginknih taht eyht kadse uyo ocamepr to a “n”omalr roneps, so the xVma owl’utnd ghnace sncie ehty ettas ahtt shi ittaiycv runsrte ot a oarnml lvlee. lnOy teh -isaxx douwl cneis ti uwold eb ta sdneeciar ornetcnitconas in osc.mrpnoia

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 +2  upvote downvote
submitted by an_improved_me(91)
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oS i onfud tsih tuesioqn ..rosildciuu. the soinxapletna vdredopi idd ont elalyr ceral ti pu ofr e,m btu i kithn i ddnnuretas it won easpe(l toerrcc me if im' )o.nwgr

iFrts nad r,motsofe Im' tno neve sreu if sith is yutrl a lib-evrernkuweea opt,l ncies teh Xs-ixa is otn 1Km./

tBu, rome lerlyange, I edtir to natrudends twha penpheda ta obht metresxe of PLP][ and lto.iyeVc

LPks:P A :usyfreol rwehe no eht aprhg is [PPL] hetigh?s Wll,e if teh xaXi-s is qelua ot PP1/,L PLP lwdou eb ta ist gthishe at eth aevul csoelst ot 0 no the a.-xisx :ntk(ih tahw si 1 vdidied yb a ?lbinloi YERV OCELS TO .R)OEZ iThs lowdu psnrodcreo ot a nopit onagl eht aixs-y rfo het znmsyee tciy.vtai nI oetrh wso,rd PPL is ta tsi sghthei ernioncnotcta ta het sghpra -tirenYetc.p

emmrebeR ahwt ew soal i:das hnew hte uaemttd nzemye is durnoa oslt fo P,PL it blsylciaa utnocfnsi lkei a nlm ze.mnye sTih mns,ae htat hte xmaV of eht aumdtte meeynz si uietnqaevl to teh xVma of teh rnomal eznyem. e,feerhTor The a1/Vxm fo obht nmzeyse rea ..enqtalev.iu at teh ipre T-eint!hytsc is bi!g fI oyu tge stih f,ra hnte uyo anc tmeiialne A)( and D(,) ecisn sehte agphrs eahv tnrefidef etpYenrsti-c tre(fedfni -x)smaVe rof iehrt ercepesvti enmy.zes

gonMiv .no..

lytiVceo ():V e hWn V is at tsi hietgsh (..ei )Vmax, the vluea fo 1V/ udowl eb at sti oletw.s :Aan(gi thnki fo ti ctay:rcilalp twah si 1 iddediv yb 1 l?iiblon ~!)0 ereohre,fT hte uavle of 1V/ is ta tsi osletw wehn eht ysai-x si elaqu ot .0 reTfo,erhe ehT mVxa fo sthi rccsou nwhe eth xi-yas si seolc ot o.zre.. eHrse the gntih ..tho etehs mnzeyes riqreeu tifefednr eeslvl of PLP to atpeero at amVx.- mbereem,R the -amVx fo teh MEADTTU ymezne lwli apehpn ta a mhuc IERHGH P]P.[L rO ln,rvoeyces the mV-xa fo eht AONMRL mzeeyn ilwl hpapne ta a uchm WEORL P[PL.]..

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an_improved_me  M,nagnie enwh we okol at eht tprXe-tiecn w(hen V is ,i)thgehs the aeudtmt zeenym lwli iurqeer oerm L.PP More PLP aenms a l"ower" elauv no the xis-ax erlsc(o to oer)z tleavrei ot hte anmlro zmy.nee +1
an_improved_me  ngPutit ti LLA toert:geh itetner ypc- liwl eb eht msea orf both t/lutonmmerdaa ei nztxtpmrn-ceee wlli eb sclore to 0 rof het mtudtea enz,mey averliet to eth lraonm zmeyn.e heT nlyo rsneaw atth ash hotb trccore hiesiltrnoaps is (B). I ktinh i sepnt 5 iuentms no iths inuetsqo nyigtr ot uigefr it tu.o I plybrboa lwoud avhe eednde 01 tumisen ot acatluyl egt rete.h oufHlyepl now I can gte ti qceriuk if stnimhoeg iekl ihst swhso up no eht arle nt.ihg +2


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 +0  upvote downvote
submitted by minhphuongpnt07(5)
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be eawra tath teh sa-ixx ofr this onsteuqi is not mK"" (tiBv6 is not het bh t'srtuteasat t1[i6.B]/V to fmiypsi, beusaec eth mxVa si nnaog tsay hte em,as uyo jstu eden to esanrice ]6[Bitv to gte eth maes Vaxm kaa( fstih to rihtg no the .x)ai-xs oD'tn be oolefd rnoadu yb teh tsiuoenq ewt.rri

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poisonivy  sith kemsa seens to ,em X toacnn be K!!m seauceb fi it asw Km then lnie B udolw eb nosiwgh a pe"moecittvi ontbh"iiri etf,ecf hcwih onncta be het scae csnie yeth tsaet htta eth zemyne ytiacitv aensisrec ot onrmla reaft 6B ttidnaoirnsami os ti rfasvo hte noertaic stdeain fo esdsrceae i.t I otg htis neo ognwr fo euosc,r oot rictyk rfo e!m +


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submitted by empem28(1)
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bdNyoo sha wesernad tsih tqioeuns grtuhoh eht nles of a aelrngni viboecetj uiteq yet os sre'he ym 2 tsn:ce Km si IRDASNEEC cb isht ttiapen ash an nmeyez htiw an aovlrle LWROE nfifiyta cna( be cercedrot ot armonl feart an ceinsrae in es)ubttras ihchw si rtaeiacthircsc of ECIVTMPTEIO ib,nihtinio hhicw is ywh eht neli fo het .pt si noe fo tecptimevoi hnibiotiin no a BL tlop

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 +0  upvote downvote
submitted by stapes2big(16)
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ehT eoiqsutn si baylsclia isgttne pu a nituostai mlisira to that of a itcpioevetm ib.nirtohi yTeh sya ttah hihgre ncnrtoinsoatec fo lxyoiaprd athophpse scaesinre eht acittviy of hte enyzme ot nomlar lveel.s ,riamSiyll enhw yuo heva a eteocmvtipi hbiontiri dan eacrsein het cenctartoinon fo bu,atersst hte zymeen anc ieevcah hte esma Vmxa sa if ohuittw hte i.intrbioh

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 +0  upvote downvote
submitted by usmleuser007(464)
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mRremeeb 1 ) ceivtpmteoi sobniithir ~ elisn Crsos ta cnt-esetry2)i niteo-Nptcoevim ibnishtrio ~ no lnei ssrco

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 -5  upvote downvote
submitted by hungrybox(1277)
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nLgo swarne edha,a btu aerb thiw .em

IHTN: v soklo dikn of iekl ,y wrahese k slkoo ermo ikle .x

enrtpcyti-e = xaV1/m

  • Vxam is hte rpeup lmiti no how astf a cirenaot si cleaatyzd by meyez.ns

rtip-etxecn = /m1K

  • mK si a inarngk fo how oogd an meyzen si at nignbdi tsi ttusrb.sae An nyemze tihw a ngaiknr of 1 is terbet at dnigibn sti tratsebus tahn an nyezme whit a nkarnig fo 5. owe(rL Km = teetrb )yemzen

teoN atht Vm,ax sa a uaserem of apmfe,onrecr cna eb reatled utoghhr ynam tn.hsgi M,eanehlwi mK is a ets iastrectihcarc of the mn,ezey dna oactnn eb daetle.r

In shit ex,elpma eth ymzeen onrpecamerf maV)x( is eaercsdni yb riasenngci eth nivtmia cfrtaoco so tath it recaseh a "n"rolam ivya.ttci Howrev,e eht eemzyn si lstli elyninerht htstyi edu to a tlngaionec tfedec, os teh mK stasy hte same.

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mnemonia  mo.Awsee +
ht3  tiwa enil B sowsh the axmv sonde't ahnecg dan ahtt eht mk is itngget gaerlr nymee(z is lslti sttyih os grrale m)k so /k1m- dwuol eb a arllems neumrb nad oluwd pophrcaa 0 +1
lamhtu  ouY yas mK ancotn be lrtedae adn sit tsanygi eht mse,a tub eth saerwn fo teh hprag seomsadtretn a rieghh Km gNeelin ue.d va ehh"irg rc"tecnsonoitan fo the B6 rfo eemnyz aivtctyi si ronheat ywa of anysig Km is hrigeh isnec rmeo si rdieuqre fro 21/ vxma atitcyvi +18
sbryant6  heYa tish aptanoxenli si onw.gr +
kcyanide101  tyoslH,en shit etuqosni si nirbubg me eht nogwr .wa...y If we og yb eth neiL awreev ukrb p,lto enth "C" is eth rcrtcoe nw,easr esueabc ""B is iogsnhw opcttmiivee hn.boir..i.ti Teh yenmze eerh si teeplmitocivy ac avtnt.iig nemeooS sdeen ot aelxpin ihst rettbe lpesea, omse of us idpa no thsi ufomr to gte a neuiflamng ianatoplxne and otn uoircitntobsn orfm wolfle ttes . .rskla..eolt +


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