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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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!UYGS You lreayl vaeh ot look at the sixa .laesbl eTh ioustneq yass het '.stp caehnnytsioit hnaseyst yavtitci (y)-isax is MNAORL ihtw an IACEENDSR ouatmn fo riolxydpa saothpeph sa)i.x-(x Y-xsai is teh mesa as LM,NOAR sixa-x ifssth ot hte rthgi hnosigw ESNIDERAC dproaxliy pshhaetpo

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skonys  mmaI jtsu teka eht L on shit oen fi it csemo up. I aws albe to ronwar it odnw ot B &pma; C sbaeuce fi tyhe are nsiicngaer ryp shpo dan ta meso toinp teh sittacoheyn ahnyests victiayt si mo~ral~n neht it ustm ntseeirtc teh alomrn otpl obyarlbp at eth Y cscsae rof ssnroea I do'tn kwon it sjtu lsefe hgit.r D edntso tctnereis ta al.l A eisrtcnest ta easetsiylln /01 tyivatci kd(ei fi atth eksam eessn tbu it tusj kdeloo .ssu) oS enht I wsa twenebe B dna C nad bht at that ipnot I ikthn oryu etbs teb si ot 050/5 ti and vmoe on iwth uory file selnsu oyu nawt ot do mrde or inheostmg and ende to teg ti ccertor utb hwat od I wk?no I go ot tedanl los.hoc +
umpalumpa  I gireeads ihwt essauham axapionteln. eTh xs-xai ahs dayl/or1xip ,pheotshap cihwh aenms ahtt noggi ot the tirhg on hte a,xsix- lsv fo dolyaypxr sseahptohp rae rewlo d(an het veesrin= dipr/axlyo1 phptea,sho egos h.)ehigr +
sahusema  pamuua@plm sit' neeb a ognl eitm icsen I setodp t,ihs tub newh you do thsi /()-,X1↑ oyu aoppharc 0 mginean ouy disle eth gphra ot teh tghri +1



 +13  upvote downvote
submitted by amirmullick3(76)
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ehT vneLraewei ukrB lPot is mlynia dertrnitpee by tis X nad Y Ttrpts eeehc.in qesotiun ttssae that iiggvn B6 raessncei hte itcivyta to ornmla sleevl, hiwch seanm the ytviiact hdsoul eb eth emsa as teh el ,.anceHmorn theri Y eteticrnp dhsoul eb eth sa,em so we are eetwben eccohsi B and .C A dna D od ont evah hte easm Y cttprenie as h nlHgimrroe.a cntaonsntoceri of B6 ecsuad yitticav to mboeec lm,aorn adn so axVm wlil not eb acgighnn nad ew can lcneca A nda DA . sah a ewrol maVx dan D ahs a hcmu gihrhe VThx.ame idffreeenc wbteeen B dna C si ni rhiet .Km oMigvn ot eth etlf on eht X isxa skame hte mK lorwe and letls yuo ttah iitfnayf si g ihoserh oyu ulodw otn nede roem B.6 tuB in ruo acse iyfnatfi of eth eznemy for B6 is yalerl l,wo hihcw is ywh we eden a otn orme B.6

In ymar,mus ew awtn hte aems Vxam dan a ihrheg .em WK atwn the "lrmaon" ctvyiait asm(e maxv as lnam)or and we dnee geihhr tsmonau fo 6B fro cuscses osiy ifnfta fo teh emznye fro B6 is baybplro yrve ol.w

ecoChi B sah a 1/(K-m) vueal rsecol ot 0 wihch esman mK si erolw adn tfynifai fo teh zmenye ofr tis turbatess is ersup hlowT.s i smkea ssnee as ggiivn grheih atmonsu fo teh ioci""vetemtp btastuser 6B si nglihp.e

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apurva  hsiT nnaixtolpea is X!!go!n rw ixsa si not km1/ in hte u,eiotnqs ti is o/y1dpraixl stoehphp.a /mk1( ohudsl eb nmoy)he1ecos/ti olsA hte oqtnieus is skgnai utboa sceoltrial vitatoican fo tnycoheaits ssaneyth eud ot iainoddt of odryilaxp pphtoe.has hihWc amens the Km oudshl esaderec ntfiayi(f eensraisc etfar tidndaio of d.o Cdseioxpiinniren)gry eth x saxi ot be ydiaopl1x/r ahpth,psoe now yaplp mplsei gocil fo ht,ams ceisarne iylaroxdp phaehsopt = gribngni neil erom close ot rzoe aeus(ebc ti is /pa-drilox1y stp.hpoaeh) +13
apurva  dHa hte X isax eb ,1/mk het arsenw uhosld be C +1
pinkdinosaur  mK is vylnseeir deaterl ot teh tnfafyii of zy hmneeet fro ist sa.b uetstrheT corlse to 0 no teh ,i-asXx eht hirheg eth .mAF K 0220 gp 320 +



 +12  upvote downvote
submitted by lamhtu(139)
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eNiengd "ihhreg cntniseoatrco"n fo teh B6 ofr eynezm tyaiivct is hortane awy fo gnsaiy Km is herihg nseci oerm is uredireq ofr 12/ xvam yvcitiat. recdsnIae mK ueavls rtusel ni 1/Km gibne rasellm (rceslo ot 0 no hte ,ax-i)sx cwhih is tdesdetrmona ni aswenr iochce B.

A nomra"l" nymzee vcitiaty in eht cnepeers of rghieh B6 iocaenrotntscn nmeas ahtt axVm si nto cagnhngi, tub Km s.i

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d_holles  nI erhto Nwrds mlor,oa yezenm ivticaty = VmAxad idng orem B6 to a ateudtm mzeyen lwli eopirmv ti cbak ot lonarm mx(Va ssayt aostcn,tn so Km wlli adercdees ude ot ↑ ftiayifn fo teh mz.e)nye +3
jatsyuk38  ^^ SIHT is eht steb apelanntiox +
drdoom  s3kjt8@ayu eth mmnceot ro the nesmo?tbcum +
drdoom  o,h bedluo tcaer = ump,bmubp = the emctmon ahu(l)@tm +



 +4  upvote downvote
submitted by trazobone(97)
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emSo of ehste inpsoetnlaax ralyle oidgn hte mst.o If teh eznmey si aleb to ienrseca to rnoaml cayvttii with a eghirh lelve of teh bssutaet,r ttha nasme rewe’ in a ettivpcomie iiroitnbh tstain.uio Citmptveeio awsayl csesosr no teh agrh,p so ew cna iaelmetni A and D.

wNo we yanleza K.m eW want sllam mK’s rof teontp mynesez. eziS oesd not ywaasl mettra .😉 xcEpte in tish scae ew dt’no nawt htta e,ctpyno ew want to loko fro a y(/1ralel bgi )Km, lavu(e ahtt is secolr to eo,)zr bc ew ntaw a weka big mK ot eb eabl to vreowrpeo het teicoitemvp tino.biirh agorpimnC teh narieingm 2 ch,icsoe B ash a mK uavel solrce to rzeo os ’setehr ryuo ernasw.

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 +2  upvote downvote
submitted by navevan3(2)
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For tshi estiqn,ou I aws ihtngink thta yhet daske yuo rmapceo to a “onrlam” ,nsrepo os the xaVm t’luwdno naehgc inecs hyte atets htta ish tviactiy tsreunr to a orlmna vee.ll nOly eht xiaxs- oludw ecsni it uowld eb at ncaesderi tenonctsncaior in sarn.pcioom

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 +2  upvote downvote
submitted by an_improved_me(91)
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So i dounf ihts istueqon uorl..si.dciu teh xnaalnotsipe reoidvdp ddi ton elraly crlea it up ofr ,em tbu i htkin i satdrunend ti wno epsla(e roctrec me fi i'm orwg).n

Ftsir adn or,omefts 'mI otn vene eurs fi shti is urytl a berevuln-eiwreak ltpo, isnce teh ixa-Xs is otn m./1K

t,Bu roem e,lnaglery I rtide to sdnenuardt twha dhnpeape at tboh xeemtsre of []PPL nad yteViol.c

PLsA :Pk loyre:sfu weehr on teh arhgp si [P]PL ihtgh?se l,eWl fi het Xxisa- si aluqe ot P,PL/1 LPP wludo eb at ist gsehhit at eht ualve lcssote to 0 on the xis-.xa (htkin: thaw si 1 idvdied yb a ?iblonli VERY COELS OT .E)OZR Tsih lodwu sepoornrcd to a otinp aolgn het as-xyi orf teh eynzmse i.ytivatc In ohtre ,dwrso LPP si ta tis ithhesg tntnaencoirco ta the rhaspg Y-perttnc.ei

rRemmbee hatw we losa is:da nwhe eht uteatmd enymez si dnaoru tslo fo ,PPL ti bayclisla ocfnstuni lkei a mln ezy.emn shiT ,aensm atth eth mxVa fo eht etatdum eeynzm si lqvaueinte to het Vmxa of teh larmno z.enmey ferTrehe,o eTh 1mV/ax of thbo smezeny ear ieu..lqnvtae. ta het ietes!rhTipncty - is i!gb If oyu gte sith raf, hten yuo acn lemaitien ()A and )(,D eincs esteh gspahr eavh nedriftef ne-tiscrYpet ri(dffeten a)emVs-x fro rhiet sceetevpir yenmsze.

oiMngv .n..o

itlceoVy :)V( nh eW V si ta sti gistehh ..(ie x)a,Vm eth elvua of V/1 wodul eb at tsi tsolw.e nai:(gA ntikh fo ti caiatllr:pcy tahw is 1 iddevid by 1 nil?ilbo ~!0) hreeTef,or het evual of 1V/ si at sti wotesl enwh hte sy-aix is eaqul to 0. hfore,Tere The Vxam of hsti uorcsc nhew eht -asxiy si oelsc ot .r.z.eo esHer het inght th.o. heest ezmysen qeuierr tdfeenirf vlseel fo LPP to aerpoet at -.maxV ,emrRebme eht Vx-am fo the EDTUAMT enmyez wlil pnepha ta a umch EHRIHG ]LP.[P Or vrese,nclyo the -xmVa of teh NOMRAL nymzee will npphea ta a umhc LORWE ..PL.P[]

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an_improved_me  ,Mennaig henw we lkoo ta eht eXtein-rctp (hewn V is )hgshe,it the edumatt eyenzm illw rueriqe erom .PLP Mero PLP masne a ""lowre value no eht six-ax eorc(ls ot o)rez raeiltve ot het nlomar ymzn.ee +1
an_improved_me  Putintg ti LLA he:tregot ece -ytirntp ilwl eb teh maes rof boht aruttnmomdle/a pxrecn- metznieet lwil be rcsleo to 0 rof het tdtumea mezn,ey aierevlt ot het nrolam neyemz. Th e loyn wrneas atth ahs htbo roctrec ltieonahrpssi si B(.) I tihnk i snpet 5 uisment on tish eintsquo iygrnt to fugeri ti t.ou I oabprybl owlud ehva ddenee 10 stueimn to ltlaycua etg t.ereh puyllfoHe wno I can teg ti rqkcuei if sghtnmoei klie thsi whoss pu on the arle .ntihg +2



 +0  upvote downvote
submitted by minhphuongpnt07(5)
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eb reawa ttah teh ai-xsx ofr sthi sintuoeq is nto ""mK (tv6iB si otn het aarstttb'sut eh .t[16B]/iV to yf,mspii csubaee eht xmaV is anogn tasy teh ms,ae oyu sjut eedn to rsecaein i6]Btv[ ot get eht easm Vaxm kaa( tsihf ot rhitg no teh -xs.)ixa Dtn' o eb lfdeoo duoarn yb teh onseiuqt itr.erw

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poisonivy  sthi maske neess ot ,me X onnact be K!m! ubaecse if ti was mK enth elni B dwuol be whingso a ectoitv"miep o"tirbnhii ,tefcef chhiw acotnn be the ceas enics htey attes hatt the enyemz iivttyca erecssain to nmroal efart B6 niiotaasintdrm os it oravsf teh ratnicoe adnstie fo eressedac .it I otg hsit eno wognr of o,ecrus too rytick fro me! +



 +0  upvote downvote
submitted by empem28(1)
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obdNyo sha saerdenw htis nouqstie ougtrhh eht nlse fo a gnilraen eotvbcije eqiut ety os ehrse' my 2 cns:te Km is NDREEACSI cb sith atnipte sha na zenmey iwht an olravel WELRO nitfifay ac(n be ccretoerd ot omrlan refat an caeisnre ni uertstabs) icwhh si accsrhtrieitca fo PVITECMIOET tihni,iniob hiwch si wyh eth lnei of het .pt si eno fo ittmecpoive inboiiinth no a LB plto

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 +0  upvote downvote
submitted by stapes2big(16)
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eTh euqisotn is lscyaalib ntetgsi pu a ttianisou sriimal to atht fo a imteeipcovt rn.ohtibii eTyh asy ahtt ierhhg ittsoarnncecno of xprldyaio hpotahspe sresciane hte aitvycit fo eth eymnze ot lmrnao ellse.v iiSl,rmlay enwh uoy heav a tepveimitoc ihitobirn dna ceraisen hte rnanenocttcoi fo t,etuasrsb hte eymenz can ieacvhe het meas axmV as if htiwuot het iibo.rithn

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 +0  upvote downvote
submitted by usmleuser007(464)
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rbeRemme )1 tpoeecimvti ionsbitihr ~ nilse ssCor at ty t)isn2-rece viiNnet-omocetp bhitisionr ~ on leni csors

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 -5  upvote downvote
submitted by hungrybox(1277)
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gLon nweasr ,edaah tbu bear htwi m.e

INTH: v sloko indk of leki ,y rehwaes k kolos rmeo keil x.

ertty-ecipn = x/amV1

  • maxV is eht rupep iimlt no who tfas a raocneit is yezladcta yb seymz.en

trec-peintx = 1/Km

  • Km is a nnkriag of owh oodg an neeyzm is at igbidnn sit bse.taurts An zeenym twih a anignkr of 1 is ttereb at dinbnig its besurttsa tahn an eynzem wiht a ingknra fo .5 (rwoeL mK = eerttb y)enmze

Nteo tath xam,V as a eearums of nra,fpecmeor acn be eladert gurthoh yamn nhsit.g eha,inelMw Km si a tes iehatcrtsccari of eth zyem,en adn tcnnao eb dratlee.

In siht xpeamle, eth ynemez pnoeerafcrm m(xVa) si ndecirase yb csinranegi hte imtivna tcrcoaof so hatt ti acerseh a nma"rlo" tiivaytc. eveorHw, the enmezy si sllti elryhntine htsyit ued ot a ocitlngnae eef,tdc os eth Km assty teh a.sme

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mnemonia  Amseoe.w +
ht3  atiw eiln B shswo eth vmxa t'snedo ehangc dan ahtt hte mk si ingtegt gaelrr eemzn(y is lltsi sytiht os relagr )mk os -m1k/ dowul eb a msllaer rmbenu adn oudwl prpcaaho 0 +1
lamhtu  Yuo sya mK tnacon eb dlaeret nad its stygina het mae,s tub teh awresn of teh hprag rndeamstteos a irhghe Km ei na Ne vl.uegd "ihehrg noeroatnsnci"tc of teh 6B for mezeyn tvicyiat si hrnaoet wya fo isgnay mK is hihegr encis moer is eireqrud rfo 2/1 maxv viyttica +18
sbryant6  ahYe tish aoantlienpx si ong.wr +
kcyanide101  ,eHystnlo hits oiqenust si bibgnru em eth onrwg ..a..wy If we og by hte eLni revwae ukrb pt,ol nhte C"" is eth tccreor ,rneswa seecuba ""B si whnogis viecttoiepm oni..rbith..i hTe nzeemy eerh si ovpcymeiitetl itita.gcvan noemeoS edsne to lnpxiea hist eretbt s,epael meso fo su piad on tish oufmr to etg a miunfganle teaolnxpnai dna ton tctnioosibnru fomr lelfow ttes ..a.olterlsk. +



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