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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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!SGUY ouY ryelal vahe ot look ta hte axis sablel. ehT ioenutqs sysa teh p.t's inciaosthntye yeantshs aicyttiv -xa()syi si ONRMAL iwht na IDCASREEN autmno fo pyxailrdo teasphpoh s-)(.axxi xi-sYa si the esam sa ,NOARML xxias- sshtfi ot hte htrgi sgwohni ANIEDERCS xpiarlydo pphtohase

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skonys  Iamm tsju aekt the L on htis oen fi ti oescm .pu I aws eabl to onrarw ti wodn ot B ap;&m C eecaubs fi teyh are sancgnirei pry ohps and ta emos ntoip teh tcyoinstahe hsaeystn yactvtii si l~o~nrma hten it sumt ctnrieste the normla lotp lbroybap ta teh Y ccseas rof soasner I 'ondt wonk ti stju lfsee hitgr. D tsonde tcinserte at .lla A rcnsetseit at aylneseltsi 1/0 aiyivtct ekid( if htta mseka sense ubt ti ujts edoklo s)s.u oS enht I saw btnweee B nad C dna thb at hatt opnti I hntik uyro esbt bte is ot /0505 ti nad evmo no wtih oryu fiel nselsu you wnta ot od remd ro goisnehmt adn ened to etg it rccroet btu thwa od I ownk? I go ot entdal cos.ohl +
umpalumpa  I esiraedg wthi meaahsus antlinaxope. Teh xa-six ahs /rapylodx1i ,opahpesht cwihh aenms ttha gnigo to the thirg no hte -sx,iax vsl of ayrxpdoly atsephshpo rae rlwoe (adn teh nvsreei= xli/1oryadp oppaehsth, sgeo .i)hgehr +
sahusema  @upmaauplm ti's enbe a lgno etim cnsie I tesodp ith,s ubt henw you od ihts ↑,/-)X1( you apprhaoc 0 gennmia you esdil eth hrapg to hte trhig +1


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 +13  upvote downvote
submitted by amirmullick3(76)
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hTe ewvarneieL ukrB Potl si lamyni ditnprtreee by tsi X dna Y heirteet. snTpc nequitso seatst ahtt iignvg B6 iancsesre het tacitiyv ot raomnl esll,ve hhwci smane the ittaiycv uodlhs be eth asem as the ecna rn.emlH,o ihter Y renetctpi duhsol be het m,esa os we aer eebnewt oscceih B adn .C A dna D od nto haev teh msea Y eiptcnert as arihomnreH.lg nstcaitoncoern fo B6 aecsdu tycivati ot oecbme raln,mo dan so maVx liwl not be nnigachg nda we nac neclac A nad .A D sha a lrewo Vxma dna D hsa a mhuc hhigre .hmx VaTe dercfenfie etnbewe B adn C is ni hetir Km. vniogM to eth ftle no eth X isxa mksae the Km elwro adn sllet oyu htat ftnfyaii si ighrohes ouy lwdou ont ened meor 6B. tBu in uor aces ifitfnay fo teh nyzeme rof 6B si lelyar o,lw iwhhc si why we need a tno mreo 6.B

nI m,asmruy ew twan teh asem Vamx adn a hgeihr Kme.W natw hte oln"m"ar vitaytci asme( amvx as anro)lm and we ndee hgihre ontasum of 6B rfo cescuss to nafyisif of the yeemnz orf 6B is laorbbyp vyre lwo.

iceohC B has a /)Km(1- veula oescrl ot 0 hhiwc mesan mK is rlweo adn itafifyn fo eth zmyeen orf tis truaebtss is epsru w .oshliT ksmea seens sa giivgn hhrgei smatoun of eht ti"ipmec"otve tsaesubtr 6B is gphnlei.

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apurva  iTsh laxopenanti is Xn!r!g!wo ixsa si not 1mk/ ni hte onetusi,q it si adylo/pr1ix teoh.pahsp mk(1/ uloshd eb es1yem)thoinco/ sAlo the usionqet si kasngi btoau lrclisoeta tncavtoiai fo teonthsicay htsynsea ude ot iniatddo of pdlxyroia eothpp.sah ihWhc naesm eth Km duhols dareeecs tfni(ayfi iansceesr trefa niatiodd fo nooien .iygrsndrep)diiCx the x asix ot eb yr/xopda1li ptaph,esoh own ylppa milesp oicgl of math,s rascniee dylxoripa ahtshepop = inirbgng ienl eorm olcse to ozre e(bacesu ti is i-ylpax1ro/d paeo).htshp +13
apurva  dHa eht X axis be k,/m1 hte rawsne dhsuol be C +1
pinkdinosaur  Km is ynrelsive dtelare ot eht yitifanf of eyeetzmhn orf tis eattebhsrT .us lsrcoe to 0 on hte -,aixsX het grhehi hte K.FAm 0022 pg 320 +


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 +12  upvote downvote
submitted by lamhtu(139)
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iNndege irgeh"h tntcnasr"ooncei fo teh 6B rfo zynmee vtactyii is noterha yaw of inaysg Km si ihghre ceisn meor is qeudirer orf 1/2 axvm ytvitci.a acserIdne Km ealvsu eulsrt ni Km/1 gienb selarml colser( to 0 on teh )sx,xi-a chihw is mrddaoneetst in sneraw cceohi .B

A rlan""om menyez tatvciiy ni the nsereecp fo hegirh B6 tetarcionnonsc smnea thta maxV is nto ig,hgnnca btu Km i.s

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d_holles  nI erhto lmw Noor,arsd menyez yctatvii = xAmnV dgdai remo 6B to a dattemu myeezn lwil pivroem ti bkca to rlanmo V(xma tsyas sn,toantc os Km lliw ecadesrde eud ot ↑ ifaifytn fo het .zey)men +3
jatsyuk38  ^^ SIHT is teh btes palnxitnoae +
drdoom  jaku3ys8t@ hte onemmct or eht toumsc?bnme +
drdoom  oh, lbodue actre = pb,upbmum = het ommtcne lt)m(a@uh +


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 +4  upvote downvote
submitted by trazobone(97)
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meoS fo sehte iotsanpxlane reylal dgoin teh osmt. If eth emzyen is eabl ot rseanice to larmon titviayc thwi a hihreg eellv fo the rt,aestusb thta mnase ee’wr in a oiitemctepv hibiirton iotia.ntsu Coeeiimtvpt sawayl cssoers no het aghr,p os ew cna lmntieeia A nda D.

oNw ew yeaanlz .mK eW nawt mlsla Ksm’ orf entotp .esynezm Siez does otn aaylws mttear .😉 pxcEet ni tish scae we dtn’o ntaw ttha tcny,peo ew wtna ot kool for a el(y/arl1 gib )mK, v(alue htat si olrsec ot ez,o)r cb ew twan a weak gib mK to eb ealb ot peoworerv teh tvmeecitopi hont.iriib oanpmrigC the iraeinmng 2 s,coiehc B hsa a Km ulave csloer ot orez so e’esthr oury nrsa.ew

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 +2  upvote downvote
submitted by navevan3(2)
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For hsti onutiq,se I asw hkgniitn htta tehy kedsa uoy mreoacp ot a omnr“a”l pr,nose so the xmVa dtwu’lon hcagen scein etyh tesat taht sih atityivc ruensrt ot a lnamor vlee.l lOyn hte xxsai- uldwo neisc ti uodlw be at dnesriaec octnconrneisat in pnrosiamc.o

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 +2  upvote downvote
submitted by an_improved_me(91)
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oS i dnouf shti estinoqu ucuidl.s.oi.r teh anpnxtaielso rddipevo ddi ont llaeyr relac ti up rof m,e tub i kntih i tuesdnndar it now lasepe( rotecrc em if m'i )rgw.no

Ftsri and seofmo,rt Im' otn vnee urse fi hist is rytul a avrerenkeeubiw-l ,lpot insce teh x-Xias si ton /K1.m

uB,t omer ,elrgelyan I teird to nudtaernsd htaw eeadphnp at hobt mretexes of P]PL[ nda ltecioy.V

Ak: PsLP :ruesloyf rewhe no teh aprgh is ]PP[L ?ghhteis lleW, if eht X-isxa si aqule ot ,P/P1L LPP uoldw be ta tis tsiehhg ta teh alveu sctlsoe to 0 no teh xsi-.ax ihnt:k( ahwt is 1 idedvdi by a inbo?lli RVYE LESCO OT ZORE). hTsi oulwd osdoepnrrc ot a point lgoan teh sixy-a for eth ezsnmye iycavti.t In oehtr wo,dsr PPL is at tsi etishgh taioccnnenort at the hagrsp tirt.enYpec-

emmeRrbe hwta ew alos ai:ds ewnh het medtuat nzemey is urndao slto of PP,L ti ibsyalcal uoincntsf klei a nml zn.eeym ishT eanms, hatt the xamV of teh uedtamt neyemz is ueeatnliqv to the xaVm of eth aorlmn ye.menz erfoTrhee, hTe V/1xam of hbto ynezmes era iet..e.ualvqn ta teh hcieTrpsni-t!yte si !igb If uoy egt tshi f,ra tenh oyu cna melinaite )A( nda )(D, ecsni heets phagsr vhae ienetdffr e-rpisYtcetn dierf(tfne V-ms)xae fro rhtei reeiptecsv .syezmen

oMgivn ...on

lceoiVyt :)(V nWh e V si at its ghsheit .e.i( a)xV,m the ualev of /V1 ulowd be at tsi lw.seto g(naA:i tnkhi of ti ltry:ilpaacc hatw is 1 ddeviid yb 1 l?ilbino )~!0 f,rereoThe teh eluva fo 1V/ is at tis weltso enhw eht a-xysi si queal to 0. eeerTf,hro The amVx of tsih rusocc ehnw eht x-aisy si lsceo to z.eo.r. eserH eth tghni ..hot stehe eesynmz uereiqr tfeerifdn lslvee of LPP to eoepatr ta a-Vmx. Re,rbmmee the mVxa- fo hte EDUAMTT zemney wlli ehappn ta a umch HHIEGR PLP][. rO eey,vrcsonl teh xVam- of eht LNOARM myneez llwi paehpn at a chmu WROEL [P]L...P

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an_improved_me  gn,enaiM nhew ew ookl at eht Xtte-npirce hn(ew V is het,gh)si hte mtaduet zenmye ilwl iuerqre more PPL. eoMr PLP asmne a eor""wl velua no hte ixxs-a ceolsr( ot oer)z aetvrlie ot teh amlorn zn.eyme +1
an_improved_me  Puigttn it ALL :teogrteh cenryt-iep t llwi be teh msea for hbot atdoumnmlter/a mneixt- reczpente lilw eb esolrc ot 0 rfo teh ametdtu eymzne, eaivltre to hte nmraol ymne.ez hTe lnyo nasrew atht ash otbh rtcrceo stirneoahlisp si (.B) I thnik i setpn 5 unmeits on tish eqsnuoit yitnrg ot fuerig ti t.ou I braoblyp wludo ahev deneed 10 tismenu to ayclault etg eh.rte lpufyHole nwo I cna tge it ikeuqcr fi ontmhegis eikl isht hwsso up no eth elar itghn. +2


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 +0  upvote downvote
submitted by minhphuongpnt07(5)
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eb aeawr atht het xasix- fro siht ioetnqsu is otn Km"" tB(v6i si not het es rthsttu'aabt ]i.1Vt[B6/ ot miiysf,p abcusee the maxV si naogn saty hte ems,a uyo juts ndee to seiecran Bv[ti]6 ot gte het msae aVmx (aka htsif to htgir on het isa-xx). nt D'o be ofeodl ardnou yb hte oneuqsit .werirt

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poisonivy  tshi maske eenss ot ,em X aonnct eb !mK! ubcseea if ti was Km hten neil B dowlu be nsighow a ecpitomt"ive "inhbiiort c,ffete hwich atnonc eb eth seca iensc ehty setta tath teh zneyem viactyit sneeciras to lraomn treaf B6 tromiiiasnnatd os ti asofvr the oetiarnc aitedns of earcsdees .ti I got sith noe rowgn fo uscoe,r oot ckryit orf em! +


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submitted by empem28(1)
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ybdNoo sha wndseera hist uiteonqs uhhgtor eth elns of a nngrelia ebotcivej teuqi eyt so s'eerh ym 2 ct:nse Km is SDEEANRCI cb thsi itnteap hsa an zmeney thwi an eovlarl REOLW atfnyfii ac(n eb coceretrd ot olramn raetf an ceireans ni ss)ubtaert chihw is tarchcecsritia fo TEIEOMCVPTI ihn,iotbnii iwhch si hyw the lnei fo the .pt is one fo etvmtpicieo tiibniionh no a LB lpot

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 +0  upvote downvote
submitted by stapes2big(16)
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heT tosuqine si lcaialybs netgsit up a uotiaitsn irlaims ot thta fo a ivcometptei .boitrihin Teyh asy atht gerhhi tceiotnncasorn of dylxpiaor pheosathp nicrasees het iitatcyv of the zeynem ot mornla lseel.v irlamliyS, nhwe uyo vaeh a vitetpimeco initohrib nda cniserae hte caiernotnocnt of sbtrut,eas eth nzeemy acn eacehvi the emas axmV as if oithwtu hte nrihtii.ob

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 +0  upvote downvote
submitted by usmleuser007(464)
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mbermeeR 1) etmitvipeco robstiihni ~ esnil Csors ta er t-t)ens2iyc iovenpe-Ntotimc bhsniitoir ~ on leni orscs

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 -5  upvote downvote
submitted by hungrybox(1277)
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gnoL wanser a,ehda ubt earb iwht em.

:HITN v lsook nkid of lkei y, heaewrs k slkoo reom ielk x.

etytrn-ceip = xa/1Vm

  • maxV is eth reupp miitl no how fats a tirneoac is azatyclde yb ezm.yens

in-eprtxetc = mK/1

  • Km si a kginnra fo who dogo an zyeemn is at ndnigbi its but.stsera nA eyenzm itwh a krangni of 1 si terebt at ibdngni ist surstetab hnat na yenzme twhi a rnangki fo .5 wreLo( mK = etbert zenye)m

etoN ttah amVx, sa a mesaeru fo cemrpaerfno, cna be redltea hthorgu nyma histg.n wiael,nhMe Km is a tse hiraccrstteica fo the y,ezenm adn ontacn be rlt.edae

nI hsti ,peaxlme the eyenzm remfcrepnoa aVxm)( is rcesdneai yb isgneinrca teh imnavit rccotofa os taht it earcshe a lmr"no"a tvtcai.iy w,vreeHo eth nyzmee si tlsil yretlnihne ttyish deu to a naintoegcl ,edectf so hte mK satys teh s.ame

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mnemonia  mo.Aewse +
ht3  tiwa nile B hsows eht mvxa ntd'ose egcahn adn thta teh mk is getintg ragrel m(zyeen si slitl ttsihy so elrrga )mk os /m1-k lwoud eb a maellrs rbmeun and dwuol aaophrcp 0 +1
lamhtu  uoY ays Km onncta be eldetra adn its tsnaigy hte m,aes but het nresaw fo eth rhapg mredatostens a hgrhie Km dgeev l iua n.eN heh"gri eocnciaontrt"ns fo hte 6B fro eynzem avyttcii is hrtoean ywa of yisgan Km is grhhie ncesi omre is iqeuerrd ofr 1/2 mvax iacivytt +18
sbryant6  eahY itsh anealitoxpn si wnrog. +
kcyanide101  ,oHselnty htis qsiuoetn si unribbg em hte rgown w..a..y If we go yb the nieL waevre rkub pl,to hent "C" si the roeccrt sa,newr scabeeu ""B si iognhsw tieicvteomp .rih..ntoiib. hTe nzmeey reeh si eymtcvilioept natg .atvcii noSeome eends to lniaepx hits rtbtee s,leape soem of su dpia on itsh fromu to etg a nunmilafge iaeopnlxnta nda tno ritnucoobsint rfom oewlfl tset a.trklselo... +


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