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NBME 22 Answers

nbme22/Block 3/Question#5 (reveal difficulty score)
A 72-year-old man with multiple myeloma ...
Unrearranged immunoglobulin gene 🔍 / 📺 / 🌳 / 📖
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 +70  upvote downvote
submitted by sacredazn(101)
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Teh noptcec is a ocouvnetdl way fo inskga if uoy nwke who VJD citemioarnonb sokrw, chiwh is ttah it si ualylact an leempxa fo glniaret the ADN fo the T/B lomyy.thecp

trSneohu tobl hnc:eueiqt So wehn yeth esu a epbor taignsa emso og,neri and gtuntouipt a iesz fo 15. kb or 6 ,bk itsh is teilgln you teh esiz of the DNA remfgant in aech cell dn(etos’ emratt if yeht ays J rebop or tntcnsao egiron ,orpeb t’ereyh sjut inyags r’eythe nttegragi esmo leneictoud nesqeuce dfoun in eht gI Rosu/TlcC teba nciha lsuoc yvstcpeeelir for TB/ ).ellsc

I kihtn eht iunfcngos atpr docul be nideogrnw who uoy nkow eethhrw ey’rou tyarlp urghhto eeatgnremarrn nrswea( hccosei B rthu D) ro fi it nsaht’ ecrorcud ta lla yet c(rroetc )en.wars H,ere the tnpcoec is ahtt B lselc duengor ()JVD rrtgeaeeannrm ni eth beno mrro,wa iehlw T llcse od ti in teh hys,mut and ti lal pnasehp at .eocn So a amslpa ellc ni eht olbod keil ni ipleutMl Mmoyela wulod ahve llfyu eodnnrueg oe,biocntmrain elhiw a T ecll ni hte oobld ulcod iehetr eb lyufl eucdeadt nd(a eavh fnisihde DVJ aniroonmetic)b ro rmtiamue ah’t(sn eatrstd VJ)D.

icneS eth T lecl neeg wsa 6 bk dan tnldfyieie iregbg atnh the 15. bk egne, hte T clel nah’st oeneunrdg iennbcomroiat ty.e

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trichotillomaniac  vyre inec ientpoxan!la +29
nwinkelmann  iTsh swa emwoase! eMad so humc sseen and ullhefpyo I liwl be able ot hkitn atth alcltciryi tboau soisqeutn ni hte eutfru buscae(e I RVENE loudw have emco up htwi tsih no ym o,nw )h.ha +5
eacv  O!MG HNTKA UY.O I DINDT ONWK HNAYITNG botua it!s!h epoH htsi is ont setetds no rale maexne p: +5
ajss  o!ww htsi xnpotleaain aws mawoee!s tkshna! +
mrglass  slAo teh lT-elc -V-DJ etmessng era ton eth mesa sa het lcBl-e DJV-- eesmgns.t eTheforer a Bcll-e J gensmet rseoutnh ltbo uwldo kolo for weehthr teh B-lcel tesi JDV mentegs in a Tell,-c hicwh luwdo wyasal rneenaadonr-rg. +6
mynamejeff  nkhaT uy!o S o is tshi eceuabs tpeliulm loyamem roeudcsp isesevcxe anomollnoc htgli nhiac I?g sI iths eht 1.5 kb eg?en rh,sWaee cT-lesl htta aveh tno geon othugrh ieidefttfoarnin tey adn tiehr J ernoig undslice yvthneregi JDV() sv. tsju VJ in het tiglh nchia? AF( 0022 gp 0)14 +
peridot  shTi aotianpexnl si mzg!inaa ,oreveHw to fully ddnruteans haroent pets of waht hte usqoiten is ttgiegn a,t eslape ekta a lkoo at rhawdysdsoiielsh@'ardgb d/nroa sas@'gmrl xnapiatleno sa ellw - a yerv pimartont niod!tadi! +1
skonys  yM giclo saw nwogr tbu my awnesr rtre.occ I am gisenffur omfr ueccsss. +
fhegedus  !wow itsh si am!nizga thkna yu!o +



 +18  upvote downvote
submitted by highyieldboardswards(18)
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rShto :nwsare All egnse are nstpree in btho B adn T cle,ls btu ethy aareerrgn nda xpsrees rpreostec taht rea eificcsp to ehtri enelag.i iheTr are tdpnindneee DJV igeonsr rfo B elcl croeprte eenaontrgi and T clel crreteop ingea!teorn ihsT wiik aretlci esdsh ghilt no it:sh

l.p/_JepD(icVeaTdelior#oiect/kingrwmnrb/iiw_aokis/ehopcrt)st_ne.:t

I too ltalgicray mdsesi ..this btu it si atcayull os miplse tath ew rea ssiimgn eht tosfer hthroug het seert l-hi-eW hbto B nad T llcse uregndo DVJ raege,nanerrmt eht ,V ,D nda J egsen rea IERFNDETF GESEN eepdtis giben gorezndai adn teeorfhre ledciaifss in a iilsram osfnahi ued to hrtie srdahe ened to eaneterg iverdes srustruc.et oT kema tsraetm orme ,sinufngoc thbo esst fo JDV eesgn rae on rocseomhom 4.1

iThs is yhw hte BMEN edsecfiip atht etyh ear iggtnga EHT EMAS J IGROEN ihcwh is tath of the B cell eoprcret eegn J ngiroe, not hte T clel oreetpcr gnee aeJ-tb roigne (see iwki c)eairt.l The B llce orercpet neeg is not erdraaengr in a T ,lcel fi ti s,aw T lsecl oluwd evah !intieasbdo

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redstrat  hiT.s oS hcum t!sih +1



 +5  upvote downvote
submitted by david_bball(5)
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eTh awy I ttohhgu oautb stih queiosnt was ttha ni MM reeth si a NOT of otedinbsia gbeni made, os het JVD mngsete is bgeni okrben rrl/adetpesgauener/cde nyam itmes dan sah eben derhtenos ot .5k1.b As rof the T ll,esC htta neorgi ’nist iebgn duse (neisc theer si on lnoacl xasnpinoe or cesntlio)e os ’tis still tog het lflu bk6 etglnh ehut.cudon

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d_holles  T eclls lslit goedrnu JDV oimeonbniacrt to mfro rtehi CRTs. +7



 +2  upvote downvote
submitted by sam1(22)
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eihlW T lecls od esu eht VDJ ,tbanncmriooie het T llce petorcre scahin aer dntfirfee eengs mrof eth B llse'c vyahe dna lhitg i.hcnsa einSc htye esud a B lcle J-reoing or,bep teh T l'cels dbna lliw be mhuc rrlgae as hsit aare of its DAN e(th B lecl hyave or hltig ianhc s)enge veha ton been geernrdara -- diesatn tis T cell rrcotpee nseeg veah bnee erarr.aedgn

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 -5  upvote downvote
submitted by welpdedelp(270)
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/1eeqope_ta/rirten7udmtso2hszs/otnbb_l/niwrn.c:rstdx/_n/spsiee/4pcn/al.uow_h_imbmlttwqemoeptpe2_e

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