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NBME 21 Answers

nbme21/Block 1/Question#17 (86.1 difficulty score)
A 7-year-old girl is brought to a clinic in a ...

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submitted by usmleuser007(418),
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fI uoy ctnolu'd eerrmemb hwihc erwe asele;sint enth reaevaltnit would hvae eben to eeazlri ttah grwonig lierhdcn deen lslec ot ded.iiv sihT erqruies DAN ncrloetiapi and lsanno.tatri Of hhicw eht inucecl idca thmyie si iattopnrm. It uirreesq a ehtmyl .rsefrnat

sTih is hreew nneoihetmi eoscm .ni ehniMietno nocsemib twhi ATP to mrof AMS a( tmlyeh )orond

whossayin  That’s a legendary explanation. Thanks dude! +  
makinallkindzofgainz  This is exactly how I solved it! I remembered that Methionine is essential for methyl transfers, and you would need that in dividing (growing) cells. But now I'll just remember PVT TIM HaLL too :) +2  

submitted by nosancuck(90),
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Yo gadw ew lal obuat VTP ITM aHLL

nynlhePea,nlai ,Valien TD,NrpoyAKt re,ennoTih eulneIoc,si eneioithnM, iisti,neHd iueLcne sLinye

meningitis  I don't understand what the question is asking... can someone please explain it to me? Patient doesnt eat protein, shes chubby. What does methionine have to do with this? +2  
charcot_bouchard  Just basically asking which is essential amino acids. +3  
usmleuser007  Essential amino acids (something i came up with) 1. "Three HAL fans will try meth" a. Threonine = Three b. Histidine; Arginine; Lysine = HAL c. Phenylalanine = fans d. Valine; Isoleucine; Leucine = will e. Tryptophan = try f. Methionine = meth +3  
nala_ula  They're saying there is a lack of good quality protein -> slight nutritional deficiency. She may have acquired weight but it's not because of protein. So they're specifically asking what amino acid she might be missing due to her subpar diet. Since essential amino acids are those that the body cannot make itself, out off those listed, methionine is the essential amino acid. It's on page 81 of FA 2019. +11  
nala_ula  correct me if I'm wrong please :) +  
hello  For anyone confused trying to follow @usmleuser007's comment -- slightly modified Essential amino acids mnemonic "Ah, Three fans will try meth" Ah = arginine, histidine Three = Threonine Fans (phans)= Phenylalanine Vil (Will -- German accent pronouncing English word 'will') = valine, isoleucine, leucine, lysine Try = tryptophan Meth = Methionine +1  
pg32  Why does @hello and @usmleuser007 mnemonic contain arginine? That isn't in the PVT TIM HaLL mnemonic for essential amino acids... +  
paperbackwriter  @pg32 arginine is semi-essential. It is essential in preterm infants who cannot synthesize it +  

submitted by usmleuser007(418),
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1. "hTree HAL snaf lilw ryt tehm"
    a. enreoTinh = eehrT 
    b. estd;iHini nieigrA;n seynLi = HAL
    .c nylnenhiealPa = 
fsna    d. naVl;ei iuIesc;nloe uenLeci = l
wil    e. tyrpopnahT = yr
t    f. tnnioeiehM = hmt
pparalpha  Thanks! Good mnemonic +1  
b1ackcoffee  best mnemonic +  

submitted by usmleuser007(418),
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eilsstnae Ainom dsica A)A(

1) tAlusd rqieuer 9 )A(A = albe to akem aegnrin via raue cy 2elc) ihdeCnrl eeuiqrr 10 AA() = htye rea lltis e3npelo i)gvd hitW PUK stierony eoemcsb laisntese in hbot uldats adn redlihnc

submitted by drzed(254),
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'tLes asy uoy 'indtd wonk eitonmnhie swa ties.lesna

A)( ilnnAae -- you nac tecare laeinan morf het eyzmne LTA an(aneil sferntsema)i,anroa shtu hits zenyme acnotn eb altnisees

(B) reAspttaa -- oyu cna caeret aparsetat ofrm het myeezn TAS arpta(esta ,r)sarnfteaiesamno huts sith nzeyem oncant be ilesstnae

)(C iyGclen -- thsi oen is wol ,edyli but ti is meda fomr rnsiee sie(ner + FHT ;t&-g C2O + MeHF-T + .cyinelg) fI oyu i'tndd nwko otaub th,is yuo had a 00/55 stho

E() Tnyrioes -- uoy cna ceetra yreoistn ofmr lieyanenaphln lessn(u of orecus uoy vahe innol,teaeup)hykr dna huts thsi antonc eb e.lssainte

submitted by hello(350),
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roF eoaynn esfndouc igtnry to flowlo 7sm0les@ur'0seu mcnomte

hlStygil doifiedm

iEssaeltn aomin csadi cmnmneio ,"hA erTeh fsna will ryt tet"mehh

hA = n,niigera iieisnhtd

ereTh = Teoenrnhi

saFn (ph=n)as Pilelaeannynh

liVl illw( -- rGanem ntcace ncropgoninu Enlgish drwo )l""lwi = levani, inouicel,se ,einulec iyelns

ryT = rttpypnoah

etMh = ntihnoeeMi

submitted by mrglass(41),
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Teh way I membrere hte nelaeitss onmai sadic si by fcgrnnireee eth iomna cisad rusgop I dlyaera own.k So hte asselneti nmaoi dsiac ra:e

  1. eTh raecnbhd anchi aonim cidas: ,eIloenicus iLe,unce dna lVeina

  2. hTe egrnid nioma adcsi TXEECP ioTyensr whh(ic osemcbe easnsitel ni hotes whit :PU)K hryptnopTa, ediist,Hni ehlanenyilPan

  3. heT lusruf nniogatinc anmoi :dscia iCseteyn and tdiisienH u(oY will ese edbeat oevr rhwhtee Ceynteis qaliufsie sa tseelsina or )not

  4. eTh wto ouy tusj aehv to omei:zmer hTnereion nad sLyeni

mrglass  I meant to say Cysteine and Methionine* +  

submitted by saqeer(4),
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a ltetil damsigneli ehr creeians ni ihgtwe mdae it eesm sa fi esh hda wlo dhrytoi ehroomn nad yrienost is a scep.rrour

b1ackcoffee  but hypothyroidism would decrease the height. +  

submitted by codyluvr95(6),
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2B1 oescm ormf npotrei dan si a asnceryse fotoccar for eoetnimnih hs.anetys woL 21B = olw nmiie.eohtn

submitted by mcl(618),
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oeiMietnnh is na aeeslnsit omina .cdai lAl ehtsor litsed rea .otn

scalpelofthenorth  Pg 81 Tyrosine is listed as an essential AA. Should be tryptophan for those who got this wrong like me. +  
neonem  But tyrosine can come from phenylalanine, so it's not really essential right? +1  
gh889  in FA2019, it is listed as Tryptophan, not Tyrosine. That was corrected. +16  
usmleuser007  Note: Tyrosine is ONLY essential with PKU in children +  
niboonsh  bro FA2018 lists tyrosine as an essential AA. They played us. +1