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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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UYSG! oYu yaller aehv to oolk at teh aixs slel.ab hTe siuotqne ssay the s't.p etanytoischni ythsnesa ayvtctii (s-yiax) si MLONAR tiwh an EACISRDEN tnamuo fo idpayoxrl pehsahotp isa(.-x)x Yxsi-a si eht seam sa LMNO,RA -xasix ihstsf to eht itrhg gwnsohi SECNEIDAR iprlydoxa sahteppho

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skonys  Imma tsuj etak hte L on sith neo fi ti mscoe up. I swa aelb ot wrraon ti nodw ot B m&;ap C beuasec if eyht ear iisncgnera yrp pohs dna ta emso nipot the nioeastyhtc hsensyat ititavcy si lmrno~~a ehtn it utsm eitrntesc hte lrnoam plto borplbya at hte Y cseacs ofr arnesso I 'ntdo nkow it jtsu seefl gtrh.i D ensotd ecnerttsi ta l.la A ncsirtetse ta saeltysline /10 tyiaitcv ikde( fi taht mskea ensse ubt ti tsju okldeo ss)u. oS ehtn I swa weebten B dna C dan thb at htta point I hktni yoru sebt ebt si to /5005 ti and vome no with rouy iefl slnseu you tawn ot do demr ro hoetnigsm dan deen ot get it coecrrt utb hwta od I ok?nw I go ot ldtean olosh.c +
umpalumpa  I greesadi htiw ssaamheu ean.olpintxa ehT isx-xa has rol/ida1pyx po,ahteshp whchi manse atth noigg ot the rhtig no eht x-i,sax svl fo lpyodraxy thpassheop rea rewol (dna het sei=nrev 1x/ipoardly othaspp,eh oesg )hrgieh. +
sahusema  @mpaulumpa is't nebe a glno emit cneis I ostped hst,i ubt ewhn yuo od iths ,-(1X)↑/ uoy hrpaoacp 0 imnngea uyo idles eht aphgr to teh rthig +1



 +13  upvote downvote
submitted by amirmullick3(76)
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heT eienweravL uBrk olPt si ymlnai rdtreetnepi yb ist X and Y episTt .rtchnee sequonit saetts hatt gnviig 6B eainressc hte vyciitat ot onrmla ,lelesv hciwh measn teh ayvtciti loudhs eb the ames as het ,lmeHrnca.n eo hetri Y iecrpttne odlsuh eb teh sam,e so ew rea neweebt oceshic B and C. A dan D do ont hvae eth emas Y ireenptct as orimnre.g ahlH ocnoritsnnatec of B6 sedacu ivictyta ot ebecmo mnaorl, nad so maxV llwi not be ginaghcn adn ew can cnelac A nda .AD sha a orwel maVx and D has a ucmh irehhg haV .Tmex eefcfdrine ewnteeb B nda C is ni etirh K.m gviMon ot eth felt on eth X xisa smkae eht mK rlewo dna tlesl uoy ahtt nififyat is e ghihosr uoy lduwo ont deen roem .6B tuB ni uor seca atiffyin fo eht meyzne fro B6 si erllya lo,w whhic is hwy we deen a ont rome 6B.

nI a,mrsyum we nwta teh eams Vxma nda a herihg m.eWK ntaw eht an"ol"mr cvyiitat e(ams xavm sa ln)roam adn ew dnee rhghie mantsuo fo B6 ofr suecssc aifsfyinot of eth eemnzy fro 6B si rybpalob ervy l.wo

hCceoi B ash a )/1Km(- vuael locrse to 0 whhci msaen mK is olwer dan niatfyif fo eht mzneye fro its rtesbaust si erpsu hilTo. ws ksame esens as gniivg ehhirg tamnuos fo eth pttieoci"vme" suebrsatt 6B is lip.gehn

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apurva  sihT xalntanpioe si !owr!n X!g xsai si otn mk1/ ni hte ntoe,uiqs ti si p/1iyaodrlx ohapsehtp. m1k/( houdsl eb /netsy)ecioho1m lsoA eht eqsiotun si ksgani tuoab rsocllaeit iitanvtaco fo ynisatctohe tsyeashn deu to aditdion fo ldiyraoxp haops.tphe ihWhc seanm het mK ulhosd seredace aiitynf(f rneiaessc rtfea aiidontd of osyndr)oerixedinngiCi.p hte x isxa to eb l/y1paixord apsht,hpoe nwo lypap miplse gcoil of as,mht rscineea ixrlapdyo tpoehashp = gnirigbn elin roem cseol to zroe eaes(bcu it is aolrd/p-1yxi tpap)eoh.sh +13
apurva  dHa hte X asix be /k1,m eth nwsrae luodsh eb C +1
pinkdinosaur  mK is ynvleseri dlterae to het itfafyin fo y ehtzemne rof sti tTaer h.esbtus rsloec to 0 no hte -,aiXxs het griheh the KmF A. 0220 gp 023 +



 +12  upvote downvote
submitted by lamhtu(139)
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iedNnge h"geirh "ocesnattonncir fo hte 6B for emyzen iavictyt si tnaeorh way fo ygnias mK is rgeihh niesc rmeo si rrueqide ofr /21 amvx ytci.tvia adcrIseen Km vsleua luerst in /m1K bigen lrlmaes slco(er ot 0 on the ,xis)ax- chhwi si retesomanddt in nwrsea ioehcc B.

A m"ral"no mezney aitctivy ni eht resnecep fo gihher 6B ocietnnrtacnso nsmae that xaVm is not nahgncgi, tub mK i.s

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d_holles  nI oerht s,Nr olwodrma yemzen vytcitia = AdnVi agdxm oerm B6 to a tatudme mnezye liwl prmeoiv ti kabc ot larmon xm(Va sasyt tsnac,otn os Km lliw eecerddsa due to ↑ iffyanti fo teh e)mynez. +3
jatsyuk38  ^^ THSI is eht tbes axapnteinlo +
drdoom  8ytjks3@ua the omtmnce or hte csnotmmu?be +
drdoom  ,oh uelodb traec = upum,bmpb = eth ecmotnm )ulma(t@h +



 +4  upvote downvote
submitted by trazobone(97)
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oSme fo ehste saapixtenonl yallre dngoi teh m.ost fI het zmeney si bale to nesciare to nlaorm iictvtya tiwh a ihgehr eelvl fo the ,bssrutaet htat esman ’ewer ni a pimtetoevic ihiortbni tinos.iatu Cpiemetvtio laasyw csrssoe on eht a,hrpg so ew acn etnmeliai A dna D.

oNw we nyalaez Km. We nwta sllam msK’ rfo entpto ezes.ymn Siez sode ton walyas etatmr .😉 etcpxE ni tish scea ew tdn’o antw htat cnpy,oet we twan to oolk for a l1y/e(ral igb K,)m auv(le tath is slcroe ot eo,r)z cb ew tawn a awek bgi Km ot eb abel to reoovepwr eht itevpiocmet iot.nbhrii Crapnigom eht giarneinm 2 escch,io B sha a mK aulve oscerl to rzoe os erse’ht uyor n.warse

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 +2  upvote downvote
submitted by navevan3(2)
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oFr tish ,nieqsuot I was iktnnigh taht htey kased ouy mcpoear ot a lr”moan“ oe,prsn os hte xVma odt’wuln hcegna cnesi heyt taets ttah sih iivactyt rurtens to a mnaorl l.eevl ynlO het isax-x luodw nisce ti uoldw eb at dcrniseea csnatrenonitco ni nrs.paimooc

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 +2  upvote downvote
submitted by an_improved_me(91)
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So i fduno itsh eotuiqsn cd.oulir.u.si eht nxstoleiaanp rvodidpe did nto lylear relac ti up ofr e,m tbu i tknih i nstdreaund ti won seapel( ectorrc em fi im' w.)orng

rtiFs nda mes,torfo 'Im ton enev uesr if itsh is urlyt a veiee-bwunarrlke ,tpol esicn hte Xaxs-i is ton ./K1m

tB,u rmoe glrn,ayele I tierd to annduertsd twha enppaedh ta btoh eserxetm fo LPP[] dna ole.Vytic

s:PAkLP e:ulosyfr eherw no teh aphgr si ]P[LP e?sigthh ,eWll if het xi-asX is uqael to ,PL/1P PLP owdul eb at its stiehhg at teh avleu sotecsl ot 0 on het xai-xs. (knit:h waht si 1 videidd by a lbioinl? ERVY CSOLE OT R.)ZEO This udlwo ecnrsodopr to a itnpo onlag het -syxia orf the zseemyn ctyiiat.v In threo ,drwso LPP is at tsi ehtigsh ttnnainroceco at eth harpsg p.incrt-teeY

merbReem thaw we saol s:dia wnhe eht teduatm yzmeen si rdanou tols of ,LPP ti aiblasycl ciuotnnsf leki a lmn .ezeynm This n,maes hatt teh maVx of hte mtdeuta yzemne si evqeitalun to teh Vaxm fo hte namorl ymz.nee ,ereeorhfT Teh 1xma/V fo both enmszye era tnvee.ai.uql. ta hte ipseictn!h-erTty si gi!b fI yuo egt siht ra,f ethn uoy anc niliaeetm (A) adn )(,D isnce seeht srphga heva firfdetne rnptict-seeY nft(edrefi Vme-x)sa rof tirhe ceivtepers y.eenzms

vigonM ..o.n

Viyltcoe :)V( Weh n V si ta tsi sithegh (i.e. ma),xV eth auelv of /1V dlwuo be ta tis e.lwsto a:iA(ng tnhki of it acracpiltl:y hawt si 1 didvdei by 1 ?lniboil )0!~ Tere,rfoeh eht eualv fo /V1 is at tsi owlste nweh the x-yais si eaulq to .0 hrToeee,fr eTh xVma fo siht rsccuo whne hte -isaxy is locse to ...zeor eHers het hingt oth.. etehs zsyenme ruqiere tfndreife lelsev fo PPL to peortae ta am-.Vx ,bmermeRe the Vmx-a fo the UDEATMT nyzmee llwi pnapeh at a mhcu IRGEHH P].LP[ rO ensor,ecyvl eht a-xmV of eth NAROML enmyze ilwl hpenap ta a umhc ROELW PL.P.[].

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an_improved_me  ge,Mnain hewn we ookl ta teh rti-Xecpent (hewn V is )tsgih,he teh tduetma zneemy illw eeqruir rome LP.P reMo PLP enams a eow"rl" lvaue no hte xsaix- sel(cro to ero)z taeleivr to teh lnarom meyenz. +1
an_improved_me  Pnuttig it LLA ttohreg:e epieyctt nr- ilwl be eht saem fro boht d/mtnlreaomtau nmcize-eter txnep lliw be cslero ot 0 orf hte mtetdua eyn,zem tevailre to the lnmrao ee.zmny T he ylno nrawes atht sah bhot troccer lisasntrhiope is )(.B I nhtik i sntep 5 tunmesi on isht tniosqeu irytng to eifrgu it .uot I rabybolp uwdlo aevh nedede 10 eiumsnt to yaulcatl egt tere.h pyloHleuf now I anc etg it kceuqir if gomnehsti leki tshi shwso pu no teh eral g.ihtn +2



 +0  upvote downvote
submitted by minhphuongpnt07(5)
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eb wraea ttah eth xaxs-i orf hist onsuteqi is nto K"m" B(t6iv si not teh tebustaatsr th' /t6BiV]1[. ot pyi,mfsi uaesbce hte xamV si angon asyt hte ,aems ouy ustj dnee to eansicre tBi[v6] to tge the meas xmVa a(ak tihfs to hrtig on teh ixx)s.-a oD'n t eb lodeof odunra by eth untieoqs tre.irw

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poisonivy  tsih emsak sense to m,e X tonanc eb !K!m usaeceb if ti was Km hent nlie B oludw eb nhwsgio a emtiiot"cepv oinbi"tihr et,cffe chhwi aonntc be het csea sinec tyeh esatt that eth nemyez iyaittvc inecsreas to anlmor afret 6B ataoimtnrdniis so it fvroas eht ctianreo sidetna fo essdarece .it I otg sthi neo rnwgo fo e,cousr oot kciyrt ofr !me +



 +0  upvote downvote
submitted by empem28(1)
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bdyNoo ash wranesde tish oiuntesq togrhhu het esnl of a rinagenl vijectebo qtiue tye so rhs'ee ym 2 stcne: Km si EDNACSRIE bc shit pttinea has na nmeeyz tihw an elavlro WLEOR nafyfiit nca( eb rceertodc ot alrmon terfa an aeescinr ni etb)suasrt chwhi si catartcsirhice of ETICOMVITEP itn,bhiioin iwhhc is hwy hte lein of eth p.t is eno of tiicmevopet nhiiibntoi no a LB oltp

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 +0  upvote downvote
submitted by stapes2big(16)
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hTe itenoqsu is aslicybal sntiegt up a tisuoaint rsiialm ot atht of a copvtiimeet .nribhotii eyhT yas atth ehgirh tosrtcoecnnina fo lriypdoax teoaphhps nasreices teh taviicyt of eth yzemne ot alnorm le.vesl llyriim,aS wneh you eavh a epmicevtiot ohiintibr adn escreina eht cottnaiecnrno of ssaet,rtbu hte yeznem acn vieecah eth aesm mVxa sa fi thowtiu eth hiibrntoi.

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 +0  upvote downvote
submitted by usmleuser007(464)
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mrebemeR 1 ) tcioievptme niithsibro ~ lnesi sosCr ta itsen2c)-yr te -oeNempctinotiv ihbiironts ~ no ilen corss

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 -5  upvote downvote
submitted by hungrybox(1277)
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Lnog eswanr hdea,a tub rbea itwh em.

I:TNH v skloo inkd fo leki ,y ewaerhs k kolso omer ekli .x

etti-precyn = Vm1x/a

  • Vaxm si het urppe tlmii on woh fsat a riaocten si adlczyaet by smyneez.

rtcxpnt-eei = /mK1

  • mK is a nnraikg of hwo ogdo an yneemz is ta idnbing ist .sartstbeu nA eenzmy whit a raiknng fo 1 is retetb ta dniinbg tsi erttabuss atnh na eezynm tihw a krngina fo .5 woe(rL mK = trebte ym)eezn

Note thta ,Vmax sa a sraemeu fo nefmpcaroe,r cna be terldea huhtgor aymn .ihntsg elne,ahiwM Km si a tse reaisathctricc of teh ezeym,n and nancto eb teadr.le

In tshi ep,lmaex eht emnezy mfrenpeacor )Vx(ma si rniesdace by ncsiinareg het iivtmna rofctoca os atht it areeshc a mrn"ola" vaicyt.ti H,eeovrw eht zmeyne is ltsil yeirhnelnt tihtsy deu ot a ongnteacli etdcf,e os eht Km tyssa teh e.ams

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mnemonia  eewos.mA +
ht3  wiat eiln B hwsso teh xamv sendo't chgaen nda ttah eth mk is egnitgt elgarr mz(eeny is tslil ithtys os egrlra k)m so /-mk1 ulwod be a esllram nbreum dan wulod raocphap 0 +1
lamhtu  Yuo ays mK natcon eb eeatdlr and ist yntiasg het sam,e but hte rasnew fo eht arghp raosmnetdset a igrheh mK giv adlneue. e N "hrgehi nanotsect"cnior of hte B6 ofr yeeznm iaicvtty is rahoten ayw fo giynsa Km is ierghh insce reom is quderrie orf 21/ mxva tviaiytc +18
sbryant6  ehaY isht inlntpxoeaa is .grwon +
kcyanide101  notHe,lsy tihs squitoen is gnubirb em eht rwnog a..w.y. If ew go by hte eiLn rvewae krbu ,tplo etnh C"" si teh orrtecc wern,sa esauceb "B" is oignhws mcetvetopii ..nhit.iorb.i heT eyznme reeh si ioilpeycemttv ittiac. gnav Seoeonm edesn ot aipenxl ihst trbete aese,lp emso fo su adip on htis mrfou ot egt a nilanfmgue xalaotneinp nad ont ntriousibcton omrf efwllo tets o...s.aetrl lk +



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