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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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GYSU! uYo elyalr aevh to lkoo at teh siax ebla.ls The oseunqti sasy teh 'pst. iinyhncestaot enasysht vtiyicat )(xasi-y is OMLNRA hwit an ENEIACDSR uamont of xrapydlio eoshptpah s.x)(ixa- xasYi- is hte meas as ARLMNO, xaxs-i tfshsi ot eth irgth wgnshoi NERDASECI plrodxyai eahhtspop

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skonys  mamI tsuj keat the L no tshi neo fi ti eomsc .up I was lbae ot wrroan it ndwo to B p;m&a C acbuese fi thye era iainrscgen pry ohsp nad at emso pnoit hte actohtyisne tshsaeny iittacyv si r~amn~lo nthe ti stmu sctrenite hte ralomn lopt blpbaryo ta hte Y ssaecc ofr soneras I otnd' wnok ti sjut slfee rhgit. D edsont rtenictse ta lal. A esrtsncite ta eeyllstnisa 10/ ivctyait ik(de if htat eakms essen ubt it ujts lkdooe u.ss) So nhet I aws tbeween B dna C nad htb at hatt tiopn I nkith uyor best etb is ot 5050/ ti dna meov no tihw uryo lefi snselu you awnt to do rdme or getnshmio dna eend ot gte ti creotrc tbu what od I n?owk I go ot atenld .lhcsoo +
umpalumpa  I iesgerda tihw ehsuasma .lnxpaoetani hTe axxis- sah dpyoxr/la1i o,hsetaphp hchwi anems tath inogg to eht gihrt no eth x-ais,x svl of yyorlpaxd pasotphseh rea eowrl (nda het =esnrevi y1piord/axl aht,oshepp osge i.ghr)eh +
sahusema  ummalpp@ua si't bnee a nlgo mtei cisen I tdopes ht,is btu enhw uyo od shti )X(-,1/↑ ouy orphcapa 0 nmeinag uyo lisde het phgar to het ihrtg +1



 +13  upvote downvote
submitted by amirmullick3(76)
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The rLeiewneav Burk oPlt is aiymln tinpderreet by ist X dan Y reshn i.tctTepe oteqinus tsatse ttha igvgni B6 neaissecr teh ctitiavy ot olmnar evlsle, cwihh mnaes het vtciaity dushlo be hte emas sa hte e mnaHnrec.lo, hreti Y tiprencet dlosuh be the eas,m so ew aer beentwe cseohci B nad .C A and D do ont vhae het esma Y ipcentrte sa .reiongHhr lma antooscictennr fo B6 ecausd yiatctvi to obceem rla,nmo dan so Vmxa will ton be hnggnaci nda we can acencl A nda . AD ahs a elorw mxVa dna D has a hmuc hghrei hmV ae.xT redniceeff etewnbe B nad C si in hetri K.m iovgnM to eht elft on eht X isax asmke het Km rwelo nad stlel yuo that tfinfyia si hisheogr oyu ulwod ont deen orme .6B Btu in ruo asec fiytfain of het eeymzn rfo B6 si allery lo,w chihw is yhw ew dene a ont ermo 6.B

In mysmu,ra ew awtn het asme xamV nda a ihehgr . emWK nwat eht r""noaml yvcittia sme(a amvx as o)namrl dna ew eend eghrhi monutsa of B6 rof ccsssue iynsatffio of eht meenzy rfo 6B si alybpbor vrye o.lw

oihceC B sah a m(1K-)/ laveu recslo to 0 iwhch ensma Km is orewl dna tifynaif fo eth enyezm rof its etssurbta is suerp Towh ls.i emkas esesn as ingigv irgehh asnomtu fo hte teoe"vicptmi" betrusats 6B si n.geilph

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apurva  Tsih lonneiaxatp si !!!w ngXor asix is not k1m/ in hte neuqo,tis ti si iy1ld/raoxp pthaheo.sp /k1(m oslhdu be ne/mscto)oe1ihy Alos the qtosiuen si gksnai atbou ltaierocls atiotavcin fo oheycnistat hetnsysa due to otididan of lxdaiypor pp.asohthe hiWch menas hte Km olsduh deercaes naiyff(it iearscens areft idtadnio fo riCid)ynn rnxiegepd.soio het x asxi ot be adxioylrp/1 htashoppe, now apypl seplim clogi fo t,mash cenisera opirlxday hhtoapeps = nirbgnig lien mreo socle ot zero sc(eabeu ti is -a1d/iroylpx ets.ahpoph) +13
apurva  Had teh X xsia be m/k,1 teh wnesar doshul eb C +1
pinkdinosaur  mK is sverenyil teardel to eth ftainiyf fo mzeetehn y for its ssheu.arbet Tt esolcr ot 0 no het -aisXx, teh ehghri het .AFmK 0202 pg 230 +



 +12  upvote downvote
submitted by lamhtu(139)
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niedegN "hrighe nantstoorinc"ec of teh B6 ofr mneezy itvytaic is anethro awy fo agsnyi Km si eihgrh censi meor is rreediqu fro 21/ xamv aitvcy.ti Iendrecsa Km laevsu tsruel in K/1m ibnge slmearl ole(rsc ot 0 no hte x)xsi-,a cihwh is tdnedaeotrms ni nsaewr coiche B.

A oamr"n"l eynzme yvaictti ni het sereenpc of heighr 6B nrnaoictncseto eansm thta mxaV si ont nggnah,ci btu mK .is

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d_holles  nI hetor Noldsrr,mwoa zemeyn ttyvicai = gddiAanVxm more B6 ot a etatdmu mzyeen lliw piromev ti kcba ot rnlaom xma(V asyst otn,natcs os Km illw dcseeader eud ot ↑ tiiyfnfa fo hte ezey)n.m +3
jatsyuk38  ^^ TSIH is eth btes nlxenaaipto +
drdoom  @8jtkuya3s eht etomcmn or het mt?obsecnmu +
drdoom  ,oh ldboeu eartc = umppbu,mb = het mctnmeo l(@mh)aut +



 +4  upvote downvote
submitted by trazobone(97)
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meoS of eshet inseaxonatlp lyrael oingd eht otm.s fI het meynze si ebal to eaercisn to rmlano itvciaty wtih a irgehh ellve fo the rua,tebtss ttah asemn ’eewr ni a iietmocvept rohinitbi n.suioiatt Ceiomtpievt swlaay cssseor no eht hpra,g os ew nac nleiaitem A dna .D

Now we azenaly Km. eW tanw msall K’sm for ptntoe e.ysmzen Seiz osed otn waysal etrmat .😉 Exeptc ni hsit case we otn’d wtna htat ,poyntec we nwat ot kool for a l1(eya/lr igb ,mK) eula(v hatt is oecslr ot z,)oer bc we twan a aewk gib Km ot be albe to oewpvrroe eth oetcipvmtei otiirihn.b riapmgnCo hte gnmiraien 2 hceosci, B has a mK euval eroscl to zero so rh’stee uyro en.asrw

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 +2  upvote downvote
submitted by navevan3(2)
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rFo isth tise,uoqn I wsa gninthki ahtt htye akesd you cpaoemr ot a onrl”am“ nso,erp so the mxVa tu’lwdno anehgc nceis ehty tteas atth ihs ttcaviyi tnerrus to a lnrmao l.vlee nOyl the xxias- wloud ecsni ti dluwo eb ta irsceeadn srennotcacinto ni pimoa.nrcso

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 +2  upvote downvote
submitted by an_improved_me(91)
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oS i odfnu thsi toienusq cuui.idr.lo.s the anxotnepsail vproidde idd tno ryeall lraec ti up rfo ,me tbu i tnkih i anrtsnudde it wno sel(pae ccerrot em fi im' ngr)o.w

siFrt dan r,femoost m'I ont neve ruse if tish si truly a ek-rueeenalbrvwi o,ptl since eth ai-sXx si not .1Km/

u,Bt moer glraneyle, I idert to endrntadsu thwa dpaneeph ta boht mseeerxt of PL[]P dan itleVc.oy

skPP:AL soerylf:u wrehe no teh aphgr si ][PLP i?theghs lelW, fi the asxi-X si leuqa to 1/PP,L PPL dwoul eb ta sti eshghit ta hte vleau ctelsso ot 0 no eth asx-ix. (ktn:ih atwh is 1 ddeivdi yb a ?obnllii VREY EOLCS TO )O.EZR hsTi uodlw rpsnecdoor ot a tnipo noalg hte sxy-ia orf hte eeyznms yvcaitit. In ohetr wd,sro PLP si ta tsi hisetgh nnoicrntcaeto ta hte argphs cenpeiYr-tt.

rReeemmb thaw ew osal id:sa enhw teh tetuamd neezmy is nrudoa solt fo P,LP it csbalaliy nonsifcut keli a nml myzee.n iTsh nasm,e htat the maVx of het amtetdu yneemz is nveualteqi to the Vamx fo teh onlarm ezemny. hTe,freoer Teh /aV1mx fo othb yzemsne rea tin.vl.aee.uq ta eth e sp!ryt-ihtcTein si ig!b fI ouy get isht rf,a nteh oyu anc ntmaeleii )A( adn )(D, enisc tehse sphgar aevh rfneeftdi e-rctsYipnet ef(fdrneti a)xsmVe- orf ithre streevecip emy.nsze

nogviM ...no

cVletyio V:)( enhW V si ta tis tehhgis (.i.e )axmV, teh vluea fo 1V/ uowdl be at sit .eswlot agA:(in hntik of it triclcy:apla hwat is 1 ideivdd yb 1 ilonil?b !)0~ ee,rfhoreT het evula fo /V1 si ta tis ltoesw nhwe hte i-aysx is leauq to .0 heeferTo,r hTe xamV of hsit uccors wnhe the isyxa- si cselo ot ..eoz.r resHe eht htgni .hot. sehet eseymzn qieurre etrdiefnf eslevl fo PLP ot eptoaer ta x.aV-m r,Rmeeemb eth aVm-x of het MDUATTE ynzeme wlli epphan ta a chmu GREHHI [.]PLP rO ,rveeoslnyc teh -mxVa of the LOANRM eymnze lwil epphna ta a mcuh LWEOR ...P[L]P

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an_improved_me  Mengian, hnew ew oklo ta eht etc-nperXti ehn(w V si ih,sgeth) the udtemat menzye illw rreeqiu emor PLP. rMoe PLP asnem a "leo"rw euval on eth xxs-ai selro(c to re)oz avlretie ot hte mroaln yezn.em +1
an_improved_me  iPtgnut it LAL tre:oegth iecn ettpyr- wlli eb eht smae orf tbho tlnameoam/trud neneezpxticr-tme will eb eolsrc ot 0 orf hte aeutdtm eemy,nz eavlreti to hte mnrlao eenm.yz eh T lnyo aerwsn that sha hbto cercotr naitirseolhsp si .()B I hitnk i npste 5 nsemtiu on shti neustoiq rgtniy ot uirfge it ot.u I arlyobbp udwlo haev eddeen 01 enimtsu ot laulytac gte erthe. llfeHuopy own I cna teg it ciqkrue if nmohsigte leki tihs shsow up on eht aelr tnhi.g +2



 +0  upvote downvote
submitted by minhphuongpnt07(5)
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eb eawra hatt eht si-xxa rof itsh eqosunit si ton "Km" i(B6tv is otn eth baeusat'ttsthr ti1[6]BV/. ot mpsiify, eeucsba teh xaVm is ngona ayts the smea, oyu sutj nede to esnaecri []B6itv ot egt hte smea xmVa (aak hfist ot rtghi no eth a.xxs)i- no t'D be doolfe nruado by het stqeniuo ert.irw

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poisonivy  isht akmse essne ot e,m X natcon eb !!mK cueabes if ti was Km tenh eiln B ouldw eb sihngow a iee"tiptcovm birhn"iito efcte,f chhwi tonnac be het asec icesn tehy sttea thta eht nemeyz ticiavyt aeensrsci ot loamnr etafr 6B isimrtnoatinda so it fsorva eht acoienrt esditna fo drasescee ti. I otg htis one orgwn of us,rcoe too tiryck fro !me +



 +0  upvote downvote
submitted by empem28(1)
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bodyoN has asnrwdee isht qiesontu gruhhot het lnes fo a lnienarg ibotecvej quite tye so h'sree ym 2 etc:ns Km si EDIRCSNEA cb thsi tepanti sha na mnyeez iwht an ealrlvo REOWL finyfita na(c eb oetccrerd ot alnrom atefr na ierensac in stebtsrau) iwhch si irctctrcsahaie fo VIIMTETEOPC n,itioinhib wchih si hyw het lein of the t.p si one of vcteiipeotm iiotbihnni on a LB lotp

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 +0  upvote downvote
submitted by stapes2big(16)
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Teh utoiensq is lalsybcia sgtietn up a nistaituo lmiairs to that of a moepicitvet trbiiionh. hyTe say that ehhgri annoitcencsort fo lrxdaoypi aeppthsho nsericase teh viattiyc of the emeyzn ot arlonm evll.se irmli,Slay nhew uyo evah a ovmitecteip nibhiitro nad iseenrac eht teocnocrainnt fo rtbaus,tes eht zmeyen anc eiahevc hte aesm maxV as if oithutw eht .rnbohiiti

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submitted by usmleuser007(464)
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brememRe 1) etteoivipcm niorsbihti ~ nlies srsCo at y2e c)-ttiesrn itpomvn-eiNoect rhsitnobii ~ no line csrso

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 -5  upvote downvote
submitted by hungrybox(1277)
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nogL srenwa ed,haa tub abre ihwt .em

:IHTN v ooskl dink of klie y, wsehare k okols mreo lkie x.

-ypcreittne = /1xmVa

  • Vamx is het erpup itlmi on ohw stfa a eoatircn si atldczeya by zmeys.ne

nirxtt-epce = K/1m

  • mK si a rigankn fo who dgoo na yzemne si at gibinnd tsi tbuesar.st An neezmy tiwh a gnnrkia of 1 is eebrtt at nindigb its beattusrs htan na meynze wiht a kingrna of 5. Low(er mK = tbteer neezy)m

tNeo ttha mVa,x as a asmueer fo mpfnroe,race nac be eedrtla ghhrotu yman nishg.t eah,eilwnM Km is a ets ieirhtccacrtsa of hte zme,nye and nnotca be eadlrte.

In siht pxm,eela the eynmez frrpamocene (Vx)am si neiacdrse yb aincrgeins eth tvinami ctcrafoo os hatt it sarhece a a"m"rnol va.titiyc er,wvHeo the ezmeyn si lltsi enyrtnheil yttish ued to a noligancte dfcte,e os teh mK tayss eth .sema

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mnemonia  .Aseoemw +
ht3  twai ieln B whsos hte axmv oensdt' heganc dna ahtt teh km is gtetgin rergla me(yenz is lstil ithyts os lrgaer mk) so 1k/-m ouwdl eb a elalsmr ebnumr dan lduwo pcrahpoa 0 +1
lamhtu  oYu say mK tanocn eb teedalr and its stygnia the msae, tbu hte snarew fo eht hgarp nrstemaestod a ghrhie mK e v deNl n.aeig u ehrgh"i rtscinoeotna"nc of eht 6B ofr eezmyn iiatytvc is hteorna ayw of ynasig Km is gheihr nscie more si urireqde ofr /21 amvx ictvatyi +18
sbryant6  eahY this itoexlnnaap si nr.wog +
kcyanide101  eHynotl,s tsih nusqetoi is bbgnrui me het nrogw .y...wa fI we og yb eht neLi erwave rubk ,oplt nthe ""C si eht ercctor ena,wsr uceaseb ""B si ohswnig mectoteivpi .h.tbioiir..n hTe enzmey eerh si lcevtymtoepii .citnvia atg enmSooe ensde to xnielap htsi terbte esp,eal esom of su dapi on this ofmru to teg a nglfuaneim ioxntaeapln nda nto nornoutitbcsi rofm lofewl ttse as.o.r.klt.el +



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