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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(174)
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YG!US uYo ealylr avhe to kloo at hte xais bllsea. eTh uiseontq ysas teh p.st' tetiiyoshnnac thaneyss iatyivtc sai-x(y) is RLNOAM whti na CEIAEDSNR onmuat fo rpdxaoily eahptosph -()xi.asx axiYs- si eht mesa sa L,OARMN iaxxs- fsshti ot the hrtig swgihno RIDCESNEA yoiarxlpd haopephts

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skonys  mIma utsj take het L no ihts noe fi ti oscme .pu I asw albe to rwaron it donw to B ma;&p C csueeab fi heyt rea gennaicsir rpy hpso and ta osme iotnp eth oettcsnyahi tsahnyse tyaivtic si ~nlmor~a enht ti msut srectetni the manrol ptol rpabyblo ta the Y scceas orf asorsen I dnto' onkw it stuj sleef .rihgt D ndsoet etrctenis at l.la A etrtsincse ta tasenyslile /10 itvytiac (keid if atht samke eessn but ti ujst ekodol s.)su oS neht I wsa btewene B nad C adn bth ta tath ntpio I ihktn uroy tebs tbe is to 00/55 it nda ovem no wtih royu feil lssnue you nawt to od dmre or shitnogme adn ened ot tge ti rretcoc but twha od I nwko? I go ot edlatn .shocol +
umpalumpa  I geearids htwi eamhsasu otln.pnaeiax The isxax- ahs r/aodpxy1il hpasehpot, wchhi anmse atth nggio ot eth tirhg on the ixx,s-a vsl fo ypxoardly hseotpsahp rae rewlo (dna het ei=svren 1aridply/ox ophpt,sahe gose .ghrh)ei +
sahusema  @mupmuapal 'ist bnee a nlgo tmei ncies I septdo h,sti utb hnew oyu od sthi )-(1X↑,/ you aprhpcao 0 aegnimn uoy iseld hte hagpr ot het trigh +1



 +13  upvote downvote
submitted by amirmullick3(76)
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The enLirevwea rkuB tlPo si mnliya ntedptieerr by tis X and Y tn.eihteTrpe sc unotisqe tsstae atht nigigv B6 ncrseiase the yivatcit to nalmro els,vel cwhih means eth atciiytv doshlu eb eht smae sa eth reHnelc,a.mn o rieth Y preettcni hdluos be eth esma, os we are between chcoesi B and .C A nda D od tno veah eht esma Y tineterpc sa r nlHrm.iahgeo neacorttsicnno fo B6 auedsc ctivayit to bmeoce lamrn,o nda os aVmx ilwl nto eb cnighgan dan we nac clanec A and D.A has a elorw Vaxm and D hsa a cmuh hrhgei . hVemaxT nidecfreef weenetb B nad C si ni ertih .mK oinvMg to het ltef no teh X isxa meaks hte Km erwol dan tlsle oyu atht tyfiinaf is rehsioh g oyu ludow nto need roem 6B. uBt in uro eacs ftiiyfna fo eht zneeym ofr B6 si llryea ,olw ichhw is hyw ew ndee a tno more B.6

nI uyms,mar ew antw het msea maVx dan a gehrih .eW mK watn het lra"o"nm tvyicati (emas axvm as )lnmrao dna we dene gihhre snauomt fo 6B orf suecscs tfoniysfia fo eth menzye rfo 6B si ylpobabr ryve l.wo

hieCoc B hsa a 1m-)(/K aulve olcers to 0 wchih amsne mK si elwro nda afyintif of het eenmzy orf its sasutrebt is persu Toi.w hsl asekm neess as iiggvn higreh ntosmau of eth imeive"tcpt"o sbteratsu 6B is nepighl.

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apurva  iTsh xlnpnteioaa si Xog!r!n !w xsai is not mk1/ in eth tns,qioeu it si l1y/poiraxd phhs.pateo m1(/k sldohu eb yiotoh)nmesce/1 osAl hte ostnquie si agsnik obatu laercsilto ativoaticn fo aecntstihoy eyssanth eud to indiotad of adoypxril sp.theapho Whchi sneam hte Km dhluos eecrsaed ntyif(afi eisascern ratef ndotaiid fo .ryeixndroioi sengnp)dCi het x asxi ot be adpy1/rxoli hs,otpheap nwo palyp mspiel clogi fo ahts,m eaincers adpoliyxr tohhasppe = gniirngb elin eorm elcos ot ezor eusacbe( ti is ry1-adoxlpi/ psotha)e.ph +13
apurva  aHd the X ixas be ,m/1k hte wenrsa housld eb C +1
pinkdinosaur  Km is leerivnys radteel to the itfnyafi of ey zhnetem for its s.hstbretT eau slreoc ot 0 no teh x-aXs,i the hhirge teh mFK .A 2020 pg 203 +



 +12  upvote downvote
submitted by lamhtu(139)
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dNgiene rgihhe" oaietnr"scnonct fo het B6 for yenmez ctavtiyi si otrneha ywa of ngaysi Km si ihehrg cnesi rome is iredquer rfo /21 maxv yaittivc. serecadnI Km suvale retsul in m1/K giben rsmllae crlos(e ot 0 no eth isxx,)a- hciwh is mddtesaetnor in rsenwa icoche B.

A mlor"an" ezenmy atcyiitv in hte enpecsre fo ihherg B6 nonicnaetotrsc mensa htta Vaxm si ont iganhgnc, utb mK is.

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d_holles  nI rtheo rdsma wr,Nool zyemen iavytcti = AVmangxdid emro B6 to a maudett zneyme llwi pivrmeo ti kabc to lamrno am(xV sysat tsc,atnno os Km wlli dsecareed eud to ↑ fniaifty of het )mze.yen +3
jatsyuk38  ^^ HIST si eht bste otpexaannil +
drdoom  a8k3tysuj@ teh enmtmco ro eht usncbtomme? +
drdoom  ,ho ldoebu acret = ubbu,pmpm = eth cmemtno tahmul(@) +



 +4  upvote downvote
submitted by trazobone(97)
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emSo of etehs naleotxnpsai lylrea onidg eht tsom. fI the eynemz si ealb to rscnaiee to oamrln acitvtiy tiwh a hgihre levle of eth t,tasbsure htta esanm rwe’e in a ceoepititvm bitrnoihi i.onsuatit Ctitoempeiv yalaws cossres no teh rpg,ah os ew nac eienimlta A dan .D

wNo ew nalzyea mK. We tanw llams sKm’ for otetnp seenmz.y ezSi sedo tno aslway tametr .😉 petxEc ni tshi acse ew d’tno wnat atht oenypct, ew awnt ot oklo orf a l/y(1erla bgi ,K)m ule(va tath is ocserl to rzo),e cb we tnaw a kwae big Km ot be beal to wrpeoorev the ieteopitvmc bhnriioit. amorpniCg eth neamginir 2 socie,hc B ash a mK eluva sorlce to zreo os rete’hs uroy s.wenra

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 +2  upvote downvote
submitted by navevan3(2)
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rFo tsih tei,oquns I swa ninkgith taht htey dkase yuo eapmrco to a n”“mlaro esnor,p os eht maVx wtlodn’u ncgaeh cnsie tehy aetst ttah ihs itvaciyt treunrs ot a nlroma e.vlle Only hte -xsxai ouwld csnei it luowd eb ta sniereadc arneoinsnttcco ni mpsra.nicoo

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 +2  upvote downvote
submitted by an_improved_me(91)
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oS i undfo htis otnqusie .csuor.lidui. eth npteioaanlsx verpoddi ddi ont yaller relac ti pu ofr me, tbu i knhti i ertnsddaun ti nwo elaeps( tcreorc em if mi' w.)ognr

risFt dna smfo,erto Im' ont neev ersu fi tish is tulyr a e-rewrauleebnivk t,opl esnci eth is-Xax si ont mK/1.

tu,B rome ragle,nley I tdier ot taurdnesnd hatw pdepeahn ta hbot eexrtsem fo PP][L nad yl.eocVti

Pk: LPAs eyuofl:sr herwe on hte rhgap si ]P[LP esgh?thi llWe, if the -Xsxai is alequ to PP/L1, LPP would eb ta its ethsihg ta eht avuel cotslse to 0 on het xsa-.ix :khti(n whta si 1 evddidi yb a obinli?l RYEV OELCS TO )ZE.OR hsiT uwdlo ordrseocpn to a itopn gnaol het a-yisx fro teh ynsmeez ttcia.vyi nI rteoh orw,sd PPL si ta sit ithhges ritconneocant at eth rsaghp -Y.cttneerpi

bremeRme twah ew oasl adsi: nehw eht tuetmda eezmyn si dunroa tsol fo PLP, ti sbcalylia icfnsunot klei a mnl nmzye.e This ns,eam htta eht amVx of eth aeutdtm znyeme si unveitaqel ot het aVxm of the amornl .ezymen rTehorf,ee eTh xmV1/a fo hbot snzmyee rea e.tlvan.iqu.e ta eht tihy!c espnirtTe- is gb!i fI ouy tge hsti ,rfa enth oyu can eleiantim )A( dan ),D( icsen heets asgprh vhea deetrffni -triencsptYe ffreen(itd Vesa)x-m rfo tehir vepirteesc zmneys.e

Minvgo .no..

citVelyo (V): hn We V si at its teishgh ..(ie V),max hte elavu of /1V uwodl be ta its .swteol ngA:(ia nkhti fo it rclacalyipt: htwa si 1 diievdd yb 1 oil?inbl 0)!~ heferr,Toe eth elauv of 1V/ is ta tsi soltew wnhe het asxyi- is uaeql ot .0 Terf,eeorh Teh aVxm of stih cscrou wneh hte -ayxsi is lscoe ot z...oer sereH eth nigth toh.. tehse enzmsye urqreie fndtirefe slvele fo PLP to apereto at x.am-V ebmree,mR eht mVa-x fo teh UEATMDT meneyz wlil hneppa at a chum EGIRHH PP[].L rO ,vsercoyenl teh x-maV of eht ORALMN nyezme ilwl phepan at a chum EWRLO .P].P.L[

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an_improved_me  ngenaM,i whne ew lkoo ta het rnpe-ceXtti (wnhe V is iehthg)s, hte eamuttd menzey lliw rqeieur rmeo LPP. roMe PLP ansem a "lweo"r luaev no eht ixxa-s elcrso( ot oe)zr rleeativ to eht rmloan nzm.eye +1
an_improved_me  nPtguit it ALL :rogehtet tn ipe-tycre llwi eb teh meas fro tohb notu/lmmraeatd etciepmeztn-xe rn lliw eb srloec ot 0 rfo teh tutmdea ze,ymne etialvre ot teh lonmra mney.ez hT e nloy raewns ahtt has both croretc ilesntaihsrpo si )(B. I ktnih i nespt 5 imntuse on hist siqeoutn iyrgtn to ufegir ti otu. I yplaorbb odwlu vahe eneedd 10 sutmine ot uayllact tge rt.hee uefpHyoll won I can get ti rukcqei if gothismne kiel tish ohssw up on eht elra tngh.i +2



 +0  upvote downvote
submitted by minhphuongpnt07(5)
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be ewara ttha eth ia-xsx rof shit eqiuotns is not "Km" v6(tBi si otn the ttbeasrt't sahu ]B[6itV1./ to mfpii,sy saceueb eth aVmx si gnona ayts eht ae,sm uyo stju ende to seecanir [6iBt]v ot egt the asem aVxm ka(a hftis ot hitgr on the )xaxs-.i tnD' o be eodlfo radnuo yb het teinuosq ertirw.

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poisonivy  hsit seakm esnse ot e,m X ntacon eb !Km! bsaeecu if ti saw Km neht nile B olduw be gwhsoin a ciptvmtoie"e i"itnobhir ct,ffee ihhcw aotcnn eb hte aces sncei eyth atets atht eth emenyz tiavctyi csernaies ot aonrlm ferat 6B sminttoiindara so it saofrv teh aotirnec estaind fo aederescs ti. I otg ihts eon wngro of u,resco oto yikcrt for em! +



 +0  upvote downvote
submitted by empem28(1)
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Nbodyo ash deraesnw htis iqonestu hgotrhu teh esnl of a nlieragn evicbjote qitue tye os h'erse my 2 n:cset m K si ENCIEDASR cb thsi tipaten ahs an mzeeny twhi an ovlelra REWOL natfyifi a(cn eb dtrrceceo ot ornlam aertf na rneiscae ni )seuatstbr chiwh is crcaichstetari of VTMCPOEITEI ,hiobitnnii hhicw si yhw hte neil fo the tp. si eon of otpemiicvet hbtiioniin on a LB lpto

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 +0  upvote downvote
submitted by stapes2big(16)
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hTe oeiutnqs is allsycabi nsgitte up a oitanuits ramiils to htat fo a tipvimtocee biiior.thn heyT sya atht rheihg centnrstooniac fo oxrldyiap photpahse eicassren hte iatvticy fo teh yeeznm to monarl lvelse. mlliarS,iy nwhe uyo veha a toceiitpmve rnbiotihi nda riesneca hte ronotnacitecn fo ,srsautbte teh enemyz anc vceeiha the eams aVxm as if houiwtt hte .oiitihnrb

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 +0  upvote downvote
submitted by usmleuser007(464)
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bRmemeer 1) iceivpmtteo niriiosbht ~ sneil Cross at eetiyts2cnr-) -moieoptnctvieN iinhrtisbo ~ on enli ossrc

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 -5  upvote downvote
submitted by hungrybox(1277)
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nLog aesrnw a,dhea ubt rbae thiw e.m

NHT:I v kloos ikdn of keli y, rhesawe k oolks ermo ilek .x

-tycenrietp = x/a1mV

  • axmV is the puerp mtili on ohw fats a tronicae is deatyaclz by emeyz.sn

ere-ttnicxp = /m1K

  • mK is a ankigrn fo owh gdoo na neymez si at indnbgi tsi bettrsasu. An zeeynm thiw a inkrnga of 1 si etetrb at indbgni ist bsetsurta tnha na emnyez tihw a rkanngi of .5 Lowr(e Km = eetrbt eze)ynm

oeNt hatt Vx,ma sa a emeuars of mec,enoparrf anc be laderte oghrthu myna hgn.tis eneihlw,aM Km is a est shccrcaiaeritt fo hte ,mnzyee nda actnon be .edtaler

nI hist l,mpaeex hte zyemne cenfmpeaorr )m(axV si esaidncre by nigeniarcs teh vianitm tfroocca so thta it arseceh a "ln"roma ytivct.ia evow,eHr hte meeynz is lsitl ryeinlhtne htstyi deu to a icngoleatn fedt,ec so eth mK ytass eht ema.s

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mnemonia  eAoemsw. +
ht3  wiat inel B soswh hte xmva tnedo's hngeac and ahtt eth mk is teitgng ragerl zn(eyem si stlil shtyti so raelrg k)m so km/1- dwuol eb a mllsrae rnbemu adn udlwo paohrcap 0 +1
lamhtu  uYo say mK ctoann be drteeal dan sti tagsniy eht saem, tub hte nawesr fo eth arhpg ressanmdtote a rghieh mK a iN.egu veel nd ih"ehrg io"nensatconrct fo teh B6 orf yznmee icitavty is tnaorhe awy of yisnga Km si gehirh niesc eomr is ereriduq ofr 21/ xvam yciavitt +18
sbryant6  haeY sthi eotaxnalpin si gnrw.o +
kcyanide101  teyonsH,l tshi iqonetsu is bginubr em het owrgn ....way If ew go by hte ineL evaewr rbku l,tpo enth ""C si eht ecrcotr rn,asew ceesuab "B" is hnowisg ciottvmpeie b.ro..iithi.n hTe ymneez rehe is imvectoeytpli tvitn aaci.g oemeonS dense to nelpxai tihs erbtet eapel,s oems fo us idpa no shti orumf to teg a gnulenmafi xaltopeiann nda ton btcsournnioit mfor owfell sett tl. srkal..oe. +



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