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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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Y!GSU oYu rllyea veah ot loko at hte axis .beslla heT seqnouit ayss the .tp's tnecnysioahti nasteysh ivtiacyt )ix(sya- is LOMNRA htiw na CEADESRIN auomtn fo yplxradoi htspeoaph sx.-xi)a( xs-Yai is eth smae as A,MLNRO si-xxa sshfit ot het irtgh ngsiwoh SCIEANRDE ylxoiradp hpeaophst

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skonys  mIam sutj take teh L on ihts eno fi it omesc p.u I wsa ebal to onrawr it ondw ot B ;am&p C beucsae fi ythe ear engisicanr pyr ophs dan ta omse pnoit the chsotaetiyn eytsnsah tyaivitc is mao~rl~n tenh ti usmt nsreteict eth lmonra ltop braploby at hte Y cceass rfo rnessoa I t'odn onwk ti juts efsel .rithg D ndsoet reticntes ta a.ll A irecttnses at aneytisslle 01/ aicvttiy kied( if htat ksame esnes utb ti tjsu eolokd ss).u So then I was eewnbte B and C adn thb ta atth tiopn I khint oyur sebt teb is to 0505/ ti dna emvo no wtih oyur feil ulenss yuo natw ot do merd ro soemginht nda deen ot teg it occrert ubt tawh od I o?knw I go to tedlan .lsocoh +
umpalumpa  I gsdaerie hitw mehsuasa naxplaneit.o heT xsx-ia ahs 1dlrpayoxi/ ehshp,opta hciwh msnea hatt igngo to teh grhti no hte ,isa-xx slv of ydpoxaryl sptahpesho aer lerow dn(a hte vseri=ne /1xiplardoy pahope,hts ogse )hher.ig +
sahusema  aumapmpl@u 'tsi eenb a nlgo etmi ensic I edtpos h,ist ubt hnew oyu do tsih ↑)(X/1-, ouy ophapcra 0 anngime ouy dilse eht pgahr ot het grith +1



 +13  upvote downvote
submitted by amirmullick3(76)
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heT ewraeLinev ukrB tlPo is lmayni tdprretniee yb tis X and Y tsTeri nhce.pet iqonuste sttesa hatt vgingi 6B rsiceesan het caivttiy to onlarm v,elesl wihhc emsan teh acivitty udsloh be the saem sa hte a,rlcH.nm eneo theri Y tenietrcp doluhs be teh ,msae so ew era eetwneb eshccio B dna .C A adn D do ton haev hte smae Y pecnittre as iganrhHmr.ole tacntnieoonsrc of B6 ueacsd tavciyit to ecmobe almrno, and os amVx lwil tno eb ancghgni dna ew nca canelc A nad A.D hsa a wreol xVam nad D sha a umch ihregh xa.heV mT rfeidnefce nwebeet B dan C is ni rthie Km. novgiM ot the left on eth X sxai skema het Km lorwe nad tlels ouy tath nfiyatif si ghirheos ouy owdul otn eend rome 6B. tuB in oru cesa yatiinff fo teh eyemnz rof 6B si aerlly o,wl iwchh is wyh ew eden a tno remo 6.B

In rsmu,aym ew atwn het esma xmaV dan a hiehrg KWem . ntaw eth "nol"ram yvtctaii ea(sm amvx sa )lanmro adn ew eedn rhhieg otumnsa of B6 rfo ccussse ayii fsntof fo eth zeyenm orf 6B si ylbbaorp yerv lo.w

cheoCi B hsa a -mK)1/( vaule lrecso ot 0 ihcwh masne Km si woelr and atyiffin fo hte neyezm rof sti ertsabtsu is srpeu soTw. ihl mseak senes as nvigig rhgihe soamntu of teh toipvi""cmeet teaubtssr 6B si lhi.ngep

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apurva  hTsi ntanxipoela is w! !!oXrng xais is not /m1k in teh otsq,ienu ti si /pyd1aolxir pohethpa.s 1k/(m dsholu be ht1eiosymonc/)e lsoA teh ieqousnt is knsgia aobut lasertloic ivtoacntia fo sintceaytoh nhysatse deu ot dtoinida fo drylipxao aphh.steop chihW msean the mK ouhsld resecaed fyintf(ai inrsaseec ftaer tdaiinod fo srpxCid)doiyiennige.no r the x isxa ot be 1lxpory/iad ppha,otshe nwo ylapp mplise gcilo fo sh,tma ieenasrc dliyrxaop phaopseht = gbgnirin nlei orme oscle to ozre cee(baus ti si idlay/px1-or t.ape)hshpo +13
apurva  dHa eht X asxi eb k/,1m teh srnawe dulsoh eb C +1
pinkdinosaur  mK is lvyirseen lrtaeed ot eth aiynitff fo ztnyee ehm ofr tis Thb.seuaterts sloerc ot 0 on teh -sixaX, the hiehrg eth F .KmA 2200 gp 230 +



 +12  upvote downvote
submitted by lamhtu(139)
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enidNge r"ihgeh enrttainnsoocc" fo hte B6 ofr znemey ityvacit is oathrne awy fo ngsayi Km is ihergh esicn meor is eqriredu rof 12/ xavm ycitva.ti nIsrdecae Km saveul uetlrs in m1K/ eigbn marlsle e(lscro ot 0 no het x,-)sxai chwhi is daoreedtstmn ni rwsane eccohi B.

A "moa"lnr neyemz iictavyt in eht reecsenp of ihhger B6 ntrnaocntieocs naems hatt xmVa si otn a,ngcihgn utb mK .si

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d_holles  nI oreht Noor lsdr,wma zeneym aiivytct = AVgndmdaix erom 6B to a medttau zeemny ilwl oevrpmi it kbac ot aonlrm mVax( tyass otc,ntasn so Km lliw ededresac deu ot ↑ niffitya of het eyme).nz +3
jatsyuk38  ^^ SHIT is eth ebts npeaxiotnla +
drdoom  tj3@8uayks the mconemt ro teh emsu?nmotbc +
drdoom  o,h lobued tecra = mupbp,bmu = eht mcoment au(m@)lht +



 +4  upvote downvote
submitted by trazobone(97)
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eSmo of eesth plannotaexis leylar giodn hte os.tm If the yenzem si lbea to sareeicn to nalrom caiiyvtt thwi a hhgeri leelv fo hte est,trbusa ttah aesmn e’wer ni a ceivmioeptt birhnioit intuioa.ts Cvmeeittiop yawals coresss on eht rpg,ah os ew cna mtaelinei A nad D.

Now ew yzleaan m.K eW twan llmsa sKm’ orf opettn m.yesnez zieS sdoe tno lasway rmetta 😉. cetpxE in stih seac we on’dt watn htat pe,oytnc we wtna to kool rfo a l/le1r(ay gib ),Km au(vel thta si lsecor to zr)e,o bc we watn a wake bgi mK to eb aelb to wroerepvo het pcomtievtei n.ibrihiot npromgiaC hte ignneiram 2 cihc,seo B sha a mK lueav lorcse ot ezor so ’sehrte oyru rewns.a

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 +2  upvote downvote
submitted by navevan3(2)
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For isth esioq,tnu I saw kihgtnni taht heyt sdkea oyu rpoaemc to a “rmanlo” srnp,oe os eth Vxma dlow’ntu cgaenh inces tyeh ttsea ahtt hsi tycvtiia usrrent ot a morlan vllee. lnyO hte ixxas- ldouw ceisn ti olduw be at esiardcen itrcanoestnnoc in ar.mnscopio

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 +2  upvote downvote
submitted by an_improved_me(91)
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So i nudof hist otnuiesq ri.ou.cl.dsiu het osnpaaenixlt ivdrdepo did nto llaeyr creal ti pu for e,m but i nthki i aseurdndtn it own e(lepas croertc em if mi' .r)ngow

rsitF nda sfootrme, m'I ont vene ersu if tish is lryut a vanl-eieburrweek t,opl ncise het -sixaX si ton ./K1m

Btu, ermo realy,genl I irdet ot dersudantn thaw pneadhpe ta thbo etxesemr of ][PLP dan iotelc.yV

PPA:skL :syulfero ehwer on the rhapg is PL[]P shei?thg leW,l fi eht X-sixa is elqua ot /,PL1P LPP oludw eb ta sit hsihtge at hte veual setolcs to 0 no the -ixxa.s n:khi(t thwa is 1 dvddiei yb a ?olibnli EVYR COELS OT ZE.R)O siTh wodlu eocsrponrd ot a ntopi oangl teh sixay- rfo hte esnzyme ivtatiy.c nI heotr ,owdsr PPL si at ist htegsih etionarncncto at teh gprsah it-rp.eecntY

ebRmreem athw we also :sdia nweh the etduamt yenmze is drouan otsl of P,LP ti ailyacbls innsotufc keli a lmn .zemney hTis aem,sn ahtt eht maVx of eht aemdtut enyezm is uaieevqntl ot the mVax of eth ramlon .enemyz ohreTe,ref ehT x1m/Va of obht neysemz era evelit.na..qu ta eht !yeencirtTs tih-p is gbi! If uoy etg tsih f,ra ehnt you acn tlmiiaeen )(A adn ,(D) iesnc shtee ahrpgs veha efnedftir srncYepe-tit eif(rtfdne xVem-sa) rfo ihret evsiceeptr .yemzens

ongviM n...o

loectVyi )V(: e hnW V si at its tigehsh (.ei. mV)ax, eth vealu of /1V doulw eb ta sti .stlewo Ainag:( kitnh of it acar:tlcylip hwat si 1 vidided by 1 oinilbl? )!0~ hr,feToere teh vluea fo 1/V si ta tis stwleo wenh hte a-iysx si aeuql to 0. rTeeeo,rhf Teh amVx fo iths rcscou wenh the axsiy- si celso to o.ez.r. sHree eht tghni ..hto htese enmszey eureirq ifneerfdt llvsee of LPP ot tepoare at aV.xm- ee,rRbemm teh a-mxV fo eht TAETMUD eynzme lliw hanpep at a uchm RHGHEI ]PP[.L Or nsvcrl,eoye eth mxaV- of teh LMNROA emnzye lwli apphen at a uhcm EOLWR [L.P..P]

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an_improved_me  iagneM,n hwne we okol at het eetrticnX-p nhw(e V is h)sh,tgei eht tdatuem ymneez will eeruqri rome LPP. roMe LPP names a owe"r"l aelvu no teh sxxai- eso(clr to or)ze evleairt ot the rnomal m.eneyz +1
an_improved_me  iutntgP it LAL erthtge:o ipny-e trcte illw be het same rfo tobh tnmuadtomael/r zenecimrpx t-eetn lliw eb clores to 0 ofr eht ameuttd ,menyze eltviear to eht mranlo .nmeyze he T lyno asenwr atht sha both ocerrct psnioraitslhe is .(B) I thkin i pestn 5 tseumin no shti ensqtoui grtiny to feruig it t.uo I rbpyabol owudl avhe deneed 01 uenimts to lyctlaua teg .hrtee pyoHleful own I can get it ukecqri if tmhngeiso eilk tsih ohsws pu no hte elar it.ngh +2



 +0  upvote downvote
submitted by minhphuongpnt07(5)
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be arawe thta hte xsx-ia rof tihs qetoinsu si ton ""mK Bvit(6 is nto the 'tutbasstathre i6B.V]1[/t to p,myisfi ucseabe the xamV si noagn tasy the ms,ea uyo jstu ende to ansercei ][6Bvit ot gte het sema amxV aka( histf to rhitg no hte ais.x)-x D 'ont eb loeodf nrduao yb the osntqeiu i.ewrrt

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poisonivy  ihts askem essen to e,m X naotnc eb !K!m cueesba if it asw mK then neli B dowlu be igsnowh a eotvpimietc" triiihonb" fete,fc iwhch noncta eb eth cesa scine ethy testa taht hte yemnez ictytvia scrseeain ot roamln refta B6 oiadttrasimnin so ti oasvrf the noractie siedant of aedeercss .it I gto tsih eno rnogw of csrueo, too yirtck fro me! +



 +0  upvote downvote
submitted by empem28(1)
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bNydoo ash nesadwer tihs sutqnioe throguh het snel of a nelgianr citjeoebv euitq ety so ser'eh my 2 netc:s Km si AEECSNDIR bc ihst nitapet hsa an emyzne whit an eolvalr LWOER aftiyfin acn( eb cerdoterc to lmraon rtefa na easricne ni aesrtustb) wihch is ahreccctsiirta fo COPIVIETMET inbhon,iiit chhiw is hwy eth line of eht .tp si eno fo iecovtimpte boinhiitin no a BL tlop

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 +0  upvote downvote
submitted by stapes2big(16)
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eTh ntqsiuoe is iyclbaals tesingt pu a tatosnuii miarsil to atht fo a ptmetiicevo niot.ibihr hyTe ysa ttah ighehr rsonianntcecto fo dxoayirpl taeshhppo necssiare the ttyviaci fo eht zmyene ot nrmlao vleels. i,ymrlSail ehwn you heav a mvtetoipice nioiitbrh adn sineerca teh treoncntciona fo ets,subart teh eymnze acn iachvee eht aesm Vmxa as if owthitu eht rboitihin.

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 +0  upvote downvote
submitted by usmleuser007(464)
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rebmReme 1) cipeieomvtt hobirnisti ~ seinl rsosC at syc-i2ten tr)e ovinpectmNio-te thoiirsbni ~ no einl csros

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 -5  upvote downvote
submitted by hungrybox(1277)
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gonL wnsare hdea,a utb brae hwti em.

:THNI v osolk dikn fo lkie ,y hrwsaee k oslok orem eikl x.

eyiectnr-tp = ax/mV1

  • Vmax is eht prepu ilimt on hwo fast a creinato si tadlczeay by mn.yseez

xecerntp-ti = 1m/K

  • Km si a rgnkian of woh ogod na nyzeme is at ingnidb ist rt.eutassb nA emeyzn thiw a gnrinak of 1 si erttbe ta igdinbn tis sesatbtur hnat na yeenzm tihw a inagknr of .5 (Lewor mK = btrete nymeez)

Noet ahtt a,xVm as a maereus fo nfe,arrcmpeo nca eb talerde hturhgo ynma .sgtnhi ,nlwihMaee Km si a est rshceirictaact fo teh zeyenm, nad ncnato eb rtelade.

In htsi p,eamlxe hte mzeney eanrfmorcep (Vx)am si adrsencie yb iesnanircg eht ivtnaim otaofrcc so thta it reehacs a onmra"l" .iitcaytv H,vroeew teh eneymz si llist nnlietyhre yshtit edu to a aongineltc fee,dct so teh mK ystas het .amse

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mnemonia  sowmeA.e +
ht3  itaw elni B wshos het mxav t'eonsd encgha dna ttah hte km si ggtietn glrrae (ezyemn is iltsl yhtsti os eglrra mk) so 1-m/k dulwo eb a emrasll unebrm adn wloud oarphcpa 0 +1
lamhtu  uoY sya mK cntona be eetdrla and tsi inysatg hte a,sem but eht nsarwe fo the rphag tmasdtornees a erhghi Km uae nNeel i vd.g ghi"erh toscen"aoircntn fo teh B6 rof eemyzn viayittc is orneaht yaw of iysnag Km si rihghe iesnc mreo is redurieq orf 12/ vmax tviaycti +18
sbryant6  haYe stih onileanxpat si .ongrw +
kcyanide101  oltHe,ysn shti nuteqosi is rnbbiug em eht ognrw .yw..a. If we og yb the ienL erveaw krub ,tplo hnet "C" si eht ocetrrc sraen,w cusaebe B"" is ghiwosn iepctetoivm .ri.inb..htio The yemezn here si tcevlmyoiepit caviai.gtnt eoeSnmo nesde ot nxaplie tsih tteebr ee,alps emos fo us adip no ihst mfrou to get a mfnguaieln eotxnpaanil adn nto botcnrsiiuont rofm lwlefo ttes l.l.k.tear .os +



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