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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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GY!US ouY ryllae ehav ot kolo at eth sxai a.eblsl Teh oiuetsqn says hte pts'. encyhatosiint hsesnyat tiatcivy yia)(x-s is MRNLOA hwit an ARSECEDIN otnuma fo dlyxioarp oppsahhte .)sa-i(xx ixas-Y is the esma sa L,NORMA iax-sx ifstsh ot eth hgtir nsgohiw IECRANSDE iodaplyrx ohpsaphet

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skonys  mamI tjsu atke hte L no hist one if ti omsec u.p I saw bale to rrnowa it ownd to B ;&mpa C ceabsue if yhet era gnrenaicis pyr opsh dan ta emso iptno hte tiscnoteyha sehstyna vyctitia si ml~aorn~ tneh ti tsum ttericsen het naomlr polt lrbaobyp at the Y csesca fro ersoasn I 'dnot knwo it tusj fseel i.tghr D noetds cnttieres at a.ll A nrtietcsse ta eaitnslsyel /10 vtcayiti (keid if htat ksmae ensse utb ti tjus lookde us).s So nthe I was bweteen B dna C and bth ta htta piton I ihtnk yuor bset etb is to 055/0 ti nad vemo on twih uryo eifl lnsues uoy awnt ot od dmre ro eingmstho dan deen ot get ti ctroerc tub hatw do I o?kwn I go to eltnda olh.osc +
umpalumpa  I raeigdse hiwt huaamsse t.nxplaienoa eTh -xisxa sah yialxo1dp/r ,thheaopsp cihhw asmen htat giong ot eth hgrti no the a-six,x lvs of rlypxaody taesspphho era loewr an(d teh venr=esi pxoyl1/riad otehhpap,s geso rh.)hgie +
sahusema  @pmalumpau tsi' eebn a lgno eimt since I opteds sith, ubt ewhn ouy do this /↑X1-(,) yuo pphorcaa 0 enminga oyu ielsd the rhgpa to hte grhti +1



 +13  upvote downvote
submitted by amirmullick3(76)
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Teh vreeLnaewi uBkr ltPo si laniym eierntterdp yb ist X dan Y spi chtreeenTt. nesutqio stseta taht ingvig B6 ersiasecn het cttivayi to lraonm ,levles hcwih snema eht cvtaiyit uslhdo be eth smae as het rcema Ho.nl,en eirht Y neerttcip dluosh eb eth asm,e so we aer eetnwbe shcoiec B adn .C A dna D do not vahe eht eams Y tcternipe sa Ham.hrrigen lo tscionrentncao of B6 acudse aiicvytt to cbmeeo almnr,o and so maVx lwil ont eb ghniangc adn we cna elncac A and AD. ash a oewlr amxV nad D hsa a uchm eghihr eaxmThV. eenfefricd weeetbn B dan C si ni tehir K.m iogMvn to teh letf on teh X isax mskea teh Km rweol dna lslet yuo ahtt ytnifafi si g herosih yuo wuodl not eedn remo .6B utB ni rou cesa ftyniafi of eth eznyem rfo B6 is leryal wl,o chiwh si hwy we dnee a ont eorm B6.

nI ymamsu,r ew antw eth maes Vmxa nad a hrhegi eWKm. twna hte "moran"l itativyc ems(a maxv as )rolamn dan we ndee hrgeih ntsmuao fo 6B orf ssccesu i ffynstoia of eth enzyme orf B6 is bpyrobla ryev wo.l

eicohC B has a )-m/K1( vlaeu ocsler ot 0 ciwhh nsaem Km si orwle and tafinify of eth eymzne fro its sutaebrst si rpseu .T isohwl eksma sense sa igvngi rhhegi saounmt of eth "tm"tpeiecvio assuerbtt 6B si eplh.nig

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apurva  Tish etanxpanoli is !X!ognr!w ixas si not 1mk/ ni eht tsqenio,u it is oxrldp1a/iy tap.hohspe (k1m/ olhsdu eb nhoeyscot/i1)em oslA het nsuotqei si sginka btaou cesatlrilo intovtiaca fo yntoicestha tesnhsya eud ot adidinto of alyirdpox pe.spthoha hchiW nmsea eth mK ousdhl ecedrase ianf(yitf aserisecn eratf dtoindia fo irCpnoi)irdsi.d nneyxoeg eth x xais to be yrxdlo/1pia po,thpesha onw yppla islemp oclgi of sathm, eiaescnr iradyolxp oshhpetpa = gbiirgnn inel oemr lseco to zero sa(euecb ti si o/1r-pxylaid epo.phas)ht +13
apurva  adH the X isxa eb m,k1/ eht swarne udhlos eb C +1
pinkdinosaur  Km is ysrliveen tadeelr to eth fnaytifi fo tyezh enem ofr sti s hT.rubteaets rocesl to 0 on the -iX,sax het gehrhi het .mK AF 2020 pg 032 +



 +12  upvote downvote
submitted by lamhtu(139)
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iNgndee "hhgrie esontacc"rotnin of het B6 for enzmye yitvciat si ehratno yaw fo sniagy Km si gehhir cnies rmoe si eurqried ofr 21/ mxva iyvcitt.a dsnraceIe Km ulaves esrutl ni 1/Km ngeib mserall lrosc(e to 0 no teh axsi),-x hihcw is satdomdenert in wrnsea iccheo .B

A o"lanm"r mezney tivciyta ni hte eseercnp fo ghiehr B6 nrnatceistoonc nmesa atth xaVm is ont nggacnh,i tub mK s.i

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d_holles  In hoetr rrd Nloaw,mos nemyez citvaiyt = dVmxagd iAn orem B6 to a etuatmd meneyz liwl reomvpi ti bakc ot lmoran (maVx tyssa nascn,ott os mK illw rdecsaede eud ot ↑ itffayni fo eth nzyeem). +3
jatsyuk38  ^^ HSIT si hte btes paxnlaoietn +
drdoom  uajysk8t@3 hte mcntemo or hte n?tmmusceob +
drdoom  ,ho eubold aertc = ,pmpuumbb = hte cnmeotm ma@u(lh)t +



 +4  upvote downvote
submitted by trazobone(97)
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Smoe fo heset xipeansantlo erylal diogn the stm.o If eht enzyme is elab to sairncee to mnlrao titciyav wiht a eighhr eellv fo the reust,abts htta asmen ew’re ni a votictpeemi oibriihnt ttni.siuao Civtomitepe aslywa csrsose on hte a,hpgr so we anc iieelmtna A dna D.

wNo we yaelazn Km. We awtn lmlas mK’s orf tteonp sne.emzy Szei sode nto lwaasy tertam .😉 teExpc ni hist csae ew t’nod twna taht o,cnyept ew ntwa to ookl orf a lle/ayr(1 gbi ),Km (uevla ttha si slorec to ,r)oez bc we antw a ewak igb mK ot be aleb ot rvoproeew teh mivepeotitc bnhitii.or gromCpina eth mninagier 2 oh,eccsi B sah a mK uvela rclsoe ot zreo so shre’te uryo wasre.n

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 +2  upvote downvote
submitted by navevan3(2)
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roF htsi ut,qoiens I asw itnkngih ttah yeht dekas uyo oaemrcp to a ar“nl”mo snoepr, os eht xmVa n’uldwot ghnaec siecn yteh sttae thta shi tiyicavt rstuern ot a moanlr elv.le ylnO teh saxxi- dlwuo cesin ti uowld be ta iecdensar tconriscnnetoa in roimscnp.oa

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 +2  upvote downvote
submitted by an_improved_me(91)
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oS i nodfu htsi otniesuq duci.ol.risu. hte xipoansaelnt vrepidod did ton ylearl elrca it pu for ,em tbu i khnti i eadusrtndn it nwo eeas(pl coctrre me if mi' .o)rgwn

Fsrti nad msfto,reo I'm nto even srue fi tsih si urlyt a ewrakunibre-eelv otl,p niesc het Xsiax- si not .Km1/

u,Bt omer ,laegyernl I rtdei ot ndrtnaeusd awht dhepnpea at boht stmereex fo ]PLP[ nad l.oetVicy

:Ps PkLA fuoyres:l hewre no hte raphg si L[PP] eh?gthsi le,Wl if the -sXxai si ueqla ot 1/PLP, PLP wlodu eb ta tsi hhisgte at eht evlau tsceosl ot 0 on het ix-a.xs :tkhn(i htaw is 1 edvdiid yb a blolnii? YERV CEOSL OT ROZ.)E shTi wdluo rersnoopdc ot a piton lnago the is-axy rof eth zeemyns avctiyt.i nI ehrot ,wodrs LPP si at tis ghsehti toiaertconnnc ta eth phgsar ecptYr.etni-

Rebemerm tahw we olsa d:sia nehw het auetmtd eyznem is adruno slot of P,PL it biaclsaly ntciofnus kiel a mnl mezney. Tish nm,eas ttha het Vmax of hte teadtum neeyzm is eatlqeunvi to hte xVma fo eth amrlon nye.ezm ,roTreeefh hTe /xm1aV fo hbto esnzyme ear qv.la.te.uien at the -icey ie!npttrshT is !gbi If ouy teg hist ra,f tehn you anc letiaeimn )A( and ,()D esnci eehts rapghs vaeh fdnetierf trteip-nYsce ndfrie(tfe xmV-e)sa rof ehrti rtesveceip yeme.nsz

ngiMvo .n.o.

lVetyico V)(: W enh V si at its ishgeht (e..i x)ma,V hte eulva of 1V/ woldu be ta sit s.olewt :iang(A inhkt of it cyl:caaltrpi whta si 1 eddvdii yb 1 iioll?bn 0~!) ohe,eeTrrf the lueav of 1V/ is at tsi eolswt nwhe eth axy-is si aueql to .0 oT,heefrre Teh Vamx of tsih osccru newh eht -siaxy si lcsoe to orz..e. Hrees hte hingt t.h.o eseth zeymnse urqeier nfeirtefd leelsv of LPP to etoreap ta -xm.Va ebreeRmm, eth x-mVa of teh MATTDUE mnezye illw pphena at a hcmu GIHEHR .PL[]P Or ,neolvesryc eht xa-Vm fo hte MALNOR emnzye lwil hepnap ta a uhcm OLWER .]P.[L.P

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an_improved_me  inneg,aM ewnh ew look ta the preenXtt-ci nehw( V si s),githeh teh mtuadte ymnzee will iqreeur oerm .PLP roeM LPP eansm a re""low lvuea no het -iaxsx ersol(c ot zre)o tleveira to hte ronalm .eznmye +1
an_improved_me  tntiuPg it ALL eoteh:rgt yc epier-ttn illw be the seam for bhot ermudlntmaaot/ repztntinc ex-eem ilwl be cleors to 0 for teh maduett ey,nmez etrealvi ot hte lrmnoa .mnyzee he T lyno wraesn ttah has tohb rcetroc tsoirshelpain si B.() I thkin i tnpse 5 ueintms on shit isntoque trnygi ot ifurge it .uot I brbapoly odwlu vhae ednede 10 nmuesti to ulltycaa gte .eethr oplyHluef onw I nca egt it eckqrui fi itoghsnme kile ihts sowsh up on het elar hitg.n +2



 +0  upvote downvote
submitted by minhphuongpnt07(5)
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eb rweaa atth het -axsxi for sthi qesuitno si not "K"m 6t(ivB si nto eht ts ttahaertsub' /]BV.61it[ to ispifym, useebca the xaVm is ongan asty teh emsa, yuo tjsu eden to eansicre 6tv]B[i to egt eth mesa Vxma a(ak tfhsi ot rithg no het xa)x-i.s tDn 'o eb floeod doanur yb eth etosqiun t.reriw

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poisonivy  sith eamsk eessn ot e,m X ncotna be m!!K seabceu fi it asw Km nteh lien B wudol eb onwhsgi a ovemctepi"it ihbirno"ti etfe,fc wchih otncna be eht sace scnie eyht taste ttah eth eznmey tvyitica nareesisc to laomnr areft B6 ismrnaodittina so ti rsoavf eth teoncari atdeins fo rsscdeeae it. I got ihts eno rgwno fo esoc,ru too ycrtik ofr em! +



 +0  upvote downvote
submitted by empem28(1)
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dNboyo hsa eeasndwr siht oieuqtns htrouhg eht slne fo a irnlagne tecjoeivb iuetq ety so 'srehe my 2 sntce: Km is DIARESENC bc stih iatpnte hsa na emznye whti na lovlaer RLEOW aftifniy acn( eb trcrcoeed ot noraml tarfe an nsraecie in ast)beurst chhiw is hrscrcateitcai of CIMITOEVEPT oiii,tnhibn whhci si hwy het niel of het pt. is oen fo vetoimtcpei bointiniih no a BL lopt

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 +0  upvote downvote
submitted by stapes2big(16)
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hTe uqeniost is cbsllaayi eitstng pu a onaiutist rliaism to atht of a pmtievicote riiibhnt.o yehT say that hrgieh roenniatcocnst fo xaoiydplr hptespoah rsesiacen eht avciyitt of hte enzyme ot lmrona ve.lesl lalSirmiy, ehnw yuo aehv a tetpmeocvii iiorinthb adn seaernci eht noctcnreoatni fo ttsrbus,ea hte eenymz cna eciehva het msea maxV as if ohtuitw eth bnith.rioi

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 +0  upvote downvote
submitted by usmleuser007(464)
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rmemebeR 1) itptcevoeim tisrohibin ~ ilnes rCsso ta eetin- rs)ytc2 oe-icipNmttnvoe hobsnritii ~ no elni scros

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 -5  upvote downvote
submitted by hungrybox(1277)
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Lgno esanwr aehd,a ubt rbea tihw .me

INH:T v olkso nidk of leki ,y saehwre k ksolo rmeo leki .x

treteipc-yn = m1/xaV

  • Vxam is teh urppe imtil on how saft a orneciat si daylaeztc yb m.nezsey

riecpetx-tn = Km1/

  • Km si a nnrgaik of how good na mnzeey is ta idnngbi tis sasebr.tut An zemeyn hwti a nngkria of 1 is retebt ta bngdnii tsi rstatesbu ahnt an mezeyn twhi a ganirnk fo 5. Lewr(o Km = ertbet zyenem)

tNoe hatt ,mVax sa a useearm fo ofcerme,npar cna eb ealetrd gohturh aymn n.shtgi enMlw,haei mK is a est eiriartschactc fo eht ,yemenz nda tnonac be dateel.r

In hsti pleamex, hte eneyzm necapfeorrm ma)V(x is sndaecire yb ainnegisrc teh natmiiv crootfac so atth it creaesh a lonam"r" ia.tyictv oH,vwree het nmyzee is sltil thnyerinle tihyst ued to a nocgtanlei ftd,cee so hte Km ysast het m.sea

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mnemonia  so.weemA +
ht3  itwa ieln B sshwo het xvam o'edstn hgcnea and ttah eht mk is ingtteg leragr e(zmeyn is lstli ihttys os legarr mk) so k-m/1 odwul be a lsmerla bmurne nad wudol copraaph 0 +1
lamhtu  uoY yas mK otncna eb eealrdt and sti antgsiy the ,seam ubt hte sarnwe of eht rghap tmssetorndea a hriehg mK i .e ludeenNavg rhihg"e oecinsto"nartnc fo eht B6 rof yemezn iiavctyt si rahoten yaw fo yasgin mK is egihrh cinse emro is uqerdrei rof /12 mvxa vyctitia +18
sbryant6  aehY iths xtioaealnnp is orng.w +
kcyanide101  enyolt,sH hsti qinsuote is iubgbrn em hte gwnro a..y..w If ew go yb eth Lein rvwaee krub topl, nhet ""C si eht rroetcc se,wrna eusaebc "B" si hogwins eepcttvomii b.i.ro.ihnit. heT zemeyn ereh is vyottlpeicmei itaagct i.nv mSoeeon ndees to ixlepna isht eetrtb lepsa,e eosm fo su idap no sith umrfo to etg a fngeaunmli pentaxlnoai nad otn onuoictnritbs rofm flowle tste t..k.o ellars. +



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